At our 2016 Kaizen Live! event at Franciscan St. Francis Health, Mischelle McMillin shared practical, honest, and refreshingly human insights on Gemba Walks that remain highly relevant today.
This post explores the leadership behaviors that make Gemba Walks effective–and why Kaizen and daily improvement depend more on how leaders show up than on any Lean tool.
Michelle, who served at the time as Director of Business Transformation within the Franciscan system, wasn't offering a checklist or a compliance playbook. Instead, she focused on something far more important — how leaders show up.
Her message resonated deeply with the attendees, and it still resonates with me today because it reinforces a lesson I've seen repeatedly across healthcare organizations:
Kaizen succeeds or fails based on leadership behavior, not tools.
What follows are highlights and reflections from Mischelle's talk and Q&A, integrated with ideas I've written about in Lean Hospitals, Healthcare Kaizen, and The Mistakes That Make Us.
Learning to See: Why Gemba Walks Are Not a Drive-By
One of the most striking stories Mischelle shared was how her team started by gathering leaders in empty patient rooms.
“We stand there for 30 minutes, and we learn to see.”
That phrase — learn to see — is foundational in Lean, yet surprisingly difficult in practice. Leaders are busy. Healthcare environments are chaotic. The temptation is to move quickly, observe superficially, and jump to conclusions.
But Gemba is not about efficiency for leaders.
It's about developing the capability to see work as it really happens.
In Lean Hospitals, I've written that Gemba Walks should never feel like audits or inspections. When leaders rush through, staff quickly sense that the visit is about judgment, not learning. Mischelle's approach flipped that dynamic by slowing things down and normalizing discomfort — for leaders, not staff.
Gemba Walk “Don'ts”: Avoiding Behaviors That Shut Down Learning
As leaders began going out into clinical and support areas, Mischelle and her team realized something important: good intentions aren't enough. Even well-meaning leaders can unintentionally create fear or frustration.
So they shared a set of Gemba “Don'ts” — not as rules, but as reminders of how leadership behavior is experienced on the front line.
Leaders were encouraged not to become:
- The No Show – If you say you're going to be there, you must be there. Trust erodes quickly otherwise.
- The Riddler – Rapid-fire questioning interrupts work and signals interrogation, not curiosity.
- The Creeper – Silently hovering behind someone all day makes everyone uncomfortable.
- The Know-It-All – Demonstrating how you would do the work undermines respect for those who do it every day.
- The Speed Walker – Flying through the gemba defeats the purpose of observation.
- The Mindfully Preoccupied – Being physically present but mentally elsewhere sends a clear message.
- The Reactor – Overreacting to what you see creates fear and mixed signals.
What I appreciate about this list is that it acknowledges a hard truth: leaders are always role modeling, whether they intend to or not.
You can watch a video clip and read more about Mischelle discussing gemba “dos and don'ts.”
From “Fixing” to Connecting: A Shift in Purpose
After leaders began their Gemba experiences, Mischelle and her team didn't ask, “What problems did you solve?”
They asked, “What did you learn?”
Over breakfast discussions, leaders identified key takeaways:
- Slow down
- Develop relationships
- It's okay not to have all the answers
- Don't be the hero
- Be transparent
- Fault the process, not people
These insights didn't come from training slides. They came from being present in the work.
In Healthcare Kaizen, Joe Swartz (also from Franciscan Health) and I emphasized that daily improvement thrives when leaders resist the urge to swoop in and fix things. Heroic problem-solving might feel productive, but it robs the system of learning. Mischelle's leaders discovered that connection precedes improvement.
Daily Improvement Depends on Psychological Safety and Leadership Behavior
A recurring theme — both in Mischelle's talk and in the Q&A — was how leaders respond when they see problems.
Do they:
- react emotionally?
- assign blame?
- jump straight to solutions?
Or do they:
- ask questions?
- listen?
- and support experimentation?
In The Mistakes That Make Us, I argue that learning cultures are built when leaders normalize imperfection and curiosity. Gemba Walks, done well, send a powerful message:
“It's safe to surface problems here.”
Mischelle described leaders intentionally focusing on relationships — asking about people's lives, their families, their pets — not as small talk, but as culture-building work. When people feel seen as humans, they're more likely to speak up about work.
That's psychological safety in action, not theory.
Seeing the System, Not the People
One example that stood out involved environmental services and patient experience. Leaders noticed noise from carts affecting patients — something that might never show up on a dashboard.
No one blamed staff.
No one demanded compliance.
No one issued a memo.
Instead, leaders:
- saw the work,
- listened,
- and supported improvement.
This is a core Lean principle: fault the process, not the people.
As Deming taught — and as Mischelle reinforced — most problems are rooted in systems, not individual effort. Gemba helps leaders experience that truth firsthand.
What Healthcare Executives Can Take Away
Mischelle's message wasn't “do Gemba Walks.”
It was “change how leaders behave.”
For executives and CI professionals, the real lessons are:
- Gemba is a leadership development practice, not a compliance exercise.
- Daily improvement depends on trust, not pressure.
- Slowing down can accelerate learning.
- Psychological safety is created through consistent behavior, not slogans.
- Kaizen works when leaders are willing to learn first.
Tools matter. Metrics matter. Structure matters.
But culture — shaped daily by leadership behavior — matters most.
Final Reflection: Kaizen Begins With Us
What struck me most about Mischelle's talk is how clearly it reinforces something I've written for years: Kaizen doesn't start with staff.
It starts with leaders being willing to:
- listen more than talk,
- ask more than tell,
- and learn more than judge.
Gemba Walks are not about seeing problems.
They're about becoming the kind of leader people trust enough to show them.
That's how daily improvement becomes possible.
Leadership Behaviors That Make Daily Improvement Possible
The same leader behaviors Mischelle McMillin describes–showing up consistently, listening without overreacting, and resisting the urge to “be the hero”–are also what fueled the Kaizen transformation at UMass Memorial Health. Under CEO Dr. Eric Dickson, leaders focused on huddling with frontline teams, encouraging many small ideas, and creating psychological safety–resulting in tens of thousands of staff-generated improvements. Different organizations, same lesson: how leaders behave determines whether continuous improvement takes root.
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If you’re working to build a culture where people feel safe to speak up, solve problems, and improve every day, I’d be glad to help. Let’s talk about how to strengthen Psychological Safety and Continuous Improvement in your organization.
