Rodney Dangerfield frequently used the line “I get no respect” in his comedy routine.  He then usually expounded with (occasionally vulgar) examples of how he “got no respect.”  His examples were funny to say the least… yet occasionally applicable to real life.  As I have worked in various hospitals embarking on a Lean Healthcare transformation journey, I too have noticed examples of “no respect” in the workplace—especially for those who do the work.

Let’s take a quick look at how important “respect” for those who do the work really is.  What can respect in the workplace do for an organization attempting to transition to a Lean culture?

Many are familiar with Dr. Edward Deming’s 14 points on the organizational culture of continuous process improvement.  Point 8 speaks to the duty of management to drive out fear in the workplace.  When the fear is gone, all levels of staff are released to achieve pride in workmanship and maximum cooperation with each other as all concerned work towards achieving company goals and ultimately superior quality and customer satisfaction.  Lean leaders can drive out cultural fear by showing a consistent and genuine respect for those who do the work – where the work is being done.

I know most human resources departments work very hard to create work environments of collegial respect – respect for fellow people and co-workers.  This is the same type of respect Rodney claimed he was consistently denied access to. Dr. Deming spoke of respect in the workplace frequently during his career, but it was a different kind.  It was respect shown where the work was being done.  His observation was that a front line worker who regularly experiences episodes of respect from their supervisor or senior leader for the work they do and the way in which they do it will continue to perform that way.  Further, that employee will develop a vested interest in helping sustain improvements because their improvement was visibly valued by leadership.

Taiichi Ohno, the father of the Toyota Production System (TPS), displayed a consistent respect for those who did the work and he spent much of his time among them, asking questions and listening.  At Toyota, respect for the worker is an essential ingredient of their continuous process improvement culture.

In Lean Healthcare, as with Toyota, part of what that respect looks like is having high expectations of your frontline staff and appealing to their integrity by encouraging them to do their best.  It also means asking intelligent questions that tap into their wisdom, experience, training, knowledge and critical thinking skills they have been under-utilizing.  If respecting frontline workers is key to a successful long term Lean Healthcare transformation, as has been clearly demonstrated by Toyota over 70 years, then what would it mean to that same transformation if little or no respect is shown by leadership?

In the 1990s, Stephen Covey coined a saying that captures the heart of respect in the workplace for those who do the work.  He said.  “To maintain the P/PC Balance, the balance between the golden egg (production) and the health and welfare of the goose (production capability) is often a difficult judgment call. But I suggest it is the very essence of effectiveness.”

In other words, try not to overburden the frontline worker who produces the value being marketed to the public.  There are many ways to show respect to those who are in the front trenches of patient care and support services.  And there are many ways not to show respect as well.  One way to respect the nurse or tech that is being asked to attend a Kaizen event, or conduct an A3 improvement project is to provide the time to do it.  Don’t pile more bags of grain on a horse already loaded down with more than it can carry.  One of the major tenets of Lean Healthcare is that the people who do the work are the ones who improve the work, and with the assistance and validation of management, they sustain the improvements.

Allowing and equipping the frontline staff in patient care settings to improve their own work in a culture without fear is, simply, respect.

Respectfully, I offer the following ways leaders can show respect in a Lean Healthcare transformation journey. There are many more but, I hope you find these helpful:


This week’s blog was written by Matt Hanrion, Senior Manager with HPP.

Matt has more than 30 years experience with Lean and provides consulting services in a variety of areas within healthcare.  He is a lead trainer with HPP and has coordinated TQM teams within every area of a hospital system, developing and rolling out TQM education to staff.  Matt has a B.A. from Westminster University with a double major in Computer Science and Biblical Studies, and a M. Ed. in Education from Columbia International University.  In addition, Matt served in the US Pacific Naval Submarine Fleet as a Missile Launch Systems Petty Officer and is a Vietnam Veteran. 

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