Dan Jones on Lean Beyond Manufacturing: Public Sector, Healthcare, and Agile Connections

Returning to the podcast after his first appearance in Episode #188 is Daniel T. Jones, founder and chairman of the UK-based Lean Enterprise Academy. You can find him on Twitter now as @DanielJonesLean.

Dan collaborated with Jim Womack on the books The Machine That Changed the World, Lean Thinking, and Lean Solutions and published other books through the LEA. He is also a senior advisor to the relatively new website and journal “Planet Lean.”

In this episode, Dan and I explore the state of Lean outside of manufacturing–from public sector programs in the UK to applications in healthcare and software. Dan reflects on what's worked, what hasn't, and why consultant-driven rollouts often create “awareness without depth.” He highlights the importance of hands-on leadership, learning at the Gemba, and building problem-solving capability rather than relying on top-down directives or large Lean teams.

We also discuss parallels between Lean and the Agile movement in technology, including case studies from Spotify and other digital pioneers. Dan explains why he sees Lean and Agile converging toward a more holistic management model–one that emphasizes respect for people, continuous learning, and systems thinking. His insights provide both a critical perspective on Lean's spread and an optimistic view of its future across industries.

---

Scroll down to read a partial transcript.

For a link to this episode, refer people to www.leanblog.org/216.

For earlier episodes of my podcast, visit the main Podcast page, which includes information on how to subscribe via RSS or via Apple Podcasts.  You can also subscribe and listen via Stitcher.

Transcript:

Mark Graban: Hi, this is Mark Graban. Welcome to episode 216 of the podcast for February 20, 2015. Returning to the podcast after his first appearance back in episode 188 is Dan Jones. He's the founder and chairman of the Lean Enterprise Academy. Dan, of course, collaborated with Jim Womack on the books The Machine That Changed the World, Lean Thinking and Lean Solutions and helped publish many other books through the Lean Enterprise Academy. He's also a senior advisor to the relatively new website planetlean, and you can find links to the past episode and all of these different books and sites if you go to leanblog.org/216. In this episode, we're going to talk about some of the progress being made in areas outside of manufacturing. Dan says there's awareness everywhere, but he asks if there's real depth in lean progress outside of manufacturing.

We'll discuss how we can reframe Lean for the public sector and healthcare as a way of going beyond just cost-cutting programs. What does Dan see happening in software and startup sectors in companies like Spotify in Sweden? And how is interest in the core respect for people principle leading to a search for more holistic management methods? Those are some of the themes we'll explore this episode. Well, joining us again on the podcast today, Dan Jones. Thanks for coming back and being a guest again.

Dan Jones: Very happy to, Mark.

Mark Graban: So, we're sitting here more than 25 years since the term lean production was coined, and obviously you were part of those efforts. I'm curious, though, here in 2015, what some of the things are that you're seeing that interest you in areas beyond manufacturing sectors. What's going on with Lean?

Dan Jones: Well, part of my destiny in the partnership with Jim early on, after we coined the term and did the MIT studies, was that living in the UK, our manufacturing industry in the '80s and '90s was imploding. So there wasn't an awful lot of future for Lean beyond the few Japanese plants that came here. So I had to quite quickly go out of manufacturing and explore taking Lean to other sectors like construction and healthcare and retail and aerospace and later on public sector. So I spent a lot of time trying to find pioneers with whom to experiment and see how we could translate the concepts into the language and address the needs of different sectors. And so that's been my destiny in life. I think we can claim we've spread awareness everywhere and there are very few sectors now that haven't been touched by some form of Lean activity. But that doesn't mean that we've created depth of real experience and practice with Lean. That's still to come, I think, in many sectors. So we spread it widely. And we've also, I think, spent a lot of time over the last 15 years deepening our understanding of the management system necessary to support the Lean tools that we all learned about 25 years ago.

Mark Graban: Yeah, it seems like, yeah, you're right, awareness is a first step. But what do we do beyond being able to, you know, people being able to use some terminology? I don't know if this seems to happen to other industries. People say, “Oh, yeah, this Lean stuff seems simple and we've done that.” How do you gauge that depth of real progress in different industries?

Dan Jones: It's kind of interesting. You could reflect on the TWI stages of learning, basic job instruction. We've done the awareness step. Quite a lot of people can do lean with a lot of help. Not too many can do lean on their own without help. And then there are very few people who are at the point where they can teach Lean to others. So I think you can apply that not just to people, but also to sectors. And I would say healthcare and public sector are more recent into this field, last 10, 15 years at the very most. And really mostly the last 10 years. And they've gone through the big consultant-led programs and we've seen a dozen of those. And at some point you get a call saying, “Well, we spent the money, we had the consultants, we did a lot of activity. People were very energized by it. But actually our finance director in the end said, ‘Well, where's the result? What's all this led to?'” And I think that's a very salutary lesson that while big programs create awareness and engage people, I think they actually don't deliver the results that are promised. And that's, I think, where we're at in the public sector and healthcare right now.

Mark Graban: Yeah, well, I mean, I would think there's a risk that awareness is either partial awareness or it creates the risk of misunderstanding. Or to your point about engagement, I mean, I think awareness doesn't necessarily engage people. I think people combine old managerial habits with the Lean concept. “Okay, I'm going to use Lean to tell people they need to rearrange their workspace,” as opposed to really engaging people.

Dan Jones: Yes, I think that's absolutely the case. Of course, there is a danger with Lean that you learn a little and you think you know it all. Whereas in fact, a true approach to Lean means that the more you learn, the more you realize there is to learn. So this is a developmental path. So I think you're right that engagement quickly fizzles when it's just tools and when it's just supported by experts from outside or when it's being rolled out across the organization in classic Six Sigma style as a thing that people don't think about too much, just listen to the training sessions and just do. And that's a very kind of Taylorist approach to managing change. So I think people get pretty cynical when Lean is used that way.

Mark Graban: Now maybe we can delve a little bit into the story with the tax office in the UK, the HMRC. People maybe American listeners aren't familiar with that story. I only have a surface understanding where, I mean, I remember seeing an article years back where employees were, I think, rightfully upset that they were being told, “You have to put tape around everything and you're not allowed to have family photos on your desk.” And I read that and I think, “Well, what problem was really being solved?” Hopefully from some of that, were there any good results or what's your take?

Dan Jones: Well, I think just for American readers, the HMRC, which is the tax office in the UK, conducted a… it was the first major consultant-led Lean transformation program in the UK government. The second was in the employment agency, the Department for Work and Pensions (DWP), which was slightly kinder and probably a little bit more successful in that a lot more people learned about Lean and learned about how to teach Lean and do Lean that have survived and gone on to do other things. But HMRC, the problem with the tax office was the government was simultaneously trying to squeeze the unions and reduce headcount while they were doing a Lean program. And absolutely understandably, the trade union used the rather naive application of Lean. You mentioned some, and there are certainly others as well, of naive, “do-it-to-me,” cookie-cutter Lean that was being used and naturally the trade unions used that as a weapon against the establishment.

So I think there were a lot of good case studies and exemplars in both of those ministries that big things were achieved in certain places. But it was very difficult to make this a nationwide program across multiple offices. Now what's happened since is that many of those who really got into Lean and learned to do Lean themselves and became internal Lean agents in some ministries, when the consultants went home, actually continued working on their own. And I've seen in something like the Department of Justice, which is another big government department in the UK, some really, really impressive things that have simply grown up from the ground up. So from the resources that were left out of DWP, those people have been building great case studies in improving the process through courts and so on. So all was not lost.

And the other thing that happened was I was working with the National Audit Office in the UK, which reports to Parliament on how well the government spends taxpayers' money. And they've been asked to audit the Lean programs of many government departments, beginning with the initial program that the Royal Air Force ran to improve the maintenance of fighter jets, which was very successful. And they have become really quite knowledgeable about Lean. We developed an assessment, a process awareness assessment that the National Audit Office used to understand different ministries' approach to process improvement across government. And we have now over four or five years quite a database of different ways to compare the process readiness of central government departments and that itself has triggered a lot of awareness and understanding amongst government departments and really led to the seeding, I would say, of initiatives that I think are likely to be much more successful because they're homegrown, they're much more modest in scope. They work if they are supported by a senior person, a leader who actually has seen this before. And that's actually one of the unintended lessons from these big consultant-led programs is that senior executives have seen them fail before and have reflected on why that was the case. And some of them, not all of them, but some of them have come to the conclusion that it failed because top management was not engaged and was not leading it. For instance, I was in a hospital in Barcelona that I've written about just recently and there the CEO had experienced lean programs, consultant-led programs in two previous jobs and was determined not to do it that way in his third job when he did become CEO and has been very much the hands-on leader and been extraordinarily successful as a result. So, I'm very loath to completely damn those experiments. Maybe they were, maybe they were necessary evils in a sense to create both the awareness and the seeding of capabilities both in top management and in Lean guys that could be used elsewhere.

Mark Graban: Yeah, and I think, you know, generally organizations are very short-term focused, so longer-term goals of, you know, building capabilities or having experiments that, you know, you said, “well, it was at a failure or a learning experience.” I think one of those old habits is the short-term pressure. I mean, when I was in Japan in November, one thing I was really struck by was the consistency of manufacturing companies and service companies and hospitals that all talked about whether it was framed as quality circles or Lean or everyday Kaizen. They all said some variation of, “Our first goal is developing people and learning. The second goal is the results and benefits.” And I think just like right there, that's a mindset that's really hard for people to embrace, I think, in Western settings.

Dan Jones: Well, I think that's right. Just my most recent experience with the healthcare board in Helsinki, the big lesson for them was that yes, they understood that Lean was about problem solving and they understood that coaching was necessary and so on to develop the problem solving capabilities, but didn't actually understand that the purpose of problem solving isn't actually to solve today's problem, it's to learn the problem solving process itself. So you're better able together as a team to solve tomorrow's problem and the one after that, and the one after that. It's learning as the dynamic capability to make continuous improvement an accelerating phenomena, if you like. And that's a leap that I think a lot of people still haven't quite made. They've understood learning and yes, we need to learn to do PDCA, but actually the PDCA process is something that is not only practiced, but is the basis for real, sustained, continuous improvement. And that's an important lesson. And I think the other lesson related to that is that most people actually find it difficult to see improvement opportunities in their work because they kind of accept that that's the way things have always been done. And yes, we can deal with problems, but can we see incremental improvements we could make today, tomorrow, next week that would make life better for customers and work experience better for the providers?

Mark Graban: Yeah, well, I mean, what I see happen, I think a lot in healthcare, it's partly that people can't see the waste because they're just very accustomed to the way things are. But I think even sometimes when the waste starts to become visible, leaders and even sometimes frontline staff take it very personally, even if nobody is blaming them. And we can talk about, “be hard on the process, not on the person,” but they view it as, say, “Well, the process is the people,” and they feel shame or embarrassment that, you know, some form of defensiveness about, “Well, gosh, what… we feel terrible that we haven't fixed it before.” I think that is tough. So healthcare tends to be a little more emotion driven maybe than others.

Dan Jones: Absolutely. And of course, in healthcare, the thing about healthcare is the patient actually experiences the process. And so the patient, the experience of the process, both for staff and for the patient, is critical to how both of those judge the success of what they're doing. So I think healthcare is different, is a lot more tribal, is going to take quite a long time before it becomes the way that teams work in healthcare. But nevertheless, I kind of think of an organization like that Spanish hospital where the CEO understands they've got to be hands-on. The CEO has enough knowledge of the process so he can link the improvement efforts in different places of the system so that the overall flow actually flows, so it improves the flow and they can handle more patients for the same resource and so on. And he does that through developing very deep problem solving capabilities at the front line and making, if you like, the line, responsibility for Lean rather than having a lean team. And sometimes I have to say lean teams get in the way. Sometimes I've seen a very sad case where brilliant people taken into a lean team end up just being firefighters for a CEO, rushing off to sort fires out which just reignite as soon as they move on to another area. And that's really sad.

Mark Graban: Yeah, I mean, I saw an article, this is kind of maybe getting off the track of public sector and other areas, but I saw an article the other day talked about Xerox, which I guess is as much of a services company anymore as they are a manufacturer, that they were disbanding their centralized Lean Six Sigma team. And they said, “Well, look, we've trained tons and tons of people, we've built capabilities all throughout the organization. There's no reason to have that central team anymore.” Which, you know, I hope they… I would hope as an outsider that they're not declaring victory too early in terms of the culture change and how much that's really embedded or if that's just a positive spin on getting rid of a central group. I mean, my understanding is that Toyota has different forms of small central groups that are responsible for kind of maintaining standards and helping spread or maintain their culture throughout the world, right?

Dan Jones: Yes. And also for architecting and drawing on the lessons from different experiments around the world. It's just really striking that Toyota plants in each look very different. They have had different history and yet the principles and the problem-solving methodology has been very similar. So I think the big lean teams were actually never part of the lean agenda and I think became part of the lean agenda as the consultants got in. And Toyota doesn't use big lean teams. And I always say to a lean team, “Well, where's your next job?” And they all say it's a staff function doing lean. And I say, “No, your future job is taking responsibility for coaching a team and delivering bottom line results. You are line managers and you have to be line managers in the future because that's where you will learn next.” And they feel pretty uncomfortable about that. But actually it's true.

Mark Graban: Well, I think our friends at ThedaCare have done a very good job of that, of having their internal ThedaCare improvement system team not be a career path, but a stepping stone to spread leadership and lean leadership throughout the organization.

Dan Jones: That's how it always was when I set up the first Kaizen office and Unipart back in '92 or '93 or whatever. It was a place through which we rotated people to gain deeper experience, and particularly experience of not just being a master of a particular piece of knowledge or process or a tool, but actually learning how to teach it to others, because that's critical. And then we deployed them as support to people who needed to learn that skill next. So that was always the intention. I think the big consultant thing got us off track, but maybe it was necessary. I mean, who knows? Could ThedaCare or Virginia Mason have got where they've got to without the massive investment in consulting support they had? I don't think they probably could have done. But does that mean that every other hospital, following their example, has to do that? I don't think so. I think in truth, when Lean is really mature, then actually Lean should be a very simple set of principles and practices that even some small hospital out in the Midwest could do on their own with minimal outside mentoring. And that's when it really will hit everybody.

Mark Graban: Yeah. I mean, these questions you're posing, I think are hard to answer because it's hard. There's no way of knowing. We didn't have a control group of whether Virginia Mason or ThedaCare could have been successful with a different approach. And we certainly know everybody who spends a ton of money on consultants doesn't repeat the same success. So you have the variables of… I think Gary Kaplan, John Toussaint, Dean Gruner are rare lean leaders in terms of being… I think I know John better than the others, but I know John talks about. He's very introspective about his own personal leadership style transformation. And I think that's rare.

Dan Jones: I think it's rare, but I think there are more and more. Well, maybe I'm just being optimistic, but I am seeing more and more CEOs who've had experience, maybe at the level or two below CEO of lean programs, and who are now in a position where they can actually act as CEO and are hands-on leading it. And that's, I think, a precondition, is hands-on leadership. It's the ability to link things end-to-end value streams, end-to-end patient flows, whatever you like. It's the deploying Lean through the line and focusing on building the incremental, the continuous improvement capabilities at the front line.

Mark Graban: Yeah.

Dan Jones: So, you know, it's not rocket science.

Mark Graban: And hence the challenge. Right. I mean, you know.

Dan Jones: Yes.

Mark Graban: I've heard people say, you know, it's not that Lean principles or mindsets are really complicated. They're just very different from the way…

Dan Jones: They're not just learned from writing books as we know, they're learned by doing, by practice. Practice this thing together. And that's how we work. We act our way into a different way of thinking and it takes time.

Mark Graban: Yeah, but I think you keep coming back to the point of how do we get people to take on this challenge of trying to develop problem solving capabilities? I guess at first, somehow people have to be made aware that there's some sort of gap or problem to be solved in that area. I think for people to say, “Oh yeah, we're great problem solvers,” when they're firefighting.

Dan Jones: I think, you know, in a sense that's we leap in to use Lean and do Lean and practice Lean without actually spending enough time understanding what the purpose is, what's the problem you're trying to solve. And if the problem in healthcare, it seems to me is very clear, on the one hand it's a, it's a quality, however you measure it, performance that is still an outlier compared with pretty well every other sector in terms of its poor performance. So it's a big quality problem in healthcare still. And the second is that in every country you look at, there is a growing aging population and growing demand for healthcare and yet the middle class incomes, tax revenues are supposed to pay for this or insurance policies, their incomes have been squeezed and so there ain't going to be more money. So we're going to have to learn to cope with this growing demand with the resources we've got rather than simply frightening politicians to promise more money. It doesn't actually work and is actually going to be, it distracts us from actually doing the right things to cope with this growing demand.

Mark Graban: Yeah, and I think you raised a great point where, you know, I think in the US everyone, you know, there's a better understanding of the cost problem than there is about the quality and patient safety problem that we can't just, we can't throw money at the problem. We don't want to spend more. We can't spend more. But even our neighbors to the north in Canada, who spend probably two thirds of what the US does, has huge budget constraints. Hospitals are laying off staff because they don't have enough money and budgets are tight. I mean, this seems a fairly common problem that nobody can or nobody wants to throw money at the problem. And we know that's not really the best solution.

Dan Jones: So I think the problem is clear. How do we cope with this growing demand with the resources we've got? I think that needs to then be broken down into, “Well, how does my clinic or my department cope with increased demand?” And then that does focus the mind on, “Well, what is the, you know, where are the errors, what are the delays, what are the queues, etc. And how can we work smarter?”

Mark Graban: Yeah, well, let's transition a bit. You talked earlier about some of these more mature industries. Let's talk about technology and software companies and the digital world where Lean ideas are relatively new and hopefully taking shape in good ways. What are some of the things you've been seeing recently in the digital world?

Dan Jones: Well, interestingly, I've been attending the Lean IT Summits in Paris for the last four years and they've been really fascinating because what you've seen, I think now looking back, is that you've seen a series of parallel developments in the software design world, software management world, that have mirrored the path we've been on with Lean. You can mention hundreds of initiatives from Extreme Processing to Agile to Scrum to Kaizen to DevOps to Lean user experience, design thinking, Lean Startup, etc. And you could kind of plot those on a… you could almost compare those with the insights into standard work and creating cells and all of the things we've learned with Lean over the years. They didn't start with a reference model and we did in Lean. I think the strength of Lean is that we have Toyota as a reference model. When we get stuck to go to look at, they've been kind of struggling with an industry also had a quality problem and a problem in that people were not prepared to be treated in the traditional Taylorist fashion and wanted some space and autonomy in which to develop. So I think there's a reason why Agile and Lean are coming together, if I can characterize it as that. The first is that clearly every product, every process in the future is going to be designed around the information flows and the information flows are going to be key. So the hardware and software design is actually converging and those folks need to find a common way of working together. The second is that I think the Lean… the second is really that the Agile folks are looking still for a more holistic business management model within which to develop Agile management and so on in the future. And I think we've got a lot to learn from each other. So I think the Lean and Agile worlds have got a great deal.

And where I'm looking is that we've seen the original digital pioneers, the Apples and the Amazons and the eBays and so on that we know very well, come up with fairly traditional management answers as they grew. They were not really that innovative in the management model. And yet the next generation of startups I think is having to, is having to figure out answers to how we work at scale that the other previous digital generation didn't actually succeed in addressing. And I think there are some very, very interesting business models out there that are trying to combine several things, first of all, trying to create a much clearer product focus and focus on a direct interaction with the customer. So the lean startup movement with the “experiment, build, measure, learn” cycle, absolutely is what we all have to do and find different ways of getting closer to. The second dimension is the deepening of technical skills dimension. I think we ignore that at our peril. And the third dimension I think is the dimension of learning how to work together, what we will call Lean, all the problem solving skills and collaboration and communication skills that go with Lean.

I was recently in Spotify in Sweden, a big… I'm sure many of your listeners use Spotify as a music streaming service. They are now nearly approaching a thousand people and have come up with a very innovative business model built on squads. They're teams of five, six people with an agile coach, a technical lead and a product lead in the team. And then those teams are part of 10 tribes, as they call them, focused on different elements of the product, some of the support, some direct product development. And then in each of those layers of management, those three technical, agile and product leads are represented. And a very different form of management support in terms of setting objectives, and setting objectives in terms of outcomes rather than sort of measuring and focusing on how much resource we're devoting to it. So I think there's… Lean can learn from the software history, software guys can certainly learn from Lean. And what I think the software guys are missing is a focus on understanding how Lean. The discipline that Lean brings to making work visual, to managing deviations, from work to problem solving is all about learning and capturing that learning and building and improving on that learning. That's, I think, a dimension that I think the software guys still haven't really understood. So there's a lot of convergence, a lot of interest and I think the Agile and Lean worlds absolutely are converging right now and Lean startups are a little piece of that. But there's a much bigger picture in terms of organization design for the future.

Mark Graban: Yeah. Now I'm curious what you're seeing at some of these companies when you talk about a holistic management system. Because my concern being sort of on the outside of the Agile and software worlds is that I've seen visit organizations that do a great job of visually managing the work and trying to focus on flow. And I wonder sometimes, is this sort of like the just-in-time era of Lean where we viewed all Lean is about highjunka boxes and Kanban systems and maybe some of these technical methods that, that, you know, it's good to have better flow but that doesn't mean you necessarily have the right culture and the problem solving skills. And I would hope software companies create better, more engaging workplaces.

Dan Jones: Well, I think so and I think that's actually what's driven these startups, companies like Menlo, which I'm sure you're familiar with, and we like Spotify. That's what has driven the Agile movements, a search for autonomy to create workplaces in which people feel fulfilled and so on. And I think that's an essential element to the future because in the future I don't think anybody's going to tolerate working in a traditional Taylorist, “I'll think you do” kind of environment. But I think you're right. You know, there are elements of those early JIT days in some of the Agile and Kanban enthusiasts. They're all seeing a piece of the system and making the same mistake we did and thinking that the piece scaled up actually equals the system.

Mark Graban: Yeah.

Dan Jones: And same is true with Lean Startup. I mean, it's great what Eric's done, tremendous, but doesn't address the scale up issues. And I think that's a problem to be tackled.

Mark Graban: Yeah. And a lot of times I don't fault the authors of books like Eric and the Lean Startup or people who've written books on Kanban for example because it seems like sometimes people, the readers don't really read the book or they take away a piece of it where it's just, you know, it's just, it's frustrating to see sometimes where I think, you know, a particular book does a decent job of explaining the whole, but then the reader from their own perspective or their own lens, I think has happened, used to happen with lean production and it happens in healthcare. The reader glosses through some things and then they see something like, “Oh yeah, okay, there's something great,” and that's my takeaway. When it's just a piece instead of the whole.

Dan Jones: Right. I think that's absolutely right. But I think what is actually missing in the Agile software movement is a framework that puts it all together. And I think in a sense that we have a framework. And I think it is the same kind of framework actually, just in a different language that could help them put those pieces together in a meaningful fashion rather than as a collection of pieces.

Mark Graban: Sure.

Dan Jones: So I think the other, the other interesting lesson I get out of that and out of the learning lesson from Lean, if you like, the learning lesson from Lean is that good dynamic economies that come from continual problem solving, incremental problem solving, are at least as able to deliver very significant change over several years as a big leap program. In fact, I would argue probably more successful. And so for the future, the language of business debate is often framed around just disruption as the only answer because these hopeless behemoths can't respond. Well, I don't think that's the case. I think most of the disruptors themselves actually go through a period of incremental growth. And I think Lean and Agile does offer in the future an alternative path to being at least a fast follower and so therefore still a player in an industry. So we'll see. It's very interesting, you know, as Bosch and Daimler and so on get into the driverless car and as Google gets into it from the other direction, you know where it ends up. And I think there's a great deal of cross learning going on now that wasn't going on four or five years ago.

Mark Graban: Yeah, well, and I think, you know, some of that cross-learning is still taking place between manufacturing and healthcare. I think you bring up a really interesting point of these different strategies of the radical big-bang transformation, change versus starting small. And you know what I see happening a lot out there just around, let's say, Kaizen and continuous improvement practices is that organizations that get excited about this and they have 80 departments and somebody says, “Okay, well every department needs to order a whiteboard and we're going to set them all up this way and everyone go start doing that.” Usually those systems fail and you see, you walk through the hospital, you might see, you know, a handful of departments where the leaders were really engaged and excited about this process. And then those boards are just otherwise collecting announcements about potluck gatherings. So as opposed to starting small and then trying to spread.

Dan Jones: I think there's no question that you have to start small because this is all about building capabilities and people have to own those capabilities and practice those capabilities. And so actually you have to build from the bottom up, but you need somebody orchestrating at the top to make sure that the bottom-up improvements do add up because it's very dangerous when they don't, you will just get frustration and you won't deliver organization results or I'm sure we would agree.

Mark Graban: That, yeah, this bottom-up approach doesn't mean senior leaders say, “Okay, well, hey, you're on your own, you're empowered.” I mean, it's a more collaborative approach, right?

Dan Jones: No, absolutely. And it needs top management visiting the Gemba because… very interesting. More and more I'm seeing the way top management learns, really learns what's going on is not just going and traditionally visiting, which just doesn't really show anything.

Mark Graban: It's not a tour.

Dan Jones: No, it's actually going down and helping and mentoring and coaching and unblocking the teams at the front line solving their own problems. So ironically, management learns best by learning, helping others to learn, which is kind of interesting because I don't think management can typically see the detail of what's going on and hence then also find it very difficult to identify the few things that make a difference to linking things together. So top management has to actually go to the Gemba. And I've challenged lean healthcare leaders, asking them how many days a week they spend on the shop floor and they usually say, “Well, I don't have too much time.” And yet, let me tell you, the UK, after a disastrous couple of years and the first two years of this government we've got at the moment, they tried another reorganization of healthcare, which was a complete waste of time and a big disaster. But now they've changed. And the current Minister of Health, Jeremy Hunt, has taken a completely different approach. He said, “We may not have the perfect structure now, but basically we've got to just improve what we got instead of trying to restructure it.” And he has spent privately, with no pressure. He spent a day a week out in the field actually at the front line talking to nurses and patients and has a really, really deep understanding of what's going on in healthcare and can take on the lobbies as a result much more effectively. But it's that kind of quiet leadership that really has a deep interest in understanding the details of what's going on that I think that's a great example. Now, if a government minister can do that, then there's no excuse for any other CEO not to be able to do that.

Mark Graban: No, because it's far too easy and common for a hospital CEO to come to work for an entire week and not see a patient because they're in a separate building.

Dan Jones: Well, particularly in public sector organizations, the management has been all about administration. It's not about operational management. There's no management. And so there's been no reason for them to go down. And that's changing. And I think managers are gradually beginning to realize that actually the purpose of management is to support the frontline.

Mark Graban: And to go and see and to not be the one with all the answers requires a certain humility.

Dan Jones: Absolutely. And that, in healthcare is big, particularly if a doc is a CEO and he goes down and he doesn't know all the answers. He has to be very careful not to play that role of the big doc who does know all the answers, because that just, you know, people see through that very quickly.

Mark Graban: Yeah. Well, as we wrap up, Dan, thank you again for being a guest on the podcast. Is there anything coming up from the Lean Enterprise Academy, any conferences or events or new things going on that you want to mention?

Dan Jones: Well, I mean, we had a very successful summit last November, and all of our summits seem to be attracting a much, much more senior and more experienced audience, which is good. I think we're rethinking the role of these Lean Institutes. I no longer run any of them, of course. I've now handed over management of the Lean Network as Jim has. But I think what I put my effort into is helping to establish a communications platform, the Planet Lean Journal online journal, which is collecting more and more cases because we need to tell stories and we need to reach out to other communities. And we've not been traditionally very good at that. And that's why I spent quite a lot of time out in the software and digital community, partly nudged by my son, I have to admit, who works for eBay in Berlin and keeps bugging me about software problems. I'm not a software guy at all, but I find it absolutely fascinating trying to understand where people have come from and what the struggles are to see the same kinds of things as we've been seeing in the physical world, in the digital world. So I think there's, you know, we should be open-minded and we should be looking outwards and trying to communicate to a general management audience, which, if we do it right, will allow the Lean movement to continue to a next generation.

Mark Graban: Yeah, well, that's a great goal. And the website here, it's planet-lean.com and I'll link to that in the show notes. So again, our guest today has been Professor Dan Jones. It's great to talk to you and thanks for talking with us today.

Dan Jones: It's great to talk to you, Mark. Thanks very much indeed. Speak to you again.

Mark Graban: Okay, thank you.

Some videos with Dan:

---

Please scroll down (or click) to post a comment. Connect with me on LinkedIn.

---

Let’s build a culture of continuous improvement and psychological safety—together. If you're a leader aiming for lasting change (not just more projects), I help organizations:

• Engage people at all levels in sustainable improvement
• Shift from fear of mistakes to learning from them
• Apply Lean thinking in practical, people-centered ways

Interested in coaching or a keynote talk? Let’s talk.

---

Join me for a Lean Healthcare Accelerator Trip to Japan! Learn More

---