Throwback Thursday: Are We Training the Right People on Lean?


I'm teaching a daylong class on Lean healthcare today in San Antonio. It's something I've done twice a year for the past four years or so. My day here is part of a six-month program for healthcare professionals and different methods for improving patient safety and clinical effectiveness.

There's only so much you can accomplish in a classroom setting, as opposed to learning by doing. The participants, which are typically doctors, nurses, and various health system leaders, are all part of a project team that's trying to improve outcomes for patients.

I'll be using a number of exercises to allow people to learn and practice Kaizen or continuous improvement methods. I'm also going to be using my version of the Deming Red Bead experiment.

But as we discuss these topics, it gets me wondering about how much impact a project can have. The staff and leaders in the room probably aren't at a high enough level to really influence the culture and management system. Why do executives send relatively low-level staff (no offense to them) for education like this instead of coming and bringing other executives with them?

As Toyota's Jamie Bonini says, the philosophy of Lean and the Toyota Production System matters a lot:

Lean: The Toyota Production System is Mainly About the Philosophy

Dr. Deming said quality starts in the boardroom… that's true in healthcare, right?

No offense is meant to the people who are in the class. They're all smart people who are capable of improving something in their work. But will their local efforts and small projects transform their organizations?

The other day, Facebook reminded me of this blog post from four years ago this week:

Too Many Patients Harmed, Too Few Leaders Committed to Real Change?

As I wrote:

“I recently gave a lecture at a hospital that had hired two engineers from Toyota. The engineers were very sharp and they seemed to be effectively making the transition into healthcare. But, two engineers, no matter how good they are and what their backgrounds are, can't save an organization of 5,000 people if the leaders aren't on board.

In the class I taught, there were about 20 nurses and front-line staff, including a few charge nurses. The higher-level managers who had been invited all had a reason to skip out and not attend – apparently, there was some fire to fight (isn't there always?) and their attendance was apparently not mandatory.”

I'm happy to spend a day teaching Lean to people who are interested. But, I can't wonder if we're educating the right people to really make a meaningful and sustainable impact in healthcare?

As I asked in the post in 2013:

“Why are we teaching front-line staff about Lean when their leaders are not participating in the learning?”

What do you think? Is it a case of “all education is beneficial?” or should we wonder why executives think they can delegate culture change and their safety/quality results?

What do you think? Please scroll down (or click) to post a comment. Or please share the post with your thoughts on LinkedIn – and follow me or connect with me there.

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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 have lots of theories about why leaders delegate Lean training / learning, but one I hear frequently goes something like, “I already know what the problem is and how to fix it, but I need my people to be engaged in the process so that the solution is more sustainable.”

    • Erick: Yeah, it seems too many executives think the problem is their staff and front line leaders. They blame their employees for not working on improvement instead of asking “How can *I* improve the culture and environment, reducing fear and leading by example, so people feel free and safe to improve?”

    • Erick – the quote, “I already know what the problem is and how to fix it, but I need my people to be engaged in the process so that the solution is more sustainable,” even though it’s a paraphrase of one you’ve heard before, certainly is an arrogant one. I wouldn’t give leaders with this kind of perspective much of a chance in leading a successful transformation unless they somehow managed to change their perspective. I’m sure we’ve both beaten our heads against the wall dealing with this mindset before. Maddening, and challenging to change.

  2. Thanks for the post, Mark. Gosh, this type of thing really does make one want to put their head through the wall. There is an article from the Harvard Business Review this month (“Why Do We Undervalue Competent Management?“) that addresses why operational excellence is often ignored by the C suite. The article points out that the conventional wisdom (and what is taught at MBA schools) is that organizational strategy is how a business gets ahead. The current view is that operations is something too easily copied and is best put in the hands of lower managers. Thus, the C suite is going skip the Lean workshop if strategy calls. The article points out that the data and evidence suggests that operational excellence is as, if not more, important than strategy. The article uses Lean as an example of excellence and even mentions how GMC has been trying to figure out Toyota’s production system for years and has “failed miserably.” Hopefully some C suiters are picking up this month’s copy of HBR and taking it to heart.

    • Good points, Dan. Thanks for sharing the article. Too many executives seem to think they can not only delegate “operations” but also think they can delegate responsiblity and accountability for safety and quality.

  3. Also, Robert Quinn in his book “Deep Change” (excellent book by the way–it rocked my world) says this type of thing is typical– its human nature to believe that we have it all figured out and everyone else needs to change. I’m not sure how one gets through to leaders, though. Its been a conundrum since at least the days of Deming. I can’t help but think sometimes that the only wake up call is when the company finds itself in a crisis of becoming extinct. Unfortunately, by then, it may be too late. Surely there’s a better way.

  4. Today went really well. I got some feedback at the end of the day that “your teaching makes a big difference.”

    Some of the attendees are concerned that their senior executives don’t get it. But, they are doing their best to solve local problems that matter for patients and staff. I enjoy spending time with people who are eager to learn and improve.

  5. Comments from LinkedIn:

    Andre DeMerchant
    As always, a great blog, Mark. For transformation to occur, leaders need to not only be part of the training but actually need to LEAD the way. Lean is a great deal like justice: it must not just be done, but must be SEEN to be done, and by the executive leaders. There are many articles out there describing how leaders ‘imprint’ their organizations; if you want to shift the culture, Exec leaders need to exhibit the culture they want. It is very sad and disheartening when one sees middle management and front line absorbing and practicing Lean thinking when you do not see the most senior leaders doing the same, casting Lean progress and sustainability in doubt.

    Frances Burton
    Amen!! Therein lies the problem.

    Maureen Holtz
    Couldn’t agree more. Executive leadership sets the tone for culture. When those sitting in class are not seeing it modeled at the top it’s just another catchy slogan that goes in one ear and out the other.

    Natasha Kasprzyk
    I see this in public education as well. It’s frustrating to see people who work in the district office or even administrators in a school building not follow the requirements they impose upon teachers.

    Shrikant Kalegaonkar
    Is it a case of “all education is beneficial?”

    Yes! Emphatically, yes. You’re coaching and educating the next generation of leaders. Some of them lead teams right now. You can never know its impact, as Dr. Deming points out. You just have to believe it is so.

    Mark Graban
    Thank you for reinforcing that. It’s a great group of eager learners. People who want to make healthcare better. I respect and admire that. I hope I am helping.

    Phil Weihl
    Don’t just teach the leaders, have them deliver some of the training and have them participate in the improvements…lead by example rather than ‘do what I say.’

    Bill Waddell
    The ones that get it when they attend your class will probably go very far and have a huge influence on the organization … just not the organization that paid for the training whose leadership did not participate. Instead, they will take that knowledge somewhere else where leadership will support them.

    Steven Leuschel
    I bet in some organizations it’s easier to find frontline folks who can deliver training better than executives. Just look at problem sheets, are executives leading the way with simple 5-whys or are front line staff?

  6. I really enjoyed this article! Mark, to your point I was recently at a Lean conference, which was excellent. I remember sitting outside of a session with a group of Lean practitioners during a break, while we were all talking one of them blurted out, “we are all already drinking the cool aide, my executive team needs to be here and hear this directly from these presenters as I am clearly not getting through to them”. His comment gave me a lot of pause and reflection, that this is truly the blue ocean opportunity. This is leadership training and how to run an organization training, and how to manage people training. I think we need to bring more (hopefully all) executives to the table, but coach them that this is a journey and a process, and mistakes will be made but without this type of thinking and learning through trialing we can’t get there (Humility & Curiosity). I would love to see Lean taught in MBA and MD Schools. I would also love to see every CEO & CFO’s take this type of training when they assume the top job. I think the pull is coming, but for us in the trenches it’s not fast enough.


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