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Hi, this is Mark Raven. 
Welcome to episode 249 of lean 

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blog audio. 
This is a post from February 

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2nd, 2018 titled, employee 
complaints about lean and 

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Healthcare, even at some of the 
best organizations. 

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Now, recently, I blogged about 
some employee complaints related

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to rotating day and night shifts
at the Toyota, San Antonio plant

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in that post, I mentioned that 
employees who post on 

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glassdoor.com and other sites 
might not be a representative 

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sample of the full employee 
population. 

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So with that in mind though, 
what happens when we search the 

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glass door, surveys of some 
well-known lean hospitals, quote

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unquote, I posted a few of those
employee comments on LinkedIn. 

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The other day is a short post, 
that's received over 50,000 

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views and prompted, a lot of 
discussion. 

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One of the employee comments 
about a health system that many 

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would consider to be a long time
in leader, in lean Healthcare 

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said, the employee complaint 
read. 

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Management needs to have a 
better understanding of the work

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because this Health Systems lean
culture changes are made on a 

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continual basis by people, not 
in the work and who don't 

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understand who is all impacted 
by the change and of quote, as I

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said on LinkedIn in a lean 
culture. 

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Improvement is supposed to be 
done with people or by people, 

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it's not supposed to be done to 
them. 

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Here's another sad comment from 
a different well known lean 

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hospital. 
It says the hospital has gone 

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too far and it's attempt to cut 
costs, many behind the scenes. 

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Employees work in squalor and 
are treated like slaves, they 

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are encouraged to skip lunch and
breaks and are in constant fear 

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of being fired. 
As a new employee. 

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It only takes a few days to 
realize that you will be asked 

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to commit hari-kari if you make 
an honest mistake, that is the 

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Japanese parentheses. 
Lean way and of quote. 

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Well no no I mean the lean way 
doesn't blame or punish 

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individuals for an honest 
mistake. 

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I don't understand how the 
leaders in these organizations 

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maybe misunderstand lean or or 
maybe didn't bother to learn. 

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If even one employee has this 
perception I guess perception is

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the reality is they say we need 
to do better. 

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Another employee comment says 
there's so much focus on lean 

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and know. 
So focus on building better 

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managers. 
Well, that's sad to hear. 

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I mean lean is supposed to focus
on developing people. 

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Including managers lean is a 
different way of leading and 

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managing not to set a set of 
tools or projects. 

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Now are those comments 
representative of what most 

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employees? 
Think? 

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Well, probably not, but even if 
even a handful of employees have

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major and understandable issues 
with what they're experiencing 

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with lean, then that represents 
an opportunity for improvement. 

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Do these organizations need to 
be more consistent with what 

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lean really is. 
Do they need to invest in 

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additional or more capable 
coaches for those leaders who 

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are perhaps misunderstanding or 
Miss applying lean mean we're 20

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years into the lean movement in 
healthcare but there are still 

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way too many organizations where
lean is limited to relatively 

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trivial things, including 
straightening up, the workplace,

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or having daily Huddle's at the 
Frontline. 

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I'd say a majority of those 
organizations that are quote 

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unquote. 
Eating lean don't have 

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Executives who are actively 
learning about lean yet alone, 

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teaching it or modeling. 
The behaviors would want to see 

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in an effectively in culture. 
So what health systems are these

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employee comments about? 
Well, it kind of makes me harken

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back to a scene from the movie 
Fight Club. 

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A major one is Ed Norton 
character set in the movie. 

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Actually, it's major ones here 
are some of the comments from 

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LinkedIn about my post and those
employee. 

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Kevin pots. 
Wrote leader, should be the 

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teachers and developers of their
direct reports in lean. 

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This can't happen if the leader 
is vacant or misinformed on lean

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who was or where is the teacher 
of the leader, what is their 

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understanding of lien could 
questions. 

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Terrence T Burton wrote many of 
these and similar comments are 

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testimony to a failed lean 
approach in healthcare. 

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Many consultants simply ported 
over the tools and methodologies

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for manufacturing and 
implemented lean as quote. 

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Unquote imposed Improvement 
program. 

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They did not take the time to 
understand the unique Health 

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Care industry and adapt 
continuous Improvement to a very

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different organization and 
cultural environment. 

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I too have, heard many comments 
like we finished lean five years

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ago, and I've heard about the 
silly lean demonstrations, like 

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setting up a pole system to 
replenish yogurt and putting on 

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the floors having nurses wear a 
rainbow of color, coded 

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bracelets, and many other things
that have not impressed the 

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Listen, clinician, staff lean is
viewed by many as getting, in 

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the way of patient care. 
I went for blood work a few 

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weeks ago, and talked to the 
nurse about the hospital's 

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previous lean initiative. 
She said, I'm glad it's over and

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don't want anything to do with 
lean. 

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So the big question, how do you 
resurrect lean and CI and 

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Healthcare is the accepted daily
cultural standard of thinking 

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and working the need for 
improvement. 

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Did not go away. 
It's greater than ever before 

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James C, Larson reporting, Wrote
a big part of the problem is Six

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Sigma and lean or often used as 
tools to the self aggrandizement

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of an elite few. 
These people espoused values 

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like quality and patient 
centeredness but what they 

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really value is power and money 
the True Value creators and 

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Healthcare are the people who 
get the job done. 

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The doctors nurses Tech's 
housekeepers Cooks, AIDS billers

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Etc, when Executives and 
managers value these people. 

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That's when the magic happens. 
Kenneth stem wrote the failures 

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of land are caused by the same 
reasons. 

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For the failure of tqm back in 
the 80s, a vast majority of 

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upper management views lean as a
set of tools to be implemented, 

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Deming used to rail against the 
whole concept of implementing 

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quality management. 
The same thing is happening now,

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sadly, most upper managers 
believe they already know all 

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there is to know and therefore 
fail to realize that their job 

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is to deliver value to the 
customer, develop people and 

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drive out waste throughout the 
Many would agree. 

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But what most managers do not 
understand is that there is no 

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known answer, how to 
specifically do each of those. 

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In other words, we must learn. 
I would add we must practice 

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lien, which is why number of us,
wrote a book called practicing 

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lean, which you can find at 
www.pricescion.com by the way. 

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And his comment reminded me 
about. 

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I think a still relevant book 
from 1994 about tqm failures. 

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Something that I blogged about 
you can find a link to that blog

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post. 
The parallels between tqm 

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failures and lean failures. 
You can go to lean blog dot org,

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slash audio. 249 a few other 
comments here. 

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Todd McCann, wrote people who do
the work should be the idea 

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generators to improve the work 
if they need help leaders, clear

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the way not stand in the way or 
create barriers for patient 

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care, man. 
Even if change outside, the span

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of control should be managed and
leaders should be stepping up to

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ensure, positive outcomes. 
Focus on the patient while set 

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final comment, Holly Barrett. 
She wrote as the leader of a 

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large Global organization. 
I became a lean student and 

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Zealot. 
The day, I participated in a 

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structured direct observation of
work performed by some of my 

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more Junior Finance employees. 
I'll add a comment. 

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This was at Intel where Holly 
worked for a long time. 

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Tapping into those experts using
Kaizen events to improve the 

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quality and efficiency of the 
work was invaluable their 

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results. 
Far exceeded those, a top-down 

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approach, would have delivered 
and with minimal resistance to 

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the changes because the buy-in 
was quote-unquote designed in. 

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So I'm curious to hear what your
thoughts and reactions are and 

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you can go to lean blog dot org.
Slash audio 249 to join the 

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conversation.