Show Instead of Tell – Lean Design for Factories or Hospitals


Last week, the New York Times published a piece called “Don't Just Talk About Change. Show It,” written by Mick Wilz, an employee at  Sur-Seal, a family-owned business in Cincinnati.

As part of a Lean initiative (as evidenced by their manufacturing excellence award from AME), Mick was working on a new factory layout.

From the piece:

In 2009, as part of a strategic plan, we decided to change our factory layout, which involved moving around our work groups. Rather than simply tell our employees about the plan, I decided to show them. I brought in my children's Lego blocks and figures and arranged them into a model of our current factory floor. I even matched each Lego figure to a worker. Then I started to change the arrangement to simulate the new design.

That's what Lean is supposed to be about – involving all employees in improvement and letting them experiment with new designs.

I've led many such efforts in hospitals and I never dictated the design for anyone (nor did architects). We taught staff members how to analyze their existing layout so they could propose improved alternatives. At Sur-Seal, Mick used LEGO blocks, while teams I've led have used ‘paper doll” cutouts to create and share layouts, as illustrated in the top and right pictures in the slide below (the team at bottom left is from my friends at ThedaCare):

If you click through to SlideShare, you can see my slide deck and video from my 5-minute “Ignite” format talk from the recent Lean Startup Conference, hosted by Eric Ries. For those who don't know “Ignite,” you get 20 slides in 5 minutes and they advance automatically every 15 seconds. Quite a challenge, but a fun one.

Anyway, back to the Sur-Seal story… what were the results from getting staff members involved?

The process had striking results. As employees stood in front of the layout, they'd make suggestions, and because the staff actually saw the proposed changes, we felt that they bought into the plan more readily. They ended up helping with the redesign.

That's my experience, as well. Not only do employees “buy in,” but the layouts tend to be better than what might be created by some expert.
Mick also talks about the Lean concept of a “Visual Workplace”:

Since then, we've also become what's called a  visual workplace. We have posters in work areas with instructions on how to operate a machine, and diagrams of the product it makes. Safety instructions are posted, too.

Hanging posters might be a helpful reminder, but readers should consider the idea that posters are not a substitute for proper training and supervision. A Lean environment might have a lot of visual reminders and cues, but having a lot of posters, in and of itself, doesn't make you Lean.

Full blown “Visual Management” goes even further, allowing staff and managers to immediately see if there are any problems, so they can take action — seeing problems leads to fixing problems (especially when we move from “name, shame, and blame” to a Lean culture).

Even if you don't have purposeful visual management cues in a healthcare setting, look at the number of people in seats in the waiting room… that's visual management, but only if you MANAGE based on the visual signal. Seeing people out there every single day means nothing if you aren't fixing the process to prevent such waiting times or imbalances between patient demand and capacity.


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Mark Graban is an internationally-recognized consultant, author, and professional speaker who has worked in healthcare, manufacturing, and startups. His latest book is Measures of Success: React Less, Lead Better, Improve More. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. He also published the anthology Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also a Senior Advisor to the technology company KaiNexus.

1 Comment
  1. Al Norval says

    Great Lego story. It’s hard to get input from teams if they can’t visualize what’s going on. Many people can’t look at drawings and visualize what the finished layout will look like. Aids like Lego and cardboard cut-outs and even 2X4 and plywood mock-ups help people really “see” what the layout is and now puts them in a position to help improve the design.

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