Why We Should All Consider Eric Ries’s “Employee’s Bill of Rights”


As you might know from episode #290 of my podcast with Eric Ries on Monday, his new book was released on Tuesday: The Startup Way: How Modern Companies Use Entrepreneurial Management to Transform Culture and Drive Long-Term Growth.

I think there are many interesting thoughts for organizations of all types, including health systems, that are trying to figure out how to be more innovative. I think the equation for innovation is similar to continuous improvement, or Kaizen.

The formula seems to include customer focus, respect for employees, the ability of managers to ENGAGE those employees, and to have a rigorous and scientific approach for proposing, testing, and evaluate changes to see if they are improvements.

I saw this article and book summary in FORTUNE yesterday:

Teaching GE to Think Like a Startup

I wrote about it over on LinkedIn:

The Parallels Between Innovation (“The Lean Startup” & “The Startup Way”) and Continuous Improvement

One thing I highlighted there was a section of Eric's book that he calls the “Employee's Bill of Rights.”

I discuss it more over on LinkedIn, but the five (not ten) points are:

  1. The right to know that the work I do all day is meaningful to someone other than my boss.
  2. The right to have my idea turned into a minimum viable product and evaluated rigorously and fairly.
  3. The right to become an entrepreneur at any time, as long as I'm willing to do the hard work to make things happen with limited resources.
  4. The right to stay involved with my idea as it scales, as long as I am contributing productively to its growth.
  5. The right to equity ownership in the growth I help to create, no matter my role or job title.

I talk about how those points apply to continuous improvement, not just innovation.

Point #1 reminds me of what John Toussaint, MD learned from Paul O'Neill:

As Toussaint wrote here:

A leader who establishes cultural norms for the organization so that everyone in the organization can say “yes” to three questions, every day, that will define the organization:

  1. I am treated with dignity and respect by everyone I encounter, every day. (Without regard to my ethnicity, my title, my pay grade or rank, the duties I perform, my educational attainment, or any other distinguishing characteristic.) Everyone is accorded exactly the same high level of dignity and respect.
  2. I am given the things I need; education, training, tools, encouragement, and protection from risk so that I can make a contribution to the work of the institution, that gives meaning to my life.
  3. I an recognized for what I do.

It all comes back to the Toyota “Respect for People” principle, eh?

Would your organization embrace a version of that “Employee's Bill of Rights” for continuous improvement? What would it say? I don't think I'd change it much at all in the context of Kaizen… my changes in bold:

  • The right to know that the work I do all day is meaningful to someone other than my boss.
  • The right to have my small improvement idea turned into a small test of change, evaluated rigorously and fairly.
  • The right to become a “Kaizeneer” at any time, as long as I'm willing to do the hard work to make things happen with limited resources.
  • The right to stay involved with my idea as it scales, as long as I am contributing productively to its growth.
  • The right to recognition and equity ownership in the growth I help to create, no matter my role or job title.

“Organizations that cannot incorporate these technologies and management practices rigorously and scientifically will give way to those that can.”

As I said over on LinkedIn, I think that statement applies to organizations that cannot or will not incorporate Lean and continuous improvement techniques and management practices rigorously and scientifically… will those organizations in healthcare really “give way” to those that can?

What do you think?

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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 think we need to balance the “everyone does improvement” mentality with effective Value Stream thinking. If “everyone” is working on improvement, then by definition we’re “improving” non-constraints within our process. It also promotes a potentially erroneous assumption that “more improvement” is “better improvement”. That only leads to serial suboptimization and a serious misallocation of resources. Because regardless of how much improvement activity that occurs and how empowered all your employees are to drive change within their processes, an enterprise is either effectively executing upon their strategic objectives or they’re not. Focused strategic improvement is almost always going to be better than shotgunned mass improvement activity.

    So, at the very least, this Bill of Rights should include a preamble which lays out the organization’s mission/vision/values and strategic objectives which should create True North for all improvement activities. If an organization is talking about Lean but not talking about Hoshin (or BSC or anything else), its a huge lost opportunity.

    • Thanks for the comment, as always, Robert.

      It’s not either/or – it’s both.

      We need systemic Value Stream improvement. We also need, I’d argue, everybody making smaller, local, point improvements in their current process. Leaders should be on guard, of course, for things that are suboptimizing or dysfunctional, but I don’t see that happen often.

      Even if a point improvement affects a non-constraint, keep in mind we are building improvement CAPABILITIES. Toyota isn’t dumb. They encourage everybody to improve everywhere. But they also have strong leaders with a long-term vision who are willing to sponsor the redesign and reinvention of processes (something that front line employees can’t do).

      I’ve never said that approaches like “quick and easy kaizen” or “2 second Lean” are the only approach an organization needs. It’s a good start. I don’t think it’s at all inevitable that local small improvements “only” lead to suboptimization or a misallocation of resources. For one, small local improvements, by nature, don’t require big investments of time or money.

      Engaging people in small local improvements also helps them engage in and be more open to larger, more systemic improvements. That’s what I’ve seen anyway.

      I’d consider “Hoshin” or strategy deployment to be a very important part of a Lean approach, just as staff-driven kaizen and value stream improvements are.

      I’d wager my life’s savings on, all other things being equal, the organization that engages more people in more improvements will always outperform the organization that doesn’t.

      • I think we’re all biased by our own experiences, but I see suboptimizing all the time. It happens much more often than most people think because they’re looking at it through a departmental lens rather than an enterprise lens. Look at all the case studies and white papers out there on ED Wait Time Reduction, Imaging Cycle Time Improvement, etc. By only focusing on one aspect of a larger value stream, we really have no idea whether we’re improving or suboptimizing. I think I’ve brought up Harvard’s study of the impact of “leaning out” the ultrasound ordering processing within an ED before. Successful project if viewed through a departmental lens, but ultimately had an overall negative impact on the enterprise value stream. That happens a lot.

        And that starts to get to the real heart of the issue….. the more improvement activity you have that doesn’t create a tangible impact felt by either leadership or staff, the less likely you are you sustain the broader improvement initiative. The longer you have “quick & easy” unaligned lean, the more you hardwire the perception of what Lean is. The reason you can walk into many hospitals, factories, and offices and hear the opinion that Lean = 5S (or some other tactical tool-based concept) is that we’ve enabled that perception by separating Lean from strategy.

        Worse still is improvement activity that invisibly negatively impacts upstream and downstream processes. Nothing drives Lean disenchantment faster than that. Lean without serious Hoshin and Enterprise Value Stream Thinking will kill Lean initiatives.

        What I hear from dissatified executives more often than not is that they’e frustrated because they know they’ve done a lot of “Lean stuff”, but aren’t really feeling the impact commensurate with those efforts. And doing work that doesn’t drive customer value is, by definition, waste. There is a lot of “Feel Good” Lean out there that doesn’t ultimately translate to sustained and aligned improvement. And if we wonder why we struggle to get leadership buy-in or engagement, that’s a big root cause behind it. If we’re not specifically tying it to strategy and focusing our efforts accordingly, then why wouldn’t they view it as tactical and departmental-focused?

        I know my experience may not be representative of the larger population, but I haven’t seen a lot of benefit come out of FeelGood unaligned and unfocused mass improvement efforts.

        • Thanks for sharing more of what you’ve seen and experienced.

          But I don’t like “quick and easy kaizen” methods being labeled as “Feel Good.” The point is not feeling good. More participation and engagement leads to measurable and meaningful results, including:

          – reductions in staff turnover (big cost savings, big quality impact)
          – improvements in patient satisfaction (has a financial driver)
          – improvements in safety and quality (it’s the RIGHT thing to do, even if payment isn’t always aligned with improvement)

          The case I make to organizations (and what I see happening when people follow this path) is that you get the ball rolling with small, local Kaizens. Staff see and feel the benefit of what they’ve worked on.

          This sets the stage for larger, more systemic improvement, including bigger projects that are aligned to strategy and goals.

          So, Robert, you’re reporting your experiences… what is your recommendation then?

          What would you expect to see as side effects of NOT letting people do small, local improvement work?

          And, again, small local improvement work does not preclude larger, more systemic improvement.

          If people err and sub-optimize something, wouldn’t a truly Lean organiation Study and Adjust instead of just Planning and Doing in the PDSA framework? Oops, we sub-optimized… let’s learn from that, adjust, and do better in the future.

          Nobody’s perfect. We learn by doing. We learn by making mistakes. It’s human nature.

          But PDSA and Kaizen cycles help us prevent BIG mistakes by, if we have to, making smaller mistakes.

  2. I don’t think there are a lot of easy answers. But I think that initially contracting conversation (whether you’re internal or external) has to start with organizational strategy. I’ve had a COO ask me to help his health system do the whole “get everyone involved in a bunch of lean efforts”. From a consulting perspective, that’s pretty much gold. Relatively easy to resource/deliver and ensures a high utilization rate for years to come. But I pushed back since I was familiar with the Lean work they had already done (lots of kaizens to improve patient wait time but just shift wait somewhere downstream).

    So I did the suicidal thing of pushing back and saying no. I recommended starting with mapping the patient/clinician journeys, understanding the value stream and building a roadmap from there (rolling in quick wins as much as possible to drive more immediate value). I also started laying the groundwork for a more robust strategic planning and prioritization process.

    More focused. More aligned. And avoiding “improving” processes that the data showed didn’t impact clinical outcomes or business performance.

    So my recommendation would be to have a crystal clear understanding of the problem you’re trying to solve and build a roadmap to get you there. Tailoring the approach to that organization’s vision, culture, change readiness, data infrastructure, competitive position, etc. That has to start with enterprise strategy. Going in and teaching the masses to solve problems without clarity around the exact problems that need to be solved won’t necessarily drive tangible results. If an employee is working on a process that isn’t currently a constraint, I think you’d get more value in moving them to a constraint than having them spend any time improving the non-constrained process.

    I absolutely appreciate the value of employee engagement and empowerment, but unless you align them around a specific and coherent strategy, you’re not maximizing the benefit of those efforts. Empowerment for the sake of empowerment isn’t enough.

    So my recommendation is to start with strategy.

    • Thanks again for the comment… appreciate hearing different perspectives.

      There are no easy answers.

      But, it’s possible (and I think ideal) to “start with strategy” AND simultaneously start fixing “what bugs everyone” at a local level.

      I didn’t advocate for “empowerment for the sake of empowerment.” I agree with you that empowerment helps us achieve better performance. It’s not just nice. It’s strategic.

  3. I don’t want to be overly negative, but I find structuring these concepts as a “bill of rights” might do well for clicks, but not do well for actual implementation. We trust corporations to be sociopaths and focus entirely on optimization, and to die if they lose the capacity for solving problems that bring in money, and to then state that this sociopathic organization must also satisfy the “rights” of the employees just triggers a hot button. We have bought into a capitalistic system where there are no rights, because with rights come responsibility – only “freedom”.

    That being said, I think we are losing, certainly in American business culture, the aspect of trust. When one learns negotiating skills, it’s clear that you need to know if this is a one-time negotiating relationship, or a relationship one expects to flourish over time – or one expects reputation to be shared. If you can trust even an adversary, then systems become more efficient. I have the theory that these levels of trust made America more efficient over a period of time, but when we reach a point where “win at all costs” is the mantra, and the pressure is on, then acting within a certain set of bounds goes out the window, trust can’t exist, and efficiency goes down.

    Think, for a moment, about escrow. No escrow is perfect, and we have systems like courts to adjudicate. Yet, if one is always worried about the exchange and transfer of money, one gets less and less willing to engage in any transaction. A simple case in point: I was trying to buy a used car from someone. It was a low-milage very good looking car, and I wondered why it was on the market for so long. When I engaged, I found the seller would only accept cash – literal $100 bills – for a $36,000 purchase. The seller had been burned in another transaction, lost $100,000, could find no recourse through the courts. Thus I had to spend lots of extra hours scraping up that much cash ( hard in a virtual world ), worried that the federal government would knock on my door and arrest me for being a drug dealer. These are all effects we didn’t need, and lowered the monetary cost to the seller. Designing a more effective escrow system is also a cost.

    In the case of these “rights”, you are building in the fact that the employee can’t trust the employer. That recognition will not be given, that desire to stay with a project will not be honored. We’ve all had experiences where a manager behaved poorly ( hired the cousin , bought a replacement product vs in-house because they were taken to dinner ), or miscalculated, or even acted out of what they considered the company’s best interest ( as they are required to do in their job ).

    I think it goes against our system to expect a company to act outside of its best interest, thus one can only say “it is in the company’s best interest to obey these rules generally”, all other pleas ( “rights” language ) fall on deaf ears after generating clicks. I also know Eric in particular is sophisticated enough to understand this, and Mark maybe you are too ( we haven’t met ), so maybe you’re running some kind of experiment. If so , I look forward to your learnings on using “rights” language!

    • I don’t know Eric’s intent on using the term “rights” or the phrase “Bill of Rights.”

      A company and a country aren’t the same thing. Our U.S. Bill of Rights includes “inalieniable” rights that come from our “creator.”

      Anything a company does for its employees is a choice. Employees have fewer rights in a workplace. But, it’s easier to switch jobs than it is to change citizenship.

      I think Eric’s “Bill of Rights” includes things that companies SHOULD do… but calling them “rights” probably isn’t technically or legally correct.


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