Move to Healthcare Wrap Up – “Feels like Bias” to a #Lean #SixSigma Pro


Mark's Note: I recently closed down the Ning social network group called “Move to Healthcare,” created for people who were looking to transition their industry experience into healthcare .  I had posted a success story, shared by Michael Lombard, about how he transitioned from manufacturing (his old blog) into healthcare (his new blog). For every case like Michael's, there were probably two cases where people had a lot of trouble getting hired into healthcare. I'm sharing one of those stories below — shared with permission, but changing a few details for the sake of anonymity. Below that original post are some comments from other participants in that old site. There are some provocative comments and I'm curious to hear your thoughts…

Original Post from Move to Healthcare, by Anonymous:

I recently went through an interview (2 telephone, 1 video) process for a Director of Quality position in a hospital. This job would have been my dream come true — close to home and family, in healthcare, and a good challenge for somebody with 20+ years of quality experience, including almost ten as a LSSBB. I honestly felt that the executive group thought I was their candidate of choice. In addition to the above discussions, they just flew my wife and I out to their site, set my wife up with a local realtor, and had a VP dinner with my wife and I after I had a day of interviewing where is felt like clicked from a personality and culture standpoint. The interview was last Monday the XXth.

Sound like I should have been optimistic? Not so fast. Apparently the group of seven or 8 functional Directors were concerned that I would have a problem because of the lack of healthcare experience. (I'm guessing a little but from the CEO on down, they were the only ones that even mentioned it)

Today, Wednesday I got a call from the HR recruiter with negative news–it was thought that healthcare quality problems were different and my 20+ years in manufacturing, service, and government contracting was not enough evidence of my ability to learn new things.

So it really does feel like there is a bias against any non-healthcare skills. I am at a loss to understand how they can be so sure that another person's healthcare experience, that was gained in creating some of the problems, is critical in solving them.

I will keep working at this transition to healthcare, but next time I accept an interview offer I will make sure that the healthcare “professionals” have read and understood the exact amount of healthcare experience I have in my past (none).

Comments and discussion from other readers:


I can identify with that experience. I've had it twice in my efforts to make the transition. I think its because of their lack of understanding about the skillset of “LSS practitioners” which prevents them from seeing how we apply a set of tools to examine, analyze, measure, and improve processes without having previous experience with that process. This is a completely false assumption on their part, but not all take that point of view. Unfortunately, it is in the majority which I have found, and I believe it is primarily due to their lack of knowledge about the “lean tools.”

I'm sorry to hear about your story. It seems really irresponsible of the hospital to let it get that far into the process before deciding lack of healthcare experience was a dealbreaker. What a shame that they don't see that your experience is transferable.

Some healthcare organizations are, thankfully, open to outsiders.

I wonder if the directors vetoed you because they're not really on board with Lean anyway? I know it's no consolation, but it might have been a really frustrating experience had you gotten the job. I met someone recently, a former Danaher Business System leader who was hired by a hospital that said they wanted to do lean, but it sounds like they really don't want to (or they didn't know what it would mean to really implement lean, so she's very frustrated).

Good luck in your continued search.


The original poster:

Thanks to both of you for your responses, it helps put some perspective on the experience. In addition to the activities mentioned, they had also called and queried 3 references and initiated a background check. My profile that I brought to the application for the position was pretty broad–Lean, Six Sigma, Baldrige, ~ 10 months experience with 2 major hospitals (consulting not FTE) in Baldrige-based Lean improvment. I am thinking that the problem was that I did advocate a need for change. Reviewing the Director group interview responses I recall a focus toward “we need to get better but we are comfortable being what we are now”. And of course an “outsider” would probably seek to introduce change that would not be appropriate or comfortable, in their consideration. I think I am most disappointed in the Executive group. I feel they understood the need for a focus that was outside their current paradigm but would/could not countermand the desires of the director group. In my opinion, being a leader sometimes means you have to make choices that are not consensus, if your wisdom provides you that insight–sometimes a democracy is not the structure that is going to allow you to make the right decisions that are uncomfortable and change the status quo.


I appreciate your comments regarding the need to sometimes make the difficult decisions; choices that may make some folks uncomfortable and CHANGE the status quo. Healthcare needs to CHANGE.

I also commend your positive attitude. I was given the same advice about perhaps avoiding a poor fit. There's a lot of wisdom in that thinking. Keep that positive outlook and realize you're not the only one on the journey.

What's frustrating to me, is the pervasive attitude that some in the Healthcare industry have adopted. I read a lot about the problems, issues and ‘taxing circumstances' in Healthcare these days; but see very few articles on new solutions, creative thinking, or efforts on simulating new processes. My frustration centers on the ‘bias', as you put it, toward those outside Healthcare. If you don't think our previous experience can help improve the industry, fine…we're big boys and girls. I can't see the justification (or more importantly, the benefit); however, to groan about nothing getting done. There ARE folks out there that can help.

And so we move on. Don't just settle. Keep the positive outlook…eventually you'll find the right fit.


I had a very similar experience, I was working with a health authority in [redacted] conducting a 3P workshop for their new hospital. Long story cut short – I conducted several workshops and the feedback I received was good and the workshop a sucess. But the one thing I noticed was how bigoted these health care folks were to non-healthcare practitioners working in their field. For all their PC behavior and celebrating all things PC they do not accept any diversity in their field. Once I caught on to just how bigoted they were I kept my mouth shut so they would not discover my secret. I know it's something you can not do when applying for the position you were going fill but a word to the wise…..down play any lean knowledge you gained in manufacturing or they will label you no matter how well you did in showing them the way to true north. Someday the will see the light…but I do not think it will be for some time.


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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. I have experienced the bias of not being a clinical person. In many cases, particularly in a “Director of Quality” role, being an RN is a specific qualification. But is this really different than any other industry? Don’t we tend to hire those who are like us, or have similar experiences than us? Because of the work we do, WE know that the skills, tools, and philosophy can transition to other industries, but those on the inside don’t necessarily know that. I’ve found that many healthcare organizations are grasping at straws to find solutions to the current crisis. “Do we hire a black belt? Do we hire a nurse? Can this manufacturing guy understand us? How do we know this is the right person?” All these are questions that hospitals and hospital systems are wrestling with. I don’t have any answers – I’ve changed jobs several times since I moved to healthcare 7 years ago – but I think our challenge is to prove our worth and the worth of the Lean philosophy and tools in healthcare.

  2. I think this bias is also true in other industries, not just healthcare. I believe that organizational leaders who know only their industry and/or have not been fully versed in lean and continuous improvement methodologies are biased toward bringing in folks with direct industry knowledge. The universal applicability of the tools means that lean can by used anywhere and the ability to transfer tool skills from one application to the next is not as difficult as they make it out to be.

    I’m no expert in interviewing for roles in completely new industries, but I suppose one question I would ask the leaders is “So what does lean look like to you in your industry?” From there, take that answer and demonstrate how I have applied the tools before and how transferring those skills can be nearly seamless.

    If that doesn’t get the point across then I would agree with the poster that said maybe they don’t really want lean or know what lean is anyway.

  3. I think the challenge is less about qualifications or ability to adapt than the absence of a particular type of experience.

    I wouldn’t hire a quality pro from the auto industry to be my quality director in a pharmaceutical plant.

    The other problem I have first hand experience with in bringing on someone at the leadership level is that they have a strong tendency to see the current situation through their old glasses. And everyone that has been successful at a leadership level wears old glasses. I have no doubt that lean six sigma experts from other industries can be successful or even much more successful than healthcare trained executives given some time but most organizations want someone to hit the ground running.

  4. Thanks for sharing this, Mark. This is a topic that’s near and dear to my heart.

    As someone who spent 20 years exclusively in healthcare before venturing beyond, I grew up with the same bias toward “outsiders.” After all, OUR industry was special. We saved lives. Patients aren’t widgets. Yada, yada, yada. It wasn’t until I immersed myself in Lean and ventured into other industries that I understood how short-sighted and arrogant the healthcare industry can be.

    I also learned that it wasn’t so much arrogance as ignorance, and that the healthcare industry’s not alone. As I began moving in the opposite direction — from healthcare to manufacturing and beyond — I experienced the same bias. I’ve had to lobby hard for why my inexperience is irrelevant and perhaps even helpful for leading transformation. A process is a process. Lack of flow is lack of flow. Errors are errors.

    While I don’t have to lobby as much now because I have worked with nearly every industry, I still encounter the occasional cynic. To which I gently remind them that “same thinking” hasn’t helped them much and perhaps they need an objective eye with no preconceived notions about “solutions” and no agenda. I explain that my value is in my expertise in problem-solving, creating continuous improvement cultures, and developing people — and asking questions that most who are stuck in a specific industry may not think of or be courageous enough to ask. It works much of the time. I recommend anyone in this position try it. Sell them on why NOT having significant industry experience is a plus.

    Industry-specific biases are as dangerous as racial, religious, gender and other biases. I learned early on in Paul Hawken’s Growing a Business (fantastic book!) the value of hiring people based on aptitude, work ethic, problem-solving abilities, etc. vs. industry expertise. CEOs are hired that way all the time. Why not Quality Directors (referring to anonymous’ comment above about not hiring someone from auto for pharma work)? I feel the same way about bench marking – the bulk of it should be done OUTSIDE the industry you’re in. I cross-pollinate my clients all the time with what I’ve learned from other industries.

    Pooey on organizations that hire only those with like-industry experience. It’s the exact opposite of the stance anyone seeking transformation should have. Which brings us to the root of the entire situation – do organizations that say they want transformation really want it????

  5. Karen, I wouldn’t disagree with most everything you said, but I don’t believe there would be many if any CEOs that would make an auto parts quality director responsible for passing the next Joint Commission survey. The reasons why have very little to do with knowledge and skill of lean principles and have more to do with operating in more complex environment with much more ambiguous goals and constituencies.
    To prove my point you can put a manufacturing plant well on its lean journey in two to three years with proper leadership but even the “best” lean hospitals are only scratching the surface after 10 years of consulting engagements and small armies of internal coaches. I deeply respect these organizations and their leaders but the reality is that healthcare is a different environment and to infer automatic success for someone moving between industries in myopic.

    • Anonymous – First of all, I know many people from automotive who have very successfully transitioned into healthcare and are accomplishing great things. Second, any reasonably intelligent person can read Joint Commission standards and understand what the expectations are. They’re well written and if you have questions, TJC staff are accessible.

      I know as many manufacturing orgs (and financial services orgs & distributors & government agencies & …) that are having difficulty making progress with Lean as healthcare orgs. Every industry presents unique challenges. Assuming healthcare’s the only unique industry is what’s myopic.

  6. Anonymous –

    I understand what you’re saying about not bringing in someone from the auto industry to do hospital quality work…but what if they could do the work well? I think this is exactly the bias discussed in the article.

    Are there more complexities in pharmaceutical work? I certainly think the complexities are different and the risks are considerably higher, but can’t a lot of those complexities just equate to more steps in a process? An auto parts manufacturing process might have 50 process steps and a medical device manufacturing process could have 75 process steps – is it so easy to accurately assume that the 25-step difference can’t be understood or overcome or accomplished by an industry transplant?

    Someone’s resume is not a guarantee about job capability, one way or the other. That’s why there are interviews (and even those don’t guarantee perfect fits).

  7. Anonymous, I believe you’re caught up in the paradigm of knowledge over learning. “Healthcare is different.” This is the same copout I’ve been hearing for years. Every industry is “different,” which is why learning must be APPLIED, yet the principles remain the same and succeed when properly applied anywhere we have a process, regardless of the field of work. After 7 years in university administration, 12 years in manufacturing, and now 6 years in healthcare I’m living proof – as are countless other of my lean fellow lean thinkers reading this board – that the transitions can be made very successfully – and with huge positive impact – with people who have the right skills and attitudes but not the knowledge of the particular field. Of all the fields I’ve worked in, I believe healthcare more than any of them needs to get outside of its box and learn from other sources. In fact, that’s a big part of its problem.

    100,000 lives lost a year in American hospitals due to MEDICAL ERROR (IHI, 1999). This has been going on too long with no significant improvement. Do you think people would fly if 3 or 4 jumbo jets crashed every week? That’s the rate at which people die in American hospitals. Where’s the outrage at American healthcare? There is no outrage because 1)healthcare people are caring professionals who are trying to help patients and it’s difficult to be angry with people who are showing patients compassion and 2) because these deaths and other harm occur in ones and twos across the country – they aren’t spectactular like a plane crash and don’t make the nightly news and 3) many healthcare professionals take the attitude of, for example, “infections are inevitable – it’s collateral damage.” Tell that to Allegheny General, who nearly wiped out CLABSIs in 3 months with lean thinking, or refer to the countless other examples Mark G. and others reference – specifically by people who have taken their lean skills to healthcare.

    Before I finish this rant (apologies to all), let me share one of my favorite quotes from American Author Eric Hoffer. “In times of change the learners will inherit the earth, while the knowers will be beautifically equipped to deal with a world that no longer exists.”

    It’s the “knowers” in healthcare that refuse to get outside of their paradigms that are playing a large part in perpetuating mediocrity.


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