Thursday, 6 December 2012

LEAN Leadership

Sustaining and spreading the gains in lean Hospitals: Role of Leadership

Edly Ferdin Ramly
Principal for EFR Management, Malaysia


Whether you follow Lean, Six Sigma, or an internal methodology, one of the biggest challenges of process improvement is ensuring that process changes are adopted consistently—and sustained— and spread by your organization. How can you measure how well your process improvements have been adopted? And how can you monitor activity to ensure process improvements are sustained while identifying new best practices for continuous improvement. The success factors of lean lies on lean leadership.

Keywords: Lean Health care, Lean Leadership


People often equate “Lean” with the tools that are used to create efficiencies and standardize processes. However, implementing tools represents at most 20 percent of the effort in Lean transformations. The other 80 percent of the effort is expended on changing leaders’ practices and behaviors, and ultimately their mindset. Senior management has an essential role in establishing conditions that enable that 80 percent of the effort to succeed. Their involvement includes establishing governance arrangements that cross divisional boundaries, supporting a thorough, long-term vision of the organization’s value-producing processes, and holding everyone accountable for meeting Lean commitments. This is accomplished through regular, direct involvement. When upper management sets the example, durable Lean success and an increasingly Lean leadership mindset follow.

Most of the literature on Lean conversions has focused on implementing the Lean tools (to create flow, establish pull,  support just-in-time production, etc.) in manufacturing (Womack and Jones 1996; Rother and Shook 1998). Some of the literature has explored Lean tools in healthcare,  office settings, or product development processes (Graban 2008);  Critiques of the tools only focus note that even brilliant use of tools without changes in culture rarely produces lasting change, or even lasting .There is a missing link in Lean. This missing link is the set of leadership behaviors and structures that make up a Lean management system.Lean management bridges a critical divide: the gap between Lean tools and Lean thinking. Systematic Lean management separates Lean initiatives that start well but falter from those that sustain initial gains and deliver further improvement.

In this paper, we examines the key reasons why process changes often fail to be sustained in the long term. Explore DIET techniques on how you can track whether your organization is really sustaining and spread the lean thinking and continuous improvement.

The lean effort is consider failed once the organization stop their effort in waste elimination stop. Stop mean the gain not been sustain and the implementation not been spread. The main reason of failure are due to:
1.      Purpose – The purpose of lean initiative have not been clearly defined. In many cases, the organization adopted the lean just because it is “the best menu of the day”.
2.      Process – The process of the lean implementation not been plan, do, check and action. Yet, my own observations say this is precisely the thing that most companies can’t seem to do. Why? Surely one major reason for this is the way we lead and;
3.      People – Employees didn’t buy in the initiative.

For hospital-wide Lean initiative to succeed, leaders at three organizational levels must play complementary roles. This overlap reinforces continuity of support for new practices throughout the organization, e.g., disciplined adherence, attention to process performance at intersections, and gemba walking (which takes managers to the front lines to look for improvement opportunities). This continuity maintains the internal integrity of Lean tool implementations and the Lean management system.

Senior leaders play a central role in Lean management. Their contributions are essential in:
1. Developing and implementing structures and processes that anticipate and respond to the difficulties of a Lean initiative that crosses internal boundaries;
2. Increasing the odds that process improvements survive the transition from project mode to ongoing process and Creating conditions in which a sustainable Lean culture of continuous improvement can develop.;
3. Establishing and maintaining new, process-focused measures along side conventional measures of results;
4. Transforming commitments to change into actual change, supporting and sustaining new behaviors and practices;

The leader’s job at Toyota get each person to take initiative to solve problems and improve his or her job. The Leader’s job is to develop his or her people spirit of Lean Mentorship. “If the learner hasn’t learned, the teacher hasn’t taught”

Figure 1: Example of leadership model at Toyota

Leadership at Toyota change from managing numbers to managing the process.Leaders at Toyota, like leaders anywhere, want to see measurable results. But they know that the financial result is a result of a process. They also realize that the financial results reflect the past performance of that process. Far better is to create a process that can be managed right NOW.
Leadership at Toyota also change from Problem-hiding to Problem-solving. All actions at Toyota revolve around planning and problemsolving. It is assumed that there will be problems, that everything will not go according to plan. “No problem is problem.” For the system to work, problems must be exposed and dealt with forthrightly. Hiding problems will undermine the system. Leadership at Toyota utilised P-D-C-A. Toyota would say this is essentially the P-D-C-A management cycle they learned from Dr. Deming.

Chairman Cho of Toyota:
Three Keys to Lean Leadership
  • Go See - “Sr. Mgmt. must spend time on the plant floor.
  • Ask Why -  “Use the “Why?” technique daily.
  • Show Respect. “Respect your people.”

 Figure 2: Chairman of Toyota

In the early days of lean implementation, the leader should allowed to just try things, to make mistakes and learn from them. That’s the spirit that required in lean. “Continuous improvement comes from making mistakes and learning from them." “It is a mistake to suppose that men succeed through success; they much oftener succeed through failures. Precept, study, advice, and example could never have taught them so well as failure has done.”


Lean leadership is the key toward lean success. The leader need to define the clear purpose of lean and ensure the first project is the successful by giving full support and resources. Focus on measure should be established based on process and transformed the commitment in term coaching, education and respects.


The author would like to thank EFR Management, Malaysia Productivity Corporation, National Iranian Productivity Organization, Asia Productivity Organization, and management and staff of Hospital A, Hasheminijad Kidney Centre, Tehran, Moheb Hospital, Tehran  that provide the financial and resources support in this research.


Rother M and Shock J (1999), “Learning to See”, Lean Enterprise Institute

Graban (2008),  “Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction “, Productivity Press

Presented at - International Conference on Continuous Value Adding based on Lean Thinking in Hospital Management, Tehran, Iran,
30 Nov – 1 Dec 2011 

Edly Ramly ã2011 and

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