Guest Post from a Hospital CEO: Lean’s a Journey, Not a Sprint


Mark's note: Today's post is written by Gary Passama, the CEO of NorthBay Healthcare in northern California. He is an active blogger on the hospital's blog and he has written about Lean a few times. As he mentions in this post, we met when I spoke at a seminar he attended, which led to me coming to teach at his system. I've been impressed with his shift from the cycles of layoffs and rehiring (that he touches on in this post) to Lean as an alternate strategy to layoffs. 

By Gary Passama:

passemaNorthBay Healthcare's Lean journey enters its fourth year next month.  It has been an uneven ride because of some personnel changes, and to some degree, my impatience.

Our journey began at a one-day seminar for Lean novices at which Mark Graban was a featured speaker. Seeking some answers, I attended hoping to find a better way to achieve sustained performance improvement for NorthBay Healthcare.

We were coming off a difficult year financially punctuated by a round of layoffs.  We knew from previous experience that reductions in force provide immediate financial savings, but over time positions are gradually reinstated. There had to be a better way.

What I learned about Lean principles that day convinced me it would offer an opportunity to improve the quality of care we provide and make the work environment better for our staff. NorthBay needed to start its Lean journey.

Mark Graban, several months later, presented an on-site seminar for all our managers. They too saw the potential. Fortunately, more than a few of our managers already were very aware of Lean from experiences in other organizations.

So what have we learned since then?

Educating managers about Lean was a good thing. But it did not instill a Lean culture throughout the organization. Managers began to use Lean principles on various projects to good ends.  Staff, though, really did not understand what Lean means. In some instances Lean was seen as a threat, yet another way to mindlessly reduce staff.

We did have good results after applying Lean concepts in our medical group. Consultants from Virginia Mason's medical group in Seattle conducted a two-day seminar for our group physicians and their support staff.  Several of the physicians who had been unhappy with the long hours they were working and the difficulty of meeting their patients' needs suddenly began talking about “flow stations” and “on stage” and “off stage.”

Those physicians who redesigned their work flow using the Lean methodology found they were not only more productive, but that they were able to go home at a decent hour. Their support staff also became more productive and happier. The dominoes continued to fall. Patient access was increased. Gradually, other members of the medical group became interested.

Hospital CEO summary of #Lean: happier MDs & staff, better patient access, & more. Share on X

Our relocated Cancer Center, which opens next year, is being designed with Lean principles in mind. It will look quite different from our current center. The patient and staff experience will be much better. All of these changes were driven by the people who actually work with patients. It was not a top down process.

Changes were driven by the people who actually work with patients. It was not a top down process. Share on X

We are now more patient (no pun intended) with instilling Lean into our culture.  It is clear that more NorthBay staff need to understand Lean if we are to successfully incorporate it into our culture. We have added three Lean practitioners who are available to consult with managers and staff on performance improvement.

As we enter the fourth year of our Lean journey, we have started what we are calling a “Certified Lean Advisor” program. We will have three cohorts each year undergo a training program to achieve that certification. Most of the staff going through this voluntary program will be non-managers, staff at the ground level. Our goal is to have several hundred such advisors within the next few years. They will become Lean agents of change on the work site. Enthusiasm for and interest in this program is abundant.

NorthBay Healthcare is still in the beginning of its Lean journey.  Our success as an organization in competing with the healthcare giants in California is because we take a long view. It is no different with making Lean an inherent part of our culture.

But, we have only just begun.

About the Author (adapted from his blog bio): Gary Passama, president and CEO of NorthBay Healthcare, draws on his 40-plus years in administration to comment on health care and the politics and social influences that surround it. He has a BS in business administration and management, along with a Master of Public Health degree, from the UC Berkeley Haas School of Business.

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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 hope Northbay is doing more than launching non-managerial led cohorts. I know that is a popular approach for many. I would focus on the executive team and work my way down through the bowels of the organization.

    I don’t know the whole story, but from this blog post only it seems the attention is being directed at front-line operations.

    I am pretty sure it wasn’t front-line operations that caused the “difficult year” and the need for lay-offs.

  2. NorthBay’s Lean journey involves all levels of staff from front line to senior management. The Certified Lean advisor program which I briefly mention includes in each cohort managers as well as staff personnel.

    I do believe, however, that focusing on only management is a mistake. Lean needs to be more inclusive to be successful.

  3. Gary, Thanks for clarifying and I am glad that you are working at many levels. Yes, front-line operations do need to be involved and for them to be successful in the long run they need at least four things:

    1. Lots of practice. This means more than than one important improvement event, this means lots of improvement events. This is how learning and behavior change takes place.

    2. Lots of support. Front-line leaders need lots of facilitation at the beginning and frequent support along the way.

    3. Leadership coaching. In the lean world that I understand, principles aren’t transferable but experience is and the only way leaders learn to coach is by actually doing it. This makes for awkward dancing at first between leaders and subordinates.

    4. A desire to do all this stuff. Without enthusiastic commitment learning doesn’t take place. It’s leadership’s role to generate this desire.

    I didn’t think this stuff up myself, this is just my current thinking.

    Best wishes on your journey at NorthBay

    • Great points, Bart.

      I’d add that “lots of practice” means improvement that’s not just a formal event. Daily continuous improvement is Kaizen and that allows faster cycles of improvement and faster cycles of learning through PDSA.

      I agree that “learn by doing” is most effective when there’s a coach or a mentor observing and helping.

  4. Lean sounds like a great system; decent hours, productive work, and long term improvement are all wonderful things for everyone – patients, employees, families, and business owners. Much was said about the implication of Lean principles and their effects in this article, I’m curious though what exactly Lean is. What are the principles and applications of this system?


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