The Lean Prescription

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6

Structure for Lean Implementation

SENSEI GUIDANCE

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

transformation?”

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

sensei’s 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 sensei’s

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 sensei’s 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.

TABLE6.1

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