Tag: Quality

Quality: Leadership, Systems Thinking, and Continuous Improvement

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.

Why Warning Signs Don’t Prevent “Never Events” in Operating Rooms

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tl;dr: High-profile "never events" aren't caused by careless clinicians--and they aren't prevented by warning signs. Signs that tell people to "be careful" substitute reminders...

MLB’s Home Run Surge: What the Data Really Shows (and Why...

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TL;DR: Home runs in MLB haven't just "gone up"--the data shows a real system shift, not random year-to-year variation. Process Behavior Charts help separate...

Bob Lutz on Tesla, Threats, & Communication About Quality – and...

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Hat tip to Stan Feingold from StoreSMART (a Lean Blog sponsor) for sending me this article: Bob Lutz Talks Panel Gaps, Tesla, and Why Every...

Dr. Gary Kaplan, Virginia Mason, and Lean’s Real “War on Waste”

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TL;DR: Dr. Gary Kaplan describes Virginia Mason's adoption of Lean as a "war on waste," but the real impact goes beyond waste reduction. By...

Boeing, GM, and Hospitals: When Production Pressure Undermines Quality and Safety

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TL;DR: When leaders prioritize speed and output over quality, employees stop speaking up--and safety suffers. From GM to Boeing to hospitals, production pressure creates...

On Podcast Server Downtime, Scars from General Motors, and Taking Ownership...

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Ever since I started podcasting in 2006, I've been using a company called "Hipcast" to be the "hosting" company for the podcast audio files...

Journalists — Please Stop Using “Assembly Line” as a Lazy Synonym...

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Back in 2006, I wrote my first blog post about the unfortunate use of "assembly line" to mean "bad quality." The context there was...

Adventures in Self-Publishing: Learning from Defects and Escapes in Book Publishing

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tl;dr: Even with professional editors, designers, and multiple reviews, defects still happen in books--and some inevitably escape to readers. This post uses Lean concepts...

Friday Night at the ER: Learning Lean, Flow, and Patient Safety...

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Actually being a patient in the emergency department is a learning experience, to say the least. I've done that twice in the past twelve months (two cases of really bad stomach flu with high fever). I don't recommend this if you can avoid it. What I do recommend is an interactive learning experience called "Friday Night at the ER." More about that in today's post...

Podcast #310 – Steve Shortell, The Impact of #Lean on Healthcare...

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Joining me again for Episode 310 is Stephen M. Shortell Ph.D., MPH, MBA. He is Blue Cross of California Distinguished Professorship, HPM and is a Professor of Organizational Behavior at the University of California, Berkeley School of Public Health.  He was previously a guest on Episode 267 talking about the establishment of the Center for Lean Engagement and Research (CLEAR) at the University of California, Berkeley, where he is the director.  In this episode, we talk about some initial research that they released in a paper that was published in The Joint Commision Journal on Quality and Patient Safety: "Use of Lean and Related Transformational Performance Improvement Systems in Hospitals in the United States: Results From a National Survey"

Lean Healthcare in The Economist: What It Gets Right About Safety...

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It's great to see Lean healthcare featured in one of the world's leading news and business publications. The Economist recently published this article: "Hospitals are learning from industry how to cut medical errors"

Quality Improvement Through Obfuscation?

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Healthcare is full of terms that obfuscate things. Ironically, use of the word "obfuscate" can be an example of obfuscation. Instead of saying, "Healthcare leaders often obfuscate a situation," we can say, "The language used in healthcare often makes things sound better or more complicated than they really are."
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