(Note- Q&A was edited out of the recording) The Michigan Lean Consortium presented a free webinar with Mark Graban of the Lean Enterprise Institute on April 7. Author of the Shingo Prize-winning book “Lean Hospitals: Improving Quality, Patient Safety and Employee Satisfaction,” Graban will be speaking on the topic of “Leadership presence on the front line: A critical success factor for Michigan’s regrowth.” Graban will discuss how leadership presence on the front line can and should be done in order to improve business and employee morale. He will show how a leader can be productive while on the front line and what happens in between doing these “walks” with the information gleaned from the employees. Graban will also share his experiences on the importance of these walks to the culture of an organization and how they encourage effective problem solving and a no-blame environment. All of this can help in Michigan’s regrowth in securing existing businesses and attracting new ones. Prior to joining LEI, Graban was most recently a senior consultant for ValuMetrix Services, a part of Johnson & Johnson. In that role, Graban served as a consultant to many health care organizations across North America and in the United Kingdom. He taught and led teams of hospital personnel and leaders involved in multi-month lean transformation engagements in departments including laboratory, radiology, primary care and nursing settings. Before moving into health care, Graban worked in manufacturing for 10 years with companies including General Motors, Dell and Honeywell. Graban is also a popular blogger and has created almost 100 podcasts with lean leaders from different industries. Graban has a B.S. in industrial engineering from Northwestern University and an M.S. in mechanical engineering and an M.B.A. from the Massachusetts Institute of Technology’s Leaders for Global Operations Program. He was raised in Livonia, Mich. The mission of the MLC is to offer a diverse network of knowledgeable lean professionals who come together to share innovative practices. The organization aims to create a lean culture in Michigan to ensure sustainable competitive advantage, which could translate into healthier businesses that offer more job opportunities leading to economic growth in the state. The charter members of the MLC include: Amway, Blue Cross Blue Shield of Michigan, DTE Energy, Johnson & Johnson, The Lean Learning Center, Northwestern Michigan College, the Pawley Learning Institute at Oakland University and the Michigan Shingo Prize through The Right Place. About the Lean Enterprise Institute (www.lean.org) Lean Enterprise Institute, Inc. (LEI) is a nonprofit education, publishing, conference, and research organization founded by James Womack, Ph.D. in 1997 to promote and advance the principles of lean thinking in every aspect of business and across a wide range of industries. Through its publications, summits, conference

1. “Leadership presence on the front line: a
critical success factor for Michigan’s regrowth”
Mark Graban
Senior Fellow, Lean Enterprise Institute
Author, “Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction”

2. Agenda
• Transferring Lean from Automotive to Healthcare, etc.
• Focus on the Front Line
• Lean and “Respect for People”
• Gemba Walk Guidelines
• Engaging Staff in Continuous Improvement
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3. ?
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4. 4

5. Lean is Fundamentally About:
People doing People facing People managing
work problems other people
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6. “Gemba”: The Actual Place
“Toyota managers
should be sufficiently
engaged on the
factory floor that they
have to wash their
hands at least
three times a day.”
Taiichi Ohno
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7. “Gemba is for Everyone”
“…Kaplan tours the
hospital daily looking
for problems and
solutions. Everyone is
encouraged to look for
changes to make work
more efficient.”
- Virginia Mason CEO Gary Kaplan
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8. Patients
(Gemba)
Walkway over
tracks
Parking
Garage
Executive
Offices
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9. “Convis became the first
North American to head a
Toyota manufacturing plant
when he was put in charge
of the Georgetown facility.
He responded to the
promotion by moving his
office from the admin
building adjacent to the
Georgetown plant to the
center of the factory floor.”
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10. Toyota’s Chairman
Fujio Cho
Three Keys to Lean Leadership
• Go See
– “Senior Management must
spend time on the front lines.”
• Ask Why
– “Use the “Why?” technique daily.”
• Show Respect
– “Respect your people.”
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11. “Equally Important Pillars”
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12. It’s The System
“You respect people, you “Human error is
listen to them, you inevitable. We can
work together. You never eliminate it.” We
don’t blame them. can eliminate problems
Maybe the process was in the system that make
not set up well, so it it more likely to
was easy to make a happen.”
mistake.”
– Gary Convis, President TMMK – Liam Donaldson, WHO World
Health Alliance for Patient
safety
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13. “I’ve worked here for
six years and this is
the first time
anyone has asked me
what I think about
anything.”
Registered Nurse
15 yrs experience
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14. ThedaCare’s Lean Leader Traits
• For ThedaCare’s “steady state”
– Patient
– Inquisitive
– Keenly interested in problem solving
– Good communicator
– Mentor who likes to see people success and
wants to be in the middle of the action, not
behind a desk
– Calm, deliberative problem solver
• Source: On the Mend (2010, Lean Enterprise Institute)
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15. Lack of Lean Leadership
“This [lean] is not the
standard model executive
being produced by U.S
business schools, much
less American medical
schools.”
– Toussaint and Gerard, On the Mend
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16. What Gemba Walks are NOT
• NOT “Management By Walking Around” (MBWA)
• NOT “Undercover Boss”
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17. Gemba Walk Guidelines
• Carve out time, stick to it
• Regular schedule / rotation
• Have a “theme,” not a
random walk
• Walk with an employee
• Ask questions
• “It’s OK, I have the time”
(Studer)
• Share what you learned
• Learn by doing www.wiilean.com
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18. A Gap in Understanding
• Meetings
• Reports
• Conference
Rooms
Go To
Gemba
• “Gemba”
© 2009 Ortho-Clinical Diagnostics 18

19. Henry Ford - 1922
“In the ordinary hospital the nurses must make useless
steps. More of their time is spent in walking than in
caring for the patient.”
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20. “No Problems is a Problem”
• Examples:
• Nursing software problem
• Lack of thermometers
• Carpeted hallways
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21. Tracking Gemba Walks
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22. ThedaCare Leadership Example
• “If a unit is struggling,
I’m there to help them.
And it doesn’t mean that
unit is doing a bad job.
With our standard work
routines, nobody is
alarmed to see the V.P.
on the floor anymore.”
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23. Daily Improvement
• Lean improvement is not a
bureaucratic process
1. Associate has an idea
2. Talks with team leader
3. Experiments with idea
4. If idea works, standardize it and
share the idea with others
• Focused on improvement,
not # of ideas or $$
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24. Employee Ideas
Why a locked box?
Sources: Creating a Lean Culture, Mann
Lean Hospitals, Graban 24

25. Dealing with “Bad” Ideas
• “Treat each idea as a gift”
– Norman Bodek
• If an idea seems impractical:
– Make sure there is a clearly
defined problem statement
– Creativity over capital?
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26. Documenting Improvements
• “Kaizen Wall of Fame”
• A method for:
– Documenting changes
– Celebrating improvement
– Sharing ideas across
departments
Hard copy blank
templates

27. Livonia Before & After
Before After
• Corner Office & Meetings • More time at Gemba
• “Urgency & Intensity” • Systems & Process
• Workers are the problem • Management is the problem
• Yelling and screaming • Listening
• Being the boss • Building Trust
• “Worst of the worst” • Top quartile
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28. Data From
Children’s Medical Center Dallas
Before Lean 12 Months After
Starting Lean
3. I have the opportunity to do what I do 3.11 3.92
best every day.
8. I feel free to make suggestions for 2.84 3.48
improvement.
10. I feel secure in my job. 2.32 3.42
13. Stress at work is manageable. 2.43 3.23
17. I am satisfied with the lab as a place to 2.51 3.43
work.
18. I would recommend my work area as a 2.38 3.46
good place to work to others.
Grand Average 2.96 3.69

29. Leadership’s New Habits
• Help define the problem to be solved instead of
jumping to solutions
• Ask questions instead of providing answers
• Think of problems as golden nuggets
instead opportunities to blame
• Teach subordinates how
to solve problems
• Mentor subordinates
• Be Humble
From John Toussaint, M.D.

30. ThedaCare’s Results
• True North:
– Customer Satisfaction, Safety/Quality,
People, Financial Stewardship
• Saved $27M in first four years
• Increased margin from 2% to 6%
• Improved “door-to-balloon” time 92 min to 37 min
• Lower cardiac surgery mortality
• Fewer babies born pre-term
• Higher staff satisfaction
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31. Contact Info
• Email:
– mgraban@lean.org
• Lean Enterprise Institute:
– www.lean.org
• Healthcare Value Leaders:
– www.healthcarevalueleaders.org
• Blog:
– www.leanblog.org
• Twitter:
– www.twitter.com/LeanBlog
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32. About LEI
• Lean Enterprise Institute, Inc. (LEI) is a nonprofit
education, publishing, conference, and research
organization founded by James Womack, Ph.D. in 1997
to promote and advance the principles of lean thinking in
every aspect of business and across a wide range of
industries.
• Through its publications, summits, conferences,
workshops, webinars, online forums, and website
resources, LEI helps organizations transform themselves
into lean enterprises, based on the principles of the
Toyota Business System.
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