I heard from two different people this past week–each working in very different hospitals.
One message began with:
“The hospital removed the wrong leg from a patient during surgery last month.”
The other said:
“We're desperate to cut costs.”
Two different hospitals. Two very different issues. But they're more connected than we might want to believe.
On the surface, one is a heartbreaking patient safety failure. The other is a financial challenge that nearly every American health system is feeling right now. But here's the conundrum:
Too often, in the rush to reduce costs, healthcare organizations unintentionally cut or underinvest in the very systems and behaviors that prevent harm. Ironically–and tragically–preventable harm is incredibly expensive. Not just in dollars, but in reputation, morale, and trust.
It's not simply a matter of cost-cutting gone wrong. It's often just a lack of focus on the things that really matter: like culture, mistake-proofing, and communication.
Wrong-site surgery isn't just a clinical error. It's not just a “never event.” It's a breakdown in communication, process, systems, and ultimately–culture.
And when it happens, the costs are enormous:
- Legal settlements and litigation
- Regulatory investigations
- Staff trauma and burnout
- Patient suffering that can never be undone
- Erosion of public trust
All of that is far more costly–financially and morally–than investing in what works to prevent these events in the first place.
If hospitals are serious about reducing costs, maybe the better question is this:
What if the most sustainable path to cost savings is doubling down on quality and safety?
This means:
- Investing in systems that make it easier to do the right thing and harder to do the wrong thing.
- Creating a culture of psychological safety where people feel safe speaking up when something seems off.
- Learning from close calls and mistakes, not punishing or hiding them.
- Empowering staff to solve problems, not just work around them.
We don't have to choose between safety and efficiency. In fact, we can't separate them. They're intertwined.
In Lean Hospitals, I shared a story about a hospital that was struggling with frequent medication errors. Leadership initially saw the problem as a training issue–“people need to be more careful.” But when they went to the gemba, they discovered that nurses were regularly being interrupted during medication administration, that drug labels were confusing, and that workspaces were poorly organized.
By addressing those systemic causes–through standardized work, visual management, and error-proofing–the error rate dropped dramatically. The improvements didn't just prevent harm; they saved time, reduced waste, and lowered costs. The investment in quality paid for itself many times over.
That's the paradox that too few organizations fully embrace:
Cutting corners looks efficient. Improving systems actually is efficient.
Many have said, including Phillip Crosby, “Quality is free.”
Not because it has no cost–but because the cost of not focusing on quality is always higher.
So I'll ask:
What would it take for more health systems to treat quality and safety as their most powerful cost-reduction strategy?
And who's willing to lead that shift?
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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
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