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Tshepo folders group discussion

Excited by what I saw going on before me, I took this photograph and the LIA team posted it on our digital media, along with this text: Lean Institute Africa. We are working in partnership with Gauteng Department of Health & Thinking People on a service delivery improvement contract in 4 major hospitals around Johannesburg, with a focus on reducing waiting time. Yesterday, LIA’s Thobejane, co-facilitator, leads a discussion with the Folders group at a hospital. They are reflecting on the current condition and the obstacles to the target condition. They have set themselves the target of closing the gap from 143 minutes down to 90 minutes.

We were delighted that several people commented, some with encouragement and some with advice. When we are in settings remote from the gemba, for example when chatting with friends or with a stranger in a plane about our work, we often get advice. Daniel Kahneman (Thinking Fast and Slow, 211) would say that is to be expected: we are all ‘hard-wired’ to jump to conclusions about what to do about any problem that arises! It takes conscious effort to gather the actual facts and think rigorously about countermeasures. And so I recently had the advice once again, in the context of our work to reduce waiting times, to prioritise inadequate resources in the health system.

But I could not help reflecting on how, at least for Tshepo Thobejane’s team, this advice could be ‘right’ and ‘wrong’ at the same time. To ‘have the right resources available and working’ is of course sensible advice. From an MBA student under exam conditions I tell them it is what I call ‘always true’ advice.

But it is ‘wrong’ in two respects: one a matter of principle, and the other of fact. The matter of principle is that we should ‘Go see’ before we propose countermeasures; in the words of Mr Furuhashi, our respected sensei of many years, ‘Actualise the problem and do not generalise.’

Folders group before and after

Before I get to the matter of fact, see this photograph of the exhibit that Tshepo Thobejane’s Folder team put up. And the rushed SMS he sent me a week later:

I just had a chat with Folders Manager and he said patients say “Wow what is happening at XX” and even a staff member who was on leave. Staff morale is high and they are encouraged to sustain the changes.’ (I substituted XX for the name of the hospital.)

The target condition Tshepo and his team set was to reduce the patient journey time from around 140 minutes to 90. When they and the other model line teams were contemplating their actions on the Wednesday afternoon prior to Thursday implementation, I read to them a section from Mike Rother’s Toyota Kata where he says that when we try countermeasures they almost never work, but we find out what we need to do to get them to work.

Tshepo’s team in fact got closer to a 40 minute patient journey time, ‘overnight.’ In effect what they experimented with was reduced double-handling and reduced batching. Unlike many lean experiments, it worked pretty seamlessly and first time!

The matter of fact is that no additional ‘resources’ were used. It had mostly to do with the pattern of working and batching which obstructed flow. The general advice, though ‘always true’, was not necessary to the very considerable improvement achieved.

Well done to Tshepo and his team, and the hospital staff who engaged the experiment so willingly! They all know this is just the beginning of a long journey to stabilise operations through the implementation of a daily management system. But what an encouraging start it has been for Folders.

When we posted that first picture of Tshepo Thobejane discussing possible countermeasures with his team, we had no idea what the outcome would be. My excitement was to see their real engagement with the current state and their grappling with understanding the obstacles to progress. As Toyota says, ‘The purpose of the model line is to develop the people.’ The results will come if we do that.

Kind regards


P.S. While I have your attention, I want to alert you to a few changes to our workshop dates. We are offering Introduction to Lean, Lean Management the A3 Way and Toyota Kata workshops throughout the year. Please visit our website for more information and to register online:

Introduction to Lean (DBN 3-4 March, JHB 5-6 March, CPT 25-26 May)
Lean Management the A3 Way (CPT 26-27 March, DBN 13-14 April, JHB 20-21 April)
Toyota Kata (JHB 13 May, DBN 14 May, CPT 15 May)

Introduction to Lean Healthcare workshop

For the first time, Norman will be offering a two day Introduction to Lean Healthcare workshop, which is specifically focused on lean management as it can be applied to improve quality, reliability and responsiveness of healthcare facilities. As facilitator, he brings Lean Institute Africa’s 12 years of experience working in the health sector, as well as bringing in guest speakers – health professionals who are working with lean to increase efficiency and flow in health facilities. To read more about our Introduction to Lean Healthcare workshop visit

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