Why Lean?

“Hey Curmudge, last week we had the cart before the horse. We talked about Lean training before we explained why it is Lean, and not something else, that we are teaching.”

“Good catch, Julie. We older folks who wish we could live life backward sometimes get things out of order. Let’s go back one step and explain why we are doing what we are doing.”

“I understand that you have some stories from long ago—back when you were middle-aged—that illustrate the need for more efficient processes in health care.”

“There was a story about Pope John XXIII. In an audience with the Pope, a visitor asked the Holy Father, ‘How many people work in the Vatican?’ He answered, ‘Oh, about half of them.’ When I was living in the Northwest, I went to the local hospital for some outpatient testing. There were employees all over the place standing around and chatting. I thought, ‘This must be the Vatican. Which way to the Sistine Chapel?’”

“You concluded that health care back then was not very efficient and needed help?”

“That’s it, Julie. Fast forward to six years ago. My last paying job had ended, and like the city’s other derelicts I spent a lot of time in the public library. I found books on Six Sigma, Gemba Kaizen, Total Improvement Management, and other systems for process improvement. In my last employment I had worked with ISO 9001 and had learned about the Baldrige Award. All of the programs had some common elements, but ISO and Baldrige were very heavy on documentation. Six Sigma was felt to require a lot of training before any payoffs could be achieved.”

“So Curmudge, of the documents you could find, you favored Gemba Kaizen.”

“Right. Kaizen was used not only at Toyota but throughout Japan’s manufacturing sector. It might have been properly called, ‘The Japanese Production System.’ The focus of Kaizen was process-oriented management, as contrasted against results-oriented management used in the West. As Masaaki Imai (1) stated, ‘Many Japanese management practices (Kaizen) succeed because they are good management practices.’”

“Then, somewhat later, you learned about Lean.”

“It appears that Kaizen came to the U.S. and for most users acquired a new name, Lean manufacturing. An English word (Lean) that is often misinterpreted is better than a phrase in Japanese (Gemba Kaizen) that happens to be trademarked. It is also more palatable to Americans to speak of the Toyota Production System than the Japanese Production System. The two systems are essentially identical—same tools and same management principles.”

“Okay Curmudge, back to my original question. Why are we adopting Lean as our culture at Affinity?”

“What really matters is what one does and not what name one gives to the program. (Whenever I write that I am reminded of the line in ‘My Fair Lady’ that says the exact opposite, ‘The French don’t care what they do, really, as long as they pronounce it correctly.’) We could just as easily call Lean the ‘Affinity Performance Excellence System.’ One reason for keeping the term, Lean, is that it identifies, in general, what we are doing to all who are also striving for performance excellence.”

“So much for terminology. What I am really asking is why Lean—irrespective of its name—was selected by Affinity management to be the cultural target for Affinity Health System?”

“Our top management appreciated the value of continuous improvement, a hallmark of Lean. Our immediate boss learned about Lean in his graduate studies. Lean has been used with success in many health care locations. And Lean’s successes at Affinity are validating their choice on a daily basis.”

“Curmudge, you once told me that culture is the summation of everyone’s perception of ‘the way we do things around here.’ And that’s why Lean education is essential for as many people as possible in the organization.”

“You’re exactly right, Jaded Julie. You must have been reading my mind. I’ve always wondered how you do that.”

Affinity’s Kaizen Curmudgeon

(1) Imai, Masaaki. Kaizen (McGraw-Hill, 1986)

Note: An observation on the practice of emergency medicine in a primitive location may be accessed via this link.