KaiNexus CEO and co-founder Greg Jacobson joins host Mark Graban for the fourth episode of the Ask Us Anything series, the monthly session that answers questions submitted by webinar attendees. This episode opens with a debate that was live in healthcare circles at the time: a New England Journal of Medicine opinion piece called "Medical Taylorism" that tied Lean to physician burnout and lost time with patients. From there the conversation moves through kaizen events, the culture side of Lean, motivating improvement work, and what separates a hospital that truly adopts Lean from one that just borrows its tools.
Here is what the episode covers and the thinking behind each answer.
Mark opened with an opinion piece published in the New England Journal of Medicine, titled "Medical Taylorism" and written by two physicians. He had already written about it on his own blog. The article complained that doctors were being followed with stopwatches and having appointment times measured, equated Lean with having less time for patients, claimed clinical work cannot be standardized, and tied all of it to burnout.
Greg, an emergency physician, called the article unfortunate and built on a misunderstanding of what Lean actually is. His read: the authors are knowledge workers who are genuinely disgruntled, and they are disgruntled because they work in a system that is not practicing Lean. The clearest sign is that they are not at the improvement table. Respect for people, one of Lean's foundational principles, means the people doing the work help improve it. When change is done to clinicians rather than with them, the reaction in the article is understandable. But what they are describing is not Lean.
Both hosts took apart the stopwatch example. The old Taylorist image is an industrial engineer standing over workers with a stopwatch and a clipboard, telling them how to work faster. That is not modern Lean. In the improvement work Mark has been part of, timing was done by peers observing peers, and the goal was never to compress the moment of care. It was to find the waste around it, the trips out of the exam room for missing supplies and the interruptions, so clinicians could spend more time with patients, not less. Greg added a useful reframe. If an encounter genuinely takes 18 minutes and the schedule books 15-minute slots, that is a process problem worth surfacing. The study might even show the right amount of time is 21 minutes. That is improvement science working as intended. Mark's one caution: the real failure may well be clinicians left out of improving their own work, which is worth being upset about. Painting all of Lean with that brush is not.
A question asked for the difference between kaizen and a "kaizen blitz." Mark's take: kaizen is a Japanese word for continuous improvement, or good change, and his first association is the steady stream of small improvements identified and driven by frontline staff as part of daily work. The kaizen blitz arrived in the United States in the late 1980s or early 1990s, when Japanese consultants ran week-long events on big problems to demonstrate how kaizen works. Toyota itself rarely runs multi-day events, and when it does, the point is to teach people the method so they go back and keep improving.
The problem comes when an organization concludes that kaizen equals the blitz, that all improvement must be a scheduled, formal, week-long project. Greg, who reviewed the medical literature for a paper he published years ago, found exactly that pattern: improvement treated as episodic events rather than a daily habit. Episodic improvement alone will not change a culture. As he put it, it is like working out one week per quarter and expecting to be healthy. Both hosts recommended dropping the word "blitz" in favor of "rapid improvement event," and keeping both modes in play. Big, systemic problems may need a focused team for a week. The small stuff needs daily continuous improvement. A program that is 90 percent top-down events and 10 percent frontline improvement has the balance wrong.
Another question: how do you get leadership to understand Lean beyond the tools, especially the respect-for-people and culture side? Greg's answer was about language. Talking to a leader about Lean tools is like talking to someone who wants a house about screws and two-by-fours. They disengage. Start instead with what they are trying to accomplish this month, this year, the next five years, then bring the improvement methods in quietly, in service of those goals. Mark connected this to an organization's stated mission, vision, and values. Run an honest gap analysis: are we actually living up to the respect we claim to value, and if not, what is getting in the way?
One attendee asked how to get reluctant managers to step up amid rising demand and unpredictable staffing. Mark named a common trap. Executives say they have no time to involve people in continuous improvement because they are too busy chasing results, improving the patient experience, reducing cost. But continuous improvement is the means to those exact ends. Saying you have no time for the thing that would help you hit your goals is, as he put it, illogical.
Greg framed the manager problem in terms of security. Secure leaders understand that hitting their goals depends on the people they lead, not on doing everything themselves. Insecure leaders interpret their job as personally solving every problem. He pointed to Simon Sinek's "Leaders Eat Last" and its grounding in the biology of trust. Mark added a practical mirror: turnover. External factors always play a role, but a leader who consistently sees high voluntary turnover should look hard at how they are leading. People want to contribute to something meaningful, and strong, caring leadership is one of the few things a manager fully controls.
A comment from an attendee, that organizational health and cultural alignment are foundational to sustaining change, prompted a useful idea from Greg. Drawing on a Stanford startup course, he described culture as a way to solve a bandwidth problem. You can personally shape decisions in a five-person company. At 500 people you cannot, so the culture has to carry the decisions you are not there to make.
Asked how to assess whether an organization is ready to start, Mark gave a deceptively simple answer: an organization is ready for kaizen when it says it is. Readiness is partly a self-fulfilling prophecy. Decide you are not ready and you are right. Beyond willingness, people need time. An organization so overburdened it cannot finish its regular work has no room to improve the work. That is a real challenge, and Mark was careful to call it a challenge to solve rather than an excuse to hide behind. Greg tied readiness back to the leader. If the leader can articulate, intellectually and honestly, the connection between their goals and doing the improvement work, they are ready, and ready to commit the main resource it takes, which is time.
On sustaining motivation, Mark described a reinforcement loop. Ask people to bring problems and ideas forward, help them implement, then recognize what they did. Not necessarily with rewards, but with genuine thanks and a clear picture of the impact. Improvement leads to recognition, recognition feels good, and that pulls people toward the next improvement. Quotas and targets, four per year, miss the point. Greg added two design rules. Make participation easy, because friction kills it, and keep cycle times short. Scale an improvement down to the smallest unit of work that still produces a benefit, so the habit loop closes quickly and starts to run on its own.
Two related questions closed the session: what hurdles does healthcare face compared with manufacturing, and are more hospitals adopting Lean? Mark, who spent a decade in each, sees a real advantage in healthcare. The mission of serving others creates intrinsic motivation that improvement work can use directly, where manufacturing more often has to build that sense of purpose. The flip side: hospitals have historically paid less attention to operations management than manufacturers have, often relying on putting smart people in a room to figure things out. And yes, more hospitals are adopting Lean. But "adopting" covers everything from superficial use of a few tools to a genuine change in culture and management system. Lean has become trendy in healthcare, and Mark was blunt that copying it because others are doing it is the worst possible reason, given how much real work it takes.
Ask Us Anything is a monthly 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. See KaiNexus in action ->
.svg)
Copyright © 2026
Privacy Policy