Reader Question: A Lone Wolf in #Lean Facilitator’s Clothing

Today’s reader question comes from somebody who has been put in the position of what I call “the lone wolf” in a health system. This happens a lot. A health system hires or designates one person to be “the Lean change agent.” It doesn’t matter how amazing and/or experienced this individual is… I’d very skeptical about the organization’s Lean journey.


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That’s not the fault of the lone wolf. The organization is putting the lone wolf in a bad position. They’re often not being set up to succeed, unless perhaps that lone wolf is joined at the hip with the CEO (and I rarely hear this happening).

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The question came in via email… I’m going to chop it up and make a bit more of a dialogue than it was in our exchange.

“Hi, I’m the LEAN facilitator at [redacted health system]…”

Hi, nice to meet you… you don’t have to put LEAN in all caps, as it’s not an acronym, but let’s get to the more significant issues. :-)

I’m sorry that you’re the only facilitator. That’s a really tough position to be in. I hope I can help.

OK then, I am currently implementing a LEAN Lean Daily Management system within the hospital. I am following the model outlined in Brad White’s book where the departments begin huddling and sharing information.

That’s great. I saw some of Brad’s early work in San Antonio when I lived there. You might want to check out the podcast I did with him about his book:

Podcast #260 – Brad White, on Lean Daily Management for Healthcare

I don’t think I’ve ever seen a “Lean facilitator” go “implement” a “management system.” I think a facilitator can, at best, teach, coach and…. facilitate. If you look at the example of Kim Barnas and ThedaCare’s hospitals, look what she led there, as documented in her book Beyond Heroes. I also did a podcast with her, by the way. Kim was at the hospital president level. Yes, they had Lean facilitators and outsiders they would readily call “sensei.” But Kim didn’t delegate her responsibility. She led the push and the drive for Lean Daily Management, along with other executives.

What’s the situation at your health system?

In our approach, “quick wins” are discussed and implemented.

Great, I’d call that “Kaizen” — a very important part of this complete, nutritious management system.

I coach the leaders of the units to listen and respond efficiently to the staff needs. All of this works well until the next phase in which front line staff are coached to identify inefficiencies and develop metrics. The staff are very engaged and understand what is needed.

Great, I hope you’re also coaching the unit leaders to not just respond (which sometimes means “give answers” and “implement solutions”). Responding is better than ignoring staff concerns. But, better yet is a system where we get employees thinking to come up with solutions or countermeasures to test. And, leaders can free up time for staff to work on testing and implementing changes to see if they are indeed improvements.

It’s also very helpful for staff to understand the key metrics or measures that they should help improve (as much as they can improve them by continually improving the existing system). Sometimes, the system needs redesigned or reinvented, and that drive usually comes from leadership, since those are big, complicated changes (like ThedaCare’s development of Collaborative Care or their new care model in primary care). Those weren’t driven by a front-line staff idea… those were strategic initiatives.

Back to your story and situation…

However, this is a point where leaders must change their approach and embrace participative leadership. I am blocked every time despite how much coaching I provided. Administration supports Lean…..but is not to the point where they are willing to round on boards, etc. How do you overcome this issue? In some instances the staff is demoralized because they are excited about the journey and then instantly realize nothing has changed. Help!

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I hear this lot… administration says they “support Lean.” What does that mean? That they made a statement one time? Are they giving lip service to Lean? Or are they looking in the mirror and realizing change starts with them? That they can’t delegate culture change?

Are they “supporting Lean” or “actively engaged in Lean?” Are they “practicing Lean?

If leaders aren’t willing to go round on boards (and, better yet, round on the people and spend time out there at the gemba beyond a short huddle), then are they really “supporting Lean?” Are they doing enough?

If you can’t get them to read a book like Beyond Heroes, if you can’t inspire them to try something new, I don’t think I can help from the outside. I don’t have any magic beans or hypnotic powers.

I understand some employees being demoralized (not to mention the “lone wolf” feeling that way). I don’t blame them. If the executives aren’t motivated by reports of employees being demoralized, maybe there’s no hope?

Maybe the best a “lone wolf” can do in this situation is work on some local projects that make a difference and forget about organizational transformation? Or find a new job where leaders WANT to transform and are willing to lead it (with some help)?

I am a nurse who is a self-taught Lean Facilitator who could write a book on Lean Strategies that fail….LOL.

I’m glad you still have a sense of humor about it, or maybe it’s “gallows humor.” That’s one way to cope.

I wonder if your situation is like the old TQM failure scenarios?

From 1994, But Relevant Today: “Why TQM Fails” & Parallels to Lean

Being a lone wolf is hard… being asked to be a self-taught lone wolf is even more difficult.

One lone wolf I met once… she was brought in from the project manager function and she told me, “I got told I’m in charge of Lean Sigma, so I figured I’d better go find out what that was…”

It’s one hypothesis to think that she could succeed… but I’d guess it’s unlikely (which isn’t her fault or yours).

Yet….my organization treats me like I have invented the light bulb. I do have a lot of support, but I am reading so much information that what I know now, may change in 6 months. I really want to make Lean Daily Management happen for the organization without shoving it down Director & Manager’s throats.

You can’t shove anything down the throats of people… nor can the CEO, when it comes down to it… questions like that are one reason why I do this change management simulation and workshop.

But it’s hard to convince people they need the workshop (or a better approach to change leadership). I’m in no position to shove anything down anybody’s throat either.

But back to your scenario, I bet my readers have some advice that might be more helpful and less cynical.

How much leadership “support” and involvement do you really need? What’s most helpful? What’s your advice to the lone wolf?

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Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an book titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

6 Comments

  1. Posts from LinkedIn says

    Comments from LinkedIn:

    Jeremy Lovell-Davis
    Thought provoking. Made me think about my support for our champions of process.

    Andy Sheppard
    Thanks, Mark – that’s uncanny! I’ve been planning a post entitled “What to Do When You’re a Lone Lean Wolf” in response to a similar question, but from someone who is not in an explicit lean position. In your questioner’s case, I would also want to know more about who sponsored the creation of the Lean Facilitator’s position, why and what support they can offer (e.g. with peers) – together with that of the facilitator’s line manager, if this is different person.

    Nicolas Ruhmann
    Great Post Mark

  2. Vance Kirklin, MBA
    Twitter:
    says

    It would be awesome if everyone approached lean culture and initiatives from a purely altruistic standpoint but, human nature is what it is. All change therefore, to a large extent, will be driven by WIIFM (what’s in it for me). And WIIFM mindset typifies all levels of an organization…exec to line staff. Organizations that fail to lay a foundation that adequately speaks to this reality will lack the fundamental component of engagement – at all levels. In other words, it cannot be top down or bottom up or middle out, it must be pervasive across the organization. Without that level of engagement, I would hesitate to use the term “support.”

    1. Mark Graban
      Twitter:
      says

      Thanks for your comment. I’m not sure if anyone is asking leaders or organizations to be altruistic. Toyota is just running their business and doing what they think is best for their long-term success, which includes “respect for people,” looking out for the environment, treating suppliers fairly, etc.

  3. MVK says

    How does one eat a pie? By cutting it into small digestible pieces. Do what you can, with whatever you can, whenever you can. Start small and persist. Go where the energy is – and keep on asking the question, what is important to our customers? Why are we doing this? (Value); what’s unnnecessary? ) Don’t strive for events that fade in people’s minds – if you can make them. Culture is made one moment at a time; one decision at a time. Lean is not only a label – it is a way of being.

    1. Mark Graban
      Twitter:
      says

      But seriously, thanks for the comment. The pie advice… I think that depends on what the person asking the question wants to accomplish.

      I don’t think an individual’s effort, one bite at a time, is going to significantly transform an organization. The person asking the question can probably accomplish a series of small improvements… and maybe that’s satisfying. But, if they aim higher, they probably need to leave and join an organization with better executive participation, not just vague support.

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