I remember Mike Rona’s shock when I worked with him on developing the Virginia Mason Production System. The first RPIW in which Rona participated focused on the emergency department. He was shocked. He said to me, “I didn’t realize how bad things were.” I told him that his shock is typical of high-level leaders in organizations:
You’ve spent most of your time leading from the comfort of your office, and now you are seeing the muda—the waste and confusion—your hard-working people deal with every day. Your patients are subjects of a disservice when the leaders are not involved at the grassroots level of ferreting out the waste and leading from the hospital floor instead of from the comfort of the executive suite.