Hello from the SHS Conference & a Question for the Readers


Hello from Las Vegas, where Monday is Day 2 of the outstanding Society for Health Systems annual conference. I presented Sunday about Healthcare Kaizen and my co-author Joe Swartz took Q&A with me.

I took a lot of notes on Sunday and hoped to have a full post here… but I was fortunate to have the chance to finally meet Jon Miller of the Kaizen Institute and the Gemba Panta Rei blog in person for the first time. We were able to get together thanks to Mike Wroblewski of the Got Boondoggle? blog, as Mike now works for Kaizen Institute. Mike is presenting Monday on the “3P” lean healthcare design methodologies. So, with all of us going out to dinner, time got away from me…

I'll post more from SHS this week (follow @markgraban or #shs2012 on twitter for real time updates), but let me just pose a question for today:

I've gotten a few emails recently from Lean healthcare professionals who, after a year or two in healthcare, are frustrated with the slow pace of change, the lack of collaboration between departments, and a lack of leadership support for real change.

I talked to two recent college graduates at the SHS conference who are frustrated because they started their careers being very motivated and passionate about healthcare improvement, but they find they are working with people who don't share that passion – or at least not anymore. “We want to change the world” seems to be the common theme… but changing the world (or even one industry) is hard work.

What advice would you have for eager well-intended recent graduates? Should they learn to temper their expectations? Should they push harder? Do they risk burnout if they push harder than the organization can absorb?

My one piece of advice, in terms of thinking about their co-workers, is to ask why they seem worn down or uninterested in change. How does the system wear them down over time? How can we undo that or at least prevent this same thing happening in the next generation of those who are, hopefully, our future healthcare leaders? Your thoughts?

What do you think? Please scroll down (or click) to post a comment. Or please share the post with your thoughts on LinkedIn – and follow me or connect with me there.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. We all graduate and have the excitement to change the world. But really, to get started, you have to go for some smaller wins. Build your reputation as someone who can bring needed and impactful changes to the business. I know the recent graduates see opportunities for change, but you do also have to respect those who came before you and their experience & knowledge. I personally think it is easier to get support from the people who the change affects directly, the frontline worker. Work with them for problems they see and to help develop solutions. Then find a way for those projects (and the resulting benefits the business!) to get up to management. Finally, never underestimate asking your coworkers at all levels “how can I help”

  2. It is always harder than it seems like it ought to be.

    I don’t think that frustration is isolated to new graduates entering the health care world with great hopes. It is equally difficult for those of us in health care for 30 years. Change is slow for a good reason: there is great potential to do harm if the change does not work out as intended and the history of medicine is full of stories about great innovations that just didn’t quite work out that way. In fact, some of those stories are being created right now!

    The only thing I would say is that in trying to navigate the complex, dynamic landscape, full of competing incentives and motivations with vastly different concepts of what success is, remember the spirit of Kaizen–change for the better…for everyone involved.

    People will adopt when they see it in their interest to do so. The hard work is to learn what that perspective might be and to demonstrate that it is so.

    Mark Jaben, MD

  3. +1 to what Mark & Christina said.

    Advice For Eager Recent Gradutes:
    – Study effective and ineffective organizational change. Lots of good resources available on that. Gerald M Weinberg is a favorite of mine.
    – Start by collecting data. Share the data. Ask what others make of it without any agenda other than discovery.
    – Find allies (peers, mentors, coaches, etc) with whom you can share what is going on beyond the facts.
    – If you came of your engineering education thinking you can calculate the right answer, you will be more effective if you have more options about what makes for a compelling argument.

    Should they learn to temper their expectations:
    Yes. There a quote whose origin I don’t have ready to hand that people tend to overestimate change in the short term and underestimate it in the long term. I loved the book Bounce. The author talks about how athletes have to cultivate this paradoxical mindset where they have to believe that they’re the best when they are performing, but they have to have doubt to motivate learning and practice. I think there’s something to that.

    Should they push harder?
    Maybe. Though Lean would suggest they create the conditions for pull, rather than push. One thing to consider is pushing harder on yourself. Especially on broadening your notion of what harder means. It’s probably not more hours. It’s probably more emotional discomfort.

    Do they risk burnout if they push harder than their organizations can absorb?
    Yes. Though there are alternate risks to the opposite extreme, of course. I found this thought provoking: http://www.huffingtonpost.com/annie-mckee/life-balance_b_1284613.html.



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