I hear this question frequently—most recently by someone in Turkey—about transforming an organization into a lean one.  It’s always worth learning from those who’ve gone before you, especially if it can avoid costly missteps.

For those new to lean and its brother, six sigma, lean is a concept that focuses on maximizing value by eliminating waste. Six sigma is a measurement of variation. It’s used to improve quality. Successful lean transformations are characterized by the performance improvements they create and their staying power. That is, lean becomes a way of doing business, not another program of the day.

There are two components of lean. One is the technical, or hard side of business; the formulas, measures and processes. The other is the cultural, or the soft side that includes issues related to leadership, communication and rewards.

The starting point?  Without equivocation, I advocate that the cultural side of the change effort must be addressed first.

In every situation where I’ve been asked to help “fix” a lean transformation gone bad, the problem had been created by addressing the hard side first–changing work processes or imposing new performance measures that no one understood.  Tools, techniques and work processes were implemented on top of a value system that was incompatible with lean.

Starting with leadership, communication and involvement issues takes time. But sometimes we have to go slow to go fast. Getting the cultural issues down right will cause the lean effort to skyrocket, once you marry up the technical and cultural sides and begin the integrated implementation.

100,000-300,000 is a wide range. So, let’s be conservative and call it 100,000.  Now, contrast that with the number of deaths that occur in all of U.S. industry per year—4,340 last year.

There’s nothing different about reducing employee injuries and deaths and patient injuries and deaths. The approach is identical. If you want different results, you need to change the system that’s causing the current results.

In the case of patient or employee deaths, two things need to change—the way work is done and the culture that establishes the underlying values of the organization. 

Thanks to Johns Hopkins physician Dr. Peter Pronovost and others, the simple surgical checklist during major operations has been found to lower the incidence of deaths and complications by more than one third. The checklist is usually a single page that requires only a few minutes to complete at three critical junctures of operative care: before anesthesia is administered, before skin incision, and before the patient is removed from the operating room.

Checklists aren’t new. Airline pilots have been using them for years. Checklists have been part of what’s often referred to as standard work in many industries for a long time. They work and they’re easy to make work because all you have to do is follow the list. What’s not easy is shifting the culture of an organization from one where the surgeon is the master of the operating room universe to one where all OR occupants work as a fluid team.  

This culture shift doesn’t start in the OR. It starts in the office of the CEO and it needs to include every leader in the hospital, whether it’s the chief of the medical staff, chief of surgery, chief resident or the “chief” of human resources.

Shifting the culture requires a re-clarification of roles and expectations of each person in the hospital. It means measurement, communication, learning and development, work processes, technology  and rewards and recognition all need to be focused laser-like on becoming and remaining a zero accident  institution and nothing less.  Checklists are part of the hard, technical aspect of change. Shifting the underlying values within a hospital or any other organization is the soft side of change.

But checklists are easy. Culture is hard.

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• Strong operational hydraulics
• Rewards for performance, not mediocrity
• Core values with teeth
• The right conversations
• Adventurous leaders in key positions
• Constant pressure versus heroic efforts

It uses a straightforward and useful checklist of questions you can ask yourself.

It started with a call from Jose, a business leader in Southern California  who’d learned of our work integrating the cultural and technical aspects of lean transformations. He wanted help launching lean six sigma with his leadership team and employees. Last week was my only available four day window–day out, day back, two days at the client site.

Jose loaded me up with emails covering every conceivable aspect of his company. Everything I needed to get up the learning curve on the long ride out.  

I used day one to get to know the leaders, conduct a few focus groups with employees and tour the operation. That plus the advance reading gave me what I needed to understand the climate and culture, performance opportunities and likely barriers to achieving them.    

For the next two days we plowed through change management fundamentals and then the advanced course: defining the future condition; identifying the requisite leadership roles and expectations; creating a plan to eliminate root causes of performance problems related to on-time delivery, quality and operating income; building the framework of a continuous improvement process; and prioritizing what work needs to stay on the plate and what must go. 

All in two days!

It worked because the leadership team was business-savvy, enthusiastic, used to doing hard work fast and, of course, (here comes the self-serving part) the content was exceptional.

The team has plenty to work on. We’ll check in at regular intervals for what Jose referred to as “sanity checks.” 

Good work, happy client, nice ride home. 

I had the pleasure of working with Tom Downs when he became chairman and CEO of Amtrak. Tom is brilliant, articulate, well-read, irreverent and has an infectious sense of humor. In his first meeting with his top 115 leaders, Tom admonished them: “If you remember nothing else from this meeting, remember these four words: “Always tell the truth.”

Telling the truth became the norm at Amtrak in those days. If there was ever doubt about how Amtrak officials were to respond to the news media, how a supervisor was to communicate to a conductor in the Northeast Corridor or how an employee was to relate to a colleague, people would ask: “What would Tom say?” and people would respond in unison, “Always tell the truth.”

Way more than enough has been written about the Tiger Woods episode of late, but it’s one more reminder that in good and bad times, always tell the truth and do it damned fast. There is little if anything to be gained by dragging out a response. If you’ve got to get the lawyers involved do it only with the PR people sitting with the lawyers as equals at the table. Decide fast and get on with it. Opportunity follows speed.