Before I worked in Lean Healthcare, I worked in Lean Manufacturing.  During my manufacturing days, my boss explained a concept that has stuck with me. He said, “Managers in Lean-focused organizations need to think more about Lean management and a little less about Lean tools.”  His comment recognizes that all organizations exist to deliver value and any of the efforts associated with managing the value stream are fundamental leadership tasks.

It’s easy to become infatuated with the collection of Lean tools that have surfaced during the last 40 years but, application of these tools may not necessarily alter the value delivered to your patients if there is no management system to support them.  Healthcare organizations engaged in their own Lean Healthcare journey may occasionally need this same reminder—just using the tools is not enough.

Let’s revisit a few reminders on the basics of management systems:

  1. All value created in any organization is the end result of a lengthy sequence of steps called a value stream (read more about value stream mapping).  Improving the flow of this stream must be done continually to ensure that customers always receive maximum value.
  2. The flow of the customer through the value stream is typically horizontal. That is, the flow occurs horizontally across the organization.  However, nearly all companies, including the vaunted Toyota, are organized vertically by function, usually for basic and practical reasons. This paradox represents a big challenge for leadership.
  3. Maximizing value requires that someone work continuously to improve the delivery of value on behalf of the customer. Improvement efforts typically require support, either from internal or outside sources.

Specific strategies to help leadership transform a management system to a lean management system are:

  1. Every value stream should have a designated person responsible for identifying and overseeing its entire flow of value and for coordinating its continuous improvement. These improvements should be aligned both with the needs of the patient as well as those of the business. This does not mean that those who work in the value stream have two bosses. Top leadership must assure that both value stream leaders and functional leaders coordinate to make sure that all communication to those engaged in the value stream is both direct and unambiguous.
  2. A system of simple daily metrics is typically in place to remind and inspire those that do the regular work of what constitutes value to the customer.  Managers should give regular attention to these metrics, using both liberal praise and focused questioning to those who provide the information.  This routine sharing of status and results should ultimately include everyone who contributes to the value stream. It should never be a negative event (i.e., no “shooting the messenger” allowed). Top leadership must insist on and support this critical daily activity.
  3. Last but not least, unanswered questions or performance gaps identified through daily activity must lead to improvement experiments.  These improvement efforts should use a standard, systematic problem solving approach (like the A3 problem solving format) and utilize the full toolbox of other Lean tools to improve the delivery of value. Again, top leadership must make sure that managers have both the knowledge and skills to coach and support the use of the tools.

Gaining knowledge of specific Lean tools is always interesting and exciting. However, as Jim Womack once said, “A carpenter needs a vision of what to build in order to get full benefit from a hammer.”


Today’s blog was written David Krebs, Senior Manager with HPP.

David, a Six Sigma certified engineer, oversees various HPP projects and Lean Healthcare projects for clients throughout the United States.  David is also a licensed Professional Engineer in the state of Tennessee, with more than 30 years of experience in a variety of process and systems intensive industries, as part of firms in the U.S, Germany, and France.  David has achieved and maintained QS-9000 and ISO-14001 certification & received Nissan’s “Quality Master Award” on three occasions.  He holds a Bachelor of Science degree in Mechanical Engineering from the University of Detroit & an MBA from the University of Notre Dame. 

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