Note: This blog post is adapted from the email newsletter of Dan Jones, a leading voice in the global Lean movement and the co-author of the seminal book "Lean Thinking." Dan is the founder of the UK-based Lean Enterprise Academy. This is reprinted with his permission. Click here to sign up for his newsletter.

Lean is about helping organizations and individuals learn to do things they could not previously do, in order to meet the business challenges they face. The more problems they learn to solve, the better they get at problem solving. This, in turn, triggers a virtuous circle of never-ending improvement. The common ingredient of a lean transformation is engaging everyone, not just a few experts, in this activity of learning. It is not the specific solutions they come up with, because these will always depend on the specific situation. The leadership challenge is to trigger and support the conditions that enable this accelerated learning to take place. In my travels, I came across two very different examples of how leaders are doing just that. 

One of the most inspiring is the 433-bed public hospital Consorci Santiari del Garraf, located just outside Barcelona in Spain. Walking around this hospital, I was struck by the enthusiasm of the doctors and nurses describing the many problems they had solved and how this had made things so much better for them and their patients. It was also clear they are on a roll and are very actively supported by the CEO and the senior nurse. Nothing is going to stop them finding and solving the next set of problems. They had not only closed their original 20% budget shortfall, but had just been awarded the prize for the best-managed hospital in Spain. The full story is told in two articles on Planet Lean, which I urge you to read, A Healing Organization and My Lean Story #3.

What is telling about this example is not lots of perfect visual management boards or extensive lean training, but the engagement and enthusiasm of the staff. This is no accident, but the result of working with a very experienced mentor (who leads our Spanish Instituto Lean Management) who was able to keep asking the right questions to challenge teams to diagnose their situation and find their own answers and teaching them to stabilize their work to create a baseline for making improvements using PDCA. It is a great example of an experienced Sensei (trained directly by one of the best Toyota Senseis) working with a hands-on leader at every stage to create the front-line capabilities that ultimately drive accelerating and sustained improvement. 

After a decade of lean in healthcare it is striking that there are, in my opinion, only two whole hospital examples, namely ThedaCare and Virginia Mason, in the USA. Virginia Mason made numerous study trips to Japan and both of these pioneers had extensive outside consulting support and strong determined leaders.

Again, strong hands-on leadership and clear focus better leverages and links all the improvement activities together. What is also striking is their engagement of front-line staff and patients who understand the flows of work in designing several new hospitals, using the "3P" process. The net result is a new hospital with a much smaller footprint and lower capital cost, as well as significantly reduced running costs over the life of the building. What makes this 3P exercise so significant is that it is not led by outside experts; indeed, the architects and contractors are only allowed to observe until the front-line staff and patients have completed their mock-ups of the overall layout around the workflows and the room layouts. This 3P process is now being used in redesigning the delivery of all kinds of services.

Here we have two very different approaches to developing capabilities in very different circumstances. Lots to learn from both of them. We will be discussing these examples at the UK Lean Summit in Kenilworth on 18-19 November, join us there.