Reader Question: Hiring for a Lean Culture in Healthcare?


Here's a question from a healthcare leader that I thought I'd share for input from you, the blog readers.

This person is looking to change their hiring and people “sourcing” practices, after visiting ThedaCare and learning about their “Human Development Value Stream” work.

Based on your experience, what do you think are the most important characteristics/attributes a person needs to have to be successful in a Lean organization?  We want to define this for both frontline staff and management.

We need to clearly describe the future state culture we are aiming for and then the associated characteristics of the staff that are likely to fit and be successful.

My response:

That's a great question.

I recall a former client of mine (Children's Medical Center Dallas, in the laboratory) had started putting some lean characteristics into job postings (including some things like – paraphrasing – “a willingness to participate in continuous improvement efforts” and some things like that).  They were pretty direct in terms of making that a hiring criteria in the hopes that some people would self-select out if they just wanted to do their job without participating in kaizen and Lean. I guess you could ask behavioral interviewing questions like “tell me about a time when you participated in a process improvement” and things like that.

I think Lean organizations start hiring not just for technical skills, but also for attitude and personal characteristics. They're less interested in getting “any warm body” (an expression I hate) or a technically skilled person with stunted team skills and interpersonal skills.

So we could talk a lot about the  characteristics  of team members, but I think the better question (and more impactful one) is the characteristics of leaders in a Lean environment. I've found most front-line staff will participate in Lean and continuous improvement… it's the leaders who will (or won't) set the tone that is more of a crapshoot.

John Toussaint's description of a lean leader is a great one:

  • Patient
  • Knowledgeable
  • Facilitator
  • Teacher
  • Student
  • Helper
  • Communicator
  • Guide

It's a meaty question… what characteristics would you add, for leaders or individual team members? Has your organization starting hiring differently for Lean?

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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. Great list of characteristics. To that I would add:
    – Flexible
    – Empathetic
    – Impatient

    It may sound strange to have both patient and impatient as characteristics but I believe there is a place for both depending on the situation.
    Being flexible and empathetic are key to the human side of making and driving change.

  2. Dual visioned-able to flex between the big picture and minutia and aware of his/her own scotoma.

    Ability to embrace and reframe failure for others

    Probably can’t emphasize the student (learner) trait.

  3. It seems that those characteristics are what makes a good leader and not just a good Lean leader. If you take a look at truly effective leaders I don’t think you would make a distinction if they were “Lean” leaders.


  4. A couple of thoughts. It’s fine to put Lean behaviors in job essentials and interview questions for rank and file recruits. This stuff shows up all the time as Studer, Gallup, Ritz Carlton or whatever attitudes and behaviors.

    We need a more in-depth evaluation tool to uncloak the potential Lean leader who is unable or unwilling to make the change. Dr. Toussaint’s list is right on, but most top Leaders could BS their way through a typical interview and may even be convinced themselves that they personify all those attributes when if fact they don’t. As an example, in a recent webinar, Bob Emilliani stated that 90% of leaders don’t like to learn. Another one is that there are many leaders who have achieved “success” through command and control and holding people accountable and are entirely unfit to coach and teach and lack respect and trust because this just isn’t how success is achieved in their paradigm. Such an evaluation tool would be great for leaders tempted to try lean to see if they have the personal qualities in themselves or their leadership team to succeed.

  5. I believe being in customer-centric to a fault especially in health care. Value is determined from the customer/patient back. I also believe the field would greatly benefit by allowing non-medical Lean proponents/facilitators to work on process and value streams, as I don’t believe highly specialized medical training is always necessary to understand and solve workflow problems. If it is, there are generally plenty of very qualified individuals to provide those details.

  6. From Sami Bahri, DDS (shared with permission):

    To answer your question about the lean employee characteristics, I think that their willingness to be cross-trained and to actually perform more than one job/function says a lot about their flexibility, willingness to learn and be a team player.

  7. Great article for discussion. The first thing I would do is minimize human resource role in the process. If we are truly lean than we must select and hire at the source. The characteristics should be based on a gap assessment to identify a need. Generally speaking you need someone highly skilled yet humble with the unique ability to generate a sense of urgency but not panic. The military does this well.

  8. Great topic. A great leader, to me, is one who creates the environment where improvement can happen (vs. making all the improvements themselves). This requires humility, patience, non-blaming, failure is o.k. (as long as we learn from it) and strong coaching skills (can I ask the right questions vs. giving all the answers).

  9. “Clear awareness of problems and a very low tolerance for the current condition is the proper attitude and the right starting point for TPS or Lean.”

    This quote from Isao Kato, retired manager of Training and Development at Toyota is a favorite of mine (his remarks were included in an article by Art Smalley, Superfactory, 13 March, 2006). While it isn’t a full personality profile to hire on (you may want to mix in some of the rest of the comments above…) it is, as Kato says, a “starting point”.

    • I think the real starting point (maybe assumed by Kato) is “respect for people.” Managers could have a very lower tolerance for the current condition, which could lead to a lot of yelling, screaming, blaming, and shaming — instead of improvement done in a Lean frame of mind.

  10. We have a whole list of characteristics we look for and while important, we were still making some misaligned hiring decisions. We have found Patrick Lencioni’s book Ideal Team Player to be very helpful in hiring properly. The virtues or attributes are humility (can put team before self and defines success collectively), hunger (self-motivated and diligent), and people smarts (can read people, understand impact of one’s own behavior, etc). All three are required for an Ideal Team Player. And all three are required to move away from blame towards a culture of accountability/responsibility and to effectively work through PDCA cycles in my experience. We have started using the questions proposed by the book as our first interview and we now better identify who is a good fit and who is not. Also as suggested by Lencioni, at the end of the interview we now candidates that we are fanatical about these principles and that they will hate it here if they don’t have these values and love it if they do (because this is true). The questions have been effective for screening candidates and asking candidates to evaluate whether or not we are the right fit based on these three values has been effective in getting candidates to self-select.


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