The following blog was written by Mark Graban and originally posted HERE on  Mark is a featured speaker at the upcoming Lean Healthcare PowerDay, April 9-10, 2012


I’m sure anybody who has done any work with Lean has heard these words said in one form or another, often prefaced with a “You don’t understand…”

We’re different.

Diff’rent (it’s fun to spell that way, like the old show I grew up with, Diff’rent Strokes).

Yes, you are different. Your organization is unique. Special even.

No, I’m not being condescending (or I don’t mean to be).

I first heard the “we’re different” expression when I started working at General Motors.

“We’re different, we’re not Japanese.” This was the refrain until Toyota proved the Toyota Production System could work at NUMMI in California and TMMK in Georgetown Kentucky.

I’ll get to healthcare in a bit… considering the progress that’s been made with Lean in so many different settings, to think that one automaker would think they are so different from Toyota is kind of shocking in hindsight, no?

“We’re different, machining engine blocks is different than snapping together cars.” When I worked at a GM engine plant, this was a rationale used to explain away why that Lean stuff (we couldn’t call it “lean” – effort to keep the UAW happy) couldn’t work. Our new plant manager, trained at NUMMI, proved it could work, as it had previously at a GM transmission plant (although the engine people could say they were different than transmissions, but that was really splitting hairs).

So you aren’t a car assembly plant in Japan. Lean doesn’t apply?

“We’re different, we don’t build cars.” That could be said in many companies like Boeing or Intel where they aren’t assembling cars, but Lean methods are applied.

Books like Lean Thinking Lean Wont Work Here... Were Different lean and The Toyota Way Lean Wont Work Here... Were Different lean helped generalize high level Lean and Toyota principles that could be applied in different settings.

“We’re different, product development (or sales, or service) is more complex than manufacturing.” People outside of the factory floor struggled to see how Lean could fit until there were success stories. I recently heard a story about a car dealership apply standardized work and job breakdown sheet concepts to the salespeople… they doubled their sales conversion rates.

“We’re different, we don’t build things.” Or so said the people in credit card processing and software development until they figured out how to apply Lean principles. Cycle times fell and quality improved.

And then…… we get to healthcare. In the late 1990s, healthcare organizations realized that Lean thinking could help improve quality, patient flow, cost, employee morale and a number of other important outcomes.

So this leads to the classic statement (still heard often today):

“We’re different, we’re taking care of people, not building cars.” We have enough success stories from the early adopters to say, with a great deal of confidence that Lean CAN work in healthcare.

The same progression of “we’re differents” can be seen in a hospital. Let’s say the clinical laboratory is the starting point (a common one). Then, you get the following statements, which might be said in each and every department as Lean improvements march along. The evidence that it works in other departments isn’t enough to sway others:

  • Microbiology: We’re not the core lab, they are high volume and we run much more complex testing. We’re different.
  • Blood Bank: We’re not the core lab or micro, people could die if we make a mistake. We’re different.
  • Pharmacy: We’re not like the lab, that’s like a factory. We’re different.
  • Nursing (Telemetry): We actually touch patients here. Lean might work in ancillary departments. We’re different.

Let’s say you have success in reducing waste and engaging the staff in that first nursing unit. The chain continues:

  • Nursing (Med/Surg): We’re different, we have a much greater variety of patients.
  • Nursing (ICU): We’re different, our patients require much more attention and work, they’re much sicker. Lean can’t work here.
  • Emergency: We’re very complex, we can’t predict who is going to come in. We’re different.
  • Operating Rooms: We’re different than the E.R., we have such a variety of cases, Lean couldn’t work here.
Then, beyond the hospital, primary care providers and areas will say “We’re different….”
Dr. Sami Bahri, “The World’s First Lean Dentist” is different from a hospital. But he’s managed to make Lean work for the benefit of his patients and staff (and his practice, as a business). He’s different.
Dr. John Tebbetts and Dr. Mark Jewell are cosmetic surgeons, who while being very different, have made Lean work — again to the benefits of their patients and their practices. They are different.
I’ve heard reports of Optometrists using Lean principles to double the throughput of their offices and I had a veterinarian contact me the other day asking about Lean.
“We’re different, we take care of animals — do you know how many different species come through our door?” I wonder if they say that?
So, yes, you’re different. That just means you can’t blindly copy the other departments or areas that are different. You have to figure out how it applies to your department. Your emergency department might be different than the one down the street — OK, great, now figure out how Lean methods apply to YOU and your setting.

Is “we’re different” an excuse to not try Lean? Or is it the starting point for thinking and figuring out how Lean *does* apply? Lean in an operating room does NOT mean putting the operating room table on a moving conveyor belt that moves at a constant rate. But you can certainly find ways that Lean methods would help in an O.R. for patient, surgeon, staff, and hospital benefit.

Do Lean and TPS principles apply in pretty much every process? Yes, I’d say so. Does that mean Lean is easy to put in place? Of course not. But that, along with being different, should be no reason to not try. Am I a Pollyanna who thinks Lean is a cure all? No. But as I heard a physician in the UK say last week, “I sure hope that Lean works… because I know of no other alternatives.”

Final thought – it’s often said that “Lean doesn’t succeed or fail… Lean is just a set of principles. What succeeds or fails is the organization or the leaders who try.” Lean success isn’t guaranteed — it requires hard work and, yes, even a little creativity to figure out how Lean will work in your setting.

Because you’re different.

Lean Healthcare CertificationThis week’s blog was written by Mark Graban, author of “Lean Hospitals:  Improving Quality, Patient Safety, and Employee Satisfaction” and author of  He is a consultant and speaker in Lean Healthcare methodology, focused on improving quality and patient safety, improving access, reducing costs, and fully engaging healthcare professionals.  He is also the Chief Improvement Officer for KaiNexus.  Currently, Mark is authoring a new book, “Healthcare Kaizen: Engaging Frontline Staff in Sustainable, Continuous Improvements.”


Hear Mark speak at the Lean Healthcare PowerDay–a featured speaker along with Dr. Richard Shannon, Naida Grunden, Dr. David Munch, Dr. Samuel O. Johnson, Charles Hagood, and Terry Howell. 


April 9-10, 2012 at the Mandalay Bay Resort in Las Vegas 


For More Information on the Lean Healthcare PowerDay Click Here

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