What Dr. Deming Said About Hospital CEOs and Transformation


Two years ago, I wrote an article for the Deming Institute about Dr. W. Edwards Deming's notes from his 1987 hospitalization.

As I wrote then:

The scenarios that Dr. Deming describes in the article could all happen today in a hospital, although he'd likely have a private room and slightly better food. 

I had a chance to revisit Dr. Deming's notes and the ending jumped out at me. I didn't directly comment on it two years ago, but I will now.

As I shared on LinkedIn (which generated a lot of discussion and sharing):

The text reads (with my slight edits in italics):

“What is the moral of all this? What have we learned? One answer: the Chief Executive Officer of the hospital needs to learn something about supervision. Only the CEO can make the changes in procedure and responsibility that are required.

Talks between physicians and nurses, even with the Chief Nursing Officer, accomplish nothing. The same problems that I have noted will continue. A physician cannot change the system. A CNO cannot change the system. Meanwhile, who would know? To work harder will not solve the problem. The nurses couldn't work any harder.”

The CEO cannot delegate responsibility for the system. Responsibility doesn't mean the CEO fixes every little detail. The CEO is responsible for systems and policies, budgets and staffing, priorities and culture — the very things that are the biggest factor leading to an organization's results.

As Darril Wilburn, formerly of Toyota says:

“Leaders are responsible for providing a system in which people can be successful.”

That doesn't mean leaders have to do it all themselves. It means they need to lead.

A friend of mine works for a health system and he's perpetually frustrated in the various jobs that he's had that the organizations' senior leaders never really support Lean. So, he changes jobs and finds the grass isn't greener anywhere else. He can make local improvements in the operating rooms, but he wants to really help change the system.

His current organization is demanding that “all managers” go to a day long Lean Management 101 training course. That might be a good start, but I'm guessing the organization thinks the managers will “know” Lean after a day of training. The probably won't get the support and coaching that they'd need to really change their behaviors.

Oh, and by the way… “all managers” doesn't include the CEO. The CEO is a manager, right?

If the CEO is going to “sponsor” Lean training and then not go… is that CEO going to be leading by example? Probably not. The Lean training will probably be a waste of money and it might be a net demoralizer because the CEO and senior leaders likely won't be practicing what the Lean trainer is preaching.

Some CEOs take a good game… but that's it. More is needed.

And we wonder why there are so many problems in healthcare.

On the more positive side, CEOs like Vance Jackson and Gladys Bogoshi both seem like rare exceptions rather than the norm. They're LEADING their Lean transformation aspirations and efforts. They're involved. They're leading this.

Listening to my podcasts with them (click on their names for the episodes) is probably more inspiring than hearing me moan about CEOs who aren't willing to learn and lead by example when it comes to Lean.

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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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. Great post. I’m a senior manager at the hospital chain I work for, and I’ve seen that same thing here. I feel like the clinics/departments I oversee are well maintained, but what else can we do if our CEO doesn’t show any interest in Lean or anything like that? Since I’m not the CEO, I’m not sure what else I can do. I try to implement everything I’ve learned from different courses and books, but do you have any other suggestions on what us managers can do? Always a great read. Thanks Mark.

  2. Many CEOs “support” lean, meaning they talk about it, encourage others to use lean, but too often stop there. And the result is far from transformational. It’s also not enough for the CEO to attend the Lean Management course, although that helps. If a CEO participates and then learns through doing, and receiving coaching, and then shares that and exhorts others to follow him or her, now we’re getting somewhere. As John Toussaint and Roger Gerard wrote in On The Mend, when they used the word “we” in the book, they specifically meant themselves as direct participants in kaizen and rapid improvement events, in which they were coached along with others junior to them, by experienced lean practitioners. Without the modeling of this desired behavior from C-level leaders, the managers who attend the Lean Management training you mentioned above not only might not Get the coaching they need, many of them are likely to Decline offers of coaching or support and continue doing what they’ve always done. In my experience, that’s not unusual at all. Do our health system CEOs know this? Hear it but don’t believe it?

    Mark, I wonder if you know US health system CEOs who are truly effectively supporting lean in their hospitals without going all the way to direct participation and coaching a la Toussaint and Gerard?


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