I had the great pleasure to hear Dr. Deming speak at a packed Cobo Hall in Detroit in the late 1980’s.  Then in his late 80’s, he was a fascinating speaker that enthralled the audience with his philosophy of the changing role from manager to leader to transform a culture.

Lean Healthcare Management Systems Quote by William Edwards Deming

In Lean Healthcare, as your organization matures from a “lean tools application” organization to a “transforming culture with lean” organization, the processes and systems that support the workforce become critical for success.

These processes and systems are defined as the Lean Management System.  Dr. Deming had the knowledge that management’s role had to change in order for the culture to change.  He defined this changing role in his writings and teachings and it is exemplified in his overall philosophy.

Dr. Deming believed that you did not have to pick between quality and cost savings.  He taught that both could be achieved through practicing continual improvement and through systems thinking.

In his book, Out of the Crisis, Deming offered fourteen key principles (which later became Deming’s famous 14 points) for managers to utilize in transforming business effectiveness.  The book essentially launched the Total Quality Management movement; ironically, Deming never used the term “Total Quality Management” in the book.

I would like to examine three of the 14 principles as pre-cursors to Lean management system fundamentals.

Principle 1:  Create constancy of purpose toward improvement of product and service, with the aim to become competitive, stay in business and to provide jobs.

In a Lean Healthcare organization utilizing Lean management system thinking, this is exemplified by the Hoshin Kanri strategy: the deployment of the strategic business plan throughout the organization to ensure everyone is focused on the correct initiatives.  For example, from a service perspective, the senior staff will have key objectives and goals around customer feedback as measured by tools such as HCAHPS or Press-Ganey. For the senior staff, these are very high-level, but when these goals reach the unit level of the organization, they become very specific and focused on problem solving around detailed questions and statements.  This is the strength of Hoshin planning: that strategic alignment drives the organization.

I am currently helping a hospital through the process of a lean culture transformation and it is so empowering to see focus in areas as wide ranging as the emergency department to food services.  The transformation is consistently managed visually in each area through visual management boards that provide the plan for the day, and very importantly, the problem solving that defines the history of a problem.  The structured problem solving and the leading indicators to drive improvement show change within strategically aligned initiatives.  (I believe Deming would be proud to attend a team huddle and hear the passion and focus as the food services team drives “late trays” toward zero.)

Principle 2:  Adopt the new philosophy. We are in a new economic age. Western management must awaken to the challenge, must learn their responsibilities, and take on leadership for change.

Leadership for change is perhaps the most important aspect of a Lean management system.  This principle calls for leaders to lead the change, not manage it.  This is driven by behaviors like coaching, modeling, mentoring and empowering.  This is the leadership taking the responsibility for the transformation and actively leading the transformation.  This is going to the gemba.  This is leadership standard work driving accountability.  This is leaders leading.

Principle 14:  Put everybody in the company to work to accomplish the transformation. The transformation is everybody’s job.

An army of problem solvers includes everyone in the organization pulling the rope in the same direction.  Everyone in the organization must first understand the need for change and then embrace their role in that change model.  The model must be driven by the empowerment to solve staff’s own problems and be recognized for those efforts.

I once had an employee in a Toyota assembly plant who was installing tail-lights on Corollas tell me his job was to “solve problems.” He explained that installing the tail-lights was only the result of his efforts to perform the highest quality and most efficient job he could and to continually improve that process.

In any healthcare organization, the focus is the patient.  But the quality of care for that patient needs to be the result of staff empowered to improve their processes to take the quality of care to the next level.

Dr. Deming was certainly ahead of his time in his thinking of how to analyze and improve processes.  But, as vital as those statistical methods and process improvement applications were, they never could have sustained without his leadership philosophy of ownership and leading the transformational change.

I would like to offer one more Deming quote that parallels his philosophy with a Lean management system being critical to cultural transformation:

“The greatest waste in America is failure to use the abilities of people.”

As leaders in a transformation to a Lean Management System, this is truly is a guiding statement for success.


Today’s blog was written by Steve Taninecz, Director at HPP.

Steve has nearly 40 years of experience in manufacturing and healthcare organizations.  Steve’s work in the healthcare field began as an Educator/Trainer/Coach for the Pittsburgh Regional Health Initiative, then as part of a New England for-profit health system overseeing, counseling and coaching culture change to the hospital system’s leadership for the successful implementation of lean.  Steve holds a Bachelors Degree from Youngstown State University in Industrial Management and a Masters Degree in Organization Leadership from Geneva College.
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