is is a book I feel privileged and honored to write, as it would have been hard to imagine my
career would bring me into healthcare after a decade of working in the manufacturing world.
My undergraduate education was in industrial engineering, which was always focused on fac-
tory production and business issues. In some eerie foreshadowing, my senior group project at
Northwestern University was done at a local blood banking and distribution operation, something
that seemed like a poor fit for a “manufacturing guy” at the time. Little did I know I would run
across blood banks again about 10 years down the road.
After growing up near Detroit, Michigan, I was somewhat skeptical of career paths in the
automotive industry, but I took a job with a General Motors (GM) plant that said (during college
recruiting) it managed under the Deming philosophy. at was a real attraction for me, as I had
been exposed to Dr. W. Edwards Deming by my father, and I might have been the only college
kid to read Deming’s Out of the Crisis over a winter vacation for fun. Unfortunately (and ironi-
cally), the Deming philosophy was really just a sign hanging on the wall, as the plant management
operated under the very traditional auto industry management approach—far from Toyota ideals
(which were influenced heavily by Deming).
So there I was, a 21-year-old engineer, working in an environment in which managers yelled
and intimidated; employees were not listened to, being the source of the problems (being lazy
or careless) in the eyes of management. I was first introduced to the phrase check your brain at
the door,as many workers claimed to have been literally told this. Most employees cared about
quality and had pride in their work building premium Cadillac engines, but management wanted
them to keep the line running at all costs. Production trumped quality, and both suffered under
that system.
From this experience, I learned that the problems at the plant were not the fault of the work-
ers; it was a management system problem. It was not even that the individual managers were bad
people; it was the system they were taught and the expectations they were given. Seeing so many
disgruntled employees created a deep empathy in me for those who are mistreated in the work-
place, any workplace. Our results in quality, cost, and productivity were lousy, and nobody was
sure if our plant had much more than a few years left to live. is old way of managing was not
doing much good.
While I had learned about Toyota and Deming in college, I learned firsthand from some
incredible mentors I had at GM. ese experts took me under their wing and used the plant,
full of its problems and waste, as a teaching opportunity. We observed the process and talked to
the people. My mentors talked about how things should be, and we tried implementing small
improvements, but the overall environment was still pretty unwelcoming to any major change.

Get Lean Hospitals, 2nd Edition now with O’Reilly online learning.

O’Reilly members experience live online training, plus books, videos, and digital content from 200+ publishers.