Guest Post: Lean Healthcare Missionary Work in Tanzania


P1030358 copyMark's note: Today's guest post is by Michael Grogan, a native of Ireland who left his Lean job in the U.S. to follow his calling to help bring Lean healthcare to Tanzania. Read his blog post about his first 79 days in the country. I had a chance to talk with Michael before his trip and had the chance to record a podcast last week with Michael and Dr. Brenda – that will be released in August, so stay tuned for that. You can make donations toward their work via the Kupona Foundation. He is also doing a webinar for the ThedaCare Center for Healthcare value on August 14.

How do you want to be remembered?

By Michael Grogan:

Dr. Brenda has been on the front lines of Maternal Healthcare in Tanzania for the last 22 years. I first met her on my 3rd trip to Tanzania in Nov 2012. At the time my 1.5year long internal discussion to quit the US and move to Africa was reaching its conclusion. I remember Dr. Brenda sharing with me a story of one of her attempted interventions in maternal and newborn healthcare in Dar es Salaam, the largest city in Tanzania. She talked about of how she saw the massive gaps in the management and leadership of the maternal hospitals in the city, the blame game & unchallenged assumptions were the norm, with a total absence of knowledge of the current situation on the ground. Mothers and babies were dying at a rate that was getting worse.

She told me how she reached out to an industry that was booming in Tanzania – the tourism industry; she asked a manager of a successful hotel chain if he would consider helping the situation by training these public health managers. His answer was brutal. “It's impossible, this is public health in Africa, it will never work”. Dr. Brenda told me she refused to believe his perspective. She proclaims with all her heart “There is a way to prevent these deaths, I'm convinced of that, we just haven't found it yet”. In Lean thinking she has found the answer.


Since then I moved to Tanzania full time in Feb 2013. When I reflect on the time I have spent working with Dr. Brenda, I am amazed at the similarities between my previous experience working as an Lean Practitioner in the manufacturing industry in the US and Europe. The root causes of our problems and our management and leadership behaviors follow similar patterns. Waste is universal in every organization. Lean is the enemy of waste and the most effective & efficient method “invented” in human history to attack waste and thus increase value to humanity.

From errors in the procurement of hospital supplies to a mothers labor records not being correctly filled out, the same themes appear -Lack of communication, no standard in place, the standard not being followed or the standard being incorrect! There are no new battles. Lean can work in every organization in the world. Today we are proving that Lean Thinking is one of the greatest interventions we can make in what is one of the world's greatest humanitarian crisis – The African Healthcare System.


My job description here can be summarized in two words – Developing People. The joy I get of seeing those “ah-ha” moments in a leader that I am working with as they begin to develop habits that will transform how they manage and lead their organizations, ultimately increasing the value to patients. My proudest moments are those times at the GEMBA (the place where the work happens) when I observe the student, like Dr. Brenda, becoming the teacher to her colleagues.

In the context of this humanitarian crisis nothing that I have ever done in North America or Europe can compare with the meaning and sense of purpose I get from this work. Nothing can compare to this feeling of significance and contribution. We are currently working with 3 of the largest Maternal Hospitals in the city. In 2012 these 3 hospitals reported a total of 56,622 Deliveries with – 1,594 Still Births (2.8%), 800 Neonatal Deaths (1.4%) and 115 Maternal Deaths (0.2%). This thing we call “lean” is already starting to make a difference on preventing more unnecessary deaths.


In my recent trip back to visit my family in Ireland, I had many of my friends speak privately to me about their admiration of the work I am doing here and their wish they could do something similar. When I encourage them that they can – so starts the “yeah but” conversations. So that gets me to ask myself the question “who am I writing this for?”.  99.99% of people who read this won't do anything, 99.99% of people I engage with won't do anything.

But it's the 0.01% that will, that keep me motivated. There is a desperate need to convert great intentions into action – action in the form of boots on the ground, helping to fund our program and help in spreading the word of what we are doing here. This is an opportunity for the 0.01% to make history, to leave a legacy after the short time we have on this planet. Join me, join us, help them.

In the words of Dr. Brenda “22 years I have been in Maternal Healthcare in Tanzania, if you gave me the choice of teaching clinical skills or lean thinking – I would pick lean thinking all the time”. So my message to the 0.01% – what are you going to do? How do you want to be remembered?

Michael Grogan is a Lean Missionary – spreading lean thinking into healthcare in Africa. Michael currently works for a local Disability and Maternal Healthcare provider ( in Dar Es Salaam, Tanzania. Michael got first exposed to lean thinking when he worked as an Engineer for a Pharmaceutical Manufacturing company in the UK in 2006. Since then Michael has practiced and coached lean thinking to multiple organizations (for profit and not for profit) in Europe, North America and now Africa. Michael holds a Bachelor of Engineer degree in Chemical Engineering from University College Dublin University and considers himself a life-long student of lean with the honor of now spreading this thinking into what is one of the greatest humanitarian crises on earth – the African Healthcare system.  

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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. My hat off to you, Michael Grogan: our firm & my colleagues in Education Without Boundaries (EWB) are part of the 0.01% that not only cares but is actively contributing, not in Tanzania but in Zambia. You have inspired me to take Lean Thinking into the systems in Zambia where preventable death is our goal, particularly as relates to the high incidence of preventable death in pre-, peri-, & post-natal circumstances.
    God bless the work of Dr Brenda & continue to drive you. Mel Hughes.

  2. I met Michael for the first time today where he introduced lean thinking to Members of Management team – Restless Development Tanzania . Its left such a big print in my mind and i am more than convinced that i am going to be part of the 0.01 he is taliking of in this article. Thanks Mike for the great work you are doing supporting Dr. Brenda and her team and also finding time to speak to us.

  3. […] Joining me for episode #182 are Michael Grogan and Dr. Brenda  Dmello, joining me via Skype from Tanzania where they are working together to use Lean to improve health care at the  Comprehensive Community Based Rehabilitation in  Tanzania  (CCBRT). Michael is Irish born and left his career in the United States to work in Africa (which you can read about in his guest post that I published earlier this month). […]


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