Lean Healthcare is based on Respect for Employees

The engine that drives a Lean culture is learning.  Continual learning and involving employees in learning, is the most important prerequisite for leaders wanting to solve problems and design better processes and systems to meet their strategic objectives.  Building a learning organization requires leaders, above all, to respect people and create an environment where people feel safe to say what they think.  Let’s look at the fundamentals of building a learning organization.

Respect for People 

Toyota is big on this concept because it works.  Rank in an organization has its purpose, but rank should never be construed as an endorsement or validation of superiority of one human being over another.  The primary task for leaders of a healthcare organization is to optimize the functioning of a system to better meet the aim, or purpose for which it was founded.  This is difficult, and leaders need all the help they can get to deal with this complexity.  If anyone does their job poorly, many others are affected negatively, including patients and families.  The more minds that can be employed to improve the system the better.  All of us are smarter than any one of us.  Leaders should all be humbled by how much they do not know, regardless of how much they do know.

Rank does not ensure wisdom, but learning does.  We all have different levels of knowledge, skill and experience.  In a learning organization, everyone is a learner and a teacher and is gifted in different ways.  Used properly, Lean tools like Hoshin Planning, value stream analyses, Kaizen events, visual boards, A3 and coaching, tap into the many and varied gifts of the workforce.  None of these tools work well without mutual respect among all participants, especially leaders.  Without respect there is little learning and without learning, there is very little improvement that lasts.


People only say what is safe to say, period. If employees rarely speak up in a leader’s presence, it should be a clue that they feel it is unsafe to voice their opinion.  It is also a symptom if employees do speak up, but never disagree with their leader.  This may happen because the leader discounts input from others, thinking he or she either knows or should know all the answers.    A command-and-control leadership style, which tends to exhibit this “know-it-all” behavior, may be useful in an emergency, however, it is  very ineffective  when trying  to solve the myriad of problems found in complex systems like healthcare.  This is because the command and control leaders have only themselves to rely upon. The many great ideas his or her associates could have offered are ignored, discounted, or typically never surfaced at all.  Under this kind of leadership, employees’ work becomes dreary and mechanical as they are unable to engage in the creative process of learning, testing and improving. They tend to be less engaged under this leadership style.

It is best to engage all associates in the learning and improving process, as they are full of improvement ideas.  They live with the problems daily.  Effective leaders encourage associates to speak up and not punish them in any way for doing so.  This requires that leaders learn how to not just encourage, but manage, disagreement and conflict.  If the goal is to critically analyze problems and come up with great solutions, too little disagreement can be just as harmful as too much.

The Impostor Syndrome 

Executives often feel trapped by the expectations of others regarding their rank.  One study asked executives, “Do you feel competent to know and do all that is expected of you?”  The response of a large majority was, “No, I don’t feel competent to do all that is expected of me, but I am pretty good at creating the illusion that I am competent and live in fear that I am going to be found out.”  The cure for this is to admit what isn’t known in order to learn from others. Learning begins with the ability to say, “I don’t know, tell me.”  Generally people respect this willingness to learn.  It is a tragedy is to have an opportunity to learn and not do so because of fear of admitting a lack of knowledge.

Joy in Work

W. Edwards Deming, the premier guru of improvement, talked often about creating organizations where there is “Joy in Work.”  There is a well-studied correlation between customer satisfaction and employee engagement.  The same is true of process improvement and employee engagement.  One of the most effective ways to introduce joy in work and enhance engagement is to ensure there are many opportunities for people to learn about and create processes that better meet their customer’s needs.  Learning and creating are two activities that most people find enjoyable.  Further, most enjoy knowing they have contributed to helping their organization become increasingly successful.  Finally, people are more reluctant to leave an organization that has invested in their personal growth, has treated them with respect and honors their contribution to continual learning and improvement.

Today’s blog was written by Terry Howell, Ed.D., Sr. Vice President at HPP.
Terry has 30 years of healthcare leadership experience with a focus on performance improvement, patient experience, quality improvement, and strategic planning.  He served as Chief Quality Officer at a large academic medical center in Minneapolis where he was responsible for oversight and coordination of Performance Improvement, Patient Experience, Clinical Risk, Safety, Accreditation and Organization-wide Planning.  
Terry received a Doctorate of Education degree in Counseling Psychology from the University of Tennessee followed by post-doctoral work in Organizational Development.  He served on the faculty of the Institute of Healthcare Quality Improvement (IHI), the Healthcare Quality Improvement National Demonstration Project and taught graduate courses in Tulane University’s International Medical Management program.
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