Lean implementation requires a change in culture. The change is to create the habits of continuous improvement, problem-solving and teamwork. For many companies, this is a struggle. While it is never easy, the blended learning model greatly increases the probability of success. Relying on single modes and a short-term focus will almost guarantee failure.

The Blended Learning Model

Over the past five years I have worked with VON Canada to implement lean culture, and with considerable success. There are many aspects to the success, including strong leadership, constancy of purpose, and the proverbial “burning platform” that required change. However, the use of a blended model of learning and change has been essential to the success.

Blended LearningOver the past several months I have worked to complete a book on The Lean Coach and for a chapter in that book I have worked with the internal lean coaches at VON to write a case study of their journey using a combination of a) process and system redesign; b) online learning to provide team leaders with knowledge of lean practices; c) action-learning to develop new habits and skills; and d) internal coaching to assure continuous improvement. None of these elements alone would have been successful; however, the blended combination of these elements has produced significant improvements in performance. You can download the case study here: Case Study – Blended Learning in Healthcare. This case focuses on two sites in Nova Scotia but they are representative of the general approach to lean implementation at VON.

On-Demand, Anywhere, Anytime Training

VON Canada is perhaps the most obvious case for online learning. To put it simply, Canada is large! The VON sites are spread out over a huge area of Eastern and Central Canada. Getting the two hundred and fifty managers together to conduct workshops would be incredibly expensive. It was because of this need that I initially developed my Team Leadership (Team Kata) course that is now available on Udemy (for an incredibly cheap $50!!!). This case study is proof that this model of online learning, plus the requirement of action-learning and coaching, can be successful in changing the culture of an organization.

Developing Coaching Capability

In order to sustain the changes in behavior VON recognized the need to develop competent internal coaches. To continue to provide quality service to their clients VON established the Lean Centre of Excellence with 4 Lean Coaches (2 in Nova Scotia and 2 in Ontario) and a Director. The Lean Centre of Excellence supported the development of the “VON Way” by providing lean coaching to every level of management.

The important element is that VON is striving to provide every manager with a coach. This is the practice at Toyota and VON adopted a similar model. This can only be accomplished by adopting a peer-to-peer coaching model supported by the more experienced full-time coaches.

Coaching cover2Working with these coaches and developing a coaching manual has led me to focus energies on providing the same coaching guidance to the general lean community. Within the next month I will publish this coaching guide as The Lean Coach. In this book I will provide an easy to use model that focuses not only on short-term habits, but on the development of leadership skills and organization culture.


All of the important indicators of performance improved significantly. It is impossible to separate the results caused by the redesigned process versus the results of training and coaching. The improved measures included the key productivity measure of weekly home visits per nurse, a significant reduction in over-time hours and a reduction of travel expenses.

  • The most critical measure that affected productivity was visits per full-time nurse equivalent (FTEs). It increased from about 36 per week to 43 per week in the district highlighted in this case study. Throughout the larger organization, on average, visits increased from 35 to 48 visits per FTE, or 37% employing the same blended learning model.
  • Over-time decreased from 10% of total hours to under 1%,
  • Unscheduled time, a clear form of waste, decreased time from 10 to 20% to below 2% of total time.

There have been many changes in the social system and behavior. One obvious example of this is the daily huddles, a brief team meeting of local nurse teams. In these huddles the nurses and CSAs review any scheduling problems, and solve them on-the-spot. Despite the fact that the nurses are in the field and huddling virtually on their cell phones, there is an 80% attendance rate at the daily huddles.

VON Yellow BeltVON leadership felt that some form of recognition for completing the Team Leadership course, and implementing all the required action steps, deserved some positive reinforcement. Rather than rely on external certification, they created their own Yellow Belt award. In May 2015, the Site Management team had started the Team Leadership course and they completed this in the winter of 2015. They received their Yellow Belt award presented to them in person by VON’s CEO, Jo-Anne Poirier.