More than a decade ago, I was deeply involved in conversations with healthcare leaders about how to move beyond tools and projects–and instead build cultures where continuous improvement could actually take root. While the technology, terminology, and maturity of many organizations have evolved since then, the underlying challenges remain remarkably familiar: engaging people, learning from problems, and leading improvement without fear or blame.
That's why revisiting older conversations can be so valuable. They remind us which ideas were trends–and which turned out to be timeless.
Recently, I stumbled across a video of Dr. Greg Jacobson and me giving a talk to a local healthcare group in Austin. I believe it was recorded in 2013. Below, you'll find a detailed summary of our presentation and the Q&A that followed.
While KaiNexus software has changed and evolved significantly over the years as the company has grown, the principles behind Kaizen–continuous improvement, frontline engagement, and daily learning–are timeless. Many of the ideas we discussed then are just as relevant today, especially for organizations still struggling to move from episodic improvement projects to true cultures of continuous improvement.
Sorry for the video quality not being great, but the audio is good, and I hope you find the presentation and Q&A interesting and helpful.
Here are the slides:
A Summary of My 2013 Presentation with Greg Jacobson, MD
(and the early thinking that led to KaiNexus)
Back in 2013, I had the opportunity to present alongside Dr. Greg Jacobson, an emergency physician who had become deeply interested in Lean, Kaizen, and systems thinking in healthcare. Looking back, this presentation captures a moment when many of the ideas that later shaped KaiNexus were still forming–but the core principles were already clear.
Our shared goal was to challenge the way healthcare organizations thought about improvement.
Why We Believed Healthcare Needed Kaizen
At the time–and frankly still today–healthcare was under enormous pressure: rising costs, safety concerns, frustrated staff, and leaders who felt trapped in a constant cycle of firefighting. Too often, organizations responded by launching isolated projects or demanding large, quick ROI.
What we argued instead was simple but countercultural:
You can't fix a system by reacting to yesterday's problems. You have to build a system that learns every day.
That's where Kaizen comes in.
What Kaizen Actually Means (and What It Doesn't)
I spent time clarifying that Kaizen literally means change for the better. It's not a program, a suggestion box, or a once-a-year initiative. It's a mindset and a management approach that encourages everyone–especially frontline staff–to identify problems and improve their own work.
We were careful to distinguish Kaizen from traditional suggestion systems, which often fail because:
- Ideas disappear into a black hole
- Feedback takes too long
- Employees stop believing their input matters
True Kaizen requires visibility, responsiveness, and follow-through.
Small Improvements First–Not ROI First
One of the key points I emphasized was that Kaizen should focus first on making work easier, safer, and less frustrating for the people doing it. If you start by demanding financial ROI, you unintentionally shut down participation.
Ironically, when you stop obsessing over ROI at the front end, you often get better financial results in the long run.
I shared examples where small, staff-driven ideas–never intended as cost-saving projects–ended up generating significant financial benefits. The lesson was clear: engagement comes first; results follow.
“Bubbles for Babies” and the Power of Simple Ideas
One of my favorite examples we discussed involved a pediatric imaging challenge. Leaders initially considered spending tens of thousands of dollars on a ceiling-mounted entertainment system to help children stay still during procedures. See the Kaizen summary document:
Instead, a much simpler idea emerged: parents blowing bubbles–if they chose to when given the opportunity.
It cost almost nothing–and worked better.
That story perfectly illustrates Kaizen thinking:
- Creativity beats capital
- Frontline insight matters
- The best solutions are often the simplest
Different Levels of Improvement–All Matter
I also talked about how organizations need multiple levels of improvement happening at the same time:
- Daily Kaizen by frontline staff
- Rapid improvement events for focused problems
- Larger projects for complex system changes
The mistake many leaders make is believing they must choose one. High-performing organizations don't–they support all of them, using the same problem-solving mindset throughout.
Greg Jacobson's Perspective as a Physician
Greg shared his personal journey into Lean thinking, which began when he read Kaizen: The Key to Japan's Competitive Success. As a physician, he initially wondered whether ideas from manufacturing could really apply to healthcare.
What convinced him was realizing that:
- Clinicians already see problems every day
- Healthcare culture often teaches people to hide errors
- Lean reframes problems as system failures, not personal ones
That shift–from blame to learning–is essential for safety, quality, and engagement.
Empowerment vs. “Checking Your Brain at the Door”
One phrase Greg used that stuck with me was the idea that too many healthcare workers are implicitly told to “check their brain at the door.” They're expected to follow procedures, even when those procedures don't make sense.
I learned that phrase early in my career at GM, unfortunately. See this cartoon and reflections on checking your brain at the door.
Kaizen is the opposite of that. It says:
- You are the expert in your own work
- Your ideas matter
- Improving the system is part of your job, not a distraction from it
The Early Thinking Behind KaiNexus
During the presentation, we demonstrated the current version KaiNexus. The idea was straightforward: if Kaizen is about engaging everyone, organizations need a way to capture, track, share, and sustain improvement ideas.
Not as a database.
Not as a reporting tool.
But as a system that supports learning, transparency, and leadership follow-up.
Looking Back from Today
More than a decade later, I see this presentation as an early articulation of ideas that are now much more widely accepted–but still not universally practiced.
Kaizen isn't about tools.
It's about trust.
It's about respect for people.
And it's about leaders choosing to build systems that help people improve, rather than systems that merely measure them.
That message mattered in 2013–and it still does today.
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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.
