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 20 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.

Update: You can now buy this as a Kindle book or paperback via Amazon. Visit www.PracticingLean.com to learn more.

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

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Mark Graban is an internationally-recognized consultant, author, and professional speaker who has worked in healthcare, manufacturing, and startups. His latest book is Measures of Success: React Less, Lead Better, Improve More. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. He also published the anthology Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also a Senior Advisor to the technology company KaiNexus.

  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. […] I mentioned on Monday, I’m working on a 3rd revised edition of my book Lean […]

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

    1. Thanks!

      The eBook is “ready” and on sale now… even as a work in progress. That’s the nature of this “Lean publishing” platform.

  4. 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!

  5. And my donation:

  6. More royalties and another donation:

    Thanks to everyone who has purchased the book and contributed a chapter!

  7. […] few months back, I announced a new collaborative eBook project called Practicing […]

  8. More royalties and another donation:


    Royalties will be bigger next month as sales have increased!

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



  10. More royalties:

    And another donation:

  11. That’s $425 in total proceeds to the foundation so far.

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

  13. […] I’m documenting in the comments here, the collaborative eBook Practicing Lean has now generated more than $500 of donations to the […]

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

    Thanks to everyone who has read the book!

  15. 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!

  16. […] I’m documenting in the comments here, the collaborative eBook Practicing Lean has now generated about $700 of donations to the Louise […]

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

  18. The past two donations:

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

  20. $35 in new royalties that I’ll round up to a $50 donation.

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

  22. Donated another $20 between LeanPub and Amazon royalties…

    That’s $995 so far. I should have rounded up to $25.

  23. Another $50 donated to the foundation. That’s now over $1000!

  24. Here is the 2016 annual letter from the Louise H. Batz Patient Safety Foundation:


  25. $13 more from LeanPub and $30 from Amazon Kindle sales… rounded up to $50 donation.

  26. Rounding up to another up to another $20 donation to the foundation.

    Leanpub sent you $15.57 USD

    Just thought you’d like to know Leanpub sent you $15.57 USD.


    Your donation of* $20 *helps to bring community awareness to patient safety issues, distribute “The Batz Guide for Bedside Advocacy”, and to educate patients, their caregivers and care teams about the importance of working together to create a safe environment. Thank you for being a part of our community in patient safety.

  27. I donated another $20, rounding up from Amazon Kindle sales revenue.

  28. Donated another $100 for LeanPub ($35) and Amazon ($55) royalties, rounding up.

    Thanks, everyone!

  29. More royalties… rounding up to $150. Leanpub was about $100 and Amazon was about $35.

    Thanks to the authors and the readers!

  30. For the end of April, Amazon paid out about $259.78 in February book royalties (converting from various currencies).

    LeanPub royalties look like they will are $40.68.

    So, that’s $300.45 to be donated to the Louise Batz Foundation… I’ll round up to $315, which brings the total raised to date to be $1700 for a very good cause.

    Thanks to everybody who has purchased the book!

  31. […] our question and answer session on the topic of lean healthcare with Mark Graban, author of Lean Hospitals: Q9: You wrote in Lean Hospitals that it takes courage to point out that something is a waste. How […]

  32. Another $150 donated… the royalties from LeanPub:

    From Amazon:


  33. Between LeanPub and Amazon, I’m going to round this up to a $300 donation:

  34. $62.54 in Amazon royalties. None this month from LeanPub.

    Rounding up to a $70 donation. $2220 so far.

    With next month’s expected LeanPub payout, we’ll be over $2500 in proceeds to the foundation.

  35. This month’s royalties are in…

    $203.97 from LeanPub:

    And about $27 from early audio book sales through LeanBlog.org led to a total of $230 in my PayPal account:

    And Amazon sales totaled about $143.

    I rounded up to a $400 donation:

    Bringing the total proceeds to $2620!

    Thanks again to everybody!

  36. September proceeds from Amazon and Leanpub total $150.36.

    I’ll round up to $180 to bring the total to $2800 in donations.

  37. Amazon royalties for the month are $97.21
    Leanpub paid $213.23

    Total was $310.44, I’ll round up to $325 for the donation.

    The total is now $3125.

  38. This month, Leanpub paid $56.90 and Amazon paid $99.36. Total of $156.26, I’ll round up to $175, bringing the total proceeds to $3330 for the Batz Foundation.

    1. Only $4.23 from LeanPub and $50.06 from Amazon. I’ll round up to $70 so the total so far is now $3400 to the Batz Foundation.

  39. $28.30 in Leanpub royalties, plus $108.76 from Amazon = $137.06, which I’ll round up to $150.

    Total is now $3550 for the Batz Foundation.

  40. Roughly $60 total (rounding up) from Leanpub and Amazon — the total is now $3610.

  41. March payments are $56.97 from Leanpub and $19.74 from Amazon. I’ll round up to $90… total donation is now $3700 to the Batz Foundation.

  42. Another month’s royalties = $21.97 from LeanPub and $24.98 from Amazon… rounding up to a $50 donation.

    Total donation is now $3750. Thanks to all of the buyers and readers!

  43. Royalties = again $21.97 from LeanPub and $47.39 from Amazon, a total of $69.36. I’ll round up to $100, for a total donation of $3850 so far.

  44. This month’s royalties = $32.76 from Amazon + $13.36 from Leanpub = $46.12, rounding up to $50, makes $3900 to date.

  45. Royalties = $43.31 from LeanPub and $23.46 from Amazon = $66.77. I’ll round up to $100, making a total of $4000.

  46. Another $20 in royalties… a total of $4020 now.

  47. Another $50 donation from rounded up royalties — $4070 to date.

  48. Another $30 donation rounded up… $4100 so far.

  49. Another $20 in royalties (rounded up) from Leanpub and Amazon — $4120 in donations so far.

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