The Problem Nobody Talks About Here is a scenario that plays out in hospitals and factories every day. An organization decides to “do Lean.” They hire one person — or reassign someone from operations — to lead the effort. That…
TL;DR: Kaizen means “change for the better.” Everyone improves their own work, one small change at a time, using the scientific method. It’s not a suggestion box — it’s collaborative, fast, and action-oriented. Success depends on leadership engagement and psychological…
Here’s something I’ve learned over many years of consulting: giving people advice they haven’t asked for is a reliable way to get ignored, no matter how correct the advice is. This is also, unfortunately, exactly what every AI tool does.…
TL;DR: Three stories from a single day highlight a familiar pattern in healthcare technology: a pharmacy text message with the wrong hours that nobody has fixed, medical imaging that has to be mailed on a physical CD in 2026, and…
TL;DR: I asked ChatGPT how to use Lean to reduce hospital headcount. It gave me a detailed plan to do exactly that. My custom Lean AI refused and explained why. Generic AI will confidently help you damage your culture. I…
TL;DR: Deming and Toyota’s Fujio Cho asked the same uncomfortable question: why do management systems destroy motivation in people who started out wanting to do good work? The answer points to practices leaders can actually change. When leaders talk about…
TL;DR: I turned my Lean Hospitals book into an interactive coaching tool leaders can use during real work — exploring whether improvement knowledge can be delivered on demand instead of through workshops alone. Try the free demo This post is…
TL;DR: NUMMI proved in the 1980s what healthcare is still learning today: you can’t punish your way to safety. Real improvement comes from mutual trust, system thinking, and leaders who respond to problems with curiosity–not blame. When we talk about…
TL;DR: After three editions of Lean Hospitals, I am not planning further updates to the book. This post reflects on how the opening of Chapter 1 has evolved since 2008, including John Toussaint’s second-edition foreword, and shares a revised “Need…
In 1981, Ford Motor Company and UAW leaders traveled to Japan to study Toyota, Nissan, and Mazda — and they came home with very different conclusions about what they had seen. Another in this series drawn from the Don Ephlin…
Fear Drives Compliance — Respect Builds Pride, Learning, and Improvement TL;DR: Don Ephlin once wrote, “You can’t punish your way to pride.” That insight still resonates today. Fear might create short-term compliance, but respect creates long-term learning. Here’s what Ephlin,…
TL;DR: In 1987, GM accurately documented why NUMMI worked–and it wasn’t tools, techniques, or discipline. This internal report reveals a management system built on trust, learning, and problem-solving, and exposes how hard it is to act on insight when it…