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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 #194 – Paul Piechota, Lean at the University of Dayton

Podcast #194 – Paul Piechota, Lean at the University of Dayton

ByMark Graban February 21, 2014 1694
My guest for episode #194 is Paul Piechota, Director for the Center for Competitive Change at the University of Dayton School of Engineering. Piechota has authored over 30 publications with such...
Mark Jaben

Dr. Mark Jaben on Lean, Change, and How Our Brains Respond to Resistance

ByMark Graban February 6, 2014 2742
My guest for episode #193 is Mark Jaben, MD, talking about our brains, Lean, and change. Mark has been a guest blogger for me before and it's great to talk to him today about his research and...
John Torinus on Solving the Employer Healthcare Crisis with Lean Thinking

John Torinus on Solving the Employer Healthcare Crisis with Lean Thinking

ByMark Graban January 27, 2014 2110
Joining me for podcast #192 is John Torinus, author of the excellent book, The Company That Solved Health Care: How Serigraph Dramatically Reduced Skyrocketing Costs While Providing Better Care, and...
Podcast #191: Mike Orzen, Lean IT: Enabling and Sustaining Your Lean Transformation

Podcast #191: Mike Orzen, Lean IT: Enabling and Sustaining Your Lean Transformation

ByMark Graban January 14, 2014 1975
Joining me for podcast #191 is my friend and fellow LEI faculty member Mike Orzen (@MikeOrzen), co-author of the Shingo Award-winning book Lean IT: Enabling and Sustaining Your Lean...

More Blog Posts

Celebrating 13 Years with KaiNexus and Its Improvement Platform!

Celebrating 13 Years with KaiNexus and Its Improvement Platform!

Mark GrabanByMark Graban June 17, 2024 1682
This month marks 13 years of my formal association with KaiNexus. I've been around longer than our mascot, Ofie, seen below. As I often say, I've always had a part-time role, but also have a FULL...

Ryan McCormack’s Operational Excellence Mixtape: June 13, 2024

Ryan McCormackByRyan McCormack June 14, 2024 5568

Psychological Safety vs. Psychological Comfort: Understanding the Distinction

Mark GrabanByMark Graban June 13, 2024 3623

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

Mark GrabanByMark Graban June 12, 2024 3963

Learning From Mistakes: Psychological Safety and Continuous Improvement

Mark GrabanByMark Graban June 11, 2024 1735

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

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
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
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