What Does It Mean to Have a “Lean Management System?”


This Post in <50 Words:  Nate Hurle, from the Cleveland Clinic, writes about their visit to Intermountain Health to learn about their “Lean Management System,” what they mean by a “management method,” and the difference between “Management by Objectives” and a Lean style of leadership.

By Nate Hurle

Nate Hurle, Cleveland Clinic

Last year, and earlier this year, Mark Graban wrote about a late 2015 visit to Cleveland Clinic. In his posts, Mark describes what he sees as both strengths and opportunities. Being continuous improvement-minded professionals, we gravitated to the opportunities.

The Cleveland Clinic Improvement Model was created as a way for us to be both aspirational and directional as we worked with teams. We knew that we wouldn't have all elements in play at a high functioning level as we headed down this path. Of particular interest to us was our gaps in organizational alignment and we set out, over the past year, to learn more about what others are doing and to begin infusing those practices into our work.

Regularly, I hear about the term “Lean management system.” That cultural transformation occurs when you have a Lean management system and good problem solving skills. We've been working hard on building great problem solvers, where every caregiver every day is capable, empowered, and expected to make improvements. I've always struggled with translating a Lean management system into terms a layperson can easily grasp. What is a Lean management system exactly and how can I help others see its benefit or need?

Recently, Tim Pehrson, Regional Vice President of the North Region and Executive Vice President of Continuous Improvement, and Bryan Crowell, Assistant Vice President from Intermountain Health care invited us to come out and see their work. It was a fantastic two days, not to mention the day of skiing that I was able to fit in. We also learned a little bit about meteorology and what an inversion is in Utah.

Mike Clark, Administrator of McKay Dee Hospital for Intermountain, brought up a different way to think about this Lean management system, as he referred to it as a management method. That made me think, what's our management method? If I were to ask leaders what their management method is, would they have a succinct answer, could they show it to me? Can we see evidence of this management method at work throughout the organization?

Mike Clark Lean Management System Intermountain
Mike Clark, Administrator McKay-Dee Hospital, Intermountain., sharing his daily management method through a tiered escalation huddle.

We have begun to conduct a few experiments within our organization on creating a management method. As with all experiments, we will probably learn what doesn't work well before we learn what does work well. Our team in our finance division is hard at work to create clarity throughout the organization around what matters most. Through “True North” goals and tiered huddles, this team is working towards establishing a management method.

Another great lesson shared with me by Bryan was the difference between “Management by Objectives” and a Lean management system. Bryan illustrated that, at the senior leader levels, their metrics are typically outcome focused or lagging indicators. If we just cascade these goals down through the organization, then we have management by objective – what's the target and did we hit it?

In a Lean management system, as we get closer to the frontline, the metrics become process measures and leading indicators. I thought that was a great way to distinguish the two.

While we know that Lean in healthcare is about putting “Patients First” (as we say at Cleveland Clinic) in everything we do, differentiating how that relates to different levels of the organization can have a profound impact. By driving improvements to the process, we will drive improvements to the outcomes.

What do you find to be key components of your management method?

I'm excited to continue to learn from others as we head down this path and further build examples of this system where we can bring Mark back to share with you our progress.

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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. Healthcare is a particularly good sector in which to see Lean thinking permeating many diverse activities. Grove, Meredith, MacIntyre, Angelis and Neailey (2010) discuss it in relationship to visiting nurse services. Hayes, Reed and Fitzgerald (2010) look at Lean in sonographic services. Grove et al. (2010) studies the United Kingdom’s National Health Services primary care visiting health services. Stakeholders Theory is used to understand the scope of the program but not used to determine salience. The authors appear to want to satisfy all Stakeholders equally.

    But there is an elephant-in-the-room decision that faces healthcare providers is the choice between the amount of service provided to the customer and the containment of costs for the payer (Grove et al. 2010; Hayes et al. 2010; Radnor, Holweg, & Waring, 2012; Stopper et al. 2011; Toussaint & Adams, 2010). Grove et al. approach the decision-making process as a team responsibility. While Lean has improved efficiency, Radnor et al. are very critical of the decision-making role that Lean has provided beyond tools for efficiency. They see Lean as a means of decision-making to fix problems, particularly in meeting critical demands. In contrast, Stopper et al. sees broad ranging decision-making improvements from Lean, including strategic level decisions and tools for efficiency. Toussaint and Adams focus on how implementing Lean in a hospital setting has improved the quality of decisions.

    Do you see a challenge in balancing the needs of all Stakeholders with implementation of Lean waste management? Your phrase “Patient first” appears to mean that payer (insurance) and regulatory bodies as well as others take a back seat when decisions are made. Is this true? If not how do you balance the Stakeholders?

  2. Good Article on lean management system .i am curious to ask a question that What are the most common mistakes in implementing lean?

    • Oh gosh, there are many answers to that question.

      I addressed a few in this article I was interviewed for.

      Some of these problems include:

      Seeing or practicing Lean just as a series of tools or projects, instead of also working on a new style of management and culture change.

      Focusing only on cost or efficiency, instead of focusing first on safety and quality.

      Trying to force change on others (instead of engaging the people who do the work) and then complaining about a lack of buy in or a lack of sustainment.

      Using Lean tools, such as 5S, in trivial ways instead of solving problems that matter.

      Executives sending primarily front-line staff to Lean training classes without educating themselves or being willing to change themselves.

      Hiring one person and then expecting them to “make the organization Lean” on their own.

      Taking a hospital employee or project manager who has zero experience with Lean and putting them in charge of the “Lean program.”

      Not being willing to hire experienced Lean practitioners from other industries.

      These are problems that can derail an organization that starts with the best intentions to use Lean as a framework for improvement.


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