The Quagmire of Lean

Found myself recently, as I often do, in a lean implementation strategy session with several healthcare leaders around the table.  The discussion was centered on ways in which to broaden critical thinking and consistent problem solving methods across the organization.

The caution raised in the meeting was that we did not want to use any “lean” words including the word “lean” itself, i.e. “Let’s stay out of that quagmire.”

I had to laugh when I heard lean being called out as a “quagmire”.   Then I had to look up the definition: “a soft boggy area of land that gives way underfoot” and “an awkward, complex, or hazardous situation”.    Then I had to take a walk and ponder that one…

Where I landed was lean = quagmire = complex.

What is it that we are doing to create the perception that lean so darn complex?     How can we do a better job of sticking to the fundamental and simple principles of continuous improvement and respect?     How can we better demystify and simplify lean in the highly complex health care arena?

Those are my ponderings for this evening’s walk.  I welcome your thoughts….


10 thoughts on “The Quagmire of Lean

  1. I am reminded of a recent Bob Sutton post

    I think the problem with people being disillusioned with management strategies is both execution and the desire to find the magic bullet (that leads to great success with no significant effort).

    Plus, people that are smart and want to be right can do well, just by saying whatever management strategy is a quagmire. Based on history they will probably be right that the implementation in the organization they are with will be a quagmire. Actually making even an excellent management strategy (like lean) work is way harder than predicting it won’t and watching it as it likely fails.

  2. If Lean is seen as a quagmire, there is something amiss in how it’s being taught and/or learned. Lean is simple. Too simple, I could argue. My favorite saying is “The smarter you are, the harder Lean is.” The Lean recipe that Toyota developed and perfected over many decades apparently isn’t flashy enough for a lot of us here in the US. We’ve added a lot of bells, whistles, and belts to make it more like something Hollywood might be proud of instead of something that is simply to design, teach, implement and sustain. People have a hard time believing that a good 5S program coupled with continuous waste elimination can fundamentally change a business in just a few months. Both topics can be easily taught and the benefits can start surfacing right away. But that’s not very flashy, just very effective.

    Flashy tends to get the attention of managment. Effective gets the attention of the folks doing the work. Call me old fashioned but I’ll take effective every time…

  3. Seems to me that lean is bearing the burden of the three letter acronyms – all of the improvement methodologies that were half heartedly adopted as answers – like TQM and CQI – and the scars left behind by those strategies. I have had people ask me what the acronym lean stands for….

  4. I think that anything can be a quagmire when you are operating IN rather than ON the situation. Lean can feel like a layering on of activity if you are working so far IN a problem (due to time, resource or other constraints) that you can no longer find a way to get a broader perspective. Lean philosophy, thinking and tools can help you find a way to breakthrough the morass and make sense of the parts. Start to break it down to understandable pieces.

    1. Catherine, Love the “IN” vs “ON” reflection. I agree that the best approach is to “break it down”. Thanks.

  5. I think it is a comment that is largely based in ignorance. I realize ignorance is a strong word, and I don’t intend it to be disparaging. Imagine this: we were going to implement a new technology, say an EMR, and the leaders who are accountable for the implementation say “let’s not use phrases like physician order entry, or clinical documentation, that is just a quagmire.” That wouldn’t make sense because those terms refer to something very specific. Most of our language in lean is often perceived as not very specific and therefore a way, when wielded by people “in the know” as a way of defining those who are not in the know. It is critical for us as lean leaders to describe what the concepts are behind the words, and also describe why those concepts are important. It is also critical that we never use those terms to create a divide between those who get it and those who don’t. Ignorance is not a failure of the student, but of the teacher.

    1. James, I appreciate your thinking on this one. And I agree fully that the responsibility is on the teacher. You are spot on with the “critical that we never use those terms to create a divide…”.

  6. I sometimes forget that Lean is an entirely different way of managing and working, rather than a collection of new management tools and activities that have to be done on top of everything else. I expect that there will be additional effort at first, and perhaps even some redunancy. But Lean should keep me focused on advancing critical work to completion, one manageable chunk at a time. As Lean becomes habit for my colleagues and me, we should have faith to let go of our old work methods. We may let go of many activities that we previously regarded as important… but discovered were not.

    1. Scott, Thanks for the comment. My perspective is that as you improve your work processes (i.e. take out the waste), your thinking and actions will start to become the “habit” that you refer to. Agree with you 100% that you may indeed let go of activities that you once thought to be important.

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