Expert Online Non-technical Training for the Diagnostic Laboratory

Lean culture 101

Lean Culture 101: Laying the Foundation for a Lean Transformation

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6.0 Contact hours ($59.99)

How to set the stage for change

It may seem that building a Lean organization would require a focus on Lean principles, tools and technique but failing to first stabilize the substrate on which the Lean edifice is built is a blueprint for failure. Taiichi Ohno states that a Lean culture is first and foremost a learning culture. This suggests that at the most fundamental level the cultural underpinnings of a Lean transformation are critical to its success.

time for change


This course is focused on developing a shared definition of organizational culture, on identifying the unique characteristics of your corporate culture and leveraging the strengths of that culture to support and sustain a Lean transformation.

You will complete 5 lessons:

  • In the introductory unit you will begin your journey to understating of what “culture” means in the context of your own organization.
  • Unit 1 the stages of cultural growth are introduced; you will establish where you think your organization sits on this growth continuum.
  • In Unit 2 you will begin assessing your own culture by measuring where you are now to two cultural models.
  • Unit 3 invites you to be creative about the kind of culture you think would be a good fit for the strengths you have discovered within your own culture.
  • Unit 4 gives you tools and techniques for bridging the gap between where you are and where you want to be.

You can expect to devote, at minimum, 6 hours to the course and you will complete it at your own pace. How long you spend on each assignment is up to you. Completion of assignments and a quiz are required to obtain a certificate of completion and credit hours. 

If you are seeking P.A.C.E.® Credits, completion of the P.A.C.E.® Evaluation Form is required.

Upon completion of this course, you will be able to:

  1. Understand the concept of “Organizational Culture” and describe why this understanding matters (Introduction)
  2. Lay the groundwork for understanding the culture in your own organization (Unit 1)
  3. Identify the cultural characteristics of your existing culture (Unit 2)
  4. Determine your own ideal culture (Unit 3)
  5. Discuss and plan for shaping your culture so that it can drive and support a Lean transformation (Unit 4)

The course includes:

  • Six instructional videos (total time 1 hour 45 minutes)
  • Five assignments
  • A ten-question quiz

Course links, additional reading and references can be accessed in the Materials tab at the top of this page.

Links for Lean Culture

The following links take you to materials used during this course



Manchester Patient Safety Framework:  MaPSaF

NOTE: Recognize that the focus of this framework is healthcare in general; there are checklists for specific disciplines available.  This tool can be accessed at

Culture Factor

NOTE: The article is available to individuals and cannot be reproduced for this course.  Please follow this link to the article.

Additional Reading for Lean Culture

1. Real-Time Culture Change Improves Lean Success: Sequenced Culture Change Gets Failing Grades

Dr. Mitchell Kusy, PhD,* Marty Diamond, MSHA,† and Scott Vrchota, MS, MBA‡

Success with the Lean management system is rooted in a culture of stake- holder engagement and commitment. Unfortunately, many leaders view Lean as an “add-on” tool instead of one that requires a new way of think- ing and approaching culture. This article addresses the “why, how, and what” to promote a Lean culture that works. We present a five-phased approach grounded in evidence-based practices of real-time culture change. We further help healthcare leaders understand the differences between traditional “sequenced” approaches to culture change and “real- time” methods—and why these real-time practices are more sustainable and ultimately more successful than traditional culture change methods.


2. Creating a Culture of Continuous Improvement in Outpatient Laboratories: Effects on Wait Times, Employee Engagement, and Efficiency

Joseph Featherall, BS1 , Alexander Chaitoff, MPH1, Anthony Simonetti, MD, MBA2, James Bena, MS3, Daniel Kubiak, BA3, Michael Rothberg, MD, MPH3, Kavous Roumina, PhD4, Nathan Hurle, BS3,

Walter Henricks, MD3, and Lisa Yerian, MD3


Transforming health care remains a challenge as many continuous improvement (CI) initiatives fail or are not sustained. Although the literature suggests the importance of culture, few studies provide evidence of cultural change creating sustained CI. This improvement initiative focused on creating cultural change through goal alignment, visual management, and empowering frontline employees. Data included 113 133 encounters. Cochran-Armitage tests and X-bar charting compared wait times during the CI initiative. Odds of waiting <15 minutes increased in both phase 2 (odds ratio = 3.57, 95% confidence interval = [3.43-3.71]) and phase 3 (odds ratio = 5.39, 95% confidence interval= [5.07, 5.74]). At 3 years follow-up, 95% of wait times were <15 minutes. Productivity increased from 519 to 644 patients/full-time equivalent/month; 33/42 Press Ganey employee engagement components significantly improved. This study demonstrates the efficacy of a culture of CI approach to sustain wait time improvement in outpatient laboratory services, and should be considered for application in other areas of health care quality.

References for Lean Culture

Intro Unit: Davies HTO, Nutley SM, Mannion R. 2000. Organizational culture and quality of health care. BMJ Quality & Safety 2000; (9):111-119. Retrieved from

Intro Unit: Ohno, T. (1988) Toyota Production System: Beyond Large Scale Production. Productivity Press, New York.

Intro Unit: Schein, E. H. (1999). The corporate culture survival guide: Sense and nonsense about culture change. San Francisco, Calif: Jossey-Bass.

Intro Unit: Schein, E. H. (2010). Organizational culture and leadership. San Francisco: Jossey-Bass.

Intro Unit: Watkins, DM. May2013. What is Organizational Culture? And Why Should We Care? Harvard Business Review. Retrieved from


Unit 1: Committee on Quality Health Care in America, Institute of Medicine. (2001). Crossing the quality chasm : a new health system for the 21st century. Washington, D.C. :National Academy Press,

Unit 1: Greiner, L. (May-June 1998) Evolution and revolution as organizations grow. Harvard Business Review. Retrieved from

Unit 1: Myerson, D, Martin, J. Nov 1987 Cultural change: an integration of three different views. Journal of Management Studies, 24(6).  Retrieved from


Unit 2: Groysberg, B., J. Lee, J. Price, and J.Y.D. Cheng. 2018a.The Leader’s Guide to Corporate Culture: How to Manage the Eight Critical Elements of Organizational Life. Harvard Business Review 96; (1): 44–52. Retrieved from

Unit 2: ———. 2018b. What’s Your Organization’s Cultural Profile: A Worksheet and Questions to Get You Started. Harvard Business Review 96 (1): 53 . Retrieved from

Unit 2: ———. 2018c. How to Shape Your Culture: Steps for Setting an Aspirational Target. Harvard Business Review 96 (1): 54 . Retrieved from

Unit 2: ———. 2018d. Convergence Matters: When Employee’s Views of the Culture Align, Engagement and Customer Orientation Benefit. Harvard Business Review 96 (1): 55 . Retrieved from

Unit 2: ———. 2018e. Context, Conditions, and Culture: Consider Geographic Region, Industry, Strategy, Leadership, and Organizational Design. Harvard Business Review 96 (1): 56–57 . Retrieved from

Unit 2: Parker, D, Lawrie, M, Carthey, J, Coultous, M. (2008) Manchester patient safety framework. Clinical Risk  14 (4): 140-142. Retrieved from


Unit 3: Ashkenas, R. (Jan 2015) We still don’t know the difference between change and transformation. Harvard Business Review. Retrieved from

Unit 3: Churruca K, Chiara P, Ellis, LA, Long CL, Braithwaite J. (2019) The influence of complexity: a biometric analysis of complexity in healthcare.  BMJ Open. Retrieved from

Unit 3: Fannin, K. Feb 2018. Organizational change & transformation – 6 critical differences and why they matter.  Intelivate.  Retrieved from

Unit 3: Fraser S, Greenhalgh T. (2001) Coping with complexity: educating for capability. BMJ 323:799. Retrieved from

Unit 3: Plsek P, Wilson T. (2001) Complexity, leadership, and management in healthcare organizations. BMJ 323:746. Retrieved from

Unit 3: Plsek P. & Greenhalgh T. (2001) The challenge of complexity in health care. BMJ 323, 625–628. Retrieved from

Unit 3: Wilson T, Holt T, Greenhalgh T. (2001)  Complexity and clinical care.  BMJ  323:685. Retrieved from


Unit 4A: Ates, NY, et. al. Feb 2019. Why visionary leadership fails. Harvard Business Review.  Retrieved from

Unit 4A: Kotter, J. 1996. Leading Change. Harvard Business Review Press.

Unit 4A: Kouzes, J, Posner, B. (2017) The leadership challenge: how to make extraordinary things happen in organizations. Sixth Edition. Hoboken, New Jersey: John Wiley & Sons, Inc.

Unit 4A: Xie, J. Jul2011 Minority Rules: Scientists Discover Tipping Point for the Spread of Ideas. Retrieved from

Unit 4B: Astion M. 2013. A new model for patient safety: Laboratory huddles—what a great idea. CLN 39(4). Retrieved from

Unit 4B: Astion M. 2013. Patient safety huddles, part two—questions and answers. CLN 39(7). Retrieved from

Unit 4B: Braithwaite, J. 2018. Changing how we think about healthcare improvement.  BMJ 2018;361:k2014. Retrieved from

Unit 4B: Leavitt, H. 1989. Managerial psychology: managing behavior in organizations. University of Chicago Press.

Unit 4B: Lepsinger, R. 2010. Closing the execution gap: how great leaders and their companies get results. John Wiley and Sons.

Unit 4B: Miklewright, M. (April 2015) Gemba walking dead.  Quality Digest. Retrieved from

Unit 4B: Millard, M. The top ten worst things you could do on a Gemba walk. Krainexus. Retrieved from

Unit 4B: Outcome Engenunity. Just culture.

Unit 4B: Phillips-Donaldson, D. 2002. On Leadership (quoting Paul O’Neill, U.S Treasury Secretary).  Quality Progress. 35(8)24-25 Society for Human Resource Management. 2016 Employee Job Satisfaction and Engagement: Revitalizing a Changing Workforce. Retrieved from

Unit 4B: Solberg L, Moser G, McDonald S. 1997. The three faces of performance measurement: improvement, accountability, and research. Jt Comm J Qual Improv. 23(3):135-47.

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