I Was Asked to Share “Pet Peeves” About Lean (and Lean Sigma)


Thanks to GoLeanSixSigma.com for asking me some questions for a discussion that they've posted on their website.

The questions they asked were:

  • What advice do you have for someone that is getting started with applying Lean in Healthcare?
  • What are some common mistakes you see people making when applying Lean in Healthcare?
  • Do you have any pet peeves related to Lean application in Healthcare?
  • Is there anyone that has significantly influenced you over the years?
  • Why do you do what you do? (What motivates you?)
  • What's something exciting that you're currently working on?
  • What's your favorite application of Lean in your personal life (away from work)?

How would you answer those questions? Leave a comment below.

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On the pet peeves issue, I tried to address, in particular, some of the “Lean Sigma” stuff that I have blogged about here on this site… but I hope my message reaches their “Lean Sigma” audience.

My response to them:

One of my biggest pet peeves is more related to “Lean Sigma” in healthcare (or otherwise).

Most Lean Six Sigma training, when you really look at the curriculum and time spent, is not 50/50 Lean and Six Sigma – it's usually about 90% Six Sigma. Many people who hear about Lean decide it's probably a good idea to learn about two methodologies (Lean and Six Sigma) instead of just one.

But, too much of the “Lean Sigma” training is really just a full-blown Six Sigma program with a few superficial Lean tools thrown in. People are taught that “Lean is just another tool in the toolbox” instead of getting an appreciation for Lean as a culture, philosophy, and management system.

It also irks me when Lean Sigma trainers or books say, “Lean is for efficiency/cost/speed” and “Six Sigma is the method for improving quality.” Now, don't get me wrong… Lean and Six Sigma can co-exist and work together in an organization.

It's grossly incorrect to say or imply that Lean is only about efficiency. The roots of Lean are in the Toyota Production System, which has dual pillars of improving flow AND quality. Flow and quality go hand in hand. Improving quality (and Lean has many methods that can be used directly to do so) leads to better flow and better flow leads to better quality, especially in healthcare, when better flow means shorter waiting times for patients and, therefore, better care.

It would be more correct to say that both Lean and Six Sigma can be applied to improve all the measures and goals that matter to people – safety, quality, flow, cost, efficiency, employee engagement, etc.

Some of my past blog posts on this topic include:

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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 would guess that we’re probably all too far along to affect this abuse of terminology. Peoples’ perception of Lean, Six Sigma, and Lean Six Sigma are essentially hard-wired by now. The same principle applies when organizations say they’re “doing lean” when all they’re doing is 5S and surface-level kaizen. Our definition of “true” lean is only practiced by a tiny fraction of organizations out there. A significant majority is on the Lean cafeteria plan; a little of this tool, a little of that methodology, a little of that terminology. Even companies with pretty solid programs are just starting to align their improvements with organizational strategy, whether by Hoshin or BSC.

    I try to applaud people for leveraging both Lean and Six Sigma, regardless of how much weight is shifted towards either side, as long as they’re viewing it as the journey it actually is.

    • I think it’s not only inaccurate for people to teach that “Lean is only for speed, Six Sigma is for quality,” I think it’s harmful. If the LSS teaching slows people down in their improvement (because they think they have to get formal belts and use statistical methods to improve quality), I think that’s unfortunate.

      People can improve flow AND quality just by using Lean.

      I’d be more patient with somebody who was just trying and learning, especially if they can’t afford a book and don’t have internet access.

      I’m less patient with people who make money from books, websites, or consulting… they should know better and they’re teaching things that are incorrect. I think that’s worth more than a shoulder shrug.

      If I published a website full of incorrect statistical methods, I’d expect a Six Sigma person to call me out on it. You’d hope I’d learn from the interaction.

      Many of the Lean Sigma instructors just keep repeating the same nonsense. They seem not to learn. I think that’s very sad and unfortunately.

    • Our definition of “true” lean is only practiced by a tiny fraction of organizations out there. A significant majority is on the Lean cafeteria plan; a little of this tool, a little of that methodology, a little of that terminology.

      And we wonder (or don’t need to wonder) why these organizations aren’t successful. My guess is that they wouldn’t be any more successful by adding elements of Six Sigma into the toobox or cafeteria plan.

  2. It’s understandable when looking at the tps house that jidoka and jit are equally important.

    In practice we always told new hires “quality first, your speed will come”.

    The role of the TL is to ensure safety, quality and productivity of new hires (and the team) in that order (safety being the base of the house).


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