Last month an opinion piece was published in the prestigious New England Journal of Medicine decrying lean or ‘medical Taylorism’ and arguing that amongst other things that approaches used to standardise care have gone too far, and it is time to remember the patient, and the perennial favourite reason of ’we don’t make cars…’.
Needless to say, in the lean community, there was a bit of a to do! (see Mark Graban’s fab thread and comments here). Not only was it perceived that the authors were incorrect to say this as the criticisms are surely about ‘fake lean’ not ‘real lean’, but also that they compared lean and Taylorism to be the same thing. Ouch! How to hit the lean raw nerves! Though there are plenty of things to learn from Taylorism.
Now this might be a controversial opinion too…but some of the criticisms in the article of lean (in this case in US healthcare) are surely familiar to most of us in the lean community? They are not new, and whilst some of the statements in the article may be inaccurate, if we are all truly honest I doubt that any of us have NEVER accidently fallen into the trap of some of them. Maybe it happens whilst we were learning our practice or at times of immense pressure – we are all human after all. (At least, I hope it is not just me!). I believe it is time to be more reflective and honest about when and why ‘fake’ lean practice sometimes happens, either unintentionally or intentionally because then, we can think about what we can learn from that, and what we can do to change the situation.
So, taking a deep breath, here are my five ways of not being lean. These are my reasons (excuses?) for unfortunately practicing ‘fake lean‘, from my experience in both industry and healthcare… Needless to say, there are probably a load of other reasons too…maybe I’m not brave enough to own up to all of them yet.
Wanting to be the Expert / Lack of Humility
As a graduate industrial engineer….I thought I was special and very knowledgeable ‘a lean expert’, I have a degree in this for goodness sake. I thought with all the exuberance of youth that being lean would be easy. I thought hey I can apply these principles that I have learnt about lean production in automotive in the process sector, no bother, it will be easy.
It wasn’t, the context is hugely different, different production processes, different cultures and different products. As ‘an expert’, it is easy and arrogant to think, I have seen this type of problem before, and I remember the solution from that and go and implement it, then I’ll save a load of time and bother. It requires much more effort and humility, to listen, observe and talk to those who do the working or ask for help.
Money, Money, Money
If lean is a way to improve quality, remove waste, add value and ensure respect for people and society, why in business cases and sales pitches does the ‘return on investment’ and just how much money can be saved through lean always seem to be the main emphasis? Often closely followed by a long list of all the ‘lean tools’ that will be taught. On reflection, I think perhaps it is fair that an organisation might think that lean is about money and tools, if that is how lean is ‘sold’ to them, particularly if gain-share contracts or similar are involved. That lean is often perceived as a money saving tool is arguably a product of our own making.
Sticking to objectives / Silo Working
Understanding the history of the organisation and why they are in the position, and how that came about, to me has become critical. Once, I worked in a factory implementing a number of lean cells with huge improvements in inventory and lead-time reduction leading to improved cash flow, improved workforce morale as expected. However, the financial position of the business was so precarious, the factory still closed, partly due to the financial impact of the inventory reduction activity. A more careful understanding of the wider picture may have developed a more nuanced plan and been more respectful and careful about managing expectations with employees.
Further, few organisations I have worked with have not tried some variant of lean or similar (six sigma, lean six sigma, IHI-QI, agile, TQM, CQI, TPM, TOC, BPR, BPM, LiA etc etc). For me now, understanding the story of previous attempts to use progressive management practices, is critical to developing new ways of working and change in that organisation. In addition, I find it now vital to understand the wider commercial and regulatory environment, as well as customer needs and notice if this is changing, to allow adaptation in improvement solutions and improvement/management system if needed. For certain, I never used to take enough notice of this….maybe I still don’t take enough notice.
Lack of Courage
Sometimes, in my experience, it is hard to gain traction or commitment for a change in working practice, for so many reasons. Often it is worthwhile to enquire more into the source of this problem. Sometimes, it is easier to back away from this challenge and do something else, and rarely positions are just entrenched. Sometimes, it is easier to ‘just do something’ that you know is not in keeping with lean principles, because of the pressure to act and to be seen to do something. Sometimes cutting corners is enough, reducing the fidelity of lean practice (watch that pressure to make an A3 easier to fill in and reduce ‘the paperwork’).
Sometimes, these things might happen to just keep face, to continue to be accepted by the organisation, or even wanting to keep your job and not be seen as a troublemaker or lose a trusted advisor role. Many of us do not have the financial security or position of being able to walk away from a role or contract and accept some of the compromises. This is the art of being able to ‘rock the boat and stay in it’. Sometime, I’ve also ‘rocked the boat’ too much, and fell out of it too, this I find, is as hard to live with, as rocking it too little.
Taking comfort in the Status Quo
One of the great strengths of lean is the development of standard work and having the self-discipline to stick to it, because it has been tested to be the best known way of working. Thing is, it doesn’t really stay the best known way of working for long. Sometimes, not too often I hope, I have found it easier to keep working with improvement teams and clients encouraging them to improve in the way that I have always done, than find the time to change myself and my standard work, leading me down a route of outdated practice and that no longer fits the local working environment and context.
So, five areas of practice that could be interpreted as ‘fake lean’ and reduce my credibiltiy as a lean practitioner. My view, I am always learning and I need to reflect on when these things happen, to recognise the patterns and think about how to act differently the next time those situations may occur or are occurring so I can maybe change the outcome for the better.
On reflection though, there is an air of familiarity to these reasons/excuses. Are not these just the kinds of problems that organisations we work with typically have too? So, what are the processes we use to help them with these problems, and how as a lean community are we going to use them to improve what we do? How are we going to stop not being lean and reduce the prevalence of ‘fake lean’?