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In 2013, a paper was published claiming that Lean methodology does not support person-centered care. The argument was brief: Lean is about standardization, and standardization turns patients into production inputs. Seán Paul Teeling was a Lean practitioner and a person-centered care practitioner. He disagreed strongly. And when he searched the literature for evidence to refute the claim, he found something uncomfortable — there was almost nothing there. Not evidence that Lean was incompatible with person-centered care. But not evidence that it was compatible, either. The question simply hadn't been studied rigorously.
That gap became five years of research. Seán Paul pursued his PhD through the Centre for Person-Centred Practice Research at Queen Margaret University in Edinburgh, partnering with University College Dublin and multiple hospital sites in Ireland. The question driving it: where do Lean and person-centered improvement genuinely converge, where do they diverge, and what does the combined approach look like in practice?
This session is his synthesis. The answer isn't a simple yes or no. There are real synergies. There are real divergences. And the practical model that emerged from the research has now been applied across more than a dozen sites — with measurable results in ophthalmology, cardiology, orthopedics, and private hospital settings.
What follows is the substance of the session, organized so the page is useful whether you watched it or are landing here from search. While the examples come from healthcare, the framework and the principles apply wherever improvement work happens in systems that involve people.
Before the framework, a definitional clarification Seán Paul makes early because the terms are often used interchangeably when they mean meaningfully different things.
Patient-centered care focuses on the patient's clinical needs and preferences. It's important. It's also incomplete if the word "person" is doing no more work than the word "patient." Brendan McCormick, one of the world's leading researchers on person-centeredness, describes patient-centered care as often masquerading as person-centered care.
Person-centered care is broader. It encompasses everyone whose experience is shaped by the care system — the person receiving care, their family, and critically, the people delivering it. Nurses. Allied health professionals. Administrative staff. The cleaner whose work determines whether the environment is safe. All of them are persons. All of them are also in some sense customers of each other. Improvement work that improves patient experience by making staff work extra hours without support, running on goodwill, burning through reserves — that isn't person-centered. It's patient-centered at the expense of the people who make patient care possible.
This distinction shapes the entire research project. When the team looked for evidence that Lean supported person-centered care, they were asking not just about patient outcomes but about whether improvement work was good for the whole person — including the staff member whose working conditions, dignity, and development were also at stake.
Seán Paul's team conducted a comprehensive literature review over 13 months, updated in 2021, across Lean, Six Sigma, process improvement, person-centered care, and patient-centered care. They started with 157 publications from 13 countries and found only seven papers that genuinely touched the intersection they were investigating. From those, supplemented by field work at multiple sites, four clear synergies emerged.
Voice of the customer. This is the strongest and most immediate point of alignment. In Lean, voice of the customer means genuinely engaging the people who do the work and the people who use the service — not assuming you know what they need, not surveying and ignoring the results, but actually building change around what people express. In person-centered improvement, the emphasis on understanding what patients, families, and staff value is foundational. The practices are different in their language and their academic traditions, but they point in the same direction. For a Lean practitioner challenged that their work isn't person-centered, voice of the customer is the strongest ground to stand on.
Observational studies. Person-centered researchers spend enormous amounts of time in direct observation of care — watching how it actually flows, understanding the gaps between what staff intend and what patients experience. When Seán Paul reviewed that literature, he recognized it immediately. It's gemba. Different name, same practice, same underlying rationale: you can't understand what's happening from a conference room. Lean practitioners who walk the floor and observe the actual work are doing something deeply aligned with person-centered research practice, even if neither group typically uses the other's language.
Respect for people. Respect for people is one of Lean's two foundational pillars. The Toyota Production System articulates it explicitly. The problem in practice is that under pressure, improvement work can reduce respect for people to a checkbox — acknowledge it in the kickoff, then proceed with a tool-driven rollout that treats the people in the system as obstacles to or recipients of change rather than partners in it. That checkbox version is what critics rightly call decontextualized Lean. The genuine version, practiced well, is directly synergistic with person-centered values.
Staff empowerment. Person-centered cultures enable conditions where staff engage authentically in improvement and self-select for it — they want to be there, they volunteer, they stay because the work is meaningful. Lean at its best does the same. The research found close alignment between how each approach conceptualizes the relationship between staff agency and improvement quality. Self-selected improvement is more sustainable than mandated improvement, regardless of methodology.
Alongside the synergies, the research identified three significant points of divergence. These are not fatal incompatibilities, but they're real, and pretending otherwise would underserve CI practitioners trying to use both frameworks.
First principles. Lean starts from value — what the customer defines as valuable, and how to create more of it with less waste. Person-centered improvement starts from something different: assessing professional competence, the practitioner's commitment to practice, and the values and beliefs of everyone involved before any change begins. McCormick's framing of person-centered practice includes attributes like a caring approach to meeting needs, nurturing relationships, promoting social belonging, creating meaningful spaces, and promoting human flourishing. Some of that happens naturally in Lean. Most of it needs to be added deliberately. The first-principle difference means person-centered improvement takes longer to initiate. Seán Paul is honest about this tradeoff throughout the session.
Core values and wider social values. Lean attends seriously to the voice of the customer and the value that customers place on the service. Person-centered improvement goes further — it explicitly addresses wider social values: equity, belonging, inclusion, dignity as a social concept. In practice, improvement teams under pressure often characterize this dimension as "nice to have" or "the touchy-feely stuff." That characterization is both inaccurate and expensive. The organizations that skip the social values piece tend to produce changes that hold technically but fail to sustain because they didn't engage the full range of what people care about. For healthcare in particular, where patients arrive already vulnerable and staff already depleted, the social values dimension isn't optional — it's structural.
Standardization. Lean values standardization highly and correctly — standardized processes are measurable, improvable, and teachable. Six Sigma targets the elimination of variation. But not all variation is bad. The right formulation, which Seán Paul has come to use consistently, is "remove unwanted variation." In clinical settings, some variation is appropriate — it reflects the genuine difference between this patient and that patient, this presentation and that presentation. Oncology is not a manufacturing process. Advanced nursing practice leaves room for clinical judgment that standardization can't fully capture. Person-centered improvement builds this principle in structurally rather than as an exception. Lean practitioners working in complex service environments need to hold it deliberately.
The abstract question of whether the two approaches are compatible becomes clearer in the field work. Seán Paul walks through four cases from the Irish healthcare system.
Northeast Regional Integrated Eye Care Scheme. The northeast of Ireland had 44,000 patients on a cataract surgery waiting list. Given the age profile of cataract patients (typically in their eighties), some patients were dying before their appointment dates. The team spent the first year not on the cataract pathway but on establishing a Virtual Care Organisation across 14 centers at 10 sites — all staff participating voluntarily, none receiving additional salary. The work in year one was entirely about understanding what staff valued: place (physical environments with natural light, not repurposed storerooms), procurement (equipment to do the job), people (appropriate skill mix and staffing), and only then patients. The right prerequisites needed to be in place before the patient pathway could be improved reliably.
The results after five cataract-related pathways were redesigned: 95% right-first-time referrals, 80% first-referral accuracy for optometrists, 95% conversion rate to surgery, 51 days returned to GPs in 2022, significantly increased patient and staff satisfaction, decreased patient travel time, and more than 50% reduction in time to surgery.
Pediatric Cardiology — Dublin Children's Hospital. A family from County Kerry wrote to the newspapers and the hospital CEO after their child's experience: five hours of travel, four hours waiting, ten minutes with the cardiologist. The letter got attention. The team mapped the clinic flows and identified a core problem — the clinic overran from early morning into the evening, patients and families sat in an overcrowded waiting room, and staff couldn't take lunch breaks or set up the next clinic adequately.
Rather than relying solely on internal gemba capacity (the hospital had Black Belts but not enough), the team recruited 90 families to conduct their own observational studies — to record their clinic journeys, surface their questions, and participate in the improvement work. One question families asked: why does my child need an ECG and an echo every time? A 5 Whys investigation revealed that echocardiograms had been added at some point as routine but were not clinically necessary for every patient. Removing them changed the flow substantially. The results: clinic duration dropped significantly, the overlap between clinics was eliminated, and the model was incorporated into the design brief for what will be the most expensive children's hospital in Europe when it opens.
Cardiac Remote Monitoring Clinic. A clinic struggling to increase uptake of remote monitoring had tried the standard interventions: nurses talking to patients, doctors talking to patients, Patient Advocates making the case. Nothing moved the needle.
The person-centered addition: the team brought in patients who were already successfully using remote monitoring and asked them to explain to others why they had chosen it. The patients became part of the improvement team — not props for a campaign, but actual contributors to the design of the change. At baseline, the clinic was processing 102 remote monitoring follow-ups with 140 unscheduled attendances, causing chronic overrun. After implementation: a 72% decrease in unscheduled attendances, a 194% increase in remote monitoring uptake against a target of 50% increase, and results sustained post-implementation.
Hip Fracture Pathway. The team was tracking one metric: time to theater in under 48 hours, per the Irish Hip Fracture Database recommendation. They achieved the target. But when the combined lens stayed in place, they noticed something the metric didn't capture: patients in the emergency room were receiving opioid analgesia but not the optimal nerve block (a local anesthetic directly into the joint) because anesthesiologists were too busy to leave the operating room to administer it. Patients could wait up to 40 hours without adequate pain management, despite technically acceptable care on the metric being tracked.
The person-centered question surfaced what the metric hid. The team trained advanced nurse practitioners and orthogeriatricians to administer the block in the emergency room. Pre-intervention, 8% of patients received optimal analgesia in the ER. At three months post-intervention: 88%.
Seán Paul's practical framing for CI practitioners: think of it as adding a second lens, not replacing the first one.
You're still doing Lean. You're still mapping value streams, running rapid improvement events, using standard Lean tools. The person-centered lens asks you to check, at each stage: are we doing this with people or to them? Are we understanding what staff actually need to deliver care, not just what process maps suggest they should need? Are we attending to what patients value in their experience, not just to the outcomes we've been asked to track? Are we being honest about the variation that reflects genuine human difference rather than process instability?
The model takes longer to initiate. The groundwork of understanding what people value — through individual conversations, not just surveys; through qualitative engagement, not just data — adds time to the front end. Seán Paul estimates that on most projects, about 40% of the total time is spent in that groundwork phase before any formal improvement work begins. The tradeoff: substantially better sustainability on the back end, because the people who will live with the change were genuinely part of making it.
For organizations where Lean is already established, the person-centered lens is almost always easier to introduce than the reverse. Lean practitioners are already oriented toward voice of the customer, already doing observational studies, already working from a Respect for People foundation. Person-centered improvement extends and deepens what's already there. Organizations that start from person-centered approaches and try to introduce Lean on top sometimes encounter stronger resistance, because Lean carries industry connotations that person-centered practitioners have been trained to be cautious about.
A Q&A exchange worth lifting separately because it comes up in most Lean healthcare implementations.
Resistance to Lean often isn't resistance to the underlying principles. It's resistance to the language, the perceived industrial origin, and in some cases to prior implementations that gave Lean a justified bad reputation in specific settings. A colleague of Seán Paul's spent years in ward nursing before encountering Lean, and her reaction to her staff going to Lean training was: I need bodies on the floor, not people in training for something I don't understand. She was resistant. Then she encountered the methodology properly. Her view changed.
The practical recommendation from the session: drop the jargon wherever it's causing friction. Lean doesn't need to be called Lean to work. The underlying practices — observing the process, asking people what they need, running structured experiments, standardizing what works — can be framed in language that the specific context already values. In some organizations, the word "improvement" is more useful than "Lean." In others, "learning" works better. The tools work regardless of what they're called. The language serves the adoption, not the methodology.
Seán Paul mentions the NHS Productive Ward series, which was eventually relabeled "Releasing Time to Care." The relabeling helped. But when Irish nurses were asked what time they needed released for, their answer wasn't only "patients." It was lunch. Breaks. Recovery. Time to care for themselves, not just for their patients. The person-centered lens surfaced what the patient-centered framing missed. The nurses who said that weren't being selfish. They were being honest about what a sustainable improvement would require.
Worth naming explicitly, though Seán Paul doesn't use the term directly.
The person-centered improvement model depends at every stage on people being willing to say honestly what they value, what they're experiencing, and what they need. The 90 families who conducted their own gemba studies in the cardiology clinic trusted the team enough to give their time and their candid observations. The nurses who said "releasing time to care for ourselves" trusted the environment enough to say something that a different culture would have punished as insufficiently patient-focused.
The self-selection principle Seán Paul identifies — improvement works better when people choose to participate rather than being told to participate — is the same mechanism underlying psychological safety research. People engage more authentically, contribute more useful information, and sustain change more reliably when they feel genuinely safe in the improvement context. Fear-based participation produces compliance. Genuine participation produces knowledge.
The story about the CEO on their phone at the report-out makes the same point from the other direction. Leadership behavior teaches people whether their improvement work is actually valued. That CEO's behavior undermined the psychological safety of the team more effectively than any policy could have, and it took substantial work to repair. The person-centered lens includes explicit attention to whether the organizational conditions support authentic engagement — which is, functionally, a description of psychological safety under a different name.
A few specific things the platform does that connect to what Seán Paul describes.
The voice-of-the-customer principle that Seán Paul identifies as the strongest synergy between Lean and person-centered improvement requires a system for capturing and acting on what people actually say. Ideas that go into a void teach people not to share them. KaiNexus makes every submission visible, routed, and accountable — creating the structural conditions for voice of the customer to mean something rather than functioning as a ritual.
The observational studies that form such a central part of person-centered work produce a large volume of qualitative insight that traditional improvement management systems don't handle well. A platform designed for improvement at scale can organize, track, and connect those insights to the improvement work they drive.
Sustainability — which Seán Paul identifies throughout as the main benefit of the person-centered combined approach — requires visibility into whether changes are holding over time, across sites, and for all stakeholders including staff. KaiNexus tracks impact over time, making drift visible before it becomes permanent, and making successful improvements visible to other teams that could benefit from them.
If your improvement work is producing technically correct results that aren't sustaining — if people are going through the motions rather than genuinely participating — the gap is usually not the tools. It's whether the people doing the work feel that their experience, their needs, and their voice are genuinely part of the design. That's the gap the combined approach is built to close.
Seán Paul Teeling is the Programme Director for the Professional Certificate and Graduate Certificate in Process Improvement in Health Systems at UCD Health Systems. Prior to this role, he worked as Lean Manager at the Mater Misericordiae University Hospital Dublin, where he worked closely with the hospital and the UCD School of Nursing, Midwifery and Health Systems on the development of highly successful process improvement in healthcare programs. He completed his PhD with the Centre for Person-Centred Practice Research at Queen Margaret University in Edinburgh and is an accredited facilitator of person-centered cultures in healthcare. He is also an affiliate of the Stanford Medicine Centre for Improvement at Stanford University. His research focuses on the influence and contribution of process improvement methodologies — including Lean, Six Sigma, the Model for Improvement, and Agile — on person-centered cultures in healthcare. He was appointed by the Irish Minister for Health as a member of the Health Products Regulatory Authority Advisory Committee on Medical Devices, on which he served for two terms.
What is person-centered improvement, and how is it different from patient-centered care?
Patient-centered care focuses on the clinical needs and preferences of the person receiving care. Person-centered improvement is broader — it encompasses all the people whose experience is shaped by the care system, including staff, families, and others significantly involved in care. The distinction matters because improvement work can improve patient experience while simultaneously making staff working conditions worse. Person-centered improvement asks whether the change is good for the whole person, including the people delivering care.
Where does Lean align with person-centered improvement?
Research identified four core synergies. Voice of the customer — engaging the people who do the work and use the service — is directly aligned in both approaches. Observational studies in person-centered research are functionally equivalent to gemba in Lean. Respect for people is an explicit pillar of Lean and a foundational value in person-centered practice. Staff empowerment — creating conditions where people self-select for improvement rather than being coerced — is closely aligned in both frameworks.
Where do they diverge?
Three areas. First, first principles: Lean starts from customer-defined value, while person-centered improvement starts from assessing professional competence, commitment to practice, and the values and beliefs of everyone involved. Second, Lean's emphasis on standardization can conflict with the person-centered principle that not all variation is unwanted — some variation reflects genuine human and clinical difference that should be preserved. Third, person-centered improvement gives more explicit attention to wider social values (equity, belonging, dignity as a social concept) that Lean doesn't always address systematically.
What does using a combined approach look like in practice?
Think of it as adding a second lens, not replacing the first. You're still doing Lean — value stream mapping, standard work, kaizen, rapid improvement events. The person-centered lens asks, at each stage: are we doing this with people or to them? Do we understand what staff genuinely need to deliver care, not just what process maps suggest? Are we attending to what patients value in their experience of care, not just to the outcome metrics? The main practical difference is that the combined approach invests more time in groundwork — understanding what people value before formal improvement begins. Seán Paul estimates about 40% of project time on the front end. The payoff is substantially better sustainability.
Does the combined approach produce better results?
The case studies in the session show measurable results: 95% right-first-time referrals in ophthalmology, more than 50% reduction in time to cataract surgery, 88% of hip fracture patients receiving optimal analgesia (up from 8%), a 72% decrease in unscheduled attendances in the cardiac remote monitoring clinic. Critically, Seán Paul's observation across multiple sites is that sustainability is significantly better with the combined approach than with Lean alone — because the people living with the change were part of designing it.
How do you handle resistance to Lean language?
Drop the jargon wherever it's causing friction. Lean doesn't need to be called Lean to work. The underlying practices — observing the process, asking people what they need, running structured experiments, standardizing what works — can be framed in the language the specific context already uses. In healthcare settings with prior negative experiences of industrialized improvement approaches, "improvement," "learning," or even just "problem solving" often land better than "Lean" or "Six Sigma."
Is person-centered improvement only relevant to healthcare?
No. The principles — that improvement done with people is more sustainable than improvement done to them, that the experience of the people doing the work matters alongside the experience of the people using the service, that voice of the customer means genuinely listening rather than assuming — apply across any sector where improvement work happens in systems involving people. Healthcare provides Seán Paul's specific evidence base. The framework is general.
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