Michael Grogan is a chemical engineer by trade who has worked in the UK, he is also a LSS black belt. He has been based in Dar es Salaam, Tanzania for 18 months working for the Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) introducing lean and efficiency models to an organisation striving to provide high quality healthcare in a low resource setting.

CCBRT is a hospital specialising in offering healthcare to those below the poverty line. CCBRT focuses on maternal health and attempting to lower the infant mortality rate amongst people living in some of the lowest living standards in the developing world. LMJ spoke to him from Tanzania to learn about how his continuous improvement attempts were working.

He spoke to LMJ about his passions and ideas for the future.

LMJ: How did you get involved in lean?

Michael Grogan: That began in 2006; for about eight years I worked for a company, MSD Pharmaceuticals, in the UK. I started my career in Northumberland as a chemical engineer in manufacturing operations, and essentially MSD brought me into LSS. I quickly fell in love with continuous improvement.


LMJ: How did you get involved with CCBRT?

MG: I came to Tanzania as a tourist in 2010 and it was a life-changing moment seeing poverty for the first time and it changed my perspective on what was important.


LMJ: Did you stay in Africa?

MG: I went back in 2011 to volunteer and then in in 2012 for a five-week long spell as a volunteer. I wanted to make a difference, and I used my connections and managed to get in contact with the CEO of CCBRT, Erwin Telemans. He understood the benefits that LSS could bring to the organisation.

He invited me for two weeks and then the next year I came back for another five weeks. Since February of 2013 I’ve been here full time. The job satisfaction I experience was incomparable.


LMJ: What’s the biggest challenge in implementing lean?

MG: People may expect me to say resources or the people- and their limited exposure to education, or even professionalism. That was my answer a year ago. Now, my answer is me. The person I had to change the most is me. I had to learn there’s no bad students only bad teachers. I had to adapt my take on LSS to this situation.


LMJ: What aspects of LSS have failed in your work?

MG: The principles of continuous improvement work everywhere around the world. But some of the toolkit (six sigma) are not necessary here. This is the same for hospitals in the UK. Things that work in a factory aren’t always relevant to a medical environment.

It reminds me of the saying “He who is good with a hammer thinks everything is a nail.” I was very good with the six sigma hammer but those tools might not be needed in developing world or healthcare. There are bigger problems here to focus on. I wouldn’t say that’s where lean hasn’t worked but that there’s so much to lean that not all of it was applicable here.


LMJ: What’s been the most beneficial?

MG: I’ll put this in this context: we have 460 staff and I’m the only continuous improvement coach. One word to describe here is habits. I’m trying to create new habits for leaders of continuous improvement. I’m trying to coach problem solving. I’ll fail if I don’t achieve a change in habits.

The go see mindset is the most beneficial, the people I’ve worked with have learnt the most from lean with this idea. Classroom environments, which I was comfortable with, are ineffectual on its own.


LMJ: So what are your plans for the future of LSS at this organisation?

MG: We’ve got a big dream and I want to share it: our dream is to make this hospital, which serves the poorest of the poor, the model hospital for continuous improvement in Africa.

We want to problem solve, develop people, and develop leaders. We want to show people what this looks like. For example, Thedacare, in the US was one of the first hospitals to embrace lean, 10 years ago. And now they get thousands of visitors every year to learn about lean.

We have a partnership with them; their CEO came to visit us recently and we want to build a network with them. As well as other organisations and individual who will help us on our journey. We want to share resources and tackle the huge problem of healthcare and use this as a centre in the region for other healthcare leaders.

We believe this is the best way to help healthcare and create the best positive effect for quality of human life.


LMJ: What’s the reaction been from those at the hospital?

MG: Essentially with continuous improvement it’s about learning new ways of thinking, and de-learning the old ways. Regardless of where you are in the world, that’s a challenge we all have to overcome.

I’ve never experiences such a hunger to learn as I heave from this team. I work with the senior management and I believe the whole, 10-member team, have far more knowledge than I did, or have ever experienced in Europe or North America.

We need to develop our own people. You can throw another x-ray machine at it but a long term solution to eradicating poverty is to develop the people. We have transformed some people in how they think.

To see how they embrace it and apply it is beautiful. The permanent impact. The students are the frontline. We impact the lives of over one million people every year. How can we make their experience better? I believe everything should be linked back to them and their experience.

Our long term goal is to increase the impact of this. We have one of the worst maternal mortality rates in the world and reducing these statistics is how we measure success. It’s slow but we ultimately believe we can give more value to the patient.

And finally, I want the lean community reading this to know that we desperately need more continuous improvement coaches here.

The job satisfaction and meaning they would get here will be nothing like they have ever experienced: to do work that makes a significant contribution to the quality of human life. An opportunity to help build something beautiful. An opportunity to leave a legacy.

A new batch of LSS graduates.

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