Lean Hospital & Mark Graban

I had an interview with Mark Graban about Lean Hospital, and thanks him to have time to answer me.

It was pleasure for me to have the answers from him and get his experience about Lean.

Mark Graban is an internationally-recognized leader in “Lean Healthcare.” is the creator of LeanBlog.org and author of the books Lean HospitalsHealthcare Kaizen, and The Executive Guide to Healthcare Kaizen.

He and his jobs shows that it is obvious Lean can be implemented in any sector including as it is done in automotive sector.

You can have more detailed information about him from below web site:


Interview with Mark Graban:

(T: Tulay & M: Mark Graban)

T: How many years have you been working on Lean hospitals? Why and how do you choose to implement Lean tools in the hospitals? Most people think that Lean tools only can be applicable in manufacturing sites.

M: I’ve been working in healthcare for over 11 years now, after 10 years focused in manufacturing and the for-Tprofit sector. I had an opportunity to take a job with a consulting group that was part of Johnson & Johnson, called ValuMetrix Services. ValuMetrix taught Lean and coached healthcare organizations through projects that did more than implement Lean tools. We also taught them about the Lean management system and the culture and philosophy of Lean. Tools might be a good start for many organizations, but tools alone don’t make an organization Lean. The right tool in the wrong sort of culture might be counterproductive. For example, an “andon cord” type process won’t work in a healthcare organization that blames individuals for problems instead of looking at systems, for example. People would be afraid to point out problems, which means the tool wouldn’t be useful.

If a healthcare organization and its leaders can adopt the right philosophy, working toward a Lean culture, then Lean tools and methods certainly make a difference in healthcare, as it does in other non-manufacturing settings. Lean isn’t about a better way to build cars; it’s about a better way to solve problems, a better way to study and improve work, and a better way of leading people.


T : On your web site you tell you prefer to help clients by focusing on short, strategic engagements that provide specific experiences or value to an organization, leadership team, staff and patients. And acting like advisor or coach as part of an ongoing relationship over time. Does it mean you’re teaching them how to figure out Lean by themselves? When you start a Lean journey in a hospital, how do you act?

M: I think any good Lean coach, and I try to be one, helps others by helping them understand problems and identify solutions to test and evaluate, rather than just giving them answers or a “roadmap.” We’re trying to teach people how to think and improve more scientifically instead of just telling them what to do.

Most hospitals are large, complex organizations with a lot of silos and separation across departments. I don’t think any organization “gets Lean” across the entire organization in a short period of time.  We have to start somewhere. That usually means piloting the Lean approach in one department or one “value stream.” Some call this a “model cell” or a “model line”. We can demonstrate that Lean methods are helpful and that Lean management approaches are the better way. Then we can try to spread the approach, with our lessons learned, to other parts of the organization overtime.


T: What kind of hospitals do you work with? I mean the hospital already started to apply Lean tools or just want to start but they don’t know where they should start? Are they mostly big hospitals, small hospitals or hospital with so many wastes?

M: Believe it or not, there are some hospitals that have still not started their Lean journey in the year 2016. Or they have just barely started.  So, sometimes a health organizations get started and, hopefully, Headed down to a good path of learning and improvement. Other times, I get brought in after an organization has been on this “Lean journey” for a couple of years and they’re trying to figure out, for example, why employees or managers are not “buying in” to Lean.  Answering that question requires that we ask “why?” instead of blaming people for not buying in.  maybe the organization hasn’t done a good job of explaining what Lean is read or, they’re not engaging people to solve problems that mattered to them and their patients.

When you ask about the size of the organization, it’s interesting to see that organizations of all sizes can make an excuse about why Lean is not a good fit for their organization. Some small hospitals say they’re too small for Lean to be helpful (or they can’t afford to get started, they think). Other hospitals say they’re too large and that culture change seems impossible.  As the expression goes, the best time to start with Lean was 10 years ago. The second best time to start this now


T: What is the first step you suggest to hospitals that want to apply Lean tools?

M: If a hospital says they want to apply Lean tools, one of the first things I would do is try to help them understand the philosophy, the culture, and the management system of Lean.  It’s a fairly common question for people to ask what tools or methods they should start with. I usually try to reframe the question and ask them what problems do they need to solve. Taiichi Ohno, one of the creators of the Toyota Production System, said to “start from need.” John Shook of the Lean Enterprise Institute asks, “What problem are you trying to solve?”  We have to solve problems that matter and there are far too many important problems and healthcare, including patient safety and quality, not just cost.


T: Mostly the subject talked about Lean applications is whether we really have an improvement. Was it measurable, and was it statistically significant. Do you have any proven way to make them believe they would actually have improvement, especially money savings?

M: Sure, we have to try to measure and see the impact of our improvements in the quantitative way. We can’t just say we feel like things are better. Now there are many categories in which we would generally try to find improvement, not just financial measures. A Lean organization generally focuses on safety, quality, delivery (flow or access), cost, and employee morale. Many of our KaiNexus software customers use our software platform to track and measure the impact of Lean and continuous improvement in their organizations.  Sometimes, we have to ask the finance department to validate cost savings or ROI. Other times, we can use statistical methods like control charts (or Statistical Process Control) to see if we have a meaningful and sustained change in what we’re measuring.


T: Is there any software you implement in hospitals to track improvements, operations and savings? If yes could you please explain it a little bit?

M: Yes, so like I mentioned, KaiNexus is a system that hospitals (and now organizations in other industries) use to manage improvement efforts and measure savings.  It’s a web-based system of that everybody in the organization would have access to. People can identify problems, large or small, and start working with their teams to identify countermeasures or solutions that they can test and evaluate. People also manage their A3 problem-solving templates and kaizen events in the system, along with larger projects. They use the system to track performance measures and gauge how much of a difference their improvement activities are having on those measures. It’s built off of a kaizen –based approach to improvement, as the company’s CEO and cofounder is an emergency room physician who was taught the kaizen style of continuous improvement while working at hospital over 10 years ago. People can learn more about the company and our approach at http://www.KaiNexus.com.


T: If you evaluate last 10-15 years, is there any difference? What is easier and what is more difficult than before? 

M: Compared to 10 years ago, I think most leaders in healthcare have heard about Lean. So, 10 years ago we were having to have very basic introductory conversations about Lean, and we were trying to convince people of this approach would even be applicable in healthcare. All we had were a few early case studies to show that this approach worked in hospital labs and other settings. Today, we have a slightly different problem where people say they understand Lean, but that doesn’t always really seem to be true. For example, they have the mistaken assumption that Lean is only about efficiency or cost savings. So, now we sometimes have to help people unlearn what they thought they knew about lean to learn, instead, a more accurate version of what they were taught or what they thought they understood. What’s easier today is that we have far more case studies from around the world showing that lean can be a very helpful approach. That doesn’t mean that Lean always works, but we’ve proven that it can work given the right leadership and the right circumstances.

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