This October, I'll be returning to Japan for another Lean study trip–my fifth. With each visit, I find new layers of learning. While my earlier trips were filled with curiosity about Lean tools and practices in manufacturing settings, I now go to understand how Lean leadership and culture show up in healthcare. My visits increasingly focus on the mindsets and systems that allow sustained improvement to flourish.
Past trips have included healthcare leaders from across the globe–executives, physicians, nurses, and improvement professionals from North America, Europe, and beyond. The shared experiences and diverse perspectives always add depth to the learning. We hope the same holds true for the group joining us this October.
This year's Lean Healthcare Accelerator Experience, running October 26-November 1, is designed for leaders who want more than a tour. It's an immersive week of site visits, seminars, and facilitated reflections, organized in partnership with Dave Fitzpatrick and Reiko Kano of Zenkai Improvement Partners. Together, we'll explore some of Japan's top Lean hospitals, learn directly from TPS experts, and engage in hands-on activities–including a TQM seminar led by a former Toyota quality executive. We're not just studying tools–we're building understanding, culture, and connections.
In my Shingo Publican Award-winning book, Lean Hospitals, I wrote that Lean isn't just about eliminating waste. It's about improving flow and quality, developing people, and ultimately building a culture that makes it easier to do the right things the right way. Nowhere have I seen that done more consistently than in Japan–especially in their hospitals.
1. When a CEO Asks, “Why Aren't We Getting Ideas?”
At a hospital in Kyoto, the CEO noticed that the number of staff-submitted Kaizen ideas had declined. Rather than issuing a new mandate or demanding more ideas, he gathered his team and asked,
“Why might this be happening?”
It was a reflective, humble question–and a powerful one. Instead of jumping to countermeasures, the team explored root causes. Were people too busy? Did they feel their ideas weren't valued? Were managers supporting improvement time?
This approach mirrored what I call “respectful inquiry” in Lean leadership. Leaders don't react; they respond. They engage their teams with curiosity, not blame. It's one thing to say, “Our people are our most valuable asset.” It's another to practice that belief when things aren't going to plan.
2. The Power of Daily Practice
One CEO told us,
“Improvement must be like brushing your teeth. It's not something special. It's something we do because it's necessary.”
In that hospital and many others, Kaizen wasn't a monthly event or a consultant-led project. It was part of the daily routine. Whiteboards weren't used for show–they were tools for engagement and learning. Improvement ideas weren't collected and shelved–they were tested quickly, celebrated, and shared.
This daily rhythm of improvement connects directly to what I emphasized in Lean Hospitals: Kaizen must be built into the work, not layered on top of it. When improvement becomes a natural part of people's routines, it builds confidence and momentum.
3. Respect for People, Lived Daily
One of the most moving experiences came from watching a hospital director respond to a nursing assistant's idea. The assistant suggested reorganizing a supply cabinet to reduce wasted motion. Rather than delegating the task, the director visited the gemba–the actual workplace–to understand the problem firsthand.
They tested the idea together. It worked. The director later shared it with other units and gave full credit to the assistant.
In Lean Hospitals, I wrote that respect isn't just about being nice. It means listening, developing people, and creating systems that enable success. This director showed exactly that.
4. Systems That Support, Not Punish
In too many American hospitals, variation in performance triggers overreaction. One bad patient outcome leads to a flurry of emails, a new policy, or retraining. Often, there's little effort to understand if the change was a meaningful signal or just common cause variation.
In contrast, Japanese leaders often use visual tools like run charts to spot trends without overreacting. One executive told me,
“We don't want to discourage reporting of problems. So we respond with curiosity, not anger.”
This approach supports psychological safety–a foundational element of continuous improvement. If people fear punishment, they won't speak up. If they don't speak up, nothing improves. I discuss this dynamic at length in The Mistakes That Make Us.
5. Don't Just Copy–Learn and Adapt
In Lean Hospitals, I caution against copying what works somewhere else without understanding the context. That lesson rings loud and clear during every Japan trip. I see visual boards that work because they're part of a trusted system. I see 5S systems that persist because leaders coach, not because they audit.
In one hospital, leaders told us they didn't benchmark against Toyota. They benchmarked against themselves.
“We want to be better than we were yesterday,”
…one director said. That mindset is far more powerful than mimicry.
6. Leadership Is a Daily Habit
Across every site visit, I see the same theme: leaders show up. They walk the gemba. They ask questions. They listen. They teach. They celebrate learning, not just results.
This aligns with the idea in Lean Hospitals that a Lean transformation requires a shift in leadership behaviors, not just new tools. It's about being present, modeling improvement, and making it safe to experiment.
Final Reflection: What Are You Practicing?
As I prepare to return to Japan, I carry these questions with me:
- Are we making it easy for people to speak up?
- Do we react to variation or seek understanding?
- Are we building systems that support people–or systems that wear them down?
Lean is not a project. It's a practice. And Japan continues to show me what that looks like.
If you lead in healthcare–whether a hospital CEO or department manager–you can start today. Go to the gemba. Ask your team what gets in their way. Celebrate a small improvement. Build trust, not compliance.
That's the kind of leadership that sustains improvement. That's what Japan continues to teach me. And that's what I hope to keep sharing.
If you're curious about joining our next Lean Healthcare Accelerator Experience in Japan this October–or if you're exploring how this kind of immersive learning could benefit you and your organization–I'd love to talk. Visit www.japanleantrip.com or reach out to me directly for more details.
Please scroll down (or click) to post a comment. Connect with me on LinkedIn.
Let’s work together to build a culture of continuous improvement and psychological safety. If you're a leader looking to create lasting change—not just projects—I help organizations:
- Engage people at all levels in sustainable improvement
- Shift from fear of mistakes to learning from them
- Apply Lean thinking in practical, people-centered ways
Interested in coaching or a keynote talk? Let’s start a conversation.
