Updating “Lean Hospitals” and a New eBook, “Practicing Lean”

Lean Hospitals SmallerHopefully you’re aware of my book Lean Hospitals. It was first published in 2008 and I was able to do a second, revised edition that was released in 2011. Traditional book publishing doesn’t really allow any sense of continuous improvement, other than maybe fixing a spelling error in a new printing of an edition. So, changes get made in big batches. This page highlights the changes between the first two editions.

It’s now time for a revised, third edition that I’ll have “done” and ready to submit to the publisher by October 1st, if I’m on schedule. Given the batch-and-queue value stream of traditional publishing, the book will probably be printed and on sale by the summer of 2016.

For the 3rd edition, I have been focusing on general improvements to the book, including:

  • Clarifying text as needed
  • Adding new data and examples
  • Adding or expanding coverage of more “advanced” topics, such as strategy deployment and “Lean design”
  • Including more recent context around the need for change and the general healthcare environment

If you’ve read the book and have feedback or ideas for me, please comment on this post or contact me directly. If you have a story or example (or photo) that you think might be a helpful addition, please let me know.

Listen to Mark read this post (subscribe to the podcast):


“Practicing Lean”


It’s been 2o years now since I graduated from college and starting working with the Lean methodology. The first ten years of my career were focused on manufacturing and then I had the happy detour into healthcare ten years ago this month when I joined Johnson & Johnson and their Lean consulting group, ValuMetrix Services.

With those two big round numbers… 20 years of Lean, 10 years in healthcare, I’ve been reflecting on that time and what it has meant. Reflection is a good habit for a Lean thinker, whether you call it “hansei” or not (I generally would not).

Part of my reflection is thinking back to my early days and early understanding of Lean. I made some of the types of mistakes, early on, that I might sometimes criticize others for today (sometimes on this blog). That’s maybe not always a positive thing to do.

So, I’ve decided to launch a collaborative eBook titled Practicing Lean: Learning How to Learn How to Get Better… Better.

As I say on the web page for the book:

If we keep practicing, we might get good at it eventually. We all have a starting point in our personal “Lean journeys.” Looking back at our first year of work in Lean or continuous improvement methodologies, we probably weren’t very good at it. What are our reflections and lessons learned? What can we share with those who are just starting today? This book will be a compilation of those stories.

For this project, I’m using the LeanPub.com platform (listen to my podcasts with the founders here and here).

Some things that are different about this project, compared to Lean Hospitals:

Collaborative: I’ve written two chapters to share my reflections and to maybe set the tone for the book. But, I’m inviting others to contribute an essay or chapter with their own personal stories and reflections. If you’d like to write something, click here. Authors will be listed as contributors on the book’s page and can include a short bio in the book.

Charity: Proceeds from the book will be donated to a non-profit organization that I’m a board member for, the Louise H. Batz Patient Safety Foundation. I’ll provide an accounting of sales, proceeds, and donations as transparently as I can. So far, I have 22 readers. Some of them are potential contributors who were given free copies through my early “soft launch.” Actual buyers who paid have led to $24.91 in currently unpaid royalties. Unlike traditional publishing, a vast majority of the proceeds go to the author, and therefore the charity, not the publisher (or retailer).

Continuously Published: Unlike traditional publishing, I can edit or add to the book at any time, pushing a new updated edition to those who have already purchased the book. I’ll generally do this as a monthly batch to avoid too many update emails going out to owners of the book.

Choose Your Price: I’m using the LeanPub feature that allows buyers to choose their price within a range. There’s a recommended price and minimum price. That price is low to provide an incentive to early buyers. A buyer can voluntarily pay more, if they so choose (or you can donate to the Batz Foundation directly). Again, once you buy the book, you get all future updates for free. As content is added, the recommended price will go up over time.

Flexible: If you buy the book, you can download it as a PDF to read or print, in Kindle format that you can email to one of your devices or apps, or the more general EPUB format.

I hope this is a worthy experiment. We’ll see how it goes. There is some risk that those who have talked to me about contributing chapters don’t actually follow through. That’s one reason the starting price is low.

To reduce your purchasing risk, there are a few options as a reader and buyer.

For one, LeanPub has a no-questions-asked 30 day return / refund policy.

Secondly, you can read the first chapter of the book online or as a downloaded PDF.

Or, you can just buy it. I’d love to hear your feedback and thoughts and reactions.

As of August 30, the book has 28 buyers and unpaid royalties of just over $50. When those royalties are paid by Leanpub, I will donate the funds to the Batz Foundation. Click below for a larger view.

Screen Shot 2015-08-30 at 7.01.16 PM

Thanks for reading! I’d love to hear your thoughts. Please scroll down to post a comment. Click here to receive posts via email.

Now Available – The updated, expanded, and revised 3rd Edition of Mark Graban’s Shingo Research Award-Winning Book Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement. You can buy the book today, including signed copies from the author.

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Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an eBook titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

22 Comments on "Updating “Lean Hospitals” and a New eBook, “Practicing Lean”"

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  1. I have the 2nd edition of “Lean Hospitals” and found it to be an excellent ‘transliteration’ of Lean/TPS principles into the healthcare context. Mark Graban has written a concise guide with enough clarification to allow readers to grasp each presented topic. I look forward to edition 3 with his thoughts on strategy deployment – which is the golden thread that runs through an organization and aligns it efforts. show less

  2. Karen Skinner

    Love the title for the new eBook! And very much looking forward to reading it when it’s ready.

  3. Mark Graban

    I’ve received a royalty payment for $57 that I will be passing along to the Batz Foundation:

    The book now has 63 readers.

    Thanks to all those who have bought and read it so far!
    Mark Graban recently posted..Throwback Thursday: #Lean Equipment and a Lean Layout Isn’t EnoughMy Profile

  4. Mark Graban

    More royalties and another donation:

    Thanks to everyone who has purchased the book and contributed a chapter!
    Mark Graban recently posted..One Does Not Simply “Implement Lean”My Profile

  5. Mark Graban

    More royalties and another donation:


    Royalties will be bigger next month as sales have increased!
    Mark Graban recently posted..Update on “Practicing Lean” – Excerpts From New Chapters By @MikeLombard & Paul AkersMy Profile

  6. Mark Graban

    Another $85 in royalties, so I’ve sent that and rounded up to $100 for the donation to the Batz Foundation.



    Mark Graban recently posted..January 4 – Live Podcast with Paul Akers, Discussing His Book “Lean Health”My Profile

  7. Mark Graban

    More royalties:

    And another donation:

    Mark Graban recently posted..How Failed Lean Implementations Are Like a Bad Home Theater SystemMy Profile

  8. Mark Graban

    That’s $425 in total proceeds to the foundation so far.
    Mark Graban recently posted..HBR Article on Avoiding the Futility of Suggestion SystemsMy Profile

  9. Mark Graban

    Another $100 donated… $525 so far. Thanks to all who have bought the book!

    Mark Graban recently posted..Announced “Workplace Principles” for NHS Wales Staff Sound Like Lean PrinciplesMy Profile

  10. Mark Graban

    Another $100 for March royalties, rounded up. $625 raised to date.

    Thanks to everyone who has read the book!
    Mark Graban recently posted..#ThrowbackThursday: Past #Lean April Fools’ Day FunMy Profile

  11. Mark Graban

    This month’s royalties were about $68, so I rounded up and made a $75 donation to the foundation. Their system has some problems where it didn’t generate a receipt for me yet.

    That’s $700 from this project so far. Thanks for reading!
    Mark Graban recently posted..Why It’s OK That This Suggestion Box Was Full of CobwebsMy Profile

  12. Mark Graban

    Another $20+ in royalties, so rounding up to another $25 donation. $725 to date.

    Mark Graban recently posted..My LinkedIn Post on Bad Toast & Bad ManagementMy Profile

  13. Mark Graban

    Another $25 to the foundation based on another month’s royalties.

    Mark Graban recently posted..Key Tweets from @MarkGraban – Week of June 27, 2016: Bad #Lean Book, Good Lean EffortsMy Profile

  14. Mark Graban

    $35 in new royalties that I’ll round up to a $50 donation.

    Mark Graban recently posted..Podcast #258 – Jim Huntzinger on Deflation, Lean Management & Lean AccountingMy Profile

  15. Mark Graban

    Royalties were low from Leanpub, but a few Kindle sales now… rounding up to another $50 donation.

    Mark Graban recently posted..This Time, the NEJM Publishes Something Positive About #LeanMy Profile

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