Executive Summary (for Leaders)
Continuous Improvement–often called Kaizen–is not a program, a department, or a suggestion box. It is the daily practice that makes Lean real.
At its core, Kaizen means improving systems by engaging the people who do the work to identify problems, test ideas, and learn together. This way of working comes directly from Lean and the Toyota Production System, where improvement was never something “extra”–it was how work was designed, managed, and led.
In healthcare and other complex organizations, sustainable improvement does not come from targets, heroics, or periodic initiatives. It comes from leaders building systems that support learning, problem-solving, and respect for people–every day.
When practiced well, Kaizen becomes the operating system for improvement, not an add-on.
Kaizen and Lean: Inseparable by Design
Kaizen is often discussed as if it were separate from Lean. In reality, Kaizen is how Lean works in practice.
At Toyota, Lean was never about tools alone. It was about:
- Making problems visible (including “andon cord” pulls)
- Solving them at the source
- Improving processes incrementally
- Developing people through daily problem-solving
Without Kaizen, Lean becomes static–focused on past improvements rather than ongoing learning. Without Lean thinking, Kaizen risks becoming scattered activity without direction.
Lean provides the system and principles.
Kaizen provides the daily practice and learning.
Kaizen at Toyota: Why Small Improvements Matter
One of the clearest real-world examples of Kaizen comes from my time visiting plants at Toyota Motor Corporation–not from a major production breakthrough, but from a small, everyday improvement.
During a plant tour, our guide pointed out a simple hook that had been added to a catwalk railing so she could hang her bag instead of placing it on the floor. It was her idea. It cost almost nothing. And it required no formal ROI justification. Yet it perfectly illustrates how Kaizen works at Toyota.
That small change mattered–not because it moved financial metrics, but because it reinforced an expectation: notice problems, propose improvements, and act. At Toyota, leaders approve most ideas, encourage employees to implement them, and focus more on participation than payoff. Over time, this builds confidence, capability, and engagement. Some improvements eventually deliver measurable results–but none of that happens without first creating the habit of daily improvement.
This is a critical lesson for organizations that struggle with Kaizen adoption. When leaders demand business cases for every idea or reject “small” improvements, they unintentionally shut down learning. Toyota shows the opposite approach: develop people first, and results follow.
(You can read the full story here: “Our Toyota Tour Guide's Small Improvement: Kaizen in Action.“)
Kaizen Is Ultimately a Leadership Responsibility
One of the most persistent myths about Kaizen is that it “belongs” to frontline staff.
Yes, most improvement happens closest to the work. Not all improvement can be delegated.
But leaders own the system that enables–or disables–improvement.
Leadership responsibilities in a Kaizen-based organization include:
- Cultivating psychological safety so people can surface problems and speak up
- Designing time and space for improvement work
- Responding to problems with curiosity, not blame
- Reinforcing learning over quick fixes
As explored in The Mistakes That Make Us, organizations do not learn from errors by demanding perfection. They learn by designing systems that encourage speaking up, experimenting, and reflection.
Small Kaizen at Scale: UMass Memorial Health
A common question about Kaizen is whether small, frontline ideas really scale. The experience of UMass Memorial Health offers a clear answer.
Over time, leaders consistently encouraged staff to surface and test small improvements in daily work–without demanding that every idea be a “big project” or come with a formal ROI. That steady leadership approach has compounded. Today, UMass Memorial has implemented more than 200,000 employee ideas, a powerful indicator of engagement and organizational learning.
CEO Eric Dickson described frontline huddles as moments where ideas flow faster than teams can act on them. Rather than slowing that flow, leaders focused on prioritization and follow-through, avoiding what he called an “idea traffic jam.”
The lesson is simple but profound: small Kaizen isn't about chasing isolated wins. It's about building the habit and capability of improvement. When leaders consistently support participation, those small ideas accumulate–shaping culture, improving care, and strengthening systems over time.
Read more: A Continuing Culture of Continuous Improvement at UMass Memorial Health
Kaizen in Healthcare: Improving Care Without Burnout
Healthcare illustrates the need for Kaizen especially well.
When improvement relies on:
- workarounds
- individual heroics
- or “just trying harder”
people burn out, and patients remain at risk.
Kaizen in healthcare focuses on:
- reducing preventable harm
- improving flow and reliability
- eliminating waste that frustrates staff
- strengthening teamwork across roles and departments
As described in Lean Hospitals and Healthcare Kaizen, the goal is not efficiency for its own sake. The goal is better care delivered through better systems–systems that support both patients and the people who care for them.
Healthcare Kaizen: Small Improvements, Big Impact
Healthcare leaders sometimes worry that “small” improvements won't matter in the face of staffing shortages, financial pressure, and clinical complexity. But real-world experience shows the opposite: small Kaizen is often what unlocks big results–especially when it's led by frontline professionals.
During one of my visits to Seki Chuo Hospital, we spent time with the hospital pharmacy team, who described how years of daily Kaizen had reshaped their work. Rather than launching big projects or waiting for new technology, they focused on identifying everyday frustrations and experimenting with simple countermeasures.
Through an accumulation of small improvements–many involving layout changes, reduced walking, clearer visual cues, and better standardization–the pharmacy reduced medication preparation and inspection time by more than 60 percent. Patient education at discharge rose dramatically. Inventory levels were cut roughly in half. None of these gains came from a single breakthrough. They emerged from hundreds of modest, staff-driven changes.
One particularly telling example came from a patient-centric Kaizen: bedridden patients wanted to read the newspaper more comfortably. The solution was a simple cardboard newspaper stand–cheap, quick to implement, and deeply appreciated by patients. On its own, it wouldn't move a balance sheet. But culturally, it sent a powerful signal: we notice problems, we care, and we're allowed to improve things ourselves.
This mirrors what Toyota demonstrates so well: Kaizen isn't about chasing ROI on every idea. It's about building capability, engagement, and confidence. When healthcare organizations encourage small improvements–especially those that make work easier or care more humane–they create the conditions for larger improvements in safety, quality, and cost to follow.
Small Kaizen doesn't compete with strategy. At Seki Chuo Hospital, local improvements were explicitly connected to organizational goals and patient outcomes. Over time, frontline learning and leadership intent reinforced each other.
If Kaizen feels slow or “too small,” that's often a sign it's being evaluated through the wrong lens. The real impact shows up not just in metrics, but in how people think, collaborate, and take ownership of their work every day.
(Read the full example here: “Small Kaizen, Big Impact: Lessons from a Japanese Hospital Pharmacy.”)
What Sustained Kaizen Looks Like in Practice
What does sustained Continuous Improvement actually look like over time?
One of the clearest healthcare examples I've seen comes from Franciscan Health, where leaders committed to Kaizen not as a short-term initiative, but as a long-term way of thinking. Over nearly two decades, consistent leadership behaviors, frontline engagement, and psychological safety led to more than 27,000 documented improvements–and many more that were never formally tracked.
What makes Franciscan's story especially instructive is the patience involved. Early on, staff were skeptical. Leaders stayed the course. Over months and years, Kaizen became “just how we think and work,” shifting the culture from compliance to ownership.
I've written in detail about how Franciscan Health built and sustained a culture of continuous improvement through Kaizen, including lessons from nursing, pharmacy, perioperative services, and leadership at every level.
[Read the Franciscan Health Kaizen case study]
Kaizen Is About Learning, Not Just Ideas
Kaizen is sometimes reduced to counting ideas implemented. That misses the point.
The real value of Kaizen is not the number of changes made–it's the learning that happens through small tests of change.
Effective Kaizen emphasizes:
- rapid experimentation
- reflection on results
- sharing what was learned
- improving the next experiment
This is how organizations build capability, not just improvements.
Metrics That Support Improvement (Not Fear)
Metrics matter–but how they are used matters more.
Drawing from Measures of Success, improvement-focused organizations use metrics to:
- understand systems, not judge people
- identify opportunities for learning
- track trends over time, not snapshots
- support better decisions, not enforce compliance
When metrics are used primarily for targets, rankings, or punishment, Kaizen shuts down. When metrics are used to support inquiry and learning, Kaizen accelerates.
Good metrics answer questions like:
- What is the system telling us?
- Where is variation coming from?
- What can we learn and test next?
What Kaizen Looks Like When It's Working
In organizations where Kaizen is truly part of Lean thinking, you see:
- Problems surfaced early instead of hidden
- Leaders spending time understanding work, not just reviewing reports
- Small improvements happening every day (not just “Kaizen Events” and projects)
- Fewer large, disruptive “transformation” initiatives
- Stronger engagement and less burnout
Kaizen becomes how the organization improves, not something people are asked to do on top of their real work.
Continuous Improvement becomes most visible when it's deeply embedded in how people think–not when it's labeled as a program.
At a recent GE Lean Mindset event, Chef Wolfgang Puck described how he and his teams are always asking: How do we get better today–without sacrificing quality or the guest experience? From visual standards in food prep, to long-term supplier relationships, to treating mistakes as learning opportunities, the practices looked remarkably familiar to anyone who has studied Toyota or Healthcare Kaizen.
Puck put it simply: “Good is not good enough.” That mindset–shared across industries–is what makes Kaizen sustainable.
[See the full story from the event]
Why This Still Matters in 2026
In 2026, organizations face:
- increasing complexity
- workforce burnout
- rapid technological change
- and pressure for better outcomes with fewer resources
No dashboard, AI tool, or reorganization can replace the need for people-centered, system-based improvement.
Kaizen–grounded in Lean thinking and practiced as daily leadership behavior–remains one of the most practical, humane, and effective ways to build organizations that can learn, adapt, and improve over time.
