Posted by: Knightbird | October 12, 2010

Decision Making in a Lean Culture


Chugachmiut hosted a prominent consultant in Alaska yesterday and had a change to explain the cultural shift that has taken place over the past few years. As we talked about what led to the cultural shift, 7 pivotal decisions came to mind—each critical in their own way. Each was also traumatic and game changing for Chugachmiut except for the last, which we hope will be hope will be game changing for our customers.

The first decision was to end the culture of blame and shame. I have told that story once before, but let me repeat it. Early in my tenure at Chugachmiut, an employee came to me in order to launch a “preemptive strike.” That is, this employee wanted me to know his version of the facts of a defective situation. I raised my hand in front of my chest in a palm out position and said that we are not going to do blame here. We are going to fix things. I must have repeated the no blame no shame mantra thousands of times, and it did eventually take hold. It takes a plan to eliminate blame and shame from a workplace, and that plan at Chugachmiut was Lean Management. However, when this employee approached me, I was just working off of my knowledge of Deming, and was still struggling to find our management style.

The second decision was to adopt Lean as our management style. This is not an inexpensive decision. Change management is complex, and heavily resisted by governing boards and staff. It resolves real work, and true Executive Leadership. I was fortunate to have a board that agreed with our expenditures to introduce the tools of Lean Management to Chugachmiut. It also meant that I had a huge learning curve to truly understand the principles of Lean Culture.

Our third decision involved our purchase of a building and moving our operations to a new location. This doesn’t sound like a Lean decision, but the dynamics of the decision were substantial. Our new space allowed us to centralize our records management and improve our networking. There were also numerous financial benefits that have been realized now—five years out—that have had enormous implications for operations. One simple one is that we avoid a lot of traffic jams in our present location. A more moderate one is that we have reduced our costs of occupancy and created flexibility for accommodating staffing increases. The complexity has to do with the range of emotions from our governing body about the consequences of ownership and past management of real estate.

The fourth decision with positive consequences was the elimination of performance reviews, and daily management of performance through Kaizen or continuous improvement. Defects and employee performance issues are handled when they occur, in a non blame or shame environment. Employees have become responsible for their value stream management. I can’t emphasize enough the positive impact of this change. Improvement events are happening every day, employees no longer hide defects and there is positive engagement across functional and divisional boundaries.

Our fifth decision really caused a huge amount of health care staff defection, which I wrote about before. Although there was short term pain in dealing with our medical staff’s wholesale abandonment of their patients, we have developed a more patient centered, lean operation that provides far better service at a lower cost. As a result, we have been able to increase the range of services we provide.

A sixth decision was to reorganize our behavioral health staff. Again, this decision caused staff defection, but we were able to change the orientation of our program towards greater client service, innovation and expanded services as a direct result of the organization.

Finally, our service model is undergoing a significant change in how we implement new services through positive engagement of our customers. This is a truly Lean innovation that we have taken some time to learn. Our Restoration to Health Initiative, which is a strategy adopted by our board, will be implemented with the positive influence of our customers. We will be holding a “Consultation” with our customers in April, 2011, to discuss the initiative, the various components we are considering, and to ask for their input on how to structure the initiative.

We have much more to learn on our Lean Journey, but in an open atmosphere of no blaming or shaming, being fact based and non judgmental, having a clear vision for the future, and positive engagement of staff, the rest of the journey should be very enjoyable. I have a wonderful engaged Executive Staff, happy employees, and very little confrontation left in the engine that drives us.

That was the message I wanted to give to the Consultant.



  1. Thanks for sharing, Patrick! I appreciate you sharing the amount of persistence it takes to instill a “no blame” culture.

  2. […] Quali sono i motivi più comuni perché le trasformazioni lean falliscono? (traduzione automatica)Decision Making in a Lean Culture dal blog Lean in Alaska di Patrick Anderson: Le sette decisioni strategiche che hanno cambiato una […]

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