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A Lean Management System That Doesn’t Depend on the Lean Team — Emily Swaney, OhioHealth What 21,050 Clinicians Told Us About Fear and Futility
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Mark Graban

Lean Leadership, Psychological Safety, and Continuous Improvement

Since 2005, LeanBlog.org has shared practical insights from real-world work in healthcare, manufacturing, and beyond.

Books Keynote Speaking Coaching / Advisory Podcasts
Books by Mark Graban on Lean, Leadership, and Learning (4)

Lean Blog Interviews Podcast

Podcast #148 – Naida Grunden & Charles Hagood on ‘Lean-Led Design’ for Hospital Construction and Renovation

Podcast #148 – Naida Grunden & Charles Hagood on ‘Lean-Led Design’ for Hospital Construction and Renovation

ByMark Graban May 21, 2012 1623
Episode #148 is a conversation with a returning guest, Naida Grunden (previous episode) and her co-author Charles Hagood (of Healthcare Performance Partners), talking about their new book Lean-Led...
Podcast #147 – Scott Patten and Peter Armstrong, Founders of LeanPub.com, Part 2 on Lean Publishing

Podcast #147 – Scott Patten and Peter Armstrong, Founders of LeanPub.com, Part 2 on Lean Publishing

ByMark Graban May 15, 2012 1701
Listen Episode #147 is a part two of a conversation with  Scott Patten and Peter Armstrong from  LeanPub.com (listen to part one in episode #140). They want to be THE website for publishing...
John Toussaint, MD on Potent Medicine and Reforming Healthcare Through Lean

John Toussaint, MD on Potent Medicine and Reforming Healthcare Through Lean

ByMark Graban May 2, 2012 1760
Episode #146 is a discussion with a returning guest (#54, #62, #72), John Toussaint, MD, the CEO of the ThedaCare Center for Healthcare Value. Today, we're talking about his latest book, recently...
Podcast #145 – Interview with Natalie Sayer, Author ‘Lean for Dummies’

Podcast #145 – Interview with Natalie Sayer, Author ‘Lean for Dummies’

ByMark Graban April 25, 2012 1671
Episode #145 is a conversation with Natalie J. Sayer, co-author of the recently updated 2nd edition of the book Lean For Dummies. I was able to meet Natalie at the recent ASQ Lean and Six Sigma...

More Blog Posts

Developing Coaching Skills: Mine, Yours, Ours, with Tracy Defoe [Webinar]

Developing Coaching Skills: Mine, Yours, Ours, with Tracy Defoe [Webinar]

Mark GrabanByMark Graban March 11, 2024 2113
Developing Coaching Skills: Mine, Yours, Ours VIEW NOW I'm excited to be hosting and moderating a new webinar that's part of the KaiNexus Continuous Improvement webinar series, to be presented by...

Happy 5th Birthday to Measures of Success: Lessons from Five Years in Print

Mark GrabanByMark Graban March 11, 2024 2083

Ryan McCormack’s Operational Excellence Mixtape: March 8, 2024

Ryan McCormackByRyan McCormack March 8, 2024 5223
**Alt Text:** A presentation slide from GE Aerospace's Investor Day featuring CEO Larry Culp. The slide is titled "Introducing - FLIGHT DECK" and includes the following text: - GE Aerospace's **proprietary lean operating model** - A **systematic** approach to running our business to deliver exceptional value as measured through the eyes of our **customers** - **Accelerating** our lean progress to ensure focused execution as a public company Larry Culp is pictured on the left side of the slide, wearing a black suit and speaking against a backdrop with a gradient of warm colors. On the right side, there is an image of a turbine or engine component. The GE Aerospace logo is displayed at the bottom, and the slide is marked "2024 GE Aerospace Investor Day" with the page number 13.

Inside GE Aerospace’s Flight Deck: How Larry Culp Leads with Lean and Safety

Mark GrabanByMark Graban March 7, 2024 11988

Why Psychological Safety Should Lead to Candor — Not “Being Vulnerable” at Work

Mark GrabanByMark Graban March 6, 2024 5434

Webinars

karen martin ask the expert webinar kainexus

Ask Karen Martin Anything on Operational Excellence: A KaiNexus Webinar

March 5, 2026
Karen Martin is one of those people I've been lucky to know and learn from for a long time. She's...
1. Professor with glasses in front of EMS 20th anniversary logo and KaiNexus logo on blue background.

Unlock the Power of Leadership: A Preview of the Electrolux Manufacturing System (EMS) Webinar

December 4, 2025
KaiNexus recently hosted a webinar I was especially looking forward to: “Unlock the Power of...
Breaking Through Cultural Friction: Respect for People and Sustainable Performance

Breaking Through Cultural Friction: Respect for People and Sustainable Performance

June 9, 2025
When organizations struggle to sustain Lean transformation, people often look first at tools...
Driving a Culture of Patient Safety: Lessons for Healthcare and Beyond

Driving a Culture of Patient Safety: Lessons for Healthcare and Beyond

April 28, 2025
Recently, I had the pleasure of moderating a webinar titled “Driving a Culture of Transforming...
Why Lean Fails Without Psychological Safety

Why Lean Fails Without Psychological Safety

April 16, 2025
TL;DR: Lean tools don't fail because people resist change–they fail because people don't feel...
Preview: Driving a Culture of Accountability – Transforming Patient Safety with KaiNexus (Webinar, April 15)

Preview: Driving a Culture of Accountability – Transforming Patient Safety with KaiNexus (Webinar, April 15)

April 8, 2025
One of the most powerful elements of continuous improvement is the ability to learn from each other...
My Upcoming Webinar on Mistake-Proofing Across Industries

My Upcoming Webinar on Mistake-Proofing Across Industries

February 3, 2025
I'm excited to be presenting this webinar on February 12th at 1 pm ET as part of the KaiNexus...
Top 5 Takeaways from my KaiNexus Webinar: Psychological Safety as a Precondition for Continuous Improvement

Top 5 Takeaways from my KaiNexus Webinar: Psychological Safety as a Precondition for Continuous Improvement

January 8, 2025
TL;DR: Psychological safety isn't optional for continuous improvement. This KaiNexus webinar...
Creating Leader Standard Work (LSW) Across a Distributed Business Model — Webinar Preview

Creating Leader Standard Work (LSW) Across a Distributed Business Model — Webinar Preview

November 7, 2024
I'm happy to be hosting and moderating this webinar that will be presented by Brent Loescher, a...
Embedding Change Management into your Continuous Improvement Initiatives – Webinar Preview

Embedding Change Management into your Continuous Improvement Initiatives – Webinar Preview

September 25, 2024
I'm happy to be hosting and moderating this webinar that will be presented by Melissa Sherman, a...
View Our “Ask Us Anything” Event on Psychological Safety and Lean

View Our “Ask Us Anything” Event on Psychological Safety and Lean

August 20, 2024
Psychological safety is often described as “feeling safe to speak up.” In Lean...
From Strategy to Execution: Webinar with Karen Friedenberg

From Strategy to Execution: Webinar with Karen Friedenberg

July 17, 2024
Are you looking to transform your business strategy into actionable results? Join us for our...

Videos

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Mark Graban on YouTube

At OhioHealth, managers block 10:30 to 11:30 every day as protected gemba time. When tiered safety huddles rolled out, that hour landed right in the middle of the structure. "Oh no, what have we done?" turned into a better closed-loop process than they could have designed on purpose. Emily Swaney, VP of Operational Excellence at OhioHealth, walks through the sequence. Tier 1 huddles happen at the start of shift, between 7:00 and 8:00. Tier 2, at three of the larger sites, has managers reporting to directors around 8:30. Tier 3 is the hospital-wide huddle at 9:00, and it ends with a documented list of escalations. Leaders take that list to the floors during gemba, so within about four hours of shift start, frontline staff hear what happened to the concerns they raised that morning. Full episode: Lean Blog Interviews #548 with Emily Swaney, on how an 11-person Lean Promotion Office supports a management system for 35,000 associates. #LeanHealthcare #Gemba #TieredHuddles #PatientSafety #ContinuousImprovement
Protected Gemba Time That Closes the Loop on Huddles | Emily Swaney
Her attorney and accountant told her not to buy the dental practice, and they quit when she did. The appraisal valued it at about 5% of the asking price. In 1997, Dr. Jen Moran bought it anyway. The practice was in Chicago's Water Tower Place. It ran on the lowest tier of dental insurance and barely broke even. The appraisal put the practice's goodwill at zero: happy patients from major Chicago employers, a highly skilled hygienist, and a location on the Magnificent Mile. Dr. Moran spent years moving patients and their employers off that insurance and onto fee-for-service care. Her parents had co-signed the lease, which put their house at risk. She still gives some of the credit to luck. Her second mistake carries the sharper leadership lesson. Around 2003, she bought an early same-day crown machine on impulse and placed about 50 restorations with it. Then she couldn't sleep at night worrying about their quality. She sold the machine back at a 50% loss and redid every restoration at no charge. She says that decision earned her patients for life. What you'll learn: 🔵 Why an appraisal can score goodwill (people, relationships, reputation) at zero, and what that misses 🔵 How she worked with employers' HR teams to move patients off low-tier dental insurance 🔵 What a business coach taught her about KPIs, sharing profits, and treating the team as part owners 🔵 How a monthly team bonus tied to practice productivity gives everyone a stake in the results 🔵 Why she gave up a 50% loss and redid her own work rather than live with restorations she didn't trust 🔵 How she evaluates new technology now, and why she still wants to try something better 🔵 Her concerns about private equity ownership of dental practices and what it means for long-tenured staff 🔵 The sonic toothbrush mistake many of us make, and why dental work done overseas so often needs repair Chapters (approximate): 00:00 Meet Dr. Jen Moran 01:16 The practice purchase everyone advised against 04:06 What she saw that the numbers missed 07:36 Advisors walk and an appraisal at 5% 12:20 The business coach who changed how she led 17:56 Private equity and the dentist-owned practice 21:16 Bonus mistake: an early same-day crown machine 26:24 Sonic toothbrush mistakes most of us make 31:07 Veneers, Lumineers, and dental work overseas 38:00 JMK Wellness About Dr. Jen Moran: Dr. Jen Moran is an AACD board-certified restorative dentist. She founded Water Tower Dental Care in Chicago in 1997, then stepped away for 17 years to raise four children and overcome breast cancer. She now practices at Water Tower Dental Care and Hinsdale Dentistry. She also founded JMK Wellness, where she shares the oral health and wellness products she uses and recommends. JMK Wellness: https://jmkwellness.com Website: https://drjenmorankobes.com Water Tower Dental Care: https://www.watertowerdentalcare.com Instagram: @DrJenMoran Episode page, with show notes and full transcript: https://markgraban.com/mistake369 Subscribe for more conversations with leaders about the mistakes that shaped them and what they changed afterward. #MyFavoriteMistake #Leadership #Entrepreneurship #Dentistry #SmallBusiness #PrivatePractice #LearningFromMistakes
Her Advisors Quit. She Bought It Anyway | Dr. Jen Moran
Emily Swaney, VP of Operational Excellence at OhioHealth, explains how a Lean Promotion Office of 11 people supports a Lean management system for 35,000 associates - by developing about 1,500 leaders as problem-solving coaches instead of leading projects. Episode #548 of Lean Blog Interviews. Full transcript and show notes: https://www.leanblog.org/548 We discuss: - Why the Lean team doesn't lead projects, and how process owners take over after kaizen events - Coaching leaders to stop being heroes and to advance problem-solving at the gemba - The patient safety exception to slow coaching - Second coaches, including managers who coach hospital presidents on their coaching - Five-tier safety huddles, good catches, and a roughly twofold increase in reported concerns - Closing the loop on escalations during daily protected gemba time - How frontline teams choose their own KPIs, connected to the balanced scorecard - What's next: an associate idea platform and extending the system into corporate functions Chapters: 0:00 Introduction 1:08 Emily's path into Lean and healthcare 3:29 Why Lean over Six Sigma in healthcare 6:05 Using marketing to sell the management system 8:47 An 11-person Lean team for 35,000 associates 12:21 Why the Lean team doesn't lead projects 15:08 Coaching leaders to stop being heroes 18:29 The patient safety exception 19:01 Psychological safety and tiered safety huddles 22:59 Good catches and looking for patterns 27:30 Closing the loop through protected gemba time 30:45 Structure and accountability for gemba walks 33:44 Coaching the coaches 35:53 Connecting frontline KPIs to the balanced scorecard 42:17 Executive buy-in and results 45:01 What's next: idea platform and corporate functions 47:58 Emily's expanded role Guest: Emily Swaney - https://www.linkedin.com/in/emilyswaney/ Host: Mark Graban - https://www.markgraban.com/ Subscribe to the podcast: https://www.leanblog.org/podcasts/podcasts-how-to-subscribe/ Part of the Lean Communicators network: https://leancommunicators.com/ #Lean #LeanHealthcare #OhioHealth #ContinuousImprovement #TieredHuddles #Gemba #PsychologicalSafety #LeanManagement
How 11 People Support a Lean Management System for 35,000 | Emily Swaney, OhioHealth
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