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Updated: Aug 9, 2023


by Mohamed Saleh

This great resignation has left organizations operating at the bare minimum staffing levels resulting into concerning degrees of employee burnout. Such factors demanded attention to building more effective empowered teams that are capable of solving complex problems within a management system redesigned to distribute desired leadership behaviors and promote its practices to quickly attract and retain its people.

Within organizations lives a set of management systems that enables it to achieve its results and competitive advantage. Workers today fall victim to these systems and are the very reason workplace environments are broken and cultures are distressed. An array of studies, including my own have pointed to the Toyota philosophy and principles as a noteworthy study. Unfortunately, observations and site visits have resulted into emulations of the visible tools, that are often bastardized and misused. However, the bigger concern lies with not emulating all that you couldn’t see, the culture, the required thinking, behaviors, and disciplined rituals. In prior theleanmag editions, I outlined 12 sociocharacteristics of organizations that will often either accelerate or impede adoptions to new cultural rituals. Copying the tools and not the thinking and behaviors behind it would be like setting up a new gym and copying equipment with no understanding of the need or required thinking and discipline behind it. If you are working out to lose weight, then copying the tool might give you that short term results. If you’re working out to be fit, then you are creating a thinking routine, that will require additional components such as your dietary system of what you eat and sleeping habits and thus cherry picking becomes counterintuitive to the cause. This thinking routine, choreography is what is often referred to as “kata” and that is what is often missed when individuals emulate Toyota.

Common system within organizations is its strategy deployment system (Innovative engine to grow and align the organization) and the daily management system (performance engine to effectively support and run the business). The daily management system consists of a visual board that teams can sync up and huddle daily. These huddles foster an environment of psychological safety where scrutiny and command and control have no room, yet tiered from front line to regions, to service/product lines to business units. This tiered structure is designed to enable organizations to communicate, remove barriers and pivot in a very agile and nibble manner. It also enables the thinking routine that demands a depth of understanding when problems occur and a thorough diagnosis of the problem, without blame through a scientific problem-solving approach. This is then fueled by leadership practices, often called leader standard work, that provide the venue to demonstrate these behavioral rituals to promote leading with humility and respecting every individual thinking.

Most Huddle boards today, have a section for improvements, however, after the ideas are tested, it becomes challenging to scale. There are a few different ways, however, for the last two decades, I had established a framework with Dr. Ibrahim Saleh and Professor David Stec that has allowed for greater engagement and more effective scaling. The process goes as follows:

1- Select a Service Line/Product Family/Institute and focused Disease types

2- Outline the Value Stream Map

3- Identify Advocates for each role to be representatives/super users/process owners

within each area

4- Identify Process Managers to oversee each pillar to become the gatekeeper to updating Standard Work and the representative to leading those pillars efforts

5- Establish a cadence for the Process Managers “yellow boxes” to initially meet together with the Service Line Leadership team on a monthly basis. This Executive team session allows for standard work updated to communicated bottom-up, barriers discussed and new top-down initiatives. Let’s say for example a new initiative is to no longer mix chemo in outpatient offices that have hoods but to move the mixing into the hospital setting and then transport them to the offices. This most likely will at minimum impact the medical oncology Nursing pillar and Pharmacy Pillar. Both Process Managers would leave that meeting and conduct a joint pillar meeting with all their advocates on how best to achieve that. Similarly, if an idea comes bottom up, it would be reviewed by the Pillar, tested in an additional location and then the Pillar Advocates would be responsible to educating and hardwiring that into the practice.

This framework also allows for succession planning of emerging leaders as well to tie back to each area, what standard work observations to observe for, resetting to the skill matrix with this new standard and potentially an impact on performance metrics. Overall, this approach advances the teams knowledge threshold and performance. Often, in healthcare setting additional frameworks, such as Disease management teams, governance teams, system councils and Electronic Healthcare committees would need to be established.

This process management framework has become a significant game changer and has resolved one of the biggest challenges leaders face as they deploy daily management, gain engagement and idea generation but then struggle to manage the variability emerging among practices. This also has shown to grow leaders more rapidly than other approaches and has resulted in greater staff retention.


Mohamed Saleh has been a practitioner in Lean & Six Sigma transformations for the past several years, in both manufacturing and service sectors. Mohamed was directly mentored by one of the country’s foremost experts on enterprise-wide Lean transformation and the Toyota Production System (TPS). He has extensive experience in hands-on healthcare, manufacturing, supply chain, network optimization and enterprise information systems. Mohamed’s academic credentials include a Certified Six Sigma Black Belt from Kaplan University, a Masters in Technology Management & Bachelors in Mechanical Engineering from Central Connecticut State University and a PhD in Business Administration from Northcentral University.

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