Mr. Seddon-

Yes, this IS an important issue. So I am struggling to understand why you would chime in with what you admit here is zero experience in healthcare. What do finance examples or Starbucks have to do with this discussion? Well, they highlight that Lean is sometimes misapplied (or misportrayed in the media). Your links don't prove that Lean doesn't work.

Your American colleague Tripp Babbitt said, in the other Quality Digest post, that I "lack evidence." Quite the contrary - there are many examples where Lean works well in healthcare - including publications in peer reviewed medical journals, like Health Affairs, where the bar for "proof" of Lean working is quite high. To those, like Tripp, who say that Lean might be "dangerous" for healthcare - you are the ones with no proof. What you are bringing to the table is your own anxiety, prejudice, and opinion. You are speaking with data or having a fact-based discussion on this issue.

Your one example from my blog is your speculation based on a gemba that neither of us has been to. You can jump to conclusions that they were doing it wrong, if you wish. You say "we see" but you have not been to the gemba. Mr. Ohno should have taught you about the importance of that, yes -- to go and see and to speak with facts?

You are incorrect (and insulting) to imply that all who practice and teach Lean are "toolheads" (again, your word). You, sir, are NOT the only one out there saying that Lean is about more than tools (although you may think you invented the notion or learned it directly from Taiichi Ohno in Japan, as you imply). What I *do* believe in is the universality of Toyota’s principles, philosophy, and management system (especially the parts based on the Deming approach). Again, you say hospitals are likely just applying tools - I believe that is incorrect and I'd like to know where you get your data.

The "debate" is clear:

1) I have evidence (and first hand experience) that Lean can work in healthcare. I can separate in my mind that Lean is sometimes misunderstood and implemented with a tools-only copy-first mindset. That doesn't invalidate Lean principles, as taught by Ohno and modern-day Toyota people.
2) You paint with a broad brush and smear all "Lean" people and you have no evidence to back your blanket claims that Lean never works or that Lean is "a wicked disease."

You are fear mongering and you're doing so in a very obviously self serving way (that the answer is Vanguard).

As I've told Tripp - if your method is that good, then please have at it. Hospitals need help. I'd never bash your methodology if you could prove that it works. Why you spend so much time bashing Lean is beyond me, except for that it seems to be your marketing strategy.

It's quite sad, in my opinion.

Tripp;
Every time that I try to read your responses to questions regarding Vanguard, etc., I find myself stumping a toe at your liberal use of the word 'thinking'- a use that is not accompanied by a solid definition within its context.

You say that Deming called for reinventing management, but what does that mean? Does that involve changing the manager's response to a situation or stimulus confronting the process? If so, then your argument is one supporting command and control: one that has managers promoting a predetermined, 'best' outcome of a process. Once applied across the culture of the organization, perhaps this becomes a new thinking which you are talking about.

However, until you define thinking in a more rigorous way, your arguments will continue to appear as repetitive 'cut & paste' text from someone else's sales brochure.

Best regards.

By the way, ThedaCare (in Wisconsin) is just one organization that is working to address ALL elements of the system (structure, work design, measures, technology, management thinking, etc.). Your post implies that you have a monopoly on this thinking and understanding...