Another CEO Talk: “Can I Say That?”


The final keynote talk at the recent Society for Health Systems / ASQ Healthcare conference was given by Dr. Barry Silbaugh, a former hospital executive and the current CEO of the ACPE – The American College of Physician Executives. Silbaugh is a big proponent of Lean in healthcare, listing Lean as one of the major trends for 21st Century healthcare saying “everyone needs to” use Lean methods and thinking.

From his bio:

Silbaugh has studied the Toyota Production System, visited the Georgetown, Ky., Toyota plant twice, and used lean principles to improve work processes in healthcare.

In his talk, he shared some thoughts on Lean and a story that really illustrates what can be broken in a healthcare organization's culture.About Lean, one of the key concepts that resonates with Dr. Silbaugh is understanding the entire “value stream” from the patient's point of view. Of this, he said:

This is what's missing in healthcare!

Looking at healthcare quality, Dr. Silbaugh realizes that the focus needs to be on systems that allow people to make mistakes. This is very consistent with the Lean approach to quality, that we can't blame individuals after the fact. We're human, we make mistakes, so systems need to be designed accordingly.

Dr. Silbaugh told the audience that the only healthcare processes that can be characterized as “high reliability” are level 1 anesthesia (minimal sedation) and blood administration (transfusions). These processes are relatively safe because the healthcare industry reacted to enact systemic improvements after major incidents that occurred in the past. For other processes, quality is not nearly as good as the public thinks. Dr. Silbaugh said the general public, when surveyed, thinks there are 5,000 deaths a year in the U.S. due to medical errors, when the real number is estimated to be between 44,000 and 98,000.

Many proceses don't offer the reliability we should expect. For example, he cited a report that said 76 patients in Springfield, Missouri received radiation overdoses — not just one day, but over a period of years due to faulty machine calibration.

Dr. Silbaugh told one final story, I'll do my best to paraphrase it accurately.

While he no longer practices medicine regularly, Dr. Silbaugh was filling in for a friend and went to visit some patients at a hospital. Working with a nurse for the first time, he examined a patient and gave an order for Vitamin K to be administered orally.

A few minutes later, he realized that he should have ordered an injection, that it would be more effective for the patient. He tracked down the nurse and said, “I misspoke, I meant to say an injection.”

The nurse said, “I knew you were wrong!”

Dr. Silbaugh asked the nurse why she didn't say that he was wrong…

The nurse asked, “Can I say that????”

Dr. Silbaugh responded, “Next time, I insist….”

Having never seen Dr. Silbaugh before, the nurse was scared to speak up. That says a lot about how far healthcare needs to come in terms of creating a culture where people can speak up – in the name of quality and patient safety – without fear.

As Dr. Deming said, we need to eliminate fear from the workplace.

Thanks to Dr. Silbaugh for sharing that story and for his leadership around lean, quality improvement, and high-reliability organizations!

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. I saw a similar situation on an episode of The Ghost Whisperer last night. An older doctor with dementia made a mistake during a surgery, resulting in the death of a young woman. Some people working with the doctor knew he had issues, but they were afraid to speak-up because of the doctor’s seniority and stature. The Ghost Whisperer had to channel the doctor’s deceased wife to get to the root cause and confront the doctor. We need more Dr. Silbaugh’s because we can’t always rely on Jennifer Love Hewitt to step in and save the day now, can we?

  2. Inspiring post, Mark! Thanks for sharing. In our culture, not just in our health care system, speaking “truth to power” is a real problem. We need to work hard to get people to speak up and others to listen.


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