TL;DR: Not all waste in healthcare is equal. When Lean efforts focus on tidy 5S projects while patients are harmed or waiting, we risk “5S-ing the deck chairs on the Titanic.” Real improvement prioritizes patient safety, flow, and systems that help people speak up and solve meaningful problems.
Today, I presented a webinar for Gemba Academy on waste in healthcare (see the recording below).
One sobering starting point: Multiple studies, summarized by the Institute of Medicine, estimate that roughly $750 billion per year is wasted in U.S. healthcare. That's nearly 30% of total spending–and most of it is not waste that can be solved by tidying up supply rooms or reorganizing carts.
Not All Lean Waste in Healthcare Is Created Equal
Lean teaches us about the eight types of waste–defects, waiting, motion, overprocessing, inventory, transportation, overproduction, and unused human potential.
But one of the most important points I emphasized in the webinar is this:
The eight types of waste are not equally important in healthcare.
A defect that leads to patient harm or death is fundamentally different from excess inventory or inefficient motion. While all waste deserves attention, defects and delays that harm patients must come first.
This is where healthcare Lean efforts can drift off course.
This distinction between “important” and “trivial” waste is something I explored in Lean Hospitals. Lean in healthcare was never meant to be about generic efficiency–it's about designing systems that prevent harm, reduce waiting, and make it easier for clinicians to do the right thing for patients. When we lose sight of that purpose, Lean risks becoming busywork instead of improvement.
The Real Problem Isn't “Bad Apples” — It's the System
When tragic failures occur, the instinct–inside and outside organizations–is often to look for someone to blame.
But again and again, healthcare failures trace back not to “bad apples,” but to:
- Broken processes
- Poorly designed systems
- Management practices that discourage speaking up
Stories like Malyia Jeffers (background, video), Darrie Eason (NBC coverage), and Mary McClinton illustrate this painfully well. These cases were not caused by lazy or uncaring clinicians. They were the result of systems that allowed defects, delays, and communication breakdowns to persist.
Blame doesn't fix systems. Learning does.
Read more about Dr. Don Berwick's thoughts on the “bad apples” fallacy.
That mindset sits at the heart of Healthcare Kaizen. Sustainable improvement happens when leaders stop treating mistakes as personal failures and instead create systems where people can surface problems, test changes, and learn quickly. Without that environment, defects don't disappear–they just get hidden.
Why Better Quality and Safety Ultimately Reduce Cost
There's a persistent myth that healthcare organizations must choose between:
- Improving quality and safety, or
- Controlling cost
In reality, the opposite is true.
When we reduce harm, rework, delays, and waiting, cost comes down as a consequence–not as the primary target. As Don Berwick has long argued, improving value means improving outcomes relative to cost, not cutting cost in ways that undermine care.
The Risk of “5S-ing the Deck Chairs on the Titanic”
If we focus Lean efforts on trivial improvements while patients are harmed or waiting unnecessarily, we risk doing what I half-jokingly call:
“5S-ing the deck chairs on the Titanic.”
5S, visual management, and workplace organization can be helpful–but only when they support meaningful goals like:
- Reducing patient harm
- Shortening waits that matter
- Making it easier for staff to deliver safe, compassionate care
When Lean becomes disconnected from those aims, it loses both credibility and impact.
Why Leadership Choices Matter More Than Lean Tools
One final point that came through clearly in the webinar and the notes:
We have an obligation–to patients and to staff–to focus on what truly matters.
That requires leadership that:
- Encourages people to speak up about problems
- Treats mistakes as signals for learning, not punishment
- Prioritizes safety and flow over superficial cost reduction
Lean isn't about doing more projects.
It's about building better systems and better leadership behaviors.
If we don't do that, we may look busy–but we won't be making the difference our patients and staff deserve.
Across both Lean Hospitals and Healthcare Kaizen, the consistent lesson has been that tools don't transform healthcare–leadership behavior does. 5S, visual management, and standard work can help, but only when leaders are clear about priorities and create conditions where staff can speak up about harm, delays, and frustration without fear.
Why This Still Matters for Healthcare Leaders in 2026
More than a decade after this webinar, the risks haven't gone away–they've intensified.
In 2026, healthcare organizations face persistent staffing shortages, burnout, financial strain, and rising patient expectations. Under that pressure, it's tempting to gravitate toward visible, low-risk Lean activities that feel productive but avoid the hardest problems.
That's exactly when the “deck chairs on the Titanic” risk is highest.
The core question hasn't changed:
Are our improvement efforts reducing patient harm, unnecessary waiting, and daily frustrations for staff–or are they simply making broken systems look neater?
Lean still matters in healthcare, but only when it's anchored in patient safety, flow, and respect for people. Tools like 5S can help–but leadership choices determine whether improvement efforts address what truly matters or quietly sidestep it.
The obligation remains the same in 2026 as it was in 2013: Focus first on the waste that harms patients and staff–and build systems where people feel safe to surface and solve those problems every day.
If you’re working to build a culture where people feel safe to speak up, solve problems, and improve every day, I’d be glad to help. Let’s talk about how to strengthen Psychological Safety and Continuous Improvement in your organization.
