The tendency to erect a wall around lean

Recently I reflected with two teams on their progress with applying the lean principles. Both teams stated that the past months nothing had happened.

Nothing?

We discussed that they did not have time due to illnesses in the team and different other reasons why they were so buried under work that they did not have the opportunity. Then someone asked whether a period like that doesn't create a pressure to make changes to keep everything running. Sure, was the answer. And to the question how they had managed that they gave a range of examples how they had made improvements that reduced the time needed for activities, so that they could perform the work with less people. Different scheduling of nurses, different scheduling of patients, other task division, stop unneeded activities.

Nothing?

If that's not working on lean, what is?

They soon concluded that they did apply the principles. Why did they at first answer that they had done nothing? It became clear that they work 'on lean' when it explicitly carries that label. They apply lean when:

• a change is introduced by the 'lean team' that regularly meets and thinks of new things
• a change is decided on a workshop or so that carries the name lean in the title
• or when it is directly connected to one of the instruments of lean

Changes that are made that reduce waste, increase value, improve flow etc., but without explicitly being labeled lean were, until now, not considered lean.

Ah, now I understand 'nothing'!

Why do we erect a wall around lean? Why do we create boundaries to say when activities are part of lean and when not? In this way lean can only have a very limited effect. We do not systematic lean from experiences that are relevant, but not labeled as lean. We do not acknowledge good progress that's made. We do not integrate the principles with other activities. We get less close to the hearts of people, because lean stays something foreign, that needs a label to work on. Every team has reduced waste or improved their working conditions etc. If we recognize those improvements as good examples of lean thinking, we can integrate the principles with daily practice. We can integrate it in the DNA of the team. So, we lack so far in this ability?

I consider lean thinking as a set of principles, a coherent way of thinking and seeing that can be inspiring. Lean asks questions why you do things as you do. Lean gives examples from other organizations that give food for thought, not least examples from Toyota. Lean challenges you to reach higher. lean thinking also describes instruments that have proved themselves, but that is secondary. But apparantly that's not how we communicate it?

In my view, embracing lean thinking means that you systematically elevate your efforts to reach higher levels of performance. Lean thinking means per definition that you apply the way of thinking onto everything where it can be relevant, even in your private life. If you think according to the principles, you cannot not-apply them.

Do you recognize the tendency to erect a wall around lean? What causes this tendency? What is the root cause of 'nothing'?

Pitfall of lean

Lean is one of the most widely used and proven management approaches. Yet, also with lean applications there are many organizations that do not achieve a real lean journey. Projects might deliver results, but they rarely lead to a sustainable development. After a while the attention drops away. What are the pitfalls of lean? A first exploration.

What characterizes the (popular) literature on lean? The approaches are largely based on a rational, predictable approach to organizations. Read the most common lean method another time:

1. Determine value
2. Identify the value stream
3. Create 'flow'
4. Let the customer 'pull'
5. Continuously improve
(Womack en Jones, Lean Thinking)

Step 1. Determine value
Could it be that different caregivers often think differently about what is of value to a patient? And that patients themselves have a completely different view? Hoe do you handle a great diversity of views? An example:

A department realized that they offer a poor service by giving their patient their date to be operated just shortly before the operation. Therefore they started a project to offer every patient their operation date directly in the outpatient clinic when the operation is decided. A nice improvement. Yet something felt not right. A later study showed that 95% of the patients indeed highly appreciated the new service. 5% however is very nervous before the operation and can't sleep anymore as soon as they have the date. They prefer to be called as shortly to the operation as possible. Determining value is often more nuanced than at first glance.

Step 3. Create 'flow'
Could it be that many forms of waste are related to historical patterns and relationships? That it can be threatening when this is analysed? Or that in itself rational process improvements create uncertainties for stakeholders? An example:

An outpatient clinic had problems with no shows, pressure of phone calls from patients and GPs requiring priority, much work with rescheduling sessions, and surprisingly enough, also many unused appointment slots. A major cause appeared to be that they used various types of appointments on fixed times in the sessions. E.g. always a new patient at 9am, 9.40am, 10.20am. This offers insufficient flexibility because every week there is a different numer of patients requiring a specific type of appointment. Just stop using fixed slots and plan flexible. The group of doctors however did not allow this. Why did they use fixed slots? Because they wanted to be sure that every specialist sees an equal number of new patients, thereby ensuring that each specialist contributes the same to the group. This had gone wrong in the past. From a flow perspective, the current planning method is a (minor) disaster and there are other solutions, but they would not let go because they feared that the old quarrel would come back.

Step 5. Continuously improve
What are your experiences when you suggests an apparantly good idea? Is it often not put to practice as quickly as you can imagine? An example:

On an outpatient clinic the relations had gone from bad to worse. There was much dissatisfaction. They saw many things they did not like, but they were not able to improve them. Interviews revealed that the assistents perceived that the specialists hold all the power and blocked any improvement. The specialists however said they had many good ideas, but they needed the assistants to realize them. Since the specialists did not have any formal power over the assistents they were not able to influence them. The specialists felt powerless.

With a sense of reality
The examples are not intended to indicate that the lean principles do not apply there. To the contrary. Lean however pays little attention to the non-rational side of change processes. Even thoug they often determine the progress. In the words of Marcel Boonen, manager of a care department: "after the logic starts the confusion".

With a lot of external pressures (higher management, program management, etc.) the rational approach can deliver results. Continuous improvement, a cultural change is something different. Lean thinking can not be implemented. For the non-rational side, to reach inside, other interventions are needed. This starts with the recognition of different views on value and problems and investigating them with a sense of reality. As a secretary once spontaneously shouted during an improvement session:

Do you mean that from now on you are going to take our ideas seriously!?