[April Fool] Coming Soon – 4th Revised Edition of “Lean Hospitals”


It's time for another new, revised edition of my book! It was originally published in 2008 as Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction

The 2nd edition, released in 2011, had a number of changes and additions and the word “Satisfaction” was replaced with “Engagement” in the subtitle (arguably a better, more accurate word).

The 3rd edition (bigger and better than ever) was released in 2016 with a new color for the cover (collect them all!) and the contractually-obligated 20% additional material (more pages = more value!).

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Over time, I've tried to use new editions to clarify Lean concepts. The 3rd edition talked about “What Lean Is” and “What Lean Is Not” — basically a more polite version of the discussion around what I call L.A.M.E. (Lean As Mistakenly Explained). We have what Bob Emiliani calls “Real Lean” and “Fake Lean.” Now, we even see a lot of “Fake L.A.M.E.” so it's all the more urgent to put out a new edition that finally makes sense.

The 4th edition is the fastest new edition yet, since the world is changing quickly and increasingly uncertain. Hospitals need to react now! Do something! Cut costs! Reduce costs! Slash costs! There's no time to worry about next year!! Next year? Next month!!!

Times have been tough for Lean in healthcare and it's getting worse. Nobody wants to hear my noise about improving safety and quality… who wants to manage differently? That's hard. I get it. I empathize, even. Or maybe it's Fake Empathy.

It's time for a strategic retreat that will hopefully move Lean adoption forward… the 4th edition that more closely caters to what the market is demanding… and better something than nothing, right?

Here is the cover for the new edition:

The subtitle has changed from “Improving Quality, Patient Safety, and Employee Engagement” to:

Reducing Staff, Slashing Costs, and Boosting the Bottom Line.”

Promotional materials for the book promise 25% labor reductions, hence the revision to the team photo on the cover. Oh, that and the pile of money. That's new.

I've taken out the unfashionable advice about not using Lean to drive layoffs… this edition embraces that time-tested idea of cutting costs by laying off staff and having the remaining people figure out how to get by and survive the day through the use of Lean methods.

After writing the foreword to the 2nd and 3rd editions, John Toussaint, MD (to his credit) was not on board with this new direction… so there is a new foreword written by somebody I met in a LinkedIn Group: Khost Cutter, MBA. His guidance and advice helped me re-shape the book to something that might be more acceptable to a larger healthcare audience.

Highlights from the Table of Contents for the new edition include topics such as:

The Need for Lean in Hospitals (Cost, Volume, and Throughput)

Conversational Lean Buzz-wordery & Japanese Words

Effectively Ignoring Lessons from Other Industries

Silver Bullets, Instant Pudding, Quick Fixes, and Vampire Killers: When to Choose Which Strategy

Patients Are Not Cars and Other Pairs of Things That Are Not the Same

Real Lean, Fake Lean, and Ludicrous Lean: Becoming Less Judgmental

Getting People to Work Harder Without Them Realizing It

8S™: Always Start With 5S (Plus Safety, Salami, and Salmonella) and Other Generalizations That Are Never Not True

ROI & Cost Benefit Analysis: The Subtle Distinctions

Best Practices For Finding (and Then Rejecting) Best Practices

Using Lean to Streamline Your Merger

Safety, Schmafety: Respectfully Asking People to Be More Careful

Poka Yoke? No Thanks, I Just Ate

Kaizen, Kanban, Kamishibai, Krzyzewski and Other Words That Start with “K”

72 Ways to Say “No” to Dumb Employee Ideas That Will Make Them Feel Good

No! It's Your Fault! And Other Key Quality Improvement Strategies

Combining Lean and Six Sigma: Best Practices

Root Cause Analysis Methods for Determining Who to Lay Off (and Why)

Redefining Gemba: Reclaiming Valuable Office Time

Getting Started With Lean (For the Third Time)

How to “Lean Out” Your “Lean Journey”

Accelerating “Program of the Month” into a Week-Long Process

A Simple Roadmap and Cookbook for Guaranteed Lean Success

20 Creative Ways to Say “We're Too Busy to Improve”

Knowing When to Give Up and Fire Your Lean Team to Save Money

Glossary: Expanded with Over 328 Japanese Words to Impress Your Colleagues With

The book contains that and so much more. It's the book that all the cool kids will want to be seen with.

Readers will purchase a batch of 50 or more will receive a free Lean Sigma “Taupe Belt” with every book (since selling and shipping these one at a time wouldn't be, you know, efficient). You'll also receive a 64-color pack of 5S tape, complements of my long-time blog sponsors.

My publisher, Unproductive Press, has informed me that they will be nominating the book for the prestigious Scrooge Prize, a top honor for books in the Cost-Cutting Community.

Wish me luck! I hope you enjoy the book and that it serves you well.

A special musical interlude:

If you're part of my blog community, we're no strangers to Lean. You know the rules (no layoffs due to Lean!) and so do I. A full commitment to organizational transformation is what I'm thinking of. You wouldn't get this from any other book.

I just want to tell you, through this post, how I'm feeling. Gotta make you understand.

Because when it comes to healthcare… I'm never going to give Lean up. I hope Lean never lets you down. I hope your leaders never run around and desert you and the Gemba. Lean shouldn't make you cry, don't ever say goodbye to Lean. I'd never tell a lie about Lean and hurt you (since that violates the all-too-important “respect for people principle.”

Take advantage of this special, limited-time free book offer:

I hope you enjoy!

(April Fool)

What do you think? Please scroll down (or click) to post a comment. Or please share the post with your thoughts on LinkedIn – and follow me or connect with me there.

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Check out my latest book, The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation:

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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 think you are missing a chapter about how to overreact to a two data point trend and how to set arbitrary goals without considering the process capability. Here are some stats from your free book:

  2. Paul Taylor via LinkedIn:

    Was actually taking this seriously until seeing the book cover then smiled and laughed through the rest of the post. The Table of Contents is wicked funny!


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