#TBT: A Doctor’s Response to this Doctor Who Was Upset About Lean


throwback lean cultureYou might remember my post from June about an emergency physician who wrote a journal article bashing “Lean” — but what he described didn't sound like Lean at all.

As I said then:

“In the article, Dr. Cotton describes the poor treatment he's received from a 40-something internal “Lean consultant” named Dean.

If what Dr. Cotton describes is true, I stand by him in his concerns.

But, there are things I'll be critical of here, about his writing and behavior.”

The original post:

This Doctor is Upset About Something, But It Doesn't Really Sound Like Lean

Now, Dr. Mark Jaben, a friend of mine and an emergency physician has written a letter, co-authored with Dr. Richard MacKenzie that was published by the same journal:

Letter to the Editor: Lean is not What Makes an Organization LAME

…where “LAME” is my term for Lean As Misguidedly Executed.


The letter makes many good points, including the following:

People are not cars! Of course not. Lean evolved from Toyota's experience, but it is really about the way people organize themselves to get work done. Lean is built upon continuous improvement and respect for people. Both are essential to overcome the inevitable tension that exists between an organization pursuing its goals and individuals doing their work. Successfully navigating this dilemma explains why Lean works, not just in assembly-line manufacturing but also in software development, legal offices, nonprofits, government, and even health care. Lean is about how people function together.”

What do you think?

Check out my podcast with Dr. Jaben:

Podcast #193 – Mark Jaben, MD on Lean, Change, and Our Brains

And a webinar he did for KaiNexus:

The Science Behind the Resistance to Change


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Mark Graban is an internationally-recognized consultant, author, and professional speaker who has worked in healthcare, manufacturing, and startups. His latest book is Measures of Success: React Less, Lead Better, Improve More. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. He also published the anthology Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also a Senior Advisor to the technology company KaiNexus.

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