Friday, 4 May 2012

Does going lean = going wrong

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relating to the application of the Vanguard Method in the Health and Care sector.


  1. Great post - It aligns with some misgivings I have about the evangelist approach to lean and other management techniques. See

  2. p.s. HMRC IS incompetent - FACT

  3. If you combine this thinking with the 'myth of general management' then the wrong-headedness becomes overwhelming.

    The myth (popularised by the leadership proselytizers) is that you can give some numptie a few months of high-numptie orienteering and then parachute him on top of a system he knows nothing about and expect good results. Truth is the numptie doesn't understand the system, won't display his ignorance by learning the purposeful work, so goes about fiddle-arsing with stuff from nuptie land upwards, until one of the high numpties scoops him up and drops him on the next poor buggers that he knows nothing about.

    Numpties can be spotted by their collection of management bibles all with numbers in the title and the fact that they can quote their MBTI wih no sense of irony or shame.

  4. I haven't met a person in busines yet (be it healthcare or whatever) that hasn't gained insight from the Lean philosophy.

    Does this mean they rush out an implement SMED, 5S, RCA, A3 problem solving, etc etc. Hopefully not. The tools are not the end. Does this mean they develop "eyes for waste", "respect for people" and a desire for continuous improvement. Hopefully - because in Lean the means and the ends are inseparable.

    And to say that the jury is out on quality improvement techniques is like saying the jury is out on climate change. No one argues with the underlying rationale - that THIS is good and THAT is bad - everyone argues whether or not we have to do something about it.

    If someone wants to bring the argument that there is a better, more effective, more systematic way of improving business then I'd be happy to challenge my own conceptions and validate the theories in practice to select the best option for the best context.

    But if someone wants to argue that we can simply continue as we are, using traditional business tools and concepts, then I'm afraid I'm going to assume they're speaking from ignorance and fear rather than a desire to learn.

  5. Hi Nick

    Sorry for the late response - I've just been directed here from my own expatiation on the issues with Lean in healthcare.

    Here is a description of a better, more effective, more systematic way of improving business.

    It's designed specifically with healthcare in mind, but there is no reason it would not work elsewhere.

    Please do let me know what you think

    Dr D J Brown

    1. Thanks Dr Brown. We use the Vanguard Method, a proven method based on systems thinking and intervention theory. Looking at your blog there are more points of departure than cross over between our respective approaches, although always hard to tell from the written word alone. This is our approach You can read more about the practical application here

      Thanks for taking the time to read the blog.


  6. This is a cogent criticism of lean when applied as a tools based methodology, but I would aim this at practitioners with an incomplete understanding of lean as opposed to lean itself.

    Having seen lean projects where variations in demand are overlooked or ignored, I know firsthand the issues likely to result from such an approach. It is possible, however, to integrate a complex demand model into a lean intervention without throwing out the core tenets of a phenomenally successful business approach.

    I think one should recognise strengths alongside weaknesses in a piece such as this - certainly a systems approach is not without its critics.

    Finally, it is disingenuous to cite Brook's JAMA article as evidence that lean has not worked in health care - his article is on the quality movement in health care, an approach which brings together better reporting, transparency, standards and practices, only one of which is directly reliant on lean (and even then only intermittently). This discredits what is otherwise a thought provoking article.

  7. The last paragraph says it all - the linkages to encourage relationship building need to be shown through transparent data relating to the whole care pathway - the hip fracture pathway and measures from time of injury to discharge to home are a very elegant way of doing this with a common purpose to return a functional patient to their home environment. Where the focus has been on the whole of care pathway the quality and efficient benefits are immense and sustainable.

  8. Agreed. And possibly even greater benefits may be had in understanding the pattern of demands and taking action to prevent a fall in the first place.

  9. I would love to see data that backs up the claim that standarisation of work is the greatest cause of failure demand.

    1. Have you tried to interact with the Inland Revenue recently? See also John Seddon on the panel here