Blog #9 Organizational Transformation:People:Culture

This is the final segment in a nine post series on the core components of organizational transformation using lean.The topic is part of the rubric of People and is about organizational culture.


Corporate culture is difficult to define because it is so confusing most people steer away from writing about it. By culture I mean to describe a pattern of behavior that is widespread and ingrained in a particular group, until it is expected and sometimes codified. When people in healthcare talk about the culture of shame and blame, they refer to a common set of expectations in the medical field about how transgressions are – and are not — handled. Only recently have people in healthcare started to talk about the damage shame and blame has caused.

As disciplinary models go, shame and blame has a distinct advantage: it’s fast and easy. A cursory glance at a situation is all the evidence needed to decide on a culprit. And feeding the rumor mill with the guilty party’s name is infinitely easier than launching an investigation and then going through channels to issue an official reprimand. But shame and blame has a terrible price.

In that environment, there is no motivation to report errors or safety issues. If staff is blind to error and its cause, there is little hope for improvement. Lucian Leape recently published a set of recommendations for changes in medical education. (

In the report he describes the damage being done by our present apprenticeship education process for physicians in which the attending doctor berates, embarrasses, and belittles medical students in front of their peers. I believe this  builds distrust, anger and creates autocratic dictators that are unable to effectively work in a team environment. Lucian Leape comes to a similar conclusion in his paper.

How do we build a culture of improvement? It starts with the two pillars of lean which are continuous improvement and respect for people. In previous blogs we have discussed the methodology of continuous improvement. The continuous improvement methodology is very important because without it the next important pillar, that of respect for people is not possible.

Respect seems intuitive, but it is a complex idea, especially in the workplace. As a leader, to have respect for staff usually means giving lip service to peoples’ concerns, to say that you hold them all in high regard. This is often a polite lie.

Respect actually means wanting everyone on staff to have meaningful lives, and working actively  toward their fulfillment. As at Toyota, this is such a critical element of a lean healthcare organization that it is a foundational principle. In many ways, it is inseparable from continuous improvement, even though it is distinctly different.

People are not very different in their basic needs. Everyone wants to feel needed, to be an integral part of a team doing good work. Respect for people means helping everyone become integral to the larger team, to find fulfillment in their work through empowerment. By empowerment, we mean giving people the tools to become problem solvers and then creating the working conditions that applaud solving problems instead of sweeping them under the rug. Without a continuous improvement environment, people become frustrated because they do not have the tools or the permission to fix problems. A lean healthcare organization trains people in problem solving, then respects their opinions and experience enough to let them take the lead on improvement.  In this way, you can see how respect for people and continuous improvement intertwine to form the  bedrock foundation of lean healthcare.

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