The builder and the white coat syndrome

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To make Lean work, builders must first recognize and uncover any open wounds, a process too few builders are willing to undertake. 

February 18, 2013

Scenario 1: 

A relative of mine, Mike, goes to a new doctor. His family history includes one grandfather who died young from heart failure, a grandmother who had a debilitating stroke at 56, a mother with dangerously high blood pressure, and a father who just had a quadruple bypass. When the doctor asks if he has any family history cardiovascular problems, Mike answers, “no.” 

What is Mike thinking? If he tells the doctor about his family history, then what? The doctor might go snooping around, adding tests. And what if he finds something? Mike feels fine; he has a good job and is making money and supporting his family. They need him. 

That shortness of breath he gets every now and then and that tightness in his chest last week — they were just stress from his job, or maybe the asthma he had as a kid is coming back. And you know how these doctors are: they make money on those tests, so the more they prescribe, the better for them. Mike sure isn’t going to help the doctor buy another BMW.

Scenario 2: 

My friend Doug is hit while driving home in his pickup by a teenage boy who runs a stop sign while talking on a cell phone. Both vehicles are damaged badly, but the airbags worked and other than a little dazed and confused, neither driver seems seriously injured. Doug is about to lay into the kid for being an idiot when the EMTs arrive, take one look at the vehicles, and haul both of them to the hospital for a thorough exam. Doug, being the tough-guy type, strongly protests; he never sees a doctor for anything. 

It turns out that Doug is correct insofar as the accident is concerned. There is no damage; he’s just roughed up a bit. The next day, Doug gets an urgent call from the hospital telling him to get to an oncologist immediately. A lab technician saw something unusual and ran some additional tests after Doug left. The oncologist tells Doug three things. First, he has a rare form of blood cancer that often shows no symptoms until it is well-advanced. Second, if not for the car accident, they would have never found the blood marker at such an early stage, so Doug should thank the kid who hit him. Third, Doug owed the lab tech a nice dinner because the cancer was caught early enough that a successful outcome was likely.

What was Doug’s response? Did he scream at the lab tech for finding the cancer? Did he curse the oncologist for telling him the truth and interrupting his busy life? Doug, like Mike above, was feeling pretty good on the surface. That tired feeling he had — that was normal given his hectic schedule and worries over work and family issues. No, Doug was exceedingly grateful that the problem was found early. He engaged his treatment in high gear and used it as a motivator to get a whole lot of things reordered in his life.

Scenario 3: 

A builder calls a consultant to come in and make a presentation about “Lean process,” a well-honed technique to engage suppliers and trades in giving the builder team in-depth feedback. The feedback focuses on product, process, and plans, and the consultant describes how the information can get as personal as it is powerful. “When you ask your suppliers and trades to tell you where the baby is ugly and give them the tools, time, and audience to do it, you’d better be prepared to listen and take on the issues,” said the consultant.  

The builder thinks it over really hard. It sounds so promising, and some of his other builder friends report saving a lot of money while improving product, process, and relationships through Lean techniques. But it will also bring up a lot of stuff he would prefer to have remained buried, at least until he and his people are ready to deal with it. The builder feels his blood pressure rising. This does not need to be decided now. He sends the consultant an email saying, “Let’s talk next summer when we are done implementing the new IT system and we have more time.”

In medicine, there is a phenomenon called “white coat syndrome” — there is a marked tendency for many people as soon as they hit the doctor’s office and the cuff goes on, their blood pressure rises. At the root of this reaction is a very basic fear: Am I all right? What will the doctor find? And if she finds something, what am I going to do? What if I need surgery? What if I have to miss work? What if I am dying? Any logical analysis finds such fear nonsensical. If the doctor were to find something, well, it was already there, wasn’t it? And could it possibly be a good thing to let it go untreated? And which would bring worse consequences: treating the issue now or letting it go until later? Allowing for the possibility of miracles or otherwise unexplained events, let’s conservatively say that 98 percent of serious medical conditions never just get better on their own — and always get worse when treatment is delayed. But when it comes to personal health and fear, asking people to be logical isn’t exactly, well, logical. Is it any different in business? 

A similar response is found in the dentist office, where you know well that when the dentist finds something, it is going to hurt. But then again, how much more will it hurt if you wait? Cavities beget crowns which beget root canals or even nastier stuff like gum surgery. You’ll also find this phenomenon with your rough-running car, leaky roof, noisy refrigerator, or perhaps that annoying little anger management issue your spouse keeps bringing up. It’s not just the physical stuff we avoid. We are reluctant to take our symptoms to the expert — that man or woman in the white coat — because we are afraid of what we might find. 

My relative Mike’s fear was so great that he would rather live in denial and hope for the best. Given that in more than half the cases the first sign of cardiac disease is sudden death, I worry about him. My friend Doug’s fear was so strong that he protested going to the hospital even after a serious accident with air bags exploding into his chest and face. Our builder friend — and I have met many of them — just cannot bring himself to face what might be wrong with his operations. It is often said that knowledge is power, and that’s true. Yet with knowledge also comes great responsibility. Once you know, once you see the facts in front of your very eyes, a person of responsibility is compelled to do something about it — a change, a remedy, a solution, a fix — something that solves the problem, relieves the pain, or reduces the risk.

To Doug’s credit, once he saw the facts he took action and beat the cancer. He’d be the first to tell you, though, that without the car wreck to force the situation, he would have been dead. Mike? He might be fine, or he might be a ticking time bomb. About our builder, who knows? Perhaps all is well, or maybe he is about to blow up. Or, it could be he just needs some meds, a better diet, and more exercise — or in builder terms, fix the schedule, improve the plans, and walk the sites more. 

All three of our friends suffer from the white coat syndrome — afraid of what might be — but they need to know the truth. Is that rising blood pressure just a psychological thing or something with the potential to kill you? 


Scott Sedam is president and founder of TrueNorth Development. His articles appear monthly in Professional Builder and his Lean Building Blog appears each Tuesday on www.HousingZone.com. Sedam welcomes your questions and feedback at scott@truen.com and encourages budding “Leanistas” to join the LeanBuilding Group on www.Linkedin.com.

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