In 2014, Gregory Clancy and I co-authored an article about Allina Health's early Kaizen-based improvement journey. We told a story that felt both simple and revolutionary: when you invite everyone to improve the work, the work improves–for patients and for the people doing the work. Here is the article (PDF):
Engaging Staff as Problem Solvers Leads to Continuous Improvement at Allina Health
Re-reading the article now, I'm struck by how concrete the work was–rooted in visible problems, daily conversations, and measurable progress. Below, I've pulled forward more examples, data, and short quotes from the original piece, with reflections on what I'd underline even more strongly today.
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The Setup: Four Pilots, Clear Intent
Allina kicked off its Kaizen process under my coaching in October 2013 across four very different settings:
- a large adult/pediatrics unit
- a cardiovascular unit
- the emergency department at a large hospital
- a cardiovascular unit at a hospital in downtown St. Paul
The pilots weren't random; leaders began with a “daylong conference” that made roles explicit and even used role-playing to practice how to invite and coach ideas.
This “conference” was more of a brief training session with a lot of immediate learning through hands-on experience, supplemented by coaching and feedback.
Visually, the work lived on idea boards with four columns–“New Ideas,” “To Do,” “Doing,” and “Done”–backed by quick daily huddles. Staff captured problems and expected benefits on preprinted cards so ideas wouldn't get lost “in the midst of a busy day.”
One of their early Kaizen boards is pictured below:
Some of their earliest Kaizen cards, where they identified a problem and had a “solution” concept that could be tested–or it served as the starting point for discussions to find something that seemed worth testing:
Concrete Examples I Still Love
1) From scavenger hunt to point-of-use:
Starting an IV used to require running around to three different locations for tape, catheters, and saline–which took “five to ten minutes–assuming she was not interrupted.” Kaizen provided a mechanism for the nurse to propose and test a better setup, turning frustration into flow. That's classic example of “making it easier to do the right thing.”
2) Safer, cheaper finger-stick supplies:
A staff idea fixed a small but costly workaround: add nonsterile pads to the finger-stick supply box (instead of tissues or sterile pads). The staffer coordinated with supply, relabeled the box, and the team “celebrated” the completed project for improving quality, safety, and cost.
3) Numbing spray: documenting progress and dependencies:
When the ED proposed using an anesthetic spray before IV insertion, the card and board made the upstream constraint visible–“pharmacy approval” was required–and kept everyone informed as the status evolved.
4) Alarm fatigue > turning down the volume:
Faced with audible IV pump alarms, the team initially wanted to “turn down the volume,” but coaching reframed the real problem as “alarm fatigue,” leading to better countermeasures.
5) Coaching, not quick fixes:
The article contrasts a manager who “jumped to a solution” (a laminated phone list) with the Kaizen stance of clarifying the problem and co-creating countermeasures. The reminder is timeless: “managers must see themselves as coaches, and not as top-down activity directors.”
Here's an example of how we documented the before-and-after of a small Kaizen:
What the Numbers Said (Early but Encouraging)
Six months in, the four pilots had “more than 275 ideas” submitted, with “70 percent” completed. Managers reported ongoing commitment to the process. Here's the unit-level breakdown the article provided:
Adult/Pediatrics Unit: 104 ideas; 70 “Done,” 34 “Doing.” Engagement scores moved: “I have resources to do the work” went from 72% to 83%; “I participate in decision-making” increased 83% to 88%; “My job makes good use of my skills/abilities” improved from 76% to 83%. Patient satisfaction improved in nurse communication and responsiveness. (Forgive the two-data-point comparisons!)
Suburban Cardiovascular: 79 ideas; 59 “Done,” 20 “Doing” (plus 9 not implemented). The team used Kaizen on “reducing time to access test results” and on shift-change handoffs.
Emergency Department: 67 ideas; 31 “Done,” 17 “Doing,” 19 “To Do.” Staff “appreciated seeing their ideas quickly implemented.”
Cardiovascular (St. Paul): 27 ideas; 20 “Done,” 2 “Doing,” 5 “To Do,” with a plan to involve an adjacent unit to increase ideas and spread improvements.
Two design choices supported sustainability. First, leaders tracked ideas in a shared spreadsheet and categorized completed work by patient safety, satisfaction, operational efficiency, or staff satisfaction. Second, they emphasized recognition: “Completed ideas… are highlighted during the daily huddle and celebrated” to encourage more participation.
The People Side: Coaching, Time, and Safety
Our article was explicit that Kaizen works best when:
“managers become coaches who engage staff members in a collaborative way.”
Practical tactics included delegating responsibility to senior staff, forming unit-based committees, and–critically–protecting time: “two to four hours every other week” for people to work on ideas.
At the same time, we didn't sugarcoat the reality. Two main obstacles: “lack of time… and managers' limited ability to coach.” The response was to integrate Kaizen into existing routines and build coaching capability, not bolt it on as extra work.
The story also shows psychological safety in action–even when an idea isn't adopted. When an infectious disease nurse advised against using fans for shortness of breath (risk of spreading germs), “the rejection of the idea” became a teaching moment, not a demotivator.
Ten-plus years later, here's what still holds up–and what I'd underscore even more strongly now.
More on That Coaching Example
1) The “why” was explained clearly and quickly.
An infectious disease nurse didn't just veto the fan idea; she explained the risk–fans can spread germs in a clinical setting. That transparency transformed a rejection into a shared learning experience for the entire unit.
2) The conversation stayed respectful and public.
Because leaders were intentional about open communication and prompt feedback, the rationale was surfaced in the huddle/idea flow–not whispered later. That preserves dignity for the person who suggested the idea and models how we learn together.
3) The system reinforced learning, not compliance.
They used the Kaizen cadence (idea cards, board, huddles) to broadcast the lesson–“fans spread germs”–so others wouldn't chase the same dead end, and everyone gained infection-prevention awareness. That's organizational learning from a single suggestion.
4) Psychological safety was protected.
Notice what didn't happen: no eye-rolling, no blame for a “bad idea.” The outcome was, “Thank you; here's why we can't do this–and here's what we learned.” That keeps people bringing the next idea.
If you want to replicate this dynamic, here's a simple script leaders and facilitators can use when an idea isn't viable:
- Appreciate: “Thanks for raising this–it addresses a real pain point.”
- Explain: “Here's the clinical/safety constraint that makes this option risky…”
- Offer alternatives: “Given that constraint, what else could reduce shortness of breath or perceived heat without moving air? (e.g., cool compresses, repositioning, environmental controls, respiratory consult).”
- Make it visible: Capture the decision + rationale on the card/board so the whole team learns.
- Close the loop publicly: Mention it in the next huddle so the suggester feels respected and everyone hears the lesson.
The principle: reject the solution, not the person or the problem. When leaders respond this way, “no” expands understanding, builds trust, and actually increases the flow of ideas–exactly what happened at Allina.
What We (Collectively) Got Right
1) Improvement is everybody's job–especially leaders as coaches.
The article highlighted “effective communication, constructive feedback, and supportive delegation” as coaching behaviors. Those phrases weren't window dressing; they were the mechanism for change. When leaders ask, “What's getting in your way?” and then help remove those barriers, people respond with energy and ideas.
2) Small problems aren't small.
That wandering path to gather IV supplies seems trivial until you multiply it by shifts, patients, and interruptions. Reducing such friction improves quality, safety, flow, and morale. The pilots demonstrated tangible, local improvements–exactly the proof of concept people need to believe culture can change.
3) Start somewhere; learn fast; spread thoughtfully.
We described four units as the initial canvas. That scope was big enough to matter and small enough to learn. With each cycle, leaders and staff built capability and confidence to take the next step.
What I'd Emphasize Even More Today
Psychological safety is the pre-condition.
Back then, we showed the mechanics and the mindsets. Today, I'd make the foundation more explicit: without psychological safety, boards and huddles become theater. People won't share problems or ideas if it feels risky. In my writing since then, I've framed psychological safety as the “pre-condition” for continuous improvement: you can install the artifacts of Lean and still get no learning if people fear blame.
Respect for people is not a slogan–it's the system.
I moved from manufacturing to healthcare nearly twenty years ago and heard highly educated professionals say, “I feel like a robot.” That feeling isn't created by hard work; it's created by being excluded from problem solving. When we invite people to improve their own work, we restore dignity and unlock performance.
Leaders must respond, not react.
When you begin engaging staff, the metric lines won't instantly tilt. Leaders who react to normal noise in the data create panic and short-termism; leaders who respond–grounded in process and patterns–create stability that encourages experimentation. That's why I teach simple, visual time-series thinking and process behavior principles: learn from signals, don't chase every wiggle.
Three Practical Practices That Endure
Ask, “What problem are we trying to solve?”
Keep the focus on the patient, the people, and the process–not the tool. A tidy board without conversations is decoration. A messy board with active learning is progress.
Make it easy to do the right thing.
Point-of-use supplies, clearer flow, better handoffs–these are acts of respect. If the current process makes the right thing hard, improve the process.
Coach for learning, not compliance.
Celebrate experiments, not just results. When something doesn't work as expected, practice curiosity over judgment. That's how you get more ideas tomorrow.
What I'd Ask Leaders to Reflect On Now
- Do your people feel safe to point out problems? If not, you won't see them until they bite you.
- Are improvement boards and huddles producing conversations and action–or are they performative? If it's the latter, simplify, refocus, and listen.
- Where can you run–today–one, small, staff-led experiment? Start small, learn loudly, spread thoughtfully.
Looking back, I'm grateful for the leaders and teams at Allina who chose to believe that everyone can be a problem solver. That belief still changes lives at the bedside and beyond. The methods matter, but the mindset matters more: humility to see problems, curiosity to learn, and courage to improve–together.
Proven, Not Easy: The Real Work Ahead
Kaizen with clinicians isn't theory–it's proven. When we invite nurses, physicians, techs, and support staff to spot problems and test changes, care gets safer, flow improves, and engagement rises. We've seen it in EDs, ICUs, clinics, labs, and the “messy middle” of hospital operations. But “proven” doesn't mean “easy” or “automatic,” and it certainly doesn't mean “permanent.”
Why isn't this everywhere? Because culture isn't a project. It stalls when leaders change and the next shiny initiative arrives; when psychological safety erodes and people stop speaking up; when managers are asked to “do Kaizen” without time or coaching skills; when performance reviews reward heroics and quick fixes over learning; when boards chase month-to-month noise instead of nurturing long-term capability. In short: the system gets the results it's designed to get.
If you want different results, design a different system–one that protects time for improvement, builds coaching habits, and treats every idea as a chance to learn. For a practical playbook, see my two books with Joe Swartz: Healthcare Kaizen and The Executive Guide to Healthcare Kaizen. They show how to start, how to sustain, and how to make continuous improvement the way you deliver care–not an extracurricular activity.
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Let’s build a culture of continuous improvement and psychological safety—together. If you're a leader aiming for lasting change (not just more projects), I help organizations:
- Engage people at all levels in sustainable improvement
- Shift from fear of mistakes to learning from them
- Apply Lean thinking in practical, people-centered ways
Interested in coaching or a keynote talk? Let’s talk.
