KaiNexus CEO and co-founder Greg Jacobson joins host Mark Graban for the seventh episode of the Ask Us Anything series, the recurring session built around questions from webinar attendees. Most of this episode circles one hard problem: how do you change the way leaders behave? The conversation runs from getting a skeptical executive to take a first small step, to convincing a leadership team to do gemba walks, to why blaming people for mistakes quietly makes an organization less safe. It opens, though, with a question about whether Lean even applies outside steady, repetitive work.
Here is what the episode covers and the thinking behind each answer.
The episode opened with an attendee who had used Lean and Kaizen in manufacturing, where schedules and programs stay consistent, and doubted it would transfer to a big box retail environment with shifting employee schedules and changing daily activity. Greg recognized the worry from his own start in 2004. He had two emergency departments, more than 80 physicians, two separate buildings, and a clock that never stopped. The question then was the same: how do you connect everyone and keep the whole workforce at the improvement table when they are never in the same place at the same time? His answer was technology. A shared platform, reachable from a computer or a phone, brings people into a conversation they would otherwise miss, and it often sparks the face-to-face follow-up that would never have happened. A comment left on a night shift gets picked up by someone arriving early the next morning.
Mark widened it. The objection behind the question, that we do not have consistent demand or a repetitive product, misreads what Lean is. Toyota's high-volume, repetitive manufacturing is actually unusual. Plenty of manufacturers build custom, one-off products, and healthcare says every patient is unique. Lean is not about repetition. It is about engaging people, understanding the customer, and applying the principles to your setting rather than excusing yourself because you are not Toyota. The tactics look different in retail, healthcare, and professional services. The core principles do not change. And where demand genuinely cannot be level-loaded, you stagger staffing to match it, the way emergency departments stagger shift patterns.
A question asked how to shift the mindset of leaders whose values, management style, and communication habits clash with what Lean requires. Mark was direct: you cannot get an executive to change by telling them to change. Behavior change is learned by doing, not absorbed from a lecture, whether the behavior is reducing batch sizes or how a leader treats people. The better path is to expose leaders to peers who have made the shift, help them see what is possible, and coach them through small changes.
Greg offered three ideas. The first came from a college course on political discourse. The class spent half a semester arguing, and when the professor stopped them to ask whether anyone had changed their mind or even understood the other side, the answer was no. His instruction: listen, genuinely validate what the other person is saying, show that you understand it, and only then explain your own view. Walking up to a leader to explain how they should do their job goes nowhere. Asking about their principles and their problems, and validating them first, opens the door.
The second was the biology in Simon Sinek's "Leaders Eat Last." Cortisol and dopamine have their place, but an organization running on constant cortisol surges produces stressed people making poor decisions. Serotonin and oxytocin are the chemicals of trust, and trust is what makes people receptive to change. Understanding which environment a leader is operating in is itself useful insight.
The third was the smallest and most practical. Pitch a leader a three-year transformation with eighteen steps and their eyes glaze over. Ask instead for a small yes. Tell me about a problem, let us work on it, get one small win. Do not frame it as Lean or Six Sigma or a transformation. Frame it as solving a problem, and the leader is far more receptive.
An attendee asked how to convince a site leadership team of ten that daily gemba walks help employees, and that the walk is for the employees rather than for the managers. Mark reframed the request. A gemba walk, a leader going to where the work happens not to direct but to understand and build trust, is a countermeasure, not a best practice to be prescribed. So start with the problem it solves. Ask what happens when decisions are cooked up in a conference room. People will tell you: those solutions often miss, and that frustrates everyone. Once the problem is visible, the gemba walk makes sense, and you let leaders try one, reflect on how it went, and decide to try another. It is a progression, not a switch that flips.
Greg suggested an even smaller first step. Do not even call it a gemba walk. In a meeting about a problem, get people to stand up and go look at it. The reward, solving the problem in a way the room would never have produced, is what builds the habit. Do it a few times and the team will formalize it on its own.
Mark told the story behind the point, drawn from his book "Lean Hospitals." A hospital wanted better patient satisfaction scores, and nighttime noise was a known complaint. From the conference room, the CEO decided to carpet the patient unit hallways. Mark was on the unit when the maintenance crew arrived with a roll of carpet, and the nurse manager had no idea it was coming. There were good reasons carpet was a poor choice there. In the end, satisfaction did improve, but not because of the carpet. It improved because of small things the nurses and managers did themselves: closing doors, lowering TV volume at night, being mindful of hallway conversations. That is Kaizen, driven by the people doing the work, and it outperformed the top-down answer handed down from outside.
A short question asked how pointing fingers at employees for the team's mistakes affects morale. The short answer from both hosts: badly. Blaming people for what are usually systemic problems never helps. When something goes wrong, the productive question is what about the process allowed it, not who is at fault. Greg connected it back to the biology. Blame produces cortisol; treating the same event as a process problem produces serotonin, and it reframes the mistake as an opportunity for improvement sitting in plain sight.
Greg went further, because this is close to why he does this work. In a blame culture, the big failure that finally reaches a leader was usually preceded by dozens or hundreds of smaller signals. In healthcare these are near misses, and a blame culture teaches people to bury them, because surfacing one gets you in trouble. The result is not only a stressed workforce but a genuine safety risk.
Mark named the flip side: the belief that you can prevent problems by lecturing people to be careful. He had blogged that day about workplace safety posters, including a line of Simpsons-themed ones, and his point was simple. A sign telling people not to trip and fall does not stop people from tripping. Nobody would hang a sign in an operating room reminding surgeons to be careful. People in healthcare already know to wash their hands; when they do not, the cause is a systemic barrier, not a bad person. Greg added that a reminder is one thing, but if the culture will not correct an unsafe behavior in the moment, the sign is theater. Managing the situation is the work. Hanging the sign is not.
The last question asked whether there is a way to measure what a company invests in change management. Mark was honest that he did not have a clean answer. You could count training sessions, or the share of a rapid improvement event spent on change management rather than process observation, or how quickly a desired behavior takes hold. What the question is really after is the ROI of change management, and that, like the ROI of Lean or employee engagement, rarely reduces to a simple cost-benefit line.
Greg argued the case has face validity anyway. Consider a hospital moving from paper records to an electronic medical record. That is an expensive, top-down change, and doing the change management well or badly is the difference between a manageable transition and a painful one. When an organization commits to a strategic change, there is a body of knowledge that, applied well, makes it less painful. Mark's closing observation: people consistently underestimate how much change management a new program or project needs, focusing on identifying the problem and designing solutions while shortchanging the communication the change actually requires.
Ask Us Anything is a recurring series of short sessions answering questions from KaiNexus webinar attendees. It is hosted by Mark Graban, VP of Improvement and Innovation Services at KaiNexus, with Greg Jacobson, the company's CEO and co-founder.
See every episode in the series on the Ask Us Anything main page. Earlier episodes are also available on the KaiNexus YouTube channel and in the KaiNexus podcast archive.
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