Reader Question from an MD: One Shot to Talk to the Hospital CEO About #Lean


Before I head out on vacation, here is a reader question that I am sharing for your input.I'm sharing this with permission and I'm obscuring a few details at their request.

Please read and leave a comment below the post. My approval of comments might be a bit slow after Tuesday evening as I start to travel.

Listen to Mark read the post (subscribe to the podcast):

The Question:

I thought I'd get in touch. I have genuinely listened to every podcast you have on your site. They're brilliant, and I'm very grateful for the time you put into making them.

I'm getting in touch because I'm faced with a question I've never heard tackled anywhere. As the most accessible lean expert I know of, I thought I'd come to you.

As a bit of background, I'm an attending physician working in a hospital. I was first exposed to Lean about 4 years ago after a colleague returned from a visit to Virginia Mason, and mentioned it. Since then I've worked my way through lots of reading, podcasts and also implemented small projects within my own team.

I've become the “factory of one”, and personally have a really high amount of face-to-face patient contact, while only working my official hours. I've done the best I can to spread Lean through conversations with other clinicians, making Lego videos to explain the concepts, and we've put some basic lean principles in a new clinic design.

Unfortunately, there's almost no awareness or desire for Lean at a senior level, and I'm now at the stage where I'm frustrated by all the waste I can see, but is invisible to everyone else.

There are about 3 of us (out of a staff of 2000) who are desperate to see a proper lean transformation. My understanding is that we're more doomed to fail without senior executive support to drive it throughout the organization.

Which brings me, to my question (sorry it's taken a while). I've been given an hour with our Chief Executive to talk about Quality Improvement. This is my one shot to discuss it with her and I don't want to mess it up. I've got about two weeks to get my plan together.

I didn't know whether you knew of a resource, or some evidence of the best way to go about this?

My intention at the minute is to explain my own path through Lean and the frustration I feel as a clinician. My intention was for her to simply have to decide between “we're not doing it” or “I'll need to know more”. If she chooses the latter then we'll try and set up a three month plan for her and the board to work through.

As someone who has never done this before, my tactics may well be a bit off. If you have anything to offer, I'd be very grateful.

Many thanks, and please keep going with the podcasts. They've been invaluable to my learning.

What advice would you give an MD who is talking to their CEO about #Lean? Click To Tweet

My Response:

Thanks for your email. I'd like to be more helpful… to do so more personally and at greater length, but the timing is bad. I'm about to head off on a two week vacation Tuesday night, so I won't have much internet access.

I will (anonymously) share your question on my blog and hopefully there will be good responses from my readers.

It's great that you are taking on this important mission of improving patient care and improving the hospital for everybody involved.

I don't think you can expect to magically convince anybody in one meeting, but here is my advice:

1) Start by getting agreement and alignment around the question of “What problem are we trying to solve?” first. They might not want to “do Lean” but I'm sure they want to improve.

See this video with John Shook talking about that question and an improvement model.

2) Share some examples from other hospitals that have used Lean to help solve some of those problems (realizing that people might say “our hospital is different than those” for some reason… and that's OK, just let that be something to work through instead of being an excuse).

See my blog post on “we're different” and this video talking about barriers versus excuses.

3) Share your own personal experiences about how Lean has helped you and your patients in that setting. Explain how Lean benefits all stakeholders.

4) Propose some small scale experiments to help continue proving out that Lean is helpful.

5) Share stories and testimonials from hospital CEOs from around the world, such as Dr. John Toussaint and Dr. Gary Kaplan from ThedaCare and Virginia Mason, respectively.

In particular, see Toussaint's new book Management on the Mend and his “roadmap” for improvement.

I hope those initial thoughts will help. Now, I'll turn things over to my trusted readers and the Lean Blog community… please leave a comment and share your thoughts.

What do you think? Please scroll down (or click) to post a comment. Or please share the post with your thoughts on LinkedIn – and follow me or connect with me there.

Did you like this post? Make sure you don't miss a post or podcast — Subscribe to get notified about posts via email daily or weekly.

Check out my latest book, The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation:

Get New Posts Sent To You

Select list(s):
Previous articleHelpful Visuals for an International Flight, a Hospital, or a Dentist
Next articleOn Vacation Through July 15 – Here’s Some Recommended Reading & Listening
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. To add on to what Mark already said about John Toussaints new book…

    Recognize first that Lean at a work unit level is very different than Lean at the enterprise level especially for organizations as complex as a 2000 person hospital. One aspect of this is that successful application of Lean at a work unit level can actually dissuade an executive from doing an organization-wide transformation because change at the executive level is not required for success.

    So while many in the bowels of an organization are screaming for a method to fix all the broken processes that surround them, unless the CEO is feeling the pain it is difficult to make the case to do something different at the executive level.

    So, suggest that you frame the discussion about something that is painful for the CEO.

    For Gary Kaplan at Virginia Mason it was that the organization was losing money and one of their biggest payors told him his organization was on their watch list because of high costs and poor quality relative to competing hospitals.

    Now show how Lean can help fix that pain – preferably with relevant examples. Take them to a place where there is real complexity up and down and across the organization where success is more than just being good at assembling widgets. The leader needs to understand the personal change they need to go through if they want to go down that path.

    • Thanks for adding to the discussion, Bart. Yes, targeting that “what problem are we trying solve?” question to the CEO and their needs is key.

      Great point about Lean being far more challenging at an enterprise level as opposed to a local department.

  2. What an awesome opportunity. I agree that you have to align a lean transformation as a way to address the organization’s pain.

    I would add – how is the organization addressing the patient’s pain? Are we best serving the patient and is there opportunity to improve how the organization serves patients?

    After spending 19 years in manufacturing and seeing how lean was often used to improve the bottom line with little focus on customers, I think one thing healthcare has done well is keeping the focus on the patient and how a lean transformation enables the organization to serve the patient better. That’s what healthcare is all about and when we do that well we have really done something!

    At the end of the day, the only reason to “do” lean is to get results. So show her how lean can help her get results (which is what most CEOs want) then you have a place to start. Good luck!

  3. Can you use A3 thinking to help tell your story and share some insights/ reflections into your thinking for the problem solving of your organziation?

  4. The advice above is spot on. I’ll expand a bit on Mark’s #4: When you propose the small scale events, already have them identified along with quantifiable deliverables. Make them small enough to ensure that an improvement will be realized (since it seems this will be one of the first events with a larger team), but large enough to solve a problem the CEO cares about. That way, instead of saying “I’d like to try a few small events to show the team the power of Lean”, you can say “I spoke with some of the nurses in my unit, and we’d like to have an event to address the time it takes to get a patient admitted. We think we can reduce this time by 50%, which would mean we could service 1,000 more patients a month.” I made this example up, but you get the idea.

  5. A problem solving A3 and summary Roadmap could be utilized to explain and solidify the thinking behind your proposed activity. These must reflect and further the vision and strategy of the CEO in order to be well received. Ideally, a ‘golden thread’ runs through an organization that ties all daily activities back to the ultimate goals/targets. Documentation that clearly shows the connection can be a powerful tool to increase your presentation’s effectiveness and influence your CEO’s decision. By presenting both the A3 and Roadmap, you also then equip the CEO with enough supporting documentation to take this to his Board or executive team for communication purposes or buy-in.

    • My suggestion would be to ignore some sort of grand “roadmap” for now. It’s way too early and preliminary for that. I think Darcy’s advice is jumping the gun, even though it makes sense for a stage when there is buy in and commitment.

  6. Indeed, that is a challenge, but how exciting too! You have some good ideas and suggestions from everyone here. I agree on a small pilot to show the method and prove out the concept. But that comes after really highlighting the ‘Why do this?’ question. (What problem are you trying to solve?) Better cash flow? Higher patient satisfaction? Higher patient safety? Which one of these pain points is of interest to your CEO? By the by I have a couple of presentations from hospital administrators (COO) that outline their Lean journeys. If you’d like a copy, I’d be happy to share. For example, one relates the story of how a lean project saved them about $10M since they avoided having to build as new unit. The story goes that they were at full capacity and bursting at the seams. The COO said he would like to analyze the situation first before taking such a drastic measure as to build another facility. So they analyzed the work, removed all kinds of waste, increased their throughput and were able to attend to many more patients more quickly. Oh yeah, and they saved all that moolah too. :)

  7. If I had one hour, I’d try to find out what this person (the executive) cares about and talk about how some different ways of doing things (lean thinking and action) will address what the executive cares about. In this meeting, I’d show the executive examples of what I’ve done. Then I’d try for a 2nd meeting which would be a “show me” session (to the gemba). The goal of that meeting would be to ask for some help, to make some more improvements and to keep the improvement sustained (this is where I would focus on what I need from the executive – help with sustainability). Then I’d go for a 3rd meeting, this time with friends (other clinicians and teammates that are involved in the improvement work). The purpose of this 3rd meeting is to show what we’ve done after meeting #2 and how we’ve sustained the gains (thanks, in part, to what the executive did to help). Then I’d go for a 4th meeting … you get the idea.

  8. Hello,

    I was the doctor who had the one shot to speak to the CEO of my hospital. I’m really grateful to both Mark and all the posters for their suggestions. I considered each and every response and my presentation changed a lot as a result of the feedback.

    In the end the approach I went for was one that was fairly informal, but that was intentional as it allowed me to be very honest about the frustrations. My overall approach was:

    1) A personal account of my own experience with lean, particularly highlighting how I’m still only scratching the surface despite a few years of fairly intensive self-directed learning. We spoke about some of the improvements I’d made using the approach, and the factors that have prevented these improvements being spread outside of my immediate influence.

    2) A personal perspective of how hard it was for quality improvement to stick in the teams I work in. This then was tied in to how the whole organisation has a problem with its approach to quality improvement. I also tied it in with our plans to become “excellent”, and questioned how we achieve that without an excellent approach to quality.

    3) Showing what other organisations are doing around quality improvement, and pointing out that it’s a way of recruiting good people. We often struggle to recruit good people, and we had a frank discussion about whether excellent people will really want to work in a mediocre system (particularly as we don’t have other things to attract employees, such as a strong research base).

    4) We spoke about the need to a major commitment if we are going to do this right, and that half measures are not going to be enough to produce a meaningful change. We spoke about how there was little point in trying to get this moving without the top of the organisation being entirely behind it. I think that we concluded that the Executive team needed to learn more to be able to make a commitment one way or the other.

    Without going into more detail, it was generally a positive meeting and there were some real outcomes from it. There’s the real chance for us to push quality improvement in the coming months, and for a clear decision one way or the other about our approach.

    Thank you everyone.


Please enter your comment!
Please enter your name here

This site uses Akismet to reduce spam. Learn how your comment data is processed.