Healthcare improvement isn’t about working harder—it’s about better systems, better leadership, and a culture that supports learning and speaking up. This archive brings together blog posts, podcasts, and reflections on Lean healthcare, patient safety, quality improvement, leadership, and continuous improvement. Many of these posts draw on real hospital experiences and lessons from Deming, Toyota, and frontline healthcare teams, with a consistent emphasis on respect for people and learning from mistakes.
TL;DR: The NHS backlog gets narrated one month at a time, and millions in bonus money ride on the moves. A Process Behavior Chart shows most movement is noise — and the trusts that stay on top are running structurally…
TL;DR: Behavioral nudges can produce real gains in patient experience at almost no cost. They can also be used to dress up a process that should have been fixed. The discipline for CI leaders is knowing the difference and getting…
A lunch, a hand gesture, and the question most Lean implementations are answering backwards. The gesture is the whole thing. The late Hajime Oba held his hands out in front of him, palms down, one higher than the other. “All…
TL;DR: Rory Sutherland’s Alchemy is a useful provocation for Lean practitioners. Lean already knows how to test small, low-cost ideas without demanding an airtight ROI in advance. We sometimes forget. A Small Idea, Quietly Killed A few years ago, I…
A food company had a flowchart any auditor would love. Every step mapped. Every step mapped. Every critical control point identified. The HACCP plan (Hazard Analysis and Critical Control Points, the standard food safety framework that identifies where contamination can…
Most hospital quality dashboards are designed to answer one question: Are we OK? Green means yes. Red means no. The trouble is, once the answer is green, nobody asks the more useful question: what did we do, and is it…
There’s a hospital somewhere this quarter presenting a labor efficiency story to its board. A unit that used to have a dedicated charge nurse now has a “Working Charge Nurse” – someone who takes patients and runs the unit. The…
Thanks, as always, to Ryan McCormack for this. He always shares so much good reading, listening, and viewing here! Subscribe to get these directly from Ryan via email. News, articles, books, podcasts, and videos about how to make the workplace…
A Florida surgeon, Thomas Shaknovsky, was indicted on a second-degree manslaughter charge on April 13. The charge followed the death of William Bryan, a 70-year-old Alabama man, during what was supposed to be a laparoscopic splenectomy in August 2024. Instead…
The 8 wastes of Lean are defects, overproduction, transportation, waiting, inventory, motion, overprocessing, and unused talent. The manufacturing and healthcare examples below show how to recognize them and investigate the processes that create them. Naming the waste is a starting…
If your emergency department metric improved this quarter and you felt good about it, the problem might not be your emergency department. It might be your metric. Most hospital leaders have been in this meeting. The percentage of patients seen…
Update (November 2026): I’m no longer running open-enrollment trips on fixed dates. Instead, I’m working with organizations on custom Japan study trips for their own teams, usually 8 to 20 leaders, including planning and prep before the trip and follow-up…
