“Lean Won’t Work Here… We’re Different!” Is That Really True?

By
Mark Graban
-
98
29

I'm sure anybody who has done any work with Lean has heard these words said in one form or another, often prefaced with a “You don't understand…”

We're different.

Diff'rent (it's fun to spell that way, like the old show I grew up with, Diff'rent Strokes).

The theme song:

“What might be right for you, might not be right for some…”

True, what's right for Toyota or some other hospital might not be perfectly right for you… but a lot of Lean is transferrable.

Mr. Drummond, from the show, was described as a “man of means.” The good news about Lean is that you don't need to have a lot of money to become Lean and to think a new Lean way.

Yes, you are different. Your organization is unique. Special even. But, Lean still applies.

I first heard the “we're different” expression when I started working at General Motors.

“We're different; we're not Japanese.”

This was the refrain until Toyota proved the Toyota Production System could work at NUMMI in California and TMMK in Georgetown, Kentucky.

I'll get to healthcare in a bit… considering the progress that's been made with Lean in so many different settings, to think that one automaker would think they are so different from Toyota is kind of shocking in hindsight, no?

“We're different; machining engine blocks is different than snapping together cars.”

When I worked at a GM engine plant, this was a rationale used to explain away why that Lean stuff (we couldn't call it “lean” – an effort to keep the UAW happy) couldn't work. Our new plant manager, trained at NUMMI, proved it could work, as it had previously at a GM transmission plant (although the engine people could say they were different than transmissions, but that was really splitting hairs).

So you aren't a car assembly plant in Japan. Lean doesn't apply?

“We're different; we don't build cars.”

That could be said in many companies like Boeing or Intel, where they aren't assembling cars, but Lean methods are applied.

Books like Lean Thinking and The Toyota Way helped generalize high-level Lean and Toyota principles that could be applied in different settings.

“We're different; product development (or sales or service) is more complex than manufacturing.”

People outside of the factory floor struggled to see how Lean could fit until there were success stories. I recently heard a story about a car dealership applying standardized work and job breakdown sheet concepts to the salespeople… they doubled their sales conversion rates.

“We're different, we don't build things.”

Or so said the people in credit card processing and software development until they figured out how to apply Lean principles. Cycle times fell, and quality improved.

And then… we get to healthcare. In the late 1990s, healthcare organizations realized that Lean thinking could help improve quality, patient flow, cost, employee morale, and a number of other important outcomes.

So this leads to the classic statement (still heard often today):

“We're different, we're taking care of people, not building cars.”

We have enough success stories from the early adopters to say, with a great deal of confidence that Lean CAN work in healthcare.

The same progression of “we're differents” can be seen in a hospital. Let's say the clinical laboratory is the starting point (a common one). Then, you get the following statements, which might be said in each and every department as Lean improvements march along. The evidence that it works in other departments isn't enough to sway others:

  • Microbiology: We're not the core lab, they are high volume and we run much more complex testing. We're different.
  • Blood Bank: We're not the core lab or micro; people could die if we make a mistake. We're different.
  • Pharmacy: We're not like the lab; that's like a factory. We're different.
  • Nursing (Telemetry): We actually touch patients here. Lean might work in ancillary departments. We're different.

Let's say you have success in reducing waste and engaging the staff in that first nursing unit. The chain continues:

  • Nursing (Med/Surg): We're different; we have a much greater variety of patients.
  • Nursing (ICU): We're different, our patients require much more attention and work, and they're much sicker. Lean can't work here.
  • Emergency: We're very complex; we can't predict who is going to come in. We're different.
  • Operating Rooms: We're different than the E.R.; we have such a variety of cases, Lean couldn't work here.

Then, beyond the hospital, primary care providers and areas will say “We're different….”

Dr. Sami Bahri, “The World's First Lean Dentist,” is different from a hospital. But he's managed to make Lean work for the benefit of his patients and staff (and his practice, as a business). He's different. But he made Lean work for him.

Dr. John Tebbetts and Dr. Mark Jewell are cosmetic surgeons who while being very different, have made Lean work — again to the benefit of their patients and their practices. They are different.

I've heard reports of Optometrists using Lean principles to double the throughput of their offices, and I had a veterinarian contact me the other day asking about Lean.

“We're different; we take care of animals — do you know how many different species come through our door?”

I wonder if they say that? So, yes, you're different. That just means you can't blindly copy the other departments or areas that are different. You have to figure out how it applies to your department. Your emergency department might be different than the one down the street — OK, great, now figure out how Lean methods apply to YOU and your setting.

Is “we're different” an excuse to not try Lean? Or is it the starting point for thinking and figuring out how Lean *does* apply? Lean in an operating room does NOT mean putting the operating room table on a moving conveyor belt that moves at a constant rate. But you can certainly find ways that Lean methods would help in an O.R. for patient, surgeon, staff, and hospital benefit.

Do Lean and TPS principles apply in pretty much every process?

Yes, I'd say so. Does that mean Lean is easy to put in place? Of course not. But that, along with being different, should be no reason to not try. Am I a Pollyanna who thinks Lean is a cure-all? No. But as I heard a physician in the UK say last week,

“I sure hope that Lean works… because I know of no other alternatives.”

Final thought – it's often said that “Lean doesn't succeed or fail… Lean is just a set of principles. What succeeds or fails is the organization or the leaders who try.” Lean success isn't guaranteed — it requires hard work and, yes, even a little creativity to figure out how Lean will work in your setting.

Because you're different.

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Mark Graban
Mark Graban
https://www.markgraban.com
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.

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29 COMMENTS

  1. Mark,
    great blog post. I enjoyed reading it.
    I'd call it a "we are different summary" :-)

    Kee up the good work.

    Best regards
    Jan

  3. John – thanks for the link. You're right, in your blog post, that you can't be too dogmatic in forcing lean on anybody.

    I meant to say in my post that I'm willing to accept "we're different" but is that an excuse not try lean? Or is it something that requires us to use our brains?

  4. Mark,

    Great Post! Something I have believed for a long time – Everything has a process, everything has a flow, the secret lies in seeing it. This works just about everywhere.

    As I like to tell people who say, "You don't understand, we're different." "Yes, I understand, you're different, just like everyone else…."

    Keep up the great work!

    Glenn Whitfield

  5. Excellent post, Mark. It seems the trick in our business is to acknowledge the differences in each area we work, but yet demonstrate why those differences will not prevent those in that area from improving continuously. That's why change management is a HUGE part of what we do, but may not receive the attention it deserves. Those who are successful recognize the need to address the "we're different" statement early in the process.

  6. Mark,

    I love your view on Lean.

    When I was in a Lean facilitator role a few years back, I kept a few battered index cards in my shirt pocket and wrote down all the reasons Lean wouldn't work–my own "We're different" list.

    Whenever I heard on of the reasons, I could pull out the list and say "That's reason 14."

    Then I'd tell them about someone else who had felt the same way and what they did to get past it. It always helped people to feel like they weren't alone, plus having the reason written down before they brought it up gave me credibility.

    Keep 'em coming!
    Jeff Hajek

  7. And I was thinking you had lost your 'edge' Mark since the move ;-)

    Excellent post, thanks for the reassurance we are not alone.

    Mike

  8. I worked for a maintenance repair and overhaul company who practiced lean in their own facilities. The government asked us to redesign their maintenance operations and of course we heard the same thing from the mechanics, "We aren't like you we do maintenance on large aircraft, not engines."

    We all know that Lean = reduce waste and add value for the end customer. Why wouldn't adding value or reducing waste work in any business or organization? When you say Lean isn't the cure all you mean that the tools utilized in most Lean activities do not apply across the board but reducing waste and adding value to the customer does apply across the board!

    There are many undiscovered "Lean" tools that will improve all types of business. Focus on improving and find them!

  9. Dan, what I meant by "Lean isn't the cure all" is that an organization has to have strategy and vision. I don't think Lean is a strategy in and of itself. Lean principles can help us focus on customer needs and focus on the long-term, but is that in and of itself a strategy?

  10. Every site manager I have ever met wanted me to understand how unique their company’s products were and how special and demanding its process was. But despite their entreaties, I shared with them that it wasn’t there uniqueness that was a problem, but rather it was there ordinariness. There was nothing special about being bogged down In the minutiae of LEAN while missing the big picture.

  11. I am employed in a self-op University Food Service Dept and we have been involved in Lean for a little over a year. We have already seen many areas of improvement. We have reduced waste & food costs and by involving our hourly staff have improved overall job satisfaction. They now feel their input is valued and it is! We were all skeptical when we first began to implement Lean but we're believers now!

  12. "What you talkin' bout, Graban?"
    Bad Diff'rent Strokes reference but an excellent blog entry.

    I today just met with some scientists and they kept going back to how different their process is…just sent this on to them. THANKS PDCA

  13. Twenty years ago (!!) the first of seven groups of Boeing executives spent two weeks visiting Japanese Deming Prize winners, including three days with Toyota. In the first couple of days, many kept saying “Airplanes are different.” And indeed they didn’t visit any airplane makers in Japan. But then one of them suggested that they were there to learn about world-class manufacturing, not to call out differences. And these executives agreed to pay a $20 fine for each time one of them said “Airplanes are different.” At the end of the trip those fines had raised over $300 for United Way, and those executives had learned a lot about world-class manufacturing.
    .-= Tom Robinson ´s last blog ..5 Necessary Actions for Organizational Change =-.

  15. You haven’t mentioned – “We’re different, we’re the government, we don’t make money, we just provide services to people and provide advice to the political leadership. They don’t really want efficiency (though they say they do) they just want nobody rocking the boat.”

  16. Mark, i find this article very insightful. I follow your thoughts in twitter and RSS. I would like to quote this part: “We’re different, machining engine blocks is different than snapping together cars.” When I worked at a GM engine plant, this was a rationale used to explain away why that Lean stuff (we couldn’t call it “lean” – effort to keep the UAW happy) couldn’t work, in our internal newsletter (in Indonesia). I will also put your credit in the article. If you mind, please let me know. Thanks, Mark.

  17. […] Robots…. turning us into a factory…. this sounds A LOT like what we always hear in healthcare. That’s not the case when Lean is successful in hospitals and it shouldn’t be the case at Starbucks either. We’re not trying to turn anyone into a factory – Lean isn’t all about moving assembly lines and “andon cords.” Everyone likes to say “we’re different,” as I recently wrote about here. […]

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