When a Six Sigma/Lean/Agile black belt(s) is thrust upon your team/dept/org they would cause a great pain by forcing the cognitive dissonance between those 2 worlds upon you. You'd feel these fishbones like they are really in your throat and sticking right into your brain from inside there.
https://en.wikipedia.org/wiki/Ishikawa_diagram#Fishbone_Diag...