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by Jannalyn Lawrence - from Dr. Saleh's Leadership and Organization Bootcamp

An organization’s commitment to a Lean journey should be approached with the same mindset as any other high-stakes arrangement or pledge, with a strong sense of intention and focus. Ideally, this commitment will be backed by all levels of the organization’s leadership, and include a robust statement of purpose. These elements would, in a perfect world, assure the commitment’s longevity. Just as in any serious, long-term relationship, it’s essential for all parties to know what they’re saying “yes” to.

I recently learned a tough parenting lesson when I had to change my mind after telling my teenage son “yes” to an opportunity he was really excited about. My initial response was driven by his glowing excitement as he outlined his request, and I wanted to recognize him for being responsible by agreeing. Unfortunately, I hadn’t paused to gather all of the information; once the entire picture was clear, I had to backpedal and tell him no. For my thirteen year-old, this was devastating and really damaged my credibility as his parent for a time (even though I was confident in the decision I ultimately made).

The unfolding of this scenario reminded me of the beginning of my Lean journey. I support a large department within a healthcare system, and several years ago our executives identified the need for change; more specifically, improved efficiency, whatever that meant. I was told we’d be bringing in some consultants, whom the executive team ominously referred to as “the efficiency experts.” Now, in hindsight, it’s clear our leaders really didn’t know what they were saying yes to. Without clarity around what their “yes” entailed, it was impossible to engage fully in a commitment with the process.

In order to understand the destiny of an organization’s Lean journey, it is important to identify the behaviors and tools necessary to successfully implement continuous improvement. Saying yes to Lean requires an organization to take an honest look at leadership behavior, acknowledging areas that are problematic, and commit to addressing them. In his book “Creating a Lean Culture,” author David Mann describes the importance of the internal, mental shift that must occur at the beginning of a Lean journey, and it must begin with leaders. In order to sustain the Lean journey, any tools implemented cannot survive without ingrained leadership behaviors.

As I mentioned the damage sustained to my credibility during the incident with my teenager, a leader must prioritize trust as a foundational quality that drives leadership behavior. Research shows that prioritizing presence is key in developing leadership trust.

Leaders must understand the impact of their decisions on the team; the best way to do this is to “go and see.” Prior to bringing in the efficiency experts, one of the organization’s leaders refused to round in one of the key areas to be impacted by the project. Rather, she relied on data spreadsheets and second- and third-hand reports of the inefficiencies that needed to be corrected. This made the team dubious of the very idea of what was a well-intended effort. Those doing the work know it best: the higher up in a company you go, the less you know about what’s really going on. The team never fully trusted this leader, and ultimately felt unsupported in times of critical need. It also meant mid-level leaders had to try and compensate for the shortcomings of their leader; this caused unneeded mental load for the leaders striving to support their front-line teams to carry out the work related to the efficiency project.

Leadership focus, at all levels, is another element crucial to the longevity of a commitment to Lean. Authors Chris McChesney, Sean Covey, and Jim Huling outline the importance of narrowing leadership focus in their book, “The 4 Disciplines of Execution.” Being distracted by the ideas generated by a Lean management system can be a major pitfall of high-level leaders; the authors state, “saying no to good ideas, in order to say a focused yes to great ideas, is the key to extraordinary results.” In contrast to the disengaged leader I described, who wouldn’t come to the gemba, another of the high-level leaders was more subtly disengaged and perhaps said “yes” too easily. This led to diluted efforts in the beginning of our organization’s Lean journey and created a false sense of optimism that was tempered when later requests were hastily turned down due to budget constraints.

When deciding to embark on a Lean transformation, an organization must proactively take into account any foreseeable adversaries, especially those that could potentially be turned into allies. Lack of alignment at the executive level can be a major factor here, and even leaders who do not directly oversee areas involved in the Lean transformation should be brought into the conversation prior to the organization saying “yes.” This offers an opportunity for high-level leaders to understand where the journey may take the organization, and can provide space to voice concerns or hesitation before the journey begins. Involving the entire executive team in the decision to bring in a Lean consulting firm can also be helpful in ensuring a degree of alignment necessary for endurance. Mann, author of “Creating a Lean Culture” expounds on the notion of “aloof executives,” describing the importance of engaging executives by understanding what it is that they value. Front-line implementers of Lean rely on a tactical approach, knowing which tools to use to keep a new process working, etc.; executives, by design, take a more strategic approach, knowing when to execute strategy and how to course-correct when required. Forging a strong connection via Lean management system is an organization’s best hope for sustainment.

Another example of adversary-turned-ally in this organization was a newly-formed union, with energized members eager to issue grievances. In what felt like efforts to thwart efficiency progress, the union halted some of the work being done. They put a hard stop to space renovations in patient care areas and interrupted workflow experiments that came out of the organization’s first Kaizen event. This created a deep rift between staff and leadership, with both sides left feeling misunderstood and unsupported. A significant lesson was learned here: involve and engage union stakeholders very early on in any process, and they will become strong partners and advocates.

In conclusion, leaders and organizations who want to make a clear and informed commitment to a Lean journey should consider insights offered by others who’ve paved the way. Key insights include the importance of adopting a Lean mindset, ensuring organizational focus and building trust. Additionally, it is paramount for leaders to engage all stakeholders, even the most unlikely ones, in the process of continuous improvement and efficiency. Learning from others’ journeys and understanding the challenges faced is an important way to avoid pitfalls and ensure the longevity of a Lean transformation.


Jannalyn Lawrence, BSN RN, is a clinical operations director at a rural healthcare system in California. She is passionate about continuous improvement and impacting the wellbeing of patients and clinicians.

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