Quality doesn’t come from inspection, pressure, or choosing between speed and accuracy. It comes from well-designed systems, capable processes, and leaders who focus on learning instead of blame. This archive brings together blog posts, podcasts, and reflections on quality through a Lean and Deming lens—covering psychological safety, metrics, variation, leadership behavior, healthcare quality, and why sustainable improvement depends on fixing systems rather than managing people harder.
As I mentioned on Monday, I’m working on a 3rd revised edition of my book Lean Hospitals. Traditional book publishing is a funny (and sometimes frustrating) value stream, in a lot of ways. There are many batches and many queues along…
I saw this story when it originally appeared online as part of a local public radio station in California. It was now picked up nationally by NPR and a number of you emailed me about this Lean healthcare piece about UCLA…
In this post, I’ll present a parody video of Keith Olbermann‘s “worst persons in the sports world” videos. I don’t know how much overlap there is between people who read my blog and people who are fans of Olbermann. I’ve…
A collection of creative videos was recently brought to my attention and I’d like to share them here. They are created by Dr. Mark Harrison (@leanpsychiatry), a psychiatrist for an NHS Trust. He created the videos by taking photos of…
Editor’s note (2026): In an era of AI, dashboards, and real-time data, Spear’s reminder still holds: information only matters if it changes behavior. TL;DR: Steve Spear argues that organizations deliver quality and value faster not by working harder, but by…
There’s been a back-and-forth of views about the state of pediatric emergency medicine recently in the Wall Street Journal. Let me start first, actually, with the more recent statement, a rebuttal from Michael Gerardi M.D., FACEP, President of the American College of Emergency…
I’ve been a big fan of Dr. Atul Gawande’s writing for a long time (see previous posts about him and his work). His latest article is out, which I was able to read last night. It just came out (or…
As I sometimes do, I’m going to close out a bunch of browser tabs (which makes my Mac run faster) and I’ll do that by sharing some articles that caught my eye but maybe don’t merit full blog posts of…
Back in 2007, I had my first opportunity to travel to England, a country I really love visiting. I had the chance to attend the “First Global Lean Healthcare Summit” that was produced by Dan Jones and the Lean Enterprise…
(And Might Not Even Be Real) TL;DR: People sometimes hope for the Hawthorne Effect, treating it like a positive driver of improvement. That was always misguided–because it would only imply short-term gains from attention, not better systems. And to make…
Organizations put up slogans because they want to inspire better performance. The intent usually isn’t the problem. The problem is that slogans assume the issue is with workers’ effort or attitude rather than with the system they’re forced to work…
The One Thing Lean Six Sigma Gets Wrong About Lean? Mark’s Note: Today’s post is by Erwin van der Koogh, who is based in Australia. The thoughts and opinions here are his, though I agree with enough of them to…
