Tag: Blame

Blame, Accountability, and Leadership in Lean

Blame is often mistaken for accountability—but in practice, it creates fear, silence, and surface-level compliance. These posts examine blame through a Lean and systems-thinking lens, showing how punishment-based responses undermine learning, psychological safety, and continuous improvement.

Across healthcare, manufacturing, aviation, and leadership culture, this archive focuses less on who to fault—and more on how leaders design systems that either encourage learning or drive mistakes underground.

A Hotel, Time Quotas, Systemic Problems, and Employees Not Having the...

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I travel a lot and, thanks to my work, I'm pretty well attuned to the idea of not blaming individuals for systemic problems in...

GM CEO Mary Barra Celebrates Employee Kaizen

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Time magazine recently featured GM's relatively new CEO, Mary Barra, on the cover and in this story: "Mary Barra's Bumpy Ride at the Wheel of GM" Also,...

Ebola & Systems & Processes: Can We Do Better? Can We...

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Yesterday, Thomas Eric Duncan, the first person diagnosed with Ebola in the U.S. died in a Dallas hospital. As I've been following this story, I...

Why Red-Green Charts Mislead Leaders: Understanding Variation the Deming and Wheeler...

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tl;dr: Red-green charts push leaders to react to every up and down, turning normal variation into false drama. Process behavior charts provide the context...

What I’m Reading: Diner Muda, No Blame at Etsy, Toyota Treats...

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In case you missed it, see Saturday's post: "Why Toyota is Eliminating the Andon Cord from its Factories." As I occasionally do, today's post is...

3 Ways to React to Human Error

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What happens when a mistake is made in your organization? How do you react when an error occurs? A lab specimen gets mislabeled. The wrong...

Why “Who?” Is the Worst Root Cause Question: A Lean Lesson...

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We all know the beaver is "the engineer of the animal kingdom." That's why MIT has a beaver as a mascot... It's an engineer...

My Thoughts on “10 Ideas That Hospital and Health System CEOs...

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I saw this piece by Bob Herman at Becker's Hospital Review and ended up writing a blog post here instead of writing a long...

Chris Jerry on the Tragic Death of His Daughter Emily and...

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Listen My guest for Episode #203 (and for Part 2 of our discussion in episode #207) is Chris Jerry, founder of The Emily Jerry Foundation.  The...

The Real VA Scandal: Long Wait Times, Bad Management, and the...

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TL;DR: Long VA wait times weren't the result of "bad apples." They were the predictable outcome of bad management systems that used unrealistic targets,...

Blame: Human Error Occurs Even IF We’re Being Careful

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I'm not sure why "error" was put in quotes since this seems like an actual error, not a quote-unquote error: Staff 'error' blamed for chlorine...

Learning Not to Blame: Baseball Edition

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Following up my post about not blaming a bartender, here's another look at learning to cast aside our old habit of blaming individuals... this...
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