What Salem Health Leaders Learned from Visiting Japan About Lean and Kaizen

TL;DR: Salem Health leaders and frontline staff visited Japan to study Lean and Kaizen–and returned with a deeper understanding that transformation comes from respect for people, teamwork across titles, and leaders going to the front lines to learn. The trip reinforced that Lean is not a quick fix, but a long-term commitment to engaging people in continuous improvement to better serve patients.

As described on the YouTube page for this video, a group of Salem Hospital (Oregon) staff members (senior leaders, front-line staff, clinicians) visited Japan in 2011 to study Lean and Kaizen (continuous improvement):

“Salem Hospital leaders reflect on strategic trip to Japan.”

As the CEO Norm Gruber says at the beginning was “an experiment” but they concluded afterward it was “clearly it was worth going.” During the trip, “[job] titles disappeared completely,” says Gruber. COO Cheryl Nester Wolfe commented, “a patient is not a car – absolutely not – but the work that people do to make that product (or that patient) better are very similar. Ours is about how do we take exceptional care of our patients every single time.”

The video:

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What Stood Out from the Leaders' Reflections

What struck me most in listening more closely to the leaders' comments is how clearly they framed the Japan trip as an experiment that led to a personal and organizational shift, not a checklist of tools.

Salem Health CEO Norm Gruber said early on that the trip was “clearly… absolutely worth going,” because it helped leaders and staff learn “ways to look at problems differently and deeper than what we've ever done before.” That depth of learning came not from lectures, but from direct observation and shared experience.

One powerful theme was how quickly hierarchy faded. Gruber noted that during the trip, “titles disappeared very rapidly.” Executives, physicians, nurses, and support staff experienced Kaizen together–and, as he described it, the group “really congealed” as a team. That's a reminder that Lean transformations don't start with org charts; they start with shared purpose and shared learning.

COO Cheryl Nester Wolfe offered an important clarification that will resonate in healthcare:

“A patient is not a car–absolutely not–but the work that people do to make that product, or that patient, better is very similar.”

Her point wasn't about comparison–it was about process, teamwork, and reliability. As she put it, the real question is how healthcare organizations can “take exceptional care of our patients every single time.”

Respect for People as the Real Takeaway

Nester Wolfe described “respect for people” as her most clarifying insight from the trip–particularly the idea that improvement doesn't come from leaders having answers, but from leaders facilitating the people who do the work.

She emphasized honoring:

• The work people do every day
• Their understanding of that work
• Their ideas for improving it

That mindset shift–from directing to enabling–helped shape what she later described as real change back home.

The group also observed Kaizen in action outside of healthcare, including three days at a gas meter plant in southern Japan. Working in small teams, they identified more than 40 improvement ideas–many of which the plant either implemented or committed to implementing. As Wolfe said, the experience deepened their understanding of improvement “not because it was new, but because we learned how to do it really well.”

From Observation to Action Back Home

The trip reinforced that change isn't quick–and isn't meant to be.

Wolfe acknowledged that healthcare often tries to move too fast, calling that a mistake. Instead, Salem Health began focusing on deeper engagement and collaboration. She noted that their emergency department had since undergone a major transformation and had become a top-performing organization–driven not by speed, but by ownership and teamwork.

Leaders also committed to spending more time on the front lines, regularly rounding to better understand the challenges staff face day to day. As Gruber put it, when “everybody owns the change,” the result is deeper, more sustainable improvement.

I don't think it's absolutely necessary to go to Japan, but it's clear that Salem Health gained far more than ideas or inspiration from the trip. They gained a shared understanding of respect, teamwork, and long-term improvement. Those lessons–about engaging people, learning deeply, and resisting the urge for quick fixes–will benefit their patients, their staff and physicians, and the long-term health of the organization.

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If you’re working to build a culture where people feel safe to speak up, solve problems, and improve every day, I’d be glad to help. Let’s talk about how to strengthen Psychological Safety and Continuous Improvement in your organization.