KaiNexus CEO and co-founder Greg Jacobson joins host Mark Graban for the sixth episode of the Ask Us Anything series, the recurring session built around questions from webinar attendees. This episode digs into one of the more useful and misunderstood ideas in Lean, the trade-off between flow efficiency and resource efficiency, and from there moves through the pitfalls that stall improvement programs even when leadership is on board, which roles actually spread a culture of improvement, how Lean and ergonomics fit together, and how to handle a flood of ideas without burning people out.
Here is what the episode covers and the thinking behind each answer.
An attendee asked how to find the balance between flow efficiency and resource efficiency. Mark drew the distinction clearly. Resource efficiency is about utilization, keeping every person and every machine as busy as possible. Most organizations have chased it for decades, pushed by cost accounting and by a management instinct that idle resources are wasted money. The trouble is that it is a false economy. Run a machine just to keep it busy and you build inventory, overproduction, defects, and wasted motion. Flow efficiency asks a different question: how smoothly are products, or patients, moving through the whole process?
As an industrial engineer, Mark pointed to queuing theory. Insist on resources running at 100 percent, or even 90 percent, and flow nearly grinds to a halt. Lean leans toward flow. Sometimes the best thing for flow is to carry some slack, capacity that sits idle until it is needed, and that unsettles people, because an idle machine or an idle person is easy to see while bad flow is not.
Greg made it concrete with the emergency department, where patients cannot be scheduled. Staff up heavily and people sit idle until an unexpected surge arrives. His first point: this is exactly where a frontline manager's habits matter. A lull is the moment to go to the idea board, open the improvement system, and work through the team's ideas, not to send people home. Mark added the contrast directly. Chase hourly labor productivity, send people home in a slow stretch, and you will be scrambling to call them back when demand spikes. Toyota does not send people home when the line stops. It uses the time for improvement, training, and problem solving. That is not wasted money. It is invested time.
Greg closed with a principle from one of his mentors: err in the way that makes the patient suffer least. Decide based on the mission. An emergency department does not want a patient having a heart attack waiting in the lobby, so it errs toward carrying capacity. Mark offered the cleanest analogy. Nobody expects a fire department to be fighting fires every minute of the day. Call it surge capacity, flex capacity, or just capacity. There is more to running a good operation than keeping everything fully utilized.
Another question assumed proper support from upper management and asked what still goes wrong. Mark's answer: a program lives or dies on the habits and behaviors of frontline managers. Executive support is necessary but not sufficient. You need aligned support at every level, and the question works in any direction. A program with strong frontline managers can still stall if executives quietly fail to back it.
Greg added a useful frame. Improvement work splits into top-down work and bottom-up work. The organizations that succeed at everyday, everyone-improves continuous improvement keep the bottom-up work as simple as possible, because simplicity is what makes frontline participation likely. The harder challenge is balancing that simplicity against the genuinely complex top-down work an organization also has to manage. His blunt summary: keep it simple.
Asked which roles are most critical to spreading a culture of continuous improvement, Greg's answer was every role, and he meant it literally. Frontline staff understand the strategy and put ideas forward. Middle managers build a daily habit of problem solving and enabling. The improvement team keeps middle managers educated and clear on the path. Senior leaders set the direction. Like a sports team, the culture only works if everyone plays their position.
Mark used the question to correct a common misunderstanding about the continuous improvement department. Its job is not to generate all the ideas and do all the improvement. Its job is to teach methods, coach people, and help track results. That is education and administration, not execution. The trap is being pulled in to fix a problem for a team rather than to coach the team to fix it themselves. Greg described a customer whose engagement numbers are exceptional, and noted that the leader behind them spends very little time doing improvement work directly. She spends it coaching and, in a phrase Greg attributes to former Toyota leader Gary Convis, adding energy to the system.
That raised a practical question from Mark: how do you measure engagement? Greg pointed to the reporting KaiNexus provides, improvements per person on an annualized basis, where the strongest organizations run well above ten, and the share of people actively using the system by submitting ideas, joining teams, or commenting. Broken down by department and location, those numbers tell a coaching leader exactly where to go add energy next.
An industrial engineer asked a sharp question. Lean can cut ergonomic risk or raise it. Better tool storage removes awkward reaching, but eliminating wasteful walking also removes a natural break from standing in one place. How do the two fit together? Mark, who trained in ergonomics early in his manufacturing career, sees Lean generally helping. Traditional jobs are often fixed in one static posture. Lean environments tend to bring job rotation and cellular layouts, so people move and stay active without overexerting. In healthcare, he was skeptical of treating workplace walking as exercise. Shuffling around a unit tires people out without raising a heart rate.
Greg took the underlying idea head on. The question recognizes that waste can have a positive side effect. In his world, the inefficiency of an emergency department can mean a doctor gets to observe a patient with abdominal pain over time, which is genuinely useful. But a positive side effect is not a reason to keep the waste. The better answer is to remove the inefficiency and design in what you actually want. A deliberate five-minute movement break each hour beats relying on a broken process to make people move, and real exercise does more for a person than either.
Mark extended it to patients. Not all motion is bad, and not all time a patient spends waiting is bad. There is intentional, value-added waiting and there is preventable delay. He cited Alan Wilson, a Scottish advisor to KaiNexus, on the one case where sitting inventory adds value: wine and whiskey, because the time is transforming the product. Waiting to see how a patient responds to a medication is value-added in the same way. Pushing a patient out early just to hit a length-of-stay metric is not improvement. It violates the principle of erring toward less patient suffering.
A lighter question asked whether Lean principles apply to a job search. Mark's instinct was visual management. Treat applying, interviewing, and getting hired as a value stream, and run it on a personal kanban, sticky notes on a wall or a tool like Trello. It works like a sales funnel, with leads and opportunities, and the visual board keeps follow-ups from slipping. Greg added the improvement habit. After every interview, reflect on what went well and what to do differently next time, and treat your resume as a living document rather than a finished one. The job search becomes a series of fast learning cycles.
A healthcare attendee asked how to help people manage all the activity early on, when ideas pour in, without causing change fatigue. Mark pushed back gently on the framing. Change fatigue is real, because change is usually imposed on people and the lack of control is exhausting. Improvement fatigue, though, he has not seen. He pointed to Franciscan St. Francis Health in Indianapolis, where his "Healthcare Kaizen" co-author Joe Swartz works, an organization that had implemented some 27,000 improvements since 2007. Talk to the staff there and nobody is fatigued, because the ideas are theirs, solving problems that matter to them. The reframe: shift from change done to people to improvement done by them.
Greg's answer was about reducing complexity. Managing all of that information is a core reason organizations adopt a purpose-built improvement platform, and KaiNexus was built for exactly that. Short of that, do it collaboratively, transparently, and as simply as possible. Mark closed with a connection back to the flow discussion. When ideas flood in, do not route them all through one manager or one coordinator for implementation. That is resource utilization at 100 percent, and it creates the bottleneck. Spread the improvement work across everyone.
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.
See how KaiNexus helps organizations capture ideas, coach improvement, and connect daily work to strategy. https://www.kainexus.com/continuous-improvement-software/kainexus/kainexus-demo-overview
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