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A Lean Management System That Doesn’t Depend on the Lean Team — Emily Swaney, OhioHealth Creating a Continuous Improvement System in Accounting: Nick Katko on PDCA, Culture, and Psychological Safety
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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 #343 – Amanda Mewborn, Combining Engineering and Nursing

Podcast #343 – Amanda Mewborn, Combining Engineering and Nursing

ByMark Graban June 5, 2019 1622
My guest for Episode #343 of the podcast is Amanda Mewborn, an executive director of project management for Piedmont Health. I've known Amanda through the Society for Health Systems and she's one of...
Adam Ward on Lean Design in Healthcare and Lessons from Honda to Hospitals

Adam Ward on Lean Design in Healthcare and Lessons from Honda to Hospitals

ByMark Graban May 21, 2019 1991
My guest for Episode #342 of the podcast is Adam Ward, the author of Lean Design in Healthcare: A Journey to Improve Quality and Process of Care. Adam is an innovation process expert and independent...
Podcast #341 – Dr. Rob Hackett on the Theatre Cap Challenge & Change in Healthcare

Podcast #341 – Dr. Rob Hackett on the Theatre Cap Challenge & Change in Healthcare

ByMark Graban May 15, 2019 2459
My guest for Episode #341 of the podcast is Dr. Rob Hackett, an anaesthesiologist in Sydney, Australia. Rob has become known around the world for his role in what's now called the “Theatre Cap...
Joy Furnival on Lean in the NHS: Lessons from Manufacturing to Healthcare

Joy Furnival on Lean in the NHS: Lessons from Manufacturing to Healthcare

ByMark Graban April 23, 2019 1775
Joining me for Episode #340 of the podcast is Dr. Joy Furnival CEng MIET, an experienced senior NHS manager, improvement leader, and chartered engineer. I first crossed paths with Joy at a Lean...

More Blog Posts

Ryan McCormack’s Operational Excellence Mixtape: July 11, 2025

Ryan McCormack’s Operational Excellence Mixtape: July 11, 2025

Ryan McCormackByRyan McCormack July 11, 2025 4937
This edition of Ryan McCormack's Operational Excellence Mixtape reflects on the systems, leadership, and mindsets required for lasting improvement. From honoring Dr. Lucian Leape's foundational work...

Feedback Theater: Going Through the Motions Without Meaning It

Mark GrabanByMark Graban July 10, 2025 1019

Ken Segel on Lean Healthcare, Safety, and Building a Comprehensive Operating System

Mark GrabanByMark Graban July 9, 2025 3128

Two Years of Learning from Mistakes — Celebrate with the Book for Just $10.99

Mark GrabanByMark Graban July 6, 2025 849

Medical Mistakes and Patient Safety: Asking “Why?” Instead of “Who?”

Mark GrabanByMark Graban July 3, 2025 1509

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

PDSA Video from IHI

ByMark Graban May 21, 2011 Comments (3) 4045
It's alphabet soup Saturday, as this IHI PDSA video comes from a PhD, Robert Lloyd. A great basic...
Checklists Promoted and Debated on “Grey’s Anatomy”

Checklists Promoted and Debated on “Grey’s Anatomy”

ByMark Graban May 17, 2011 Comments (13) 2014
It's my second post about the TV show Grey's Anatomy, the first being “McDreamy” Fights...
New DVD – “Thinking Lean at ThedaCare: Strategy Deployment”

New DVD – “Thinking Lean at ThedaCare: Strategy Deployment”

ByMark Graban May 6, 2011 Comments (4) 1052
Sorry for what might seem like a very promotional post, but I'm happy to share some details with you...

Mark Graban on YouTube

I built an AI coach this year, and almost all of the work went into teaching it not to answer questions. Early on, someone would type a real problem -- our lab turnaround times are terrible, we tried 5S and it didn’t stick -- and it would immediately deliver a confident, well-organized lecture. Good content. Useless as coaching. It didn’t know what they’d tried or what their constraints were. It just pattern-matched to a topic and started teaching. The coaching prompt is now around five thousand words, and most of it is some version of: don’t answer yet, ask what’s going on. That number has stuck with me as a measure of how strong the pull toward answering is -- and not just for software. The second lesson surprised me more. I built a direct-answer mode alongside the Socratic one, assuming the coaching mode was the real one. I was wrong. Sometimes a person needs a definition or a worked example, and making them earn it with six questions isn’t coaching. It’s a performance of coaching. You can try it at https://leancoach.ai -- I’m still tuning it. More on Lean leadership, psychological safety, and continuous improvement at LeanBlog.org. #Coaching #Leadership #Lean #AI #ContinuousImprovement #LeadershipDevelopment #ArtificialIntelligence #OperationalExcellence #Mentoring #ProcessImprovement
I Spent Months Teaching an AI Coach Not to Answer
Nick Katko returns to Lean Blog Interviews to talk about his new book, Creating a Continuous Improvement System in Accounting. Nick is president and owner of BMA, a CPA, and author of The Lean CFO and Practicing Lean Accounting. Accounting teams see problems every day. As Nick puts it, they fix them, but they don’t necessarily solve them. We talk about why that happens, what a continuous improvement system looks like inside an accounting department, and why culture and psychological safety have to come before improvement events. Topics include: 🔵 Why many accounting leaders misunderstand continuous improvement, especially when it gets done to them 🔵 An accounts payable team that cut invoice defects from about 43% to 15% by starting with data 🔵 The three components of the system: simple PDCA problem solving, daily lean management, and improvement events 🔵 Why small improvements beat the next big thing (blockchain then, AI now) 🔵 Time, not ability, as the main reason problems don’t get solved 🔵 What happened when the one person who spoke up about month-end close was fired 🔵 Why psychological safety shifts when a leader walks into the room 🔵 A daily problem-solving huddle that ended finger-pointing between accounting and purchasing 🔵 Measuring a faster close in person-hours, not just days 🔵 Independent publishing, and the book covers drawn by Nick’s grandchildren Chapters: 00:00 Intro and Nick’s background 01:31 Where the book came from: coaching two accounting teams in Ohio 03:19 More than a book: checklists, assessments, and training slides on Nick’s website 04:16 Why accounting teams fix problems instead of solving them 06:03 Accounts payable example: data first, then improvement events 08:03 The three parts of a continuous improvement system in accounting 11:41 Big initiatives vs. small improvements 14:07 The real reason problems don’t get solved: time 17:19 When one person is the process: psychological safety in small teams 18:44 The person who spoke up and was fired 21:22 Psychological safety is situational 26:24 Creating the culture first, and a leader self-assessment 29:31 Fear and futility: why people stay quiet 33:12 Accounting vs. purchasing: a daily problem-solving huddle 35:34 A healthcare parallel: the ED, the lab, and crooked labels 39:37 Walking away from a top-down engagement 41:46 What a faster close is really worth 45:00 Independent publishing and the grandchildren’s book covers 50:51 Closing Nick’s book: https://www.amazon.com/dp/B0HCRDNBJM Supplemental materials: [VERIFY: URL on Nick’s website] Nick’s previous appearance, Episode 492: [VERIFY: link] About Mark Graban: Mark is an author, speaker, consultant, and Senior Advisor to KaiNexus. His books include Lean Hospitals, Healthcare Kaizen, Measures of Success, and The Mistakes That Make Us. His next book is The Silence Tax: How Lean Leaders Drive Out Fear and Futility. He hosts the Lean Blog Interviews and My Favorite Mistake podcasts and writes at https://www.leanblog.org Subscribe for more conversations on Lean, leadership, psychological safety, and continuous improvement. #LeanAccounting #ContinuousImprovement #PsychologicalSafety #LeanThinking #Accounting #CFO #PDCA #Kaizen #LeanLeadership #RespectForPeople #LeanCFO #MonthEndClose
Continuous Improvement in Accounting with Nick Katko | Lean Blog Interviews
Grant Harris teaches leaders to fix the process, not the people. Then he created the friction he helps clients remove, and it cost him a deal. A cold inbound lead landed in his LinkedIn inbox with the budget approved, the association’s president on board, and a fee close to what he hoped for. Instead of accepting the offer, he proposed a leadership session and extras before and after the talk they had asked for. The planner had to go back with new questions, review another proposal, and reopen a budget that was already approved. He was not selected, and he says rightfully so. He kept the relationship, skipped the question “why not me,” and ran a debrief instead. Grant sees the same pattern inside organizations: a capable person gets labeled rigid, aloof, or disengaged when the cause is a broken handoff, a deadline that shifted, or a project that never had a charter. What you’ll learn: 🔵 Why an extra the buyer never asked for reads as friction, not generosity 🔵 How Grant debriefs a lost deal without asking “why not me” 🔵 Accurate accountability: when it is fair to hold one person accountable, and when the same failure across different people points at the process 🔵 The question that replaces “Sally messed up”: what part of the process made this outcome possible? 🔵 Where process friction hides: talent decisions, feedback loops, and communication norms 🔵 Why retraining rarely fixes a process problem, and what a restorative response looks like instead 🔵 How a late autism diagnosis shaped the way Grant sees capable people who get mislabeled at work Chapters: 00:00 Meet Grant Harris 01:01 The speaking lead that became friction 06:14 The debrief after not being selected 14:20 Fix your process, not your people 16:56 Late autism diagnosis, mislabeled at work 22:06 Accurate accountability 27:43 Ask a question, not a statement 32:09 Wrong medication: start with the fact 34:30 Restorative, not punitive 40:51 Grant’s free friction signal check About Grant Harris: Grant Harris, MBA, CDE, is the founder and president of GTH Consulting and a speaker and consultant on what he calls human-centered performance: fixing workplace friction before capable people get misread as performance problems. He is a Certified Diversity Executive, a corporate board member, and a three-time published autistic author. He has worked with organizations including The Washington Post, the U.S. Department of Agriculture, and ASICS. Grant on LinkedIn: https://www.linkedin.com/in/grantharris555/ GTH Consulting: https://linktr.ee/GTH_Consulting Free friction signal check: send Grant a LinkedIn message with the word “Scorecard” Show notes, full transcript, and links: https://markgraban.com/mistake370 Subscribe for more episodes of My Favorite Mistake with host Mark Graban. #MyFavoriteMistake #Leadership #ProcessImprovement #PsychologicalSafety #Accountability #Neurodiversity #LearningFromMistakes
The “Value Add” That Cost Him the Deal | Grant Harris
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