Characteristics of Lean Leaders


Ted Stiles is one of the handful of key recruiters I know in the world of Lean healthcare.  Disclosure: I recently joined the advisory board for the firm Stiles & Associates, for which I receive a stipend. He was interviewed recently for Healthcare Finance News for this piece: “7 best qualities of healthcare's lean leaders.”

In this post, I'll list the seven qualities and give my own commentary… and you can read Ted's thoughts on the HFN page. I'm also curious to hear your thoughts about these seven and others you would add.

1. Experience

This experience leading a Lean transformation can come from the manufacturing world or other service sectors… or, increasingly, it comes from within as executives move between healthcare organizations – such as Kathryn Correia leaving ThedaCare to be the CEO at a health system in Minnesota.

2. Process-oriented thinking

I agree with Ted's point that you can't be only oriented around results. Traditional leaders will say “get results at any cost and I don't care how you get them”) while Lean leaders think “the right process will bring the right results.” But, you also need strategy and vision along with the rest of these traits below…

3. Ability to slow down

This applies to folks coming out of industry. I talked yesterday with a former Dell executive who is now working in a healthcare related company. Compared to the fast-paced “Dell Speed” world, he had to adjust his expectations a bit about how much you can accomplish in a given month or year (but he's also trying to get them to move faster). Moving faster is about recognizing the “burning platform” and motivating people… creating a vision about what's possible and arming them with that they need to get there.

Speeding up the pace of change might be necessary, given the challenges in healthcare, but there's something to be said for the Lean saying “go slow to go fast.” Sometimes you can't try to do it all overnight (as this Lean Meme states).

4. Brutal honesty

Maybe we need more honesty than brutality. We need to be able to speak openly and honestly about problems, waste, and challenges. ThedaCare refers to this as “candor with respect” — teaching people to be more honest (they already have respect down, since there's a lot of “midwestern nice” going on there). One east coast hospital in the Healthcare Value Network with them said once “we're good at candor, but need to work on respect.”

5. Exceptional relationship-building skills

I'll just quote Ted here, from the HFN piece:

“Candidates in healthcare won't lead with results, they'll lead with relationship- and trust-building, which is really the only way to get physicians or high-ranking clinical leaders –  even nurses on the frontline –  to talk to you about what their hopes and fears are, or where they believe the biggest amount of improvement needs to be done,” said Stiles.

6. Motivational

Yes, Lean is about change. We need more than managers (people who can oversee an existing process), we also need leaders (people who can get others to move in a new direction or try new things). There's so much pressure on healthcare to improve quality and cost… I think everybody realizes that by now. But, effective leaders help people see that change is possible, not just necessary.

7. Operational management experience

This is something that manufacturing leaders generally excel at and can bring to healthcare… if they can adapt to the softer side of a caring and relationship-driving industry. Leaders have to know how to get things done… and get the right things done.

What would you add to this list? Comments on the seven suggested by Ted Stiles and summarized in HFN?

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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’d add a thirst for learning and experimenting. As I look for and develop the leadership bench at my company, the primary characteristic that seems to indicate future lean leadership prowess is the degree and effectiveness to which they seek out, acquire, analyze, use, and disseminate new knowledge.

  2. Mark
    I agree all 7 are important. What would be the top three you would emphasize?
    Based upon the “stint” I did in Healthcare, my top three are:
    1) #5 & #6; Gaining/Building Trust through Relationship / Motivational….in my opinion I would called these cornerstones of leadership ability.
    2) #3 Ability to slow down….very difficult for some Lean/Ops folks to deal with the pace
    3) #1 Experience – not just the actual experience of a transformation, also the ability to Translate it to the Hospital or Health Org and levels embarking on the transformaion.

  3. Lead with Empathy.

    This may be part of #5, but I have found it to be one of my weaknesses that I constantly have to be aware of. As a result, it is always on my mind when I read a list like this.

  4. Not a bad list. Jeff Liker has a new book, “The Toyota Way to Lean Leadership” that expands on the list with things like principles (think Shingo Prize), self-learning, and developing people. Through the entirety of the book he identifies dozens of aspects of leadership (humility, reflection) and leadership methods (common incentives, teaching, coaching) that Toyota uses. It would be interesting to extract all those and rate the current state of our own organizations.

  5. I had this discussion yesterday with some folks at our Iowa Healthcare Collaborative conference. The most often mentioned item was the ability to learn the healthcare business (for those from industry) and not dive in and start changing things right away. Several people talked about experineces of the “know-it-all” (their words) consultant with the manufacturing terminology that immediately turned off the administrators and providers.

    • One great lesson I learned was from Larry Spiegel, who was brought in as the plant manager in 1996 where I worked in General Motors. Larry was quoted in the This American Life piece about trying to take lessons from NUMMI to the rest of the company.

      Larry spent the first few months spending a lot of time at the gemba, talking to everybody he could (and really doing a lot of listening). This was very different behavior from the previous old-school plant manager.

      I was young and anxious for change and improvement and I asked Larry, one day, when changes would be coming.

      He said something to the effect of “I know what the problems are and what the solutions are… but the people here don’t know that yet.”

      He was building trust and relationships.

      And that was moving from a GM transmission plant to a GM engine plant… dealing with the “but, we’re different here” was still an issue, but not as much as going from, say, manufacturing to healthcare.

      I think Larry knew he had to “go slow to go fast.”

      Compare that to outside consultants who are brought into an organization… clients usually pay for results… NOW! Not for long-term relationship building… consultants are usually paid for answers (which can be mutually frustrating when I want to “teach them how to fish”.

  6. Dean, Ditto that. I think in the early days of lean healthcare there was a lot of wasted effort trying to change healthcare to fit lean. Knowing when to change healthcare and when to adapt lean is an experiential and experimental process that successful lean leaders have to go through.

    Ironically, I think those in healthcare that have been at this the longest have a definite leg up in expertise and understanding over many of the “experts” from manufacturing that have simply worked a franchise lean model, however successful that has been.

  7. Those who have a skill used to coach/teach/mentor , the art and science of solving problems by working on real problems at Gemba

  8. I’d add persistence, never stops thinking (e.g. scientific method, root cause analysis, etc.), and someone who likes to read, study, and observe. Also, since Lean changes everything, a willingness to challenge everything they know and do. Oh yeah, and someone who likes people and sees them as valuable resources – whether they are employee, supplier, customer, investor, community, or competitor.

  9. In my experience “brutal” (honest) is more about the feeling those who we have to convince to be honest. They have been conditioned that you “don’t say anything if you don’t have something nice to say.” Which is a lousy improvement foundation. It is important to get a culture of respect.

    All the more so because our culture has developed an incredibly thin skin to anything critical. So process improvement questions are often taken as personal attacks when they shouldn’t be. Of course with performance appraisals, rack and stack, internal competition for bonuses… it is understandable how this problem develops.

    Creating a culture of respect makes it so honest doesn’t have to be brutal. It is just honesty. And most of it isn’t personal at all.


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