On a very high level, my job in performance excellence is to assist hospital transformation projects that aim to spread Toyota Production System principles. Our overall goal is to create a Lean health care environment at Stanford Hospital. A big part of Lean is empowerment. Lean concepts strive to make whistleblowers of employees, and also make employees the actors and originators of transformation. What this means is that employees identify the problems, they come up with ideas to fix the problems and then they implement their ideas to bring about change. After all this, they must sustain their efforts. This last part is always the hardest. How this part usually plays out is that our team hands-off the management of the project to the unit or the department. After at point, the recipient of the hand-off is expected to run with the project and manage it into the future, making changes and/or seeking advice from our department as needed. Well, as you can imagine this isn’t always easy. At the same time employees want to be empowered to make changes, they often balk at the responsibility that follows close behind. This makes sense, considering that the duties associated with empowerment impose new daily tasks. I mean–no one wants more work, right? But this entire concept of not wanting empowerment conflicts with what we’re taught in school–or, maybe I should say what we aren’t taught. What we are [impliedly] taught is that employees want to be empowered. Yay! What a great thing empowerment is! Well, not really. Don’t get me wrong, empowerment really is great, and to efficiently run hospital empowerment is needed. What school doesn’t teach, though, [or doesn’t expressly convey] is that people are fickle and empowerment is tricky, and working to align fickle with tricky is downright difficult! Needless to say, achieving unequivocal and wanted empowerment (i.e., true empowerment) takes much longer than I originally expected. Knowing that empowerment is necessary is only the half of it. The other half is selling the idea, and that’s where effective management comes into play.