Structure for Lean Implementation
Sensei is a Japanese term that refers to a teacher with a mastery of the dis-
cipline. ink of a sensei as a seasoned attending for the Lean discipline,
a person with deep and broad knowledge and deep personal experience.
Some have interpreted the term to mean, “One who has traveled the path
before.” is clearly is not the old house sta model of “See one, do one,
teach one.
As with any discipline, we learn from our teachers and the more gied
and experienced the teachers are, the more we can learn. Our teachers
give us foundational knowledge and they oversee our practice. Lean is no
dierent. Both the information transfer and the oversight are important.
Despite our enthusiasm for this book, other authors on Lean have stated,
A book is not a sensei” (Brenner and McKibben, 2011). Given this per-
spective, a question that leader ship needs to ask early in the Lean journey
is, “Do we need an outside person or group with extensive Lean knowledge
and experience to be our sensei and to guide our organization on our Lean
We answered “Yes” to that question as have other Lean pioneers in health-
care such as Virginia Mason Hospital and Medical Center, edaCare,
and Park Nicollet Health Services. Our consulting group’s knowledge and
experience as well as their externality gave them the ability to provide
meaningful guidance and constructive criticism, and to push us in ways
that might have been dicult for an internal person. Although this may
change over time as healthcare institutions adopt Lean, few in healthcare
now have had deep and long experience in leading Lean transformation
in their own organization to serve as a sensei. erefore, currently most
92 • e Lean Prescription
sensei have had their deep immersion in Lean through leading manu-
facturing companies on their Lean transformation. We consider several
characteristics that are detailed in Table6.1 worth considering in choos-
ing a Lean consultant group.
It is useful to know how many RIEs the sensei has actually conducted.
ose with decades of experience have said that aer personally par-
ticipating in 12 events you have only completed kindergarten and aer
100 events you become a convert to Lean; you may not yet be a sensei
(Koenigsaecker, 2013)! is is similar to the concept that it takes 10years
in the practice of a medical discipline to become a master clinician. Our
senseis role and time commitment evolved as we became more experi-
enced with Lean, much as the role of a seasoned attending is dierent for a
medical student than for a fellow or a junior faculty member. e senseis
initial primary duties were to teach our executives, facilitators, and our
Black Belts about the journey, the philosophical underpinnings, and the
tools in the Lean tool box, and to oversee the conduct of the TPOC, VSAs,
and RIEs. e senseis role evolved into directing the disciplined deliv-
ery; rigorous and consistent use of key Lean tools such as ow cells, takt
time, and visual management; driving the pace; directing the use of the
more advanced Lean eorts such as 3Ps; and more intense teaching of
the executive team and the individuals in the Lean systems improvement
department. Initially, our external sensei was only present for the two
RIE weeks/ month. is proved to be a limitation for our learning and our
pace; therefore, we moved to a weekly presence.
Characteristics to Consider in Choosing a Sensei or Lean Consultants
Sensei who have held senior leader ship position
Sensei who have led Lean transformation at an enterprise level
Sensei who have conducted over 100 rapid improvement events
Sensei who are excellent teachers in one- on- one coaching and mentoring, in small groups,
and in the classroom setting
Sensei who can work in a healthcare environment (ideally have healthcare experience)
Sensei who can cultivate trust and relationships at all levels from the executive team to the
frontline sta
Consultants who utilize sensei with these characteristics
Consultants who focus on Lean as a transformational journey, not just on the Lean tools

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