Posted by: Knightbird | September 13, 2012

Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements By Mark Graban and Joseph E. Swartz

Another wonderful book has been added to my Lean Healthcare library. I am fortunate to know Mark and Joe personally, but that doesn’t influence this review of their book. At 361 8 1/2 by 11 inch sized pages, the book is full of lean knowledge, improvement stories and anecdotes about engagement of patients and staff in making a hospital great. As a lean leader in an organization myself, I was curious to see how Mark and Joe would present their story.

It doesn’t take long for the concepts of continuous improvement and respect for people to surface. Kaizen and continuous improvement underscore the first chapter. One cultural concept introduced very early was that failure is actually good for an organization, if they see the failure as a coaching opportunity and use the failure to improve their process. This teaching is contrary to Western management implementation, and as a consequence, many potential improvements are hidden away by employees who don’t want to call attention to failures in their value stream.

The book is also full of small tidbits of wisdom from many famous business leaders. Here’s one: “Most people spend more time and energy going around problems than trying to solve them.” Henry Ford said that, and not many Western style managers know that Ford’s concept of continuous flow is one of the foundations of lean thinking. Eliminate batching and encourage continuous flow. The book recognizes Ford’s contribution, as well as the contributions of Dr. W. Edwards Deming (Mark is a Deming disciple, as I am). I must say that one of my new favorite quotes is from Winston Churchill, who said: “Courage is what it takes to stand up and speak, Courage is also what it takes to sit down and listen.” From personal experience, I can tell you that active listening is one of the best learning tools available to an Executive.

Chapter 9 addresses the role of leaders in Kaizen, and cites one of the well know examples of a leader who learned that it wasn’t enough to accept lean as a management system. Dr. John Toussaint required his managers to participate in 2 kaizen a year, but did not participate himself until his mentor pestered him to become a real leader and learn what it was that he wanted his leaders to learn. He did, and ultimately participated in 14 full-length rapid improvement events. I have also participated in many improvement events, although I know find that we have so few longer events.

As a seasoned lean practitioner, there is one practice that St. Francis still requires, annual performance reviews. Although Dr. Deming’s admonition to eliminate them is discussed in the book, I encourage all lean leaders to learn as much as they can about the detrimental effect of annual performance reviews, and eliminate them. If St, Francis continues on its lean learning path, and the CEO is involved, they will ultimately come to this conclusion. In lean, our employees are who they are, and to compare them to a standard that is evaluated only once a year is not lean. As you develop standard work, and train your employees to that standard work, an amazing thing happens. They become more creative, enthusiastic and focused on their mission instead of trying to survive their workday. Too often, the ones who score well on performance reviews are those who are great at workarounds and at wearing the cape (borrowed from my friends at Virginia Mason as in, you know, “here I come to save the day.”) An annual performance review gives supervisors an excuse to ignore coaching and training. Employees in a performance review system learn quickly not to identify defects or to shift them to other areas where different employees are involved. There is no valid reason I can see for performance review.

This post is getting quite long, but let me add this. Mark told me that they would publish an Executive Guide to their book. Don’t get it. Get the real book. If you are too busy to read the book, then you need it the most. As I have found in my organization, the more lean permeates the organization, the more time you have to lead, instead of pretend to fix. I have worked in organizations where the CEO pretended to fix by yelling at us subordinates to fix it or else. Never worked. Get this book, learn from it, and fix things for real. Then keep improving them, for real.


  1. […] And Patrick Anderson’s Lean in Alaska Blog: his review post. […]

  2. Thanks for your comments, Patrick.

    I certainly hear you on the issue of annual reviews. They are the current reality in many healthcare organizations and I agree that I hope we could move away from them, as they do cause many dysfunctions as Dr. Deming taught. I’m glad you are a continued advocate for that view (as are others:

    Thanks for the thoughts on the Executive Guide version. We’re hoping that the smaller introduction might also prompt deeper study of Kaizen. I think we’re also trying to accomodate the current reality of “busy executives” who want an introduction that’s easier to carry with them on a plane.

    I appreciate your kind words for the book and for the thoughtful constructive criticism.


  3. […] Another wonderful book has been added to my Lean Healthcare library. I am fortunate to know Mark and Joe personally, but that doesn't influence this review of their book. At 361 81/2 by 11 inch sized pages, the book is full of …  […]

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