1 in 7000 – What are the Odds for Lean Healthcare Transformation?


If you're a gambler and you take my post title literally, you might be thinking, “The odds? The odds are 1 in 7000, or 0.000142857143.” OK, you probably weren't thinking that many significant digits, but what's the point of 1 in 7000? Those aren't the odds of my Northwestern Wildcats men's basketball team winning the NCAA tournament (if we even get in this year, which would be the first time ever).

I'm talking about the conversations I've had recently with Lean or Process Improvement professionals at recent conferences or via email who lament, “I'm just one out of 5,000” or “I'm the only one in our organization of 7,000” people. How Lean is that organization going to get with a sole Lean coach or practitioner?

The lament of “I'm just one person” usually comes with:

  • Feeling stretched too thin (supporting too many departments or having to educate or coach too many people)
  • Wondering where the organizational support for Lean is after they were hired
  • Feeling like the weight of the world is on their shoulders
  • Not thinking any other colleagues or help were going to be coming their way

One person was embedded in a department and hospital leadership was pressuring that individual to fix the entire systemic patient flow on their own, without good support from the departmental directors or senior leadership. It's completely unrealistic to think you can go hire a single expert who is going to magically fix a broad interconnected system of departmental silos.

I've seen a lot of hospitals that have a team of 5 to 10 Lean and/or P.I. and/or Six Sigma people to serve as trainers and internal coaches. ThedaCare has (unless this has changed) about 30 “facilitators” who work in a central group to help run events and coach others in the department. More importantly, ThedaCare is in the class of organizations that are educating all leaders and staff so that the Lean transformation involves everybody (including senior leadership). These organizations aren't expecting one or a small number of people to be super heroes.

You have to start somewhere… hopefully the solo Lean person is just the starting point. But, if you've been hired in and you're being left alone on an island, does this reflect unrealistic expectations on the part of the hiring organization? What are the odds these organizations can be successful with one person?

Is there is mistaken belief that the COO can say “we are doing Lean” (groan) because they have hired one person?

Hiring a Lean professional, one person, isn't like piloting a new piece of equipment. Let's say your organization wants to try some new style of patient bed. It's very reasonable (and preferred) to buy one and test it out before taking a larger investment. But does the same idea apply to a Lean professional? I think not. What is the minimum critical mass to be able to make a difference to help “prove out” that Lean is something to which the senior leaders should make a larger commitment?

What do you see taking place out there, whether it's healthcare or other industries. How common is this solo person phenomenon? Are you a solo Lean person in your organization? Please leave a comment (and remember, you can do so anonymously).

As the song “One” by Three Dog Night goes, “One is the loneliest number that you'll ever do..” (lyrics)

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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. Hi Mark,

    Sadly, it is way too common. Fortunately, there is something that can be done about it, but it requires us to largely ignore the collective wisdom of how to “implement” Lean. My take on this is as follows:

    IF the loneliness is due to implementation of tools and programs, then I say it is no surprise that a person feels alone in the wilderness. I can imagine some friends I know snorting, “Easy for you to say Bryan, you can impose a top-down approach!” My response to that is the result will be the same as the rogue Lean Coordinator: alone in my efforts. Why is this? Because I would be ramming tools down the collective throats of my team, and if that doesn’t meet their intrinsic needs, then it is likely those met needs will not carry forward with them 20 years from now – which is where we draw the power of continuous improvement from.

    So, whether top-down, or bottom-up, why do we continue to be surprised that tool-based-program-goal-driven “implementations” leave us feeling unsatisfied and desperate? Thankfully, we have consultants and Amazon to fill the void. :)

    Now, if I focused on the following – “What is the problem?” – and pulled the right people around the table to tackle that problem, I suspect I could get somewhere. And if I taught others, over time, to do the same, I wonder how alone I would feel? It may take fifty years with this approach, but isn’t that the point?

    The problem as I see it, is that the people who are frustrated expect us to “get there” in 3-5 yrs. That is unrealistic, since big, nasty problems never go away, skills, leaders, technology, regulations and markets are always changing. An important question is what will your implementation program look like in year 6, when your lean program is complete? What happens to all of that structure that was being maintained by your lean coordinators and champions? The answer leaves one feeling empty and this seems to me to be at the heart of the loneliness that people can feel.

  2. Mark,

    it is a very common problem, especially at the beginning of the LEAN process. It should not surprise us, though. Even if the C-level suite is implementing and supporting LEAN in healthcare, it takes years to get buy-in for a new concept in any organization. New ideas rarely take root in any community quickly. The initial slope of an exponential curve is nearly flat.

    On the other hand, one person starting small can start a movement with enough energy and patience. Rome was not build in a day, no department or organization gets LEAN in a year. The important part is for the one LEAN person to get tasked with projects which are appropriate to the scale of the LEAN culture at that point in time of the organization. The second component is to create a psychologically safe culture for the early adopters of LEAN. Negative feedback or active discouragement of innovative ideas in the early stages of LEAN can handicap the process for years to come, if it does not outright kill it.



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