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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

The image is a promotional cover for the Lean Blog Interviews podcast, Episode 510. It features a teal background with rays emanating from the center. The title "MISTAKES & LEAN" is prominently displayed in bold, black letters with a white outline. The episode number "Episode 510" is written below the title. On the right side, there is a photo of Karen Martin, smiling and looking towards the camera. In the top left corner, there is a smaller image of Mark Graban with the text "Lean Blog Interviews" and his name, "Mark Graban."

Karen Martin on the Power of Mistake Proofing in Lean Management

ByMark Graban July 10, 2024 4873
Karen Martin and Mark Graban discuss mistake proofing in lean management, why “zero harm” is a meaningful aspiration, and how building quality at the source reduces errors without blaming...
Leveraging Lean & AI in Optometry: Ankit Patel’s Journey from Dell to Vision Care

Leveraging Lean & AI in Optometry: Ankit Patel’s Journey from Dell to Vision Care

ByMark Graban July 3, 2024 3774
Scroll down for how to subscribe, transcript, and more My guest for Episode #509 of the Lean Blog Interviews Podcast is Ankit Patel, the founder of My Business Care Team, a BPO company providing...
Psychological Safety in Lean Leadership: Insights from Mike Hoseus and Toyota’s Culture

Psychological Safety in Lean Leadership: Insights from Mike Hoseus and Toyota’s Culture

ByMark Graban June 19, 2024 8305
This episode of the Lean Blog Interviews Podcast explores psychological safety in Lean leadership through the lens of Toyota's culture, with insights from Mike Hoseus, former Toyota leader and...
Embracing Creative Tensions: Wendy K. Smith on Both/And Thinking and Lean Leadership

Embracing Creative Tensions: Wendy K. Smith on Both/And Thinking and Lean Leadership

ByMark Graban June 12, 2024 3963
Scroll down for how to subscribe, transcript, and more My guest for Episode #507 of the Lean Blog Interviews Podcast is Wendy K. Smith, co-author of the book Both/And Thinking: Embracing Creative...

More Blog Posts

Manga- and anime-influenced editorial illustration in a wide horizontal format. A small lone figure, seen from behind in plain clothes, stands on a glowing crimson ribbon that stretches horizontally across the frame like a floating path. The ribbon gently rises and falls but stays level. The person leans forward with one arm extended, reaching toward a soft sage-green glowing ring far below and ahead across a wide empty gap. Pale cliffs frame the distant lower edges, while most of the image is filled with a vast cream-to-blue sky with thin clouds and ample negative space. The mood is quiet, reflective, and slightly wistful.

Even in Japan: A Target of Zero and a Process That Lives Near Seven Percent

Mark GrabanByMark Graban June 19, 2026 536
The target printed on the chart was zero percent. The red line had never been near zero. Not in the nine months posted on the wall, and probably not in any month before them. It sat between 6.43% and...
Lean Blog Post Cover Image - 2026-06-04T124136.036

‘No Debbie Downers’ and the Hidden Cost of a Positive Team

Mark GrabanByMark Graban June 18, 2026 782
john toussaint collaborative care fox video

ThedaCare’s Collaborative Care, Captured on a 2009 Video

Mark GrabanByMark Graban June 17, 2026 582

102 Seconds vs. 300 Seconds: Toyota’s 1992 Case for One-Piece Flow

Mark GrabanByMark Graban June 16, 2026 676
A quiet office meeting in a modern conference room, with one woman in sharp focus looking down with folded hands while colleagues around her continue the discussion in soft blur.

Four Recent Episodes on Why People Stay Silent — and What It Costs

Mark GrabanByMark Graban June 15, 2026 515

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

What Still Matters from 2013: Kaizen, Leadership, and Learning with KaiNexus

What Still Matters from 2013: Kaizen, Leadership, and Learning with KaiNexus

ByMark Graban June 7, 2018 Comment (0) 920
Recently, I stumbled across some video of me and Dr. Greg Jacobson giving a talk at a health system...
Respect for People and Continuous Improvement in Healthcare: Lessons from Lean

Respect for People and Continuous Improvement in Healthcare: Lessons from Lean

ByMark Graban April 11, 2018 Comment (0) 2832
I was recently asked to do a recorded video presentation for a medical conference in Turkey. I spoke...
Stop Overreacting to Metrics: Lessons from Lean Startup Week

Stop Overreacting to Metrics: Lessons from Lean Startup Week

ByMark Graban April 4, 2018 Comment (1) 2207
Thanks to Eric Ries and the organizers for Lean Startup Week for allowing me to share video of my...

Mark Graban on YouTube

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
Toyota has been replacing its famous andon cord with buttons. I visited Toyota's plant in Durban, South Africa, to see how the andon system works there and why they made the switch. Toyota started the change at a plant in Toyota City in 2013. The Durban plant switched about a year ago, and they gave me two reasons. First, there are now two buttons. Yellow calls for help, and red stops the line right away for something like a safety issue. Second, with 90 to 100 andon activations a day in one area, reaching overhead that often was becoming an ergonomics risk. The hardware changed, but the response didn't. When a team member pressed the button, the team leader was there within seconds. Read more on LeanBlog.org: The Toyota Andon System in South Africa: Two Buttons Instead of a Cord https://www.leanblog.org/2026/09/toyota-andon-system-south-africa/ Why Toyota Is Eliminating the Andon Cord (2014) https://www.leanblog.org/2014/08/toyota-eliminating-andon-cord/ Follow for a new Lean short every week. #Andon #Toyota #ToyotaProductionSystem #Lean #LeanManufacturing #ContinuousImprovement #Kaizen #Leadership #PsychologicalSafety #Manufacturing #Shorts
Why Toyota Is Replacing the Andon Cord with Buttons
Strategy deployment -- hoshin kanri -- is supposed to work like a game of catch. Goals flow down from leadership, ideas and feedback flow back up from the people doing the work, and both sides adjust. The ball goes back and forth. A lot of organizations are playing dodgeball instead. The ball only goes one direction, it's thrown hard, and the people on the receiving end are just trying not to get hit. The cost isn't the meeting time you save by skipping the conversation. It's the year you lose executing against metrics that don't match the work. In this short, I share what happened when a hospital cascaded a patient falls target to a labor and delivery unit whose patients don't fall -- and the dashboard that would have looked perfect while the real risks went unmeasured. More on Lean leadership, psychological safety, and continuous improvement at LeanBlog.org. #StrategyDeployment #HoshinKanri #Lean #LeanLeadership #ContinuousImprovement #Leadership #CatchBall #OperationalExcellence #Kaizen #ProcessImprovement
Catch Ball or Dodgeball? How Goals Really Flow in Lean Management
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