Patient safety doesn’t improve through punishment, vigilance posters, or telling people to “be more careful.” It improves when leaders design safer systems, support speaking up, and focus on learning instead of blame. This archive brings together blog posts, podcasts, and reflections on patient safety through a Lean lens—exploring medical errors, near misses, psychological safety, leadership behaviors, and how healthcare organizations can reduce harm by fixing systems rather than blaming individuals.
Today is another “Throwback Thursday” post where I revisit posts from the past. Friday and Saturday, I’m going to be attending the “Patient Safety, Science & Technology Summit” in Irvine, California. I won’t be speaking, but I’ll be participating and networking…
Announcement: Dr. Greg Jacobson and I are doing a new webinar for KaiNexus on “More Leadership Behaviors That Create a Culture of Continuous Improvement‘” on January 27. It’s free… learn more and register here. * * * * * *…
It’s a simple question: what’s up with so many men wearing ties in healthcare? Are you / they wearing them because you like to, want to, or have to? When I worked at a video game and computer software store…
Call me old fashioned, but I figure any employee who works a full day deserves proper breaks, including a lunch break. This is true for nurses who work ten hour shifts. And, it’s especially true for the 65% of nurses…
Mark’s note: Today’s guest post is by Brian Buck, a fellow lean healthcare practitioner who blogged until about two years ago at his site “Improve With Me.” Recently, I took my son to his primary care provider and the doctor…
Note: This is being republished, with permission, under a Creative Commons license. See the original ProPublica page and comments. by Marshall Allen ProPublica, Sep. 19, 2013, 10:03 a.m.by Charles Ornstein and Lena Groeger, ProPublicaby Dan Nguyen, Charles Ornstein and Tracy…
I wrote about Ebola earlier this week and have been following the news closely. It’s a fascinating story on many levels, including many leadership failures. I wrote a piece for LinkedIn, written for a general public audience: A Lack of…
Mark’s Note: Today’s guest post is by Chris Burnham. I invited him to write this after I saw him share his pre-surgical “poka yoke” (or error proofing) on Twitter (caution: picture of feet). I asked him if “anybody was offended”…
Although I’m a proud alum of Northwestern University, a former marching band member, and an ardent follower of our football team (as I’ve written about before), I grew up as a fan of the Michigan Wolverines and have many friends…
In a Lean culture, the mindset is that “problems are treasure” or “problems are gold.” By honestly identifying problems, we can solve problems and prevent them from occurring in the future. Problems in healthcare can include medication errors, laboratory specimen…
I was recently interviewed by one of the reporters who put together this web article in Canada: “From the factory floor to the emergency department: Hospitals explore Lean method” The article highlights Lean success stories and it also raises some…
Chris Jerry, founder of the Emily Jerry Foundation, continues his conversation on why patient safety demands system change — not blame — and why he chose to publicly forgive the pharmacist convicted in his daughter’s death. Listen to the Episode…
