My guest for Episode #342 of the podcast is Adam Ward, the author of Lean Design in Healthcare: A Journey to Improve Quality and Process of Care.
Adam is an innovation process expert and independent advisor. He spent the first 12 years of his career designing cars for Honda and the next 12 years working with Fortune 500 companies to turn around their product development process. A resident Buckeye, he coaches students at Ohio State's MBOE program.
Adam shares the story behind his book, explaining why healthcare needs structured approaches to innovation. Unlike product design, where tangible outputs like cars and electronics exist, healthcare often evolves without formal processes for designing services. Lean design provides a systematic way to move from ideas to implementation, helping organizations avoid wasteful efforts and instead create solutions that patients and providers truly need.
The conversation covers Adam's early exposure to simultaneous engineering at Honda, his skepticism about applying Lean design to healthcare, and how hands-on experience showed him that hospitals lacked consistent innovation frameworks. He highlights common pitfalls such as weak leadership commitment, lack of dedicated resources, and the temptation to “stick smart people in a room” rather than using disciplined methods.
Mark and Adam also explore how leaders can support Lean design without reducing it to slogans or side projects, emphasizing the importance of focus and prioritization. Adam's book, written in a story-driven format, combines practical frameworks with relatable examples, making Lean design approachable for healthcare leaders at all levels.
Listeners will gain insight into how principles from manufacturing and product development can help healthcare organizations design better care processes, improve quality, and foster genuine innovation.
Streaming Player:
For a link to this episode, refer people to www.leanblog.org/342.
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Links:
- Adam's LinkedIn page
- Adam's website
- Adam on Twitter
- His book: Lean Design in Healthcare: A Journey to Improve Quality and Process of Care.
Transcript:
Announcer:
Welcome to the Lean Blog Podcast. Visit our website at www.leanblog.org. Now, here's your host, Mark Graban.
Mark Graban:
Hi, this is Mark Graban. Welcome to episode 342 of the podcast for May 21, 2019. My guest today is Adam Ward. He is the author of the book Lean Design in Healthcare: A Journey to Improve Quality and Process of Care.1 Adam is an innovation process expert and an independent advisor.2 He spent the first 12 years of his career designing cars for Honda and the next 12 working with Fortune 500 companies to turn around their product development process. He's a resident Buckeye and he coaches students at Ohio State's MBOE (Master's of Business and Operational Excellence) program.
In this episode, we discuss Adam's early days at Honda and how he made a career transition into healthcare. We'll talk about the story behind his book and some of his experiences and practices that are transferable, going from what was called simultaneous engineering at Honda to Lean Design. What are some of the most common failures? How can we coach leaders so they aren't just giving lip service to methodologies like this? We'll discuss all of that and more. If you want to find links to Adam's website and book, you can go to leanblog.org/342.
Again, we're joined today by Adam Ward. Adam, thanks for being here on the podcast with us.
Adam Ward:
Thank you, Mark. It's a pleasure to be here.
Mark Graban:
So we're excited to talk about your book and Lean Design. Why don't you start off first and introduce yourself? You've got an interesting career path.
From Designing Hondas to Lean Design in Healthcare
Adam Ward:
Yeah, I think it's quite popular now to talk about career reinvention, and I certainly wouldn't have planned this. I got my undergraduate in mechanical engineering, and I went and designed Hondas for a dozen years in central Ohio and really loved that job. Then a headhunter called me one day and said, “Hey, do you know anything about Lean product development?” And I said, “No.” He said, “Well, let me send you a book.” I read the book and I said, “Oh, you mean my job description. This is what I do on a daily basis.” I didn't know what the academics called it.
Then I switched to GE Healthcare. They wanted to do Lean product development there, and I worked there for several years. Then we got a new chief technology officer, and I had a boutique consulting firm come and ask me, “Hey, can you lead our Lean design division?” So that was almost ten years ago now.
Mark Graban:
There are some parallels in our career paths. I also have an engineering background and had that career detour when I went from manufacturing to healthcare. I'm guessing the book about Lean product development may have talked a lot about Toyota, but it sounds like Honda had some pretty similar practices.
Adam Ward:
Yeah, it was the Toyota product development system, and almost everything was identical, except for the role of a simultaneous engineer. It was not as quite a manufacturing focus. On the product development side, the design person really held more authority than the manufacturing person, but it's very, very similar.
Mark Graban:
And for people who don't know the term simultaneous engineering, can you tell us a little bit more about that?
Adam Ward:
Yeah. So that was the main person at Toyota that would be responsible for making sure the design and the manufacturability of the product were best. They didn't want to bring in designs that increased cycle time or reduced quality. So that person reported mainly through manufacturing.
Mark Graban:
So this is looking at topics like design for manufacturability or design for assembly, making sure that they integrated product and process development.
Adam Ward:
Exactly, exactly.
The Transition to Healthcare
Mark Graban:
So you ended up at GE Healthcare, and then you had an opportunity to get involved with healthcare from the side of hospitals and healthcare delivery, right?
Adam Ward:
Yes. So when Simpler hired me from GE Healthcare, the CEO, Marc Hafer, said, “I want you to take your stuff to healthcare.” And I remember telling him, “It's not going to work. I don't see how healthcare and product development go along.” He just kept pushing me, and eventually, I worked with dozens of healthcare clients, and we figured a system out that works really well for them. That ended up leading to the book getting written.
Mark Graban:
I'm curious if you could elaborate. Back to the conversation with Marc Hafer about your thoughts on, “Lean design is not going to work in healthcare.” What was behind your skepticism?
Adam Ward:
Well, it was so easy with product design; you have widgets or cars or cell phones you can actually hold in your hand. Although I'd been exposed to services at GE, healthcare is basically delivering a service. There are no products. And I didn't see how sitting in a doctor's office or being in a clinic, how product development could overlap with that. Then after I spent some time in a couple of clinics, I realized they literally had no methodology to formally go from an idea of how to try something new to actually implementing it. There weren't formalized ways for creating new services or new patient care models.
Mark Graban:
From what I've seen in healthcare, a lot of times, frankly, the processes were never really designed; they just evolved.
Adam Ward:
Right. I did a lot of early work with the VA and different military branches on clinic design and hospital floor design. And the main thing that would come in, these contractors would say, “Hey, here's what the government regulation books say. Let's multiply it times what you think you want, and this is what the floor space looks like.” And you're right, that's how it comes along. We were able to cut a clinic size in half, just using simple Lean principles.
Mark Graban:
Yeah, cutting it in half without feeling cramped because you're using space in exactly the right way.
Adam Ward:
And most people can't fathom that.
Defining Lean Design and the Role of Innovation
Mark Graban:
Let's talk about the book again. The title is Lean Design in Healthcare: A Journey to Improve Quality and Process of Care.3 What led to the writing of the book?
Adam Ward:
I was at HIMSS a couple of years ago, and there was a publisher running the bookstore. I asked if they had anything on the topic of Lean design in healthcare, and they said they really didn't. I said, “Well, would you like someone to write something on establishing systematic innovation?” So we called it Lean Design in Healthcare. Lean is one of their niches, but it's really about establishing systematic innovation–how to go from idea to launch. That's how the book was birthed.
Mark Graban:
Unlike a couple of the other books on the topic, this one is more of a story or fictionalized format. Why did you choose to write it that way?
Adam Ward:
The publisher said, “Here are two books that we like. Can you combine them into one?” One was a story, and one was a how-to. I said, “Sure, I'll write it as a fable.” I think the benefit to the story is that the characters can become relatable, and you can get through it really fast, not realizing that you're ingesting a significant amount of why things happen because you're getting it in the dialogue.
Mark Graban:
So, how do you define Lean Design?
Adam Ward:
The word “innovation” is overused, but we talk about it early in the book. It's when you actually introduce something that obsoletes what was used before. In healthcare, that's specifically around what service you're offering. “Obsoleting” means patients no longer want it. Just like when the iPhone came out, flip phones died. If we create something that nobody wants, that's the biggest waste in any type of product development.
With Lean Design, we wanted to be able to say, “How do we introduce stuff that obsoletes it? And then how do we do it so that it's extremely accurate?” We actually studied all of the development methodologies that are out there: Agile, Lean product development, design thinking, user-centered design, Design for Six Sigma, and had long arguments and debates in the real world on what works and what doesn't work in healthcare. We wanted to be able to create a model that's simple, that anyone can pick up and go run with today without having to be an expert.
Mark Graban:
One of the challenges with innovation is the uncertainty of, “Have we created something that nobody wants?” That makes me think of the discussion in the realm of Lean Startup: “Can we build something?” and “Should we create something?”
Adam Ward:
Yeah. The past 12 years that I've been doing consulting, probably the number one thing I've found is a poor voice of the customer. It's not that we say, “Hey, let's get in a room and say this is what our customers want.” It's actually getting deep. You know, Steve Jobs said no one asked for the iPhone. Henry Ford was famously noted for saying, “If I'd asked my customers, they'd have wanted faster horses, not a car.”
What I found is customers can articulate about half of what they want. The other half you can only get through observation and deep conversations. With reducing the risk, you have to not talk. You have to be all ears and listen and ask open-ended questions, and then you'll know, “Should we make this or not?”
Common Failures and the Importance of Leadership
Mark Graban:
So in the context of the Lean design process, what are some of the most common failures that you see when people try to use this approach? And how can some of those be avoided?
Adam Ward:
Yeah, that's great. I have a section of one chapter dedicated to what I call “the basics.” And some of those are, I mentioned, leadership buy-in. It can't just be lip service; the business leader has to be driving it. You need to have dedicated resources. If you don't have people, whether that's one FTE or 10 FTEs… so many clients, I would say, “Just give me one, and we can do some pretty cool things with just one.” But there had to be a dedicated FTE to that. They needed to have their own space, their own budget. It needed to be separated from operations because at the end of every month or quarter, it'd be easy to pull that budget back out.
And then we need to have a formal framework. Even if our framework is three bullet points on a Post-it note, we need to follow something. I think some of the silliest things I've heard is, “Stick smart people in a room and have them come up with a great idea in isolation.” I think you can certainly get good ideas out of that, but you will never get a great idea out of that.
Mark Graban:
You talk about executives not just giving lip service. How do you try to convince them or help them discover that they need to do more?
Adam Ward:
Mark, you've been doing Lean consulting for a while, and I think you'd probably say the same thing. If you're doing a Hoshin Kanri session and you're looking at the number of initiatives, one thing I see all the time is there are just too many things listed. We like to see focus. If you're going to say “innovation,” don't have it be one of 15; have it be one of three to five, because you can't be an active cheerleader for 15 initiatives. Getting the executive team to say, “These are the five most important things we're going to do in 2019,” is a significant amount of effort.
Mark Graban:
In a lot of these situations with executives, you're trying to play coach. You have to influence; you can't tell them what to do. Even if on some level they say, “Well, we've hired you to tell us what to do,” people are more complicated than that.
Adam Ward:
Yeah. Well, if you want me to get something done and then it disappears, then yes, I can tell you what to do. But if you want it to become part of your culture and your legacy, then I have to coach.
Mark Graban:
So a client that's more likely to be successful is asking you to help them develop an approach that's their own, and they own it, versus, “Oh, Adam, just come in and tell us how we should do this.”
Adam Ward:
Yeah. So now I don't engage with ones that say, “Hey, Adam, come in and do this for us.” That's not something I want to be part of. My legacy is to be a multiplier. When I see an executive team that's curious and humble over one that's a know-it-all and proud, I know I have the fertile soil to get done what needs to be done.
Conclusion
Mark Graban:
Let's see. So coming back again to the book, Lean Design in Healthcare: A Journey to Improve Quality and Process of Care. Where can people learn more about the book? Where can they buy it if they're interested?
Adam Ward:
Yeah. So it's available in Kindle and hard copy on Amazon or on the publisher's page, which is Productivity Press, Taylor & Francis Group.4 One thing we are adding, and the manuscript will be done here soon, is a workbook to this that will be a much more textbook feel. So with the two together, I think anyone can sit down in any organization, any C-suite, and have a really excellent game plan on how they're going to do it.
Mark Graban:
And your website is adammward.com.
Adam Ward:
Yep, two M's. The curse of having a middle name that starts with an M.
Mark Graban:
People can find you on social media as well.
Adam Ward:
Yeah. So on Twitter, @adzmichael. And if you type in “Innovation Adam” on LinkedIn, they can find me there too.
Mark Graban:
Okay, great. Well, congratulations on the launch of the book. Adam, do you have any final thought you might want to leave the audience with?
Adam Ward:
You know, Mark, thanks for having me. I just want to challenge the people that are listening to set aside thinking time each week. That's probably the number one tool that I use on innovation. Our lives get so busy. If we just have a couple of hours where we're meditating or we're thinking or we're alone, we can achieve so much more.
Mark Graban:
So less podcast listening time, more thinking time.
Adam Ward:
We need both of those.
Mark Graban:
Again, go check out the book written by Adam Ward, Lean Design in Healthcare: A Journey to Improve Quality and Process of Care. Thanks so much for joining us, Adam.
Adam Ward:
Thank you, Mark.
Video:
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