KaiNexus CEO and co-founder Greg Jacobson joins host Mark Graban for the fifteenth episode of the Ask Us Anything series, the recurring session built around questions from webinar attendees. The questions this time cluster around a tension that shows up in almost every Lean rollout: organizations want continuous improvement, but the way they actually run improvement work, as projects, as mandates, as scoped initiatives, sometimes works against the culture they say they want. The conversation covers Lean for patient experience, how to move from a project-only approach to frontline-driven improvement, how distributed teams can run effective daily huddles, and what to do when a process map surfaces non-compliance that management would rather leave out of scope.
Here is what the episode covers and the thinking behind each answer.
A reader named Jeffrey asked for examples of Lean used to improve patient experience, not just to improve flow or reduce waiting time. Greg's first reaction was that those things are patient experience, but he took the question on its own terms. Across the KaiNexus customer base, roughly 15 to 20 percent of completed improvements at the time were categorized as patient satisfaction, which is the closest direct correlate. At the most basic level, quality is meeting the needs of the customer, and the patient's experience is part of those needs. Apply the principles there and the work shows up.
Mark gave the concrete version. His "Healthcare Kaizen" co-author Joe Swartz works in a NICU in Indianapolis where the team has implemented hundreds of improvements, and a sizable share are about the family experience: better privacy for nursing mothers, curtain protocols and signs to prevent staff from walking in, a reservation system for the shared shower. He pointed to Seattle Children's Hospital, where a friend moved from a process improvement role into dietary services and used Lean to shift the unit from scheduled meal delivery to patient-driven room service ordering. That is a process improvement and a service improvement at the same time, and it is the kind of patient experience work people miss when they think Lean is only about flow.
What you ask for tends to be what you get. If leaders ask people to surface ideas about the patient experience, the ideas surface. Mark added a behavioral point that mattered more than the examples. When staff notice a confused, annoyed, or grumbling patient, that is the moment to do improvement work, not just service recovery. Surveys miss what people forget to complain about. The annoyance in the moment is better data than the survey response weeks later, and treating it as a near miss for the patient experience produces improvements that prevent the next instance.
An attendee named Jim asked how to move from a project-focused approach to involving the frontline in continuous improvement. His hospital is entirely project-based today, and the goal is to reach the frontline eventually.
Mark had been coaching a non-healthcare organization in exactly that position. They had run "continuous improvement projects" for twenty years. The projects dragged on for months or years, which is neither continuous nor improvement in the way the words suggest. The healthier pattern is layered: big strategic projects at the top, rapid improvement events or Six Sigma green belt projects in the middle, and frontline-driven Kaizen at the base. Use the right mode for the problem in front of you. A small frustration is a just-do-it, not a project. Both run on PDSA either way.
Greg made the case in numbers. About eighty percent of an organization's improvement potential sits at the frontline in bottom-up work; the other twenty percent lives in top-down efforts done well. The figure comes from Alan Robinson's research at Motorola and elsewhere, and whether it is eighty or sixty-five does not change the conclusion: the bulk of the improvement potential is at the frontline, and a project-only model leaves most of it on the table. He framed the change as a conflict-resolution problem. Find common ground first. Wouldn't it be useful to do more improvement work in these strategic areas without raising the bandwidth or stress of our project teams? Once leaders agree to that, find the middle managers most open to leading a pilot, run PDSA cycles in those hot pockets, and let the proof carry the rollout.
Mark described how the organization he was coaching had handled the shift. Executives took ownership of communicating the change to employees, with a clear message that the company believed in the value of many small improvements without beating itself up for the old project-heavy approach. The improvement team ran pilots and built proof of concept before working on broader rollout strategy.
Greg closed the segment with a five-element model KaiNexus has developed from watching customers. An organization building a continuous improvement culture is usually working on five things in some combination: bottom-up engagement, top-down strategy deployment, building problem-solving skill across the workforce, leader capability in coaching and working problems, and clear visibility into KPIs and improvement data. No organization does all five perfectly. There is no single right order to start, and no requirement that you start with bottom-up or with strategy deployment. The five are the destinations; the deliberate practice is in moving toward all of them over time.
An attendee named Amanda wrote in with a layered question. Her hospital was implementing Lean throughout, including a mandate that every unit do daily huddles. She worked in IT, on a team of business systems analysts who do varied work and sit in different offices across town. Could a distributed team like that run effective daily huddles, and if so, how?
Greg's answer started with a frame. Technology, broadly defined, has to do five things for improvement: enable collaboration, provide visibility, measure impact, build a knowledge repository, and develop standards. For a distributed team, the first two are non-negotiable, and the digital answer is obvious. KaiNexus customers run distributed huddles regularly, on a conference call, a video meeting, or a screen-share, with everyone looking at the same board. Distance is not actually the harder distributed-team problem. Time is. People working multiple shifts who never cross paths face the same challenge as colleagues in different cities, and a shared digital board solves both.
Mark used the question to raise a sharper concern, the one buried in the word "mandate." Lean and the tools that support it are countermeasures to problems. A mandate that everyone must have a board, hold a huddle, log metrics, or use a system can produce compliance without purpose. He has seen boards go up in hospitals and not get used. He has seen huddles where people cross their arms, stare at their shoes, and wait for ten minutes to be over because no one ever framed why they were there. Start from why. A huddle, a board, a system, all of them are solutions to problems people actually care about. If the problem and the solution are connected in people's minds, they engage. If the tool arrives without the purpose, you get going through the motions.
A live question from an attendee named Yvette asked what to do during an ongoing improvement project when the mapped process reveals non-compliance issues that management would prefer to exclude from the project's scope.
Mark went to the practical side first. Scope creep on the project is a real concern, but if the non-compliance is creating risk of harm or other serious problems, something needs to address it, even if it lives outside this particular project. A just-do-it, a separate smaller improvement, a different initiative, whatever it takes. The wrong answer is to leave it alone because it does not fit the chart.
Greg added the diagnostic question. When he hears "non-compliance," his first reaction is to ask why. The standard might not provide any real value to the customer. People might be overworked. The standard might exist but never have been communicated. He told a recent KaiNexus example. The company has a specific convention for meeting invites: the word "KaiNexus" comes before the customer's name in the title, so that when the title gets truncated in the customer's calendar view the brand is still visible. A relatively new employee admitted he had no idea the convention existed. The non-compliance was a training problem, not a behavior problem, and the fix was to embed the convention in employee onboarding. Most of the time, non-compliance turns out to be one of two things. Either the standard is no longer relevant to how work is actually done, or people genuinely did not know it existed. In both cases, treating it as a discipline issue misses the real cause.
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 KaiNexus in action and see how KaiNexus helps organizations capture ideas, coach improvement, and connect daily work to strategy.
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