More Improvement Requires Less “Change Management”?


As I worked on co-authoring  Healthcare Kaizen, I dove deeper into my study of “kaizen” practices and mindsets, revisiting many core books on kaizen after years of practice in different industries. I used to define kaizen as the phrase it's most often associated with – “continuous improvement.”

Breaking down the two Japanese characters in the word, “kai” means change and “zen” means good, so kaizen can be translate to mean “good change” or “change for the better” – or, basically, “improvement.”

In giving presentations and talking to people about kaizen, the question of so-called “change management” came up.

I've said for a long time that the organizational practice of “change management” seems like a bit of a misnomer. I think this was an expression I heard from Jamie Flinchbaugh – that we don't manage change, we manage people.

I've often found that people's desire for “more change management” is polite code for “how do we force people (or convince) them to do what we want?”

So, change management often becomes a big communication campaign, trying to convince people to use a new technology or adopt a new practice.

One expression I've come across again is Meg Wheatley's expression “people support what they create” (see her saying this on YouTube). That's a powerful notion in kaizen. When everybody in the organization is involved in identifying and implementing improvements, there's no forced change management required. People take initiative and they take action because it makes their own work easier or it makes things better for customers (or patients).

Now, there are some changes, major ones, that everybody can't be involved in. Take new medical technologies like Electronic Medical Records or Computerized Physician Order Entry. Physicians are often seen as being “resistant” to these technologies and leaders try to find “change management” (which smacks of “reeducation”) to get physicians to fall in line.

Back to the definition of kaizen – meaning good change, or basically just “improvement”… all improvements are change, but not all changes are improvement. Not all changes make our work easier or more rewarding and not all changes lead to better results for customers or patients.

If a change is really an improvement, people tend to go along without being forced. I saw an article the other day about how physicians (and I'd extend this to others) don't hate technology – they hate technology that sucks.   As my friend and KaiNexus colleague Dr. Mark Jaben said, physicians in the 1990s flocked to adopt cell phones, because it was way easier than stopping and getting out of the car to use a pay phone when you got paged. There's an example of a technology that wasn't perfect (“can you hear me now?”) but it provided value… so physicians adopted it.

For all of the talk about how “people hate change” (supposedly), have you noticed how many people have flocked to iPhones, Android phones, etc.? Sure, people complain about them, but it's not a hard sell to get people to adopt technologies that benefit them.

So, whether it's a new technology or a new process that you're trying to get people to adopt, instead of blaming the “resistors” and blaming the lack of change management, maybe the technology needs to be easier to use than what they had before? Maybe it needs to create value where there wasn't value or utility before?

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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 enjoyed your article on change management – the line that probably hit home the most is…….”people support what they create” and involvement is the key to a successful engagement and culture of change

  2. I prefer to think of change management as understanding how change affects people and organizations, rather than “how can we coerce people into doing what we want”. Involvement in the process of change is one of the key strategies in improving the odds of success, as are several other strategies, including communication, education, feedback mechanisms, honesty, and many more. Maybe “understanding change” or “planning for change” are better ways of stating the concept.

    • That’s a great articulation of what it should be about, Dean. I think too many organizations think about communication and involvement as an afterthought – too little, too late – and that’s when it seems to be coercive.

  3. I agree with Dean’s list of strategies and Mark’s observation. I’ll add a couple of observations of my own from my daily practice of Lean in a hospital setting:

    1) People accept change more readily when they see that evidence-based decision-making is driving the change, not the personal preferences of whoever is most influential at the moment.

    2) People accept change more readily when they see that it is aligned with a shared vision. I don’t mean that the change agent (hate that term) has to do a great job of convincing people that the change is aligned; what I mean is that the change actually needs to be aligned (duh!), so well-aligned that it’s obvious. Of course, that’s all predicated upon having a shared vision, which is certainly not always the case.

    And elaborating on Dean’s mention of honesty as a strategy, we need to honestly admit that we don’t know the future with certainty and that the ideas of today may not work tomorrow, and that that is okay. In other words, honesty about our limited knowledge should promote an environment of experimentation and collegiality, which should help us cope with change.

  4. Mark,
    I loved the line ” ‘more change management’ is polite code for ‘how do we force people (or convince) them to do what we want?’ ” What most people want isn’t change management they want their way with out the input of the other people involved in the process. Change is a tricky thing because it deals with behavioral issues and technical issues and a Kaizen is a great venue for integrating both behavioral changes and technical learning.

    To your point of the iPhone, there are more things in play with that particular situation such as social circumstances. Part of the change process is changing your environment. Basically it’s easier for people to accept the iPhone because their friends have it, they see other people they know have it, celebrities have it, etc. Interestingly enough you can use that same principle in a Lean change. You just have to find a way to integrate it into the social fiber of the organization.


  5. Mark,
    As an expert in high level change I completely agree with “change management” with the quotes. Senior practitioners have been looking for a way to rephrase for years.

    Your comments about change as improvement ring true. I use the term “makes sense” change in my own practice. So both of us together- good change makes things better so participation should be a given.

    Ha. If only it were that simple.

    Even with improvement there is still structure (process and governance), culture, history, politics and individuals. Hence the career of “Change Management”…

  6. You got me Mark… I think I try not to use any term and use terms that fit the particular thing I am working on with clients. It could be process improvement, employee development, leadership development, technology improvement, etc.

    When I do HAVE to use the term I say “End State Change Management”. That at least makes it seem like a place to go that everyone can work toward instead of a present process of corralling resistance.

    • I guess I would take issue with the phrase “end state” if we are always improving… there might be a temporary end during some phase of a project, but I’d rather focus on never ending continuous improvement.

  7. Fair. But that improvement does not tend to be around innovation and things outside of operations (which is the facilitator of change).

    If “change management” means the implementation of changes, continuous improvement will keep making that work better.

    If “change management” means the overall scenario of transformation (my viewpoint is skewed because I enjoy these huge change engagements) continuous improvement is something that should happen within all the parts.

    I started using “tactical change management” and “strategic change management” to differentiate the two. Sometimes that helps the languaging.

    Agree with you completely it would be nice to see continuous improvement at more organizations. Too much of that and they lose sight of a bigger picture though…

    • I see your point that a particular change will have an end point… but then we come up with more changes to make happen.

      I agree we need more C.I. in organizations (it’s far easier said than done… more likely put in a vision statement on the way than it is to be practiced). But, there’s no reason that a tactical C.I. focus means not also focusing on the big picture and more strategic issues. I’ve found the organizations that do small C.I. well also tend to do the bigger strategy work well, as well. The tactical C.I. work is more tightly aligned with strategy (see ThedaCare as a great example in healthcare).


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