Kyle-

I'm not sure how much experience you have with Lean, but the emergency department scenario you created (reducing waiting room time while pushing that wait to the "to doc" time) is a pretty poor example of the Lean methodology.

In Lean, we look at the value stream... that's a pretty holistic view of a problem that leads to root cause solutions that don't push waste upstream/downstream or don't cause suboptimization.

I won't begrudge you for advocating for Six Sigma, but don't use a silly example of so-called Lean to make your case for what gap Six Sigma would be filling. 

By the way, Toyota has been quite successful using Lean without Six Sigma, as are many healthcare organizations.

Mark

Thanks Mark I figured you would comment on my article and of course you tweeted it as you like to do. 

It seems to me you have taken a single and isolated point to distort the essence of the article. Even you yourself have written that six sigma techniques are utilized in conjunction with lean in health care. I think it is important to keep an "open mind" to these disciplines otherwise progress and innovation will come to a grinding halt.

None the less to address your point the 1 example I used about a hospital (which was not the premise of my argument) I actually have observed in a hospital in repeated cases. The hospital did undertake Lean. Maybe they should have hired you.

I think in terms of your first question you have asked me before and the number years I have been using lean has not changed, that is over 10. I also find it interesting that in some commentary you are quick to point out that Toyota has had recalls but in others you choose to say a comment like below. Appears that you flip flop on the issue. Anyways hope all is well with you

Hi Kyle - I appreciate your attempt to make a case that organizations HAVE to use Six Sigma in conjunction with Lean but that's simply not true. The methodologies CAN be used together (if very well thought out), but they don't HAVE to be used together. It seems that you're missing quite a number of key Lean principles, practices, and tools in your characterization of "Lean." The ED outcome you have described is decidedly NOT a Lean outcome. Quite the contrary. 

You pose a key question: "So why do some lean advocates feel compelled to consider one process improvement framework only?" As a "lean advocate," let me share my reasons:

1. Because of its holistic and systems-thinking perspective that, when deployed correctly, avoids the sub-optimization you describe in your article. I agree that "shot gun Kaizen events" are wrong, but let's avoid throwing the baby out with the bath water. Kaizen events done right are tied to a systems improvement strategy, such as a VSM. Yes, there are a number of Lean novices out there that are doing the "wrong thing." But that doesn't mean that's how Lean is designed to be done. "Lean" does not equal "kaizen events."

2. Because of its root-cause orientation - I don't even know how to respond to your comments about Lean and RCA. What you say is simply not true. Why do you think Lean is used merely for "simple" problems. I wouldn't classify any of my clients' problems as "simple." In fact, in the white collar space, the problems are often monumentally complex and multi-faceted.

3. Because of its emphasis on standardization - Again, what you say is simply not true. Lean is ALL about creating process stability and predictabilty. Where do you get this idea that it's not?

4. Because of its accessibility and people-orientation. Lean's approach to business management (it's not all about process design) is inconclusive and heavily focused on learning. So, for example, a skilled Lean practitioner is not a "do-er." Rather, he/she coaches, teaches and facilitates to spread problem-solving and improvement capabilities across an organization as quickly and deeply as possible.

HBR can include articles and posts until the cows come home about how Lean cannot possibly be a standalone method for improving business performance. All that accomplishes is providing additional data points to support my hypothesis that many previously reputable publications are falling prey to printing opinion versus fact. Because the facts do indeed prove otherwise.

I have long felt as most of you do. I started my career in Quality when the consulting world hadn't yet split into specialist camps they called "Six Sigma" and "Lean." At that point in time, if people were doing anything programmatic, they were calling it something like Total Quality. People studied the seven tools, and the seven new tools, and the Toyota production system, and SPC. We studied general systems theory, and learned to do process research.

When I joined Process Management International, they were, philosophically, a Deming and Juran organization with strong ties to the Japanese Union of Scientists and Engineers. They had sponsored US Seminars with Kano, Taguchi, Ohno and other Japanese Quality experts. In 2000, JUSE sent several people to study Six Sigma. They did an exhaustive study of the literature--such as it was at the time--and concluded that Six Sigma brought nothing new to the table in terms of tools or techniques, but it was useful as a "vehicle" or a way to bring Quality to an organization, and useful as part of a portfolio of programs that could help. The conclusion was that Six Sigma's role was for breakthrough. This pre-supposes an operational definition that positioins Six Sigma as a project-based methodology for improvement; essentially, a problem-solving paradigm.

What this has always meant to me is that you most effectively use Six Sigma and the full DMAIC or DMADV project life-cycles when you have problems with common cause variation, i.e., if your process is in control but you need to move the mean on target and/or reduce variation to meet some specification that's not currently met. It should be part of an arsenal that includes all the basic tools, the new tools, lean concepts, SPC, systems thinking, Theory of Constraints, diffusion of innovation, change management and anything else that can help manage systems and processes and provide for continual improvement.

My own observation is that the opinions I most often see from people in forums like this about Lean and Six Sigma have a basis in what they were taught, and who taught them. What I have seen over the past 20 years was a rift that was driven by consulting groups, some of whom were very good and taught a more systems-based, total-quality-based approach; some of whom, however, saw some narrow subset of tools when they were hatched, and built their whole consulting practice around that narrow definition. Since just about any quality approach will have dramatic effects on the low-hanging fruit, their inital experiences--even using their narrow approach--were successful, and all to often they "learned" that their approach was all any company needs.

What really matters, though, is not the name...that's just marketing. We have to be able to effect change in systems, to instill knowledge in leadership, to appreciate and understand that our systems comprise value streams, that to channel these requires an understanding of flow through the system and a constant pursuit of "on target and continually reducing variation." So do we need Lean? Absolutely. Do we need Six Sigma DMAIC and DMADV projects? At least for the forseeable future, I think they will be very useful in achieving breakthrough...in "Lean Transformation," Bruce Henderson included "Six Sigma levels of Quality" as one of the necessary things to have in place for full Lean implementation. Do we need SPC? If you don't have it, any Lean or Six Sigma approach are going to be hollow and temporary. SPC is often neglected, though...even the ASQ Six Sigma BOK treats it as an afterthought--you do it in CONTROL.

My own view is that we'll do much better as Quality Professionals when we stop the infighting about what we call things and start rendering unto Lean those things that are Lean and unto Six Sigma those things that are Six Sigma's. Learn systems theory, statistical theory (at least, as it applies to analytic studies), psychology and sociology as they apply to organizational change and what Rogers called Diffusion of Innovation; and pick up a useful iterative learning model to guide the approach and drive organizational learning and change. Learn which things are important to measure to actually drive improvement, then work to get things on target and constantly and forever reduce variation. Channel the value streams, optimize flow through those streams, and optimize the system.