How NOT to Implement Lean – Thanks for the Lesson, Grey’s Anatomy

There are right ways and wrong ways to implement lean at a company.  True lean improvements have a benefit for the business, the customer, and the employees.  If you only focus on a single area to create benefit in, there’s a good chance that you will alienate the other two.  If you make it a perfect world for employees, you may not make any money.  If the customer is put on too high of a pedestal, you also might not make any money.  But if you only work to maximize how much money you bring in, there’s a good chance customers and employees alike will seek to go elsewhere.

Grey's 2A recent episode (aired 1/31 – “Bad Blood”) of Grey’s Anatomy features an “efficiency expert” who is essentially in charge of making the hospital run much, much more efficiently and cheaper because they are out of money because several of their doctors sued the hospital for negligence for flying them on a cheap airline where several of them were severely injured and several more died.  Following me so far?  Great.

The opening scenes caused my lean implementation radar to scream “No!  Wrong thinking!  Why would you do it this way!”  At least they weren’t calling it “lean”.  But in the first few minutes, the efficiency expert told them all they would be following new equipment storage standards to reduce their surgery changeover time, and an “eye in the sky” security system with a doctor behind it would be monitoring everyone and making improvement suggestions in real time.

Grey's 1Later on in the show, a guest is in the hospital teaching everyone his standard method of closing an incision, and that it would be the new standard that everyone throughout the Seattle Grace hospital system would be required to perform in order to help cut their surgery time in half.

I’ll give you just a few seconds to guess what the reaction of the employees in both scenes was from being dictated how they were going to operate from this point forward.  Rebellious, frustrated, not on board, rolling their eyes, combative… the list goes on!  So, what could they have done differently to implement their “efficiency programs” with more buy-in from their employees?

A really simple answer is, involve them in the problem solving and the solution.  There is great power when employees have ownership of both the problems and the solutions.  If employees and management are both aligned at the outset to the question of “what problem are we trying to solve”, and then both work together to develop solutions, implement them, and study the results, then adoption of the countermeasures across the company / hospital would happen much faster.  (it’s never that easy, of course – but better than not doing it together!)  So really, it is all about involving everyone in PDCA (or PDSA), and not just specialists.

Now, if you watch the show, you’ll counter with “Well, they are under a serious budget crunch, the hospital is going to run out of money and close down in a matter of weeks, and they have to make these drastic changes quickly in order to help everyone keep their jobs, so they don’t have time to involve the employees and do a proper job.”  And I might agree, say that’s true, but then I’ll counter with, “If they had only been using lean thinking all these years, their standards for approving private airlines may have caught a potential risk situation early on and prevented all the chaos, or they might have already made a lot of efficiency improvements that would have made them a profitable hospital in the first place.”

Are you going to wait until a crisis happens to implement or adopt lean thinking at your company?  Or are you going to implement it so that you avoid ever getting into a crisis in the first place?


  1. Mark Graban says:

    I haven’t watched all of these episodes in question, but my wife told me about them. I’m glad that the word “Lean” (as far as I know) was NEVER uttered on the show… is that correct?

    But you’re right, that top-down efficiency expert act is old, ineffective, and worn out. It’s a cautionary tale for those who would try to “implement Lean” in that style.

    • Patrick says:

      Mark, I don’t recall hearing the word “Lean” mentioned at all (thank goodness!) I think that would have stuck out in my mind.

      There was a scene I didn’t mention where the doctors were pushing back against the concept of simply focusing on how much time was spent with each patient, and asking what about spending time with the patient, getting to know their history, providing quality of care. The person teaching them their new, efficient surgical method eventually got frustrated and shouted “It’s not about the patients!” He backtracked, but it was clear they were solely about cutting costs and increasing throughput.

      Can you imagine a lean consultant shouting out “It’s not about the customers!” ?

      • Mark Graban says:

        The little bit I saw showed the doctors being forced to LIMIT their time with patients, as if it were a fixed quota or target. That’s not Lean either, but I could see somebody setting a mandate in the name of Lean, but that’s L.A.M.E. not Lean.

        “It’s not about the customers/patients!” should be a fireable offense and I’m not big into leaping to fire people.

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