Archive for April, 2010

Should Have Posted a “Caution: Don’t Knock Our House Down” Sign?

Should Have Posted a “Caution: Don’t Knock Our House Down” Sign?

I saw this on the national cable news two nights ago, the horrifying story of a Denton TX woman whose house was basically destroyed by a bulldozer. Was it a runaway bulldozer? Nope, different type of “accident.”

Workers were supposed to tear down the house across the street (oops, indeed). See this article: “Texas Woman At A Loss For Words After Workers Demolish Wrong House” and this picture.

Clearly, a huge sign on the garage saying “WRONG HOUSE” might have helped, but that’s not a practical precaution we can all take in the morning when we leave for work. Keep reading for some questions about why we rely on signs and cautions in the workplace, particularly hospitals.

Learning and Sharing Lean Healthcare in Winnipeg

Learning and Sharing Lean Healthcare in Winnipeg

The Winnipeg Free Press has an article about their local St. Boniface Hospital, a member of the LEI/ThedaCare network I’m involved with called the Healthcare Value Network. About 40 of us from different Network member organizations visited last Thursday and Friday for what we call a “gemba meeting” — going and seeing, first hand, what a network member is doing well with Lean and what their lessons are.

Dr. John Toussaint blogged about the visit and I’ll comment here on the news article (“Turning St. B into a lean machine: Standard Aero serves as example to help hospital improve care“).

The Waste of Pulling Promised Training Funds in Rhode Island

I’m sharing this appeal on behalf of a good Lean friend, Karl Wadensten from VIBCO in Rhode Island.

Karl is fired up, rightfully so, because the Rhode Island state legislature has proposed cutting some previously-promised employee training funds. Believe it not, business and the unions are united in their view that it’s wrong to cut that funding.

If you’re in (or near) Rhode Island, there is a rally TODAY at 4 PM at the State House. More details follow.

Follow Ups from @ericries #leanstartup Webinar

Thanks to Eric Ries for an outstanding webinar today for LEI, “Lessons from Lean Startups.” We had over 1300 registrants from over 60 countries, plus he had the challenge of a very diverse audience (people from startups, big companies, hospitals, and government).

The slides and audio archive will be available soon (by Friday?) on

To those who are new to LEI, I wanted to point out a few resources that might be interest for those of you in the software and startup space, although LEI traditionally hasn’t supported that field very well.

Upcoming WIHI Broadcast with Toussaint, Spear, and Kaplan

The Institute for Healthcare Improvement (IHI) has a free podcast/audio series called WIHI. My friend e-Patient Dave told me about a recent broadcast (archived here) called “The Meaningful Methodology of Patient- and Family-Centered Care.” As Dave, an advocate for patient involvement, has learned about Lean we’re both discovering the parallels and the complementary nature of the approaches.

Their upcoming episode, on Thursday May 6, features three luminaries of the Lean healthcare world:

  • Steven J. Spear, Senior Lecturer, Massachusetts Institute of Technology; Senior Fellow, IHI
  • John Toussaint, Founder and President, ThedaCare Center for Healthcare Value
  • Gary Kaplan, MD, Chairman and CEO, Virginia Mason Health System

The session is called “Success at the Right Speed: Learning from Toyota.”

Read this Book – But Don’t Copy ThedaCare

Read this Book – But Don’t Copy ThedaCare

Due out in June is a book that I think will be an important one for the Lean Healthcare movement. That book is about the Lean journey of the Wisconsin health system ThedaCare. It’s called “On the Mend: Transforming Healthcare to Save Lives and Transform the Industry,” published by the Lean Enterprise Institute (conflict of interest alert – they are my employer).

ThedaCare is widely considered one of the leaders in the application of Lean in healthcare – delivering measurable results for improved quality (patient care and outcomes), reduced cost, reduced waiting times, and improved staff engagement. The book is written by ThedaCare’s former CEO John Toussaint, MD, and their chief learning officer, Roger Gerard PhD.

I’ve read the book many times (in its various forms and stages of editing) and I recommend it highly. I think it will definitely speak to healthcare executives about why we need Lean in healthcare and what their role needs to be in engaging employees and physicians.

As much as I like the book, I’ll give this caveat that might be controversial — don’t copy ThedaCare!

How I Broke My Blog and Fixed It… Lessons Learned

How I Broke My Blog and Fixed It… Lessons Learned

For those of you who have had difficulty accessing for the past two weeks or so, I apologize. It’s been frustrating to me and I’ve gotten a number of emails from people who couldn’t get the site to load.

I think I finally got to the root cause, with the help of tech support from Things should be back to a stable, “site loads every time” state. Update: there are still some problems today, so maybe we don’t have the root cause ID-ed.

I’ll spare you all of the technical details, but will share a bit to help other WordPress bloggers who might run into the same problems. I’ll also tie it to a core “Toyota Way” principle that I violated.

Eric Ries and Lean Startups in the NY Times

Looking ahead to Wednesday’s free LEI webinar “Lessons from Lean Startups” with Eric Ries, it’s exciting to see Eric and Steve Blank featured in the NY Times today (“The Rise of the Fleet-Footed Start-Up“).

You can sign up for the webinar at The live event is Wednesday 4/28 at 2 PM EDT, where you can ask some questions, or you can view the archived event soon after.


You might wonder what lessons you can learn from a “startup” if you are a traditional business or a healthcare provider, even. Eric’s LEI talk is targeted for those who are NOT in traditional startup settings. One of Eric’s ‘4 myths’ about Lean Startups (as given in this slide deck) includes:

  • Myth: The Lean Startup is only for Web 2.0/internet/consumer software companies.

Liveblogging the Quaid Patient Safety Documentary

Liveblogging the Quaid Patient Safety Documentary

I’m blogging notes and thoughts as I watch the Discovery Channel documentary by actor Dennis Quaid and others —   “Chasing Zero: Winning the War on Healthcare Harm” that first aired April 24 at 8 am EDT. With laptop and Tivo remote in hand… away we go.

Link to the show info at is here.   I hope you’ll watch too and share your comments here on the blog. It also airs again next Saturday, May 1 or you can watch it online in multiple parts. I’ll update this post as I watch…

UPDATE: You can watch the documentary on YouTube.

Parallels between “Lean Startups” and “Adaptive Design”

I’ve been a fan of the “Lean Startups” work of Eric Ries since last year, so I’m happy to be producing a free LEI webinar called “Lessons from Lean Startups,” to be presented live on April 28 at 2 PM EDT.

I have also just started reading the book Designed to Adapt: Leading Healthcare in Challenging Times, written about the use of Lean in healthcare to create what Dr. Charles Kenagy calls “ideal care” based on the “rules in use” from Steven J. Spear, Ph.D.

I found some interesting parallels between the methodologies, which surprised me.

Retaining Employees through Respect and Development

I was recently in Toronto and I heard a story on an AM news station that really caught my ear. I have searched on the station’s website and the web, but I can’t find the exact story, but I found this newspaper article that references the same study.

The one surprising statistic, based on a Canadian survey, was that a really high percentage (80%) was looking for new employer and would gladly jump ship given a new opportunity. This is going to be more of concern for employers as the economy picks up. If you’ve been using “voluntary turnover” as a measure of staff morale, you might be kidding yourself — maybe employees are staying put because they have no other options… for now.

Does this number surprise you? Do you think it’s similar in the U.S. or your country? What can companies do to counter these employee feelings and retain their best talent? A few classic Lean principles can play a big part.

Lean is “Taking Canadian Healthcare by Storm,” but Look Out for “L.A.M.E.”

In an article (“Assembly required: Health care from the Toyota factory floor“) from Canada’s National Post newspaper says Lean healthcare is “taking Canadian healthcare by storm.”

The piece leads with some work done by Windsor’s Hotel-Dieu Grace Hospital – a member of the Healthcare Value Leaders Network that’s co-facilitated by the Lean Enterprise Institute. HDGH reduced waiting times for the emergency department, as documented in the peer-reviewed Canadian Journal of Emergency Medicine (“Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department“).

Dennis Quaid and Patient Safety – Upcoming Documentary

Dennis Quaid and Patient Safety – Upcoming Documentary

You might be familiar with the case where the actor Dennis Quaid’s twins were harmed by an overdose at the famed Cedar-Sinai Hospital in Los Angeles. I blogged about it originally in late 2007 as the post “How Often Must the Same Mistake Be Repeated?” The post title referenced the fact that the exact same set of circumstances led to the death of three babies in Indianapolis in 2006 (see “Lack of Error Proofing Kills 3 Babies”). Here is a complete list of my blog posts mentioning the Quaids.

Thankfully, Quaid’s twins survived. Dennis and his wife Kimberly have been using their celebrity status to try to bring positive change around patient safety – particularly with a systems focus. Dennis is getting out there again as the “frontman” for a new push to raise awareness about systemic medical errors, including an upcoming Discovery Channel documentary called “Chasing Zero: Winning the War on Healthcare Harm.” More about the show, including video clips, here. Site Problems

Dear readers – as you may have noticed, my site has been suffering from intermittent downtime, due to problems with the shared database server provided by my hosting company.

If you come to the site and it doesn’t load, try hitting “refresh” or “reload” in your browser until the page loads. This usually works, especially after a few tries. I hate workarounds, but that’s it for now.

Tech support at the hosting company keeps claiming to have the problem fixed, but to no avail. I may be switching to a new hosting company soon, but the address will remain the same, of course.

You can also read my site’s content through these methods:

Sorry for any inconvenience. No, I didn’t violate Dr. Deming’s rule by choosing my hosting company based on price alone!

Right Sized Capacity in a Stockholm Hospital

Right Sized Capacity in a Stockholm Hospital

When I was in Sweden in late January, I had a chance to visit the Capio S:t Görans Hospital in Stockholm. I saw many amazing things, including Lean practices and culture. I haven’t taken the time to write about this yet, but I’ll start today with some thoughts on “rightsizing” of equipment and capacity.

My host for a good portion of the visit was Göran Örnung MD, PhD, the chief of the Emergency Department (and a regular reader of the Lean Blog!)

LeanBlog Podcast #89 – Keith Russell, Ph.D., Lean in Pharma R&D

LeanBlog Podcast #89 – Keith Russell, Ph.D., Lean in Pharma R&D

Our guest for Podcast #89 is Keith Russell, a Global Continuous Improvement Leader at AstraZeneca R&D. I met Keith at a recent Lean & Six Sigma conference for Pharma R&D where we both presented.

Keith has substantial in-house R&D experience across the entire value stream and currently works with Global Drug Development. He is particularly interested in Design and Innovation and the application of Systems Thinking to complex Business problems. Keith has a Ph.D. in Synthetic Organic Chemistry from the University of Cambridge.

Click to play:

MP3 File

In this podcast, we discuss the applications of Lean and Six Sigma in a space that we’ve never talked about here – pharmaceutical development. How do you use Lean principles in such a technical field and how do you engage the highly educated scientists who do this work?

For earlier episodes, visit the

What Makes You Want to Do Better?

Recently, I was able to visit VIBCO, a Lean manufacturing company in Rhode Island. Company President Karl Wadensten is the host of “The Lean Nation” radio show. It was my third time visiting the factory in the last six months, walking the gemba to see first hand, hearing from their great employees.

This time, VIBCO was hosting a group of executives from a healthcare organization, so they could see the Lean culture that VIBCO has been working on developing the past few years.

There are many great examples of a Lean culture that I could write about, but I wanted to share one quick story about an exchange between one of the visiting execs and a VIBCO front-desk employee.

Lucian Leape Loathes Lean or “L.A.M.E.”?

Lucian Leape Loathes Lean or “L.A.M.E.”?

Noted patient safety expert Dr. Lucian Leape spoke out recently spoke out about medical school culture being a root cause of poor quality (see my blog post “Is Medical Education a Systemic Root Cause of Poor Quality?“).

Now, he’s criticizing Lean in the publication “Modern Healthcare,” as part of this article “Leape sees potential for change.” (free registration required)

It’s not the core of the article, but it has me wondering if he’s criticizing generally accepted Lean principles or what I call “L.A.M.E.” — Lean As Misguidedly Executed. L.A.M.E. includes stuff that people call “lean” but really isn’t a good representation of true Lean mindsets and practices.