My First #Lean Healthcare Visit to China: A Post Mostly About Travel and Food

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I just returned on Wednesday from my first trip to China to meet with people and give presentations about Lean in healthcare. It was a whirlwind to say the least. I spent nearly as much time traveling as I did talking to people about Lean and healthcare improvement, but it was worth it.

I'll write a number of blog posts about various aspects of the trip, what I talked about, and what I learned. It was a very interesting adventure. The people were warm, hospitable, and very eager about improving their hospitals, clinics, and health system.

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The senior leaders from the organizations always sat in the front row and they were very attentive. That's far better than the common Western approach of introducing the speaker, saying “Lean is important,” and then leaving. The photo at left is me and a hospital president from the city of Chongqing.

She was very engaged, asked questions (the senior leader always asked the first question, it seemed), and I think she had already read the Chinese translation of my book, Lean Hospitals (2nd edition).

The other Americans and I had been wearing suits and ties during the first two stops… but it was nearly 100 degrees and it was warm in buildings, even with air conditioning, and none of the Chinese doctors or executives were wearing ties, so we ended up a bit more casual the last two days.

This post maybe doesn't cover  the most important aspects of the trip, but there was a train, many planes, and many many automobiles involved. Today's post is more of a travelogue, I guess… to ease back into blogging. I'll write more about the conference content and hospital visits in future posts.

I started with a 13-hour direct flight from DFW to Beijing. I knew that flights to locations half-way around the world were done in a straight-line route (often over the north pole) instead of just flying east/west. But, I was surprised that so much of this flight was over land (the entire trip other than the water between Alaska and Russia).


The flight back took a similar straight-line path, other than veering to avoid flying over North Korea.

The trip was comfortable on the relatively new Boeing 787 “Dreamliner.” My flight was delayed for three hours due to some sort of electronics and software problems with the plane. Boarding was delayed, but the departure was delayed further as they had to “reboot” the airplane by powering it off and back on, which is a 30-minute process. On the flight home, one flight attendant told me that American needs to “always keep an extra 787 in a DFW hanger because there are so many problems with these new planes.” It's the waste of waiting, the waste of airplane inventory… but I'm glad the airline puts safety first instead of making schedule their only priority.

My one complaint with the 787 is the electronic window “shades.” Instead of the tried and true technology of pull down (or pull up) window shades, these planes have fancy windows that dim to various shades of “dark” — except that the darkest setting isn't fully dark. I was on the sunny side of the flight both times and the light coming in cast some glare on the movie screen. To me, it seems like “overprocessing” or perhaps over-engineering. I'm not the only one who thinks this way, as All Nippon Airways wanted to install traditional shades. Readers from Boeing may disagree with me, but that's fine.

I guess Boeing does recognize a problem, as:

“…”Gen 2″ windows are designed to be 10x darker than the original version of the Dreamliner windows.”

Anyway, after a day-long conference in Beijing (more about this in future posts), our group (including two guys from a New York hospital and our Chinese hosts/guides) took the high-speed train from Beijing to Shanghai that evening. The trains are very much like the high-speed trains that I loved in Japan. It's a very smooth and comfortable trip.


Even at speeds of over 300 kph, the trip took almost six hours (basically like taking the train from Dallas to Chicago).


One thing that fascinates me about China is the abundance of 25- to 30-story high rise apartment buildings. If there's one building, there's five or ten more exactly like it right near by. Even an hour outside of Beijing, farm land would be suddenly interrupted by a cluster of 20 or 25 high rises. One photo of the lookalike buildings in Chongqing:


We arrived in Shanghai in their very modern train station… then an hour-long drive to the hotel. It was a late arrival, about 1 am. Every drive from point to point (hotel to train station, hotel to hospital, etc.) seemed to take an hour with heavy traffic.


Our typical view of traffic, on highways or in cities… back bumpers and heavy congestion.


I saw a lot of VWs, Hyundais, Toyota Camrys, Audis, Buicks… a few Chinese cars, but mostly foreign brands. We always rode in a Buick mini-van, it seemed.

There was a lot of fantastic food. Some of it was “a bit difficult” for a Westerner, as my Japanese friends might say. Duck necks and duck tongues aren't my cup of tea (from the Beijing train station)… it was room temperature and too spicy for me:


Other forms of duck were fantastic and I really did eat well, even if I'm sometimes a picky eater (and one who tries to be careful to not offend my hosts). Here's a picture from a high-end restaurant in Shanghai of some delicious duck skin (with a little meat still attached):


The restaurant had carved this off the whole duck at table side. They then asked us what to do with the rest of the duck. I guess taking it home was an option. They diced up the meat and fried that for us, also very good (I need to lay off fried foods for a while).

These steamed buns were very cute… and tasty. They were filled with an egg custard instead of pork.


After the conference day in Shanghai, we flew to the western city of Chongqing. That's probably the only city of 30 million people that I've never heard of before this trip.

Before our hospital visit and presentations in Chongqing, we had the famous local “hot pot” cuisine, where you cook food in broth (yes, the bright red broth was super spicy).


Some of the food was challenging for me (again, that's my problem, not theirs), but the local Chongqing brand beer was “brewed for happiness.”

The trip was brewed for happiness. After Chongqing, we flew back to Beijing and visited a hospital that morning before I flew another 13 hours back home direct to DFW (without delay).

I really appreciate the opportunity to have traveled there. Again, the people were warm and incredibly hospital, eager to learn, and their hospitals were modern and impressive. I hope to be able to go back and explore Lean more deeply and do more than just talk.

Some organizations there have been dabbling with Lean methods. One talked about their years of experience with Total Quality Management and “Quality Circle” projects (as I had heard about in Japan).

They are increasingly serious about patient satisfaction, staff engagement, and patient safety. Again, I'll write more about this in future posts.

Thanks for reading my travelogue. More Lean-focused content to come!

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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. Hi Mark! This sounds like quite the adventure. Very interesting that the senior leaders sat up front, paid full attention, and always asked the first question. It sounds like they have the “respect” necessary to be successful at Lean. I would be interested to hear how they balance this hierarchy with front line staff being comfortable sharing ideas for improvement. I look forward to future posts about this trip. – Matt

    • Thanks for the comment, Matt. That part of respect was certainly present. That said, attendees in settings like this are just as distracted by phones and mobile devices as any audience in the U.S. Is that a sign of a lack of respect, or just the reality in this day and age?

      I’ve never felt like I was entitled to attention or respect… many of the people in the audience were paying attention, as I could tell from eye contact and body language. Even when there was translation occurring into Mandarin, I could tell which attendees were listening to me and directly understanding in English (again, from head nods, body language, etc).

      It seems like the intent of Chinese healthcare is to increase the practical respect shown to caregivers and to patients in different ways, as I’ll explore in the next posts.

  2. Great post, Mark! Loved hearing about the execs in the front row. I’m finding the same in Thailand. VERY different from U.S. leadership mindsets. The execs at both of our clients in Thailand are extremely involved and are learning right alongside their teams. They kick off and wrap every meeting/session. They’re learning PDSA alongside their middle managers and their dedicated improvement team. They’re humble, inquisitive, respectful. If only I could inject this value system into every U.S. executive…

    • Glad to hear that, Karen. Do the execs stay for the main session, not just the start and end?

      I’m always impressed and pleasantly surprised when a U.S. hospital CEO or COO stays and participates in Lean training or other work I’m involved in. They don’t need to be involved in micromanaging decision making, of course… but they should be learning Lean and leading it, not just delegating and sponsoring it.


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