Lean Blog by Mark Graban

A British Hospital Missed a Killer for Two Years. The Recommendations Are Mostly Hardware.

Mark Graban — Tue, 15 Sep 2026 18:22:35 +0000

I'm traveling internationally for ten days and I turned on one of the British news channels. There's a major story about NHS England. First, the awful reality that a nurse would willfully kill babies in the NICU. Then, the second (and more believable) reality that bad management systems (and poor leadership) made the situation worse. So what happened? On July 11th, 2016, the Countess of Chester Hospital put deaths on its neonatal unit onto a […]

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What The Rehearsal Gets Wrong About Pilots–and Right About Leadership Training

Mark Graban — Mon, 14 Sep 2026 08:53:00 +0000

Season 2 of The Rehearsal opens in a cockpit. Two pilots are on final approach. The first officer thinks they're lined up wrong and says so, mildly. The captain brushes it off. The first officer tries again, a little more nervous this time, and the captain keeps descending. Then the alarms, a go-around attempted too late, and fire filling the screen. The camera pans left and Nathan Fielder is standing there on the set, looking […]

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Training as a Countermeasure? The “Fix” You Can Finish by Friday.

Mark Graban — Thu, 10 Sep 2026 08:33:00 +0000

In 2006, regulators cited a hospital in Madison, Wisconsin for six violations of state and federal rules after a patient died — three federal, three state. They threatened its license and its Medicare contract. The hospital updated its policies and re-educated its nurses, and the citations were withdrawn. Training as a countermeasure “worked,” in the only sense anyone measured. Think about what you'd have to believe for that to be the right remedy. You'd have […]

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What 21,050 Clinicians Told Us About Fear and Futility

Mark Graban — Wed, 09 Sep 2026 08:16:00 +0000

Hospitals have Quiet Rooms now. There's soft lighting. There's a chair. There's a noise machine, which is a machine that makes calming noises. There's sometimes a succulent in a small white pot. The succulent is doing fine, which makes sense, because the succulent doesn't have a patient assignment. The nurse, on the other hand, hasn't had water since her shift started. She can't tell you the last time she used the bathroom. The hospital has […]

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GM Adopted Forced Ranking in 2024. Ford Dropped It in 2001.

Mark Graban — Mon, 07 Sep 2026 21:01:16 +0000

Phoebe Wall Howard reported recently that a fired GM engineer is suing the company over its employee evaluation system. Tuan Le, 58, spent 27 years at General Motors, moving from industrial engineer to senior throughput simulation engineer. GM terminated him on January 17, 2026. He is the third GM employee represented by attorney Michael Pitt to allege that GM's forced ranking system (as they describe it) requires managers to hit job-elimination quotas that fall hardest […]

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Ryan McCormack’s Operational Excellence Mixtape: September 4, 2026

Ryan McCormack — Fri, 04 Sep 2026 12:38:15 +0000

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 better. This week's Operational Excellence Mixtape connects stories from EY, Williams Racing, hospitals, and aviation around a common problem: organizations often know less than their people do. The issue is whether leaders redesign the work, […]

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Three Weeks to Act on a Nurse’s Patient Safety Concerns

Mark Graban — Thu, 03 Sep 2026 08:40:00 +0000

For three weeks after his surgery, a patient at the Royal Oldham Hospital (England) had no bowel movement and was in increasing pain. The ward sister kept raising patient safety concerns with the surgeon who'd operated on him. She described him as unconcerned. On September 15, 2020, she stayed on duty after her shift was supposed to end. She'd already gone around him to the ward manager, who escalated it further. A meeting was held. […]

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What I Tell People Who Want to Write a Book About Lean

Mark Graban — Tue, 01 Sep 2026 21:29:02 +0000

Twice in the past two weeks, I have talked with people who want to write a book about Lean. Both were early in the process and trying to figure out what they were signing up for. I've had a lot of these conversations over the years. I enjoy doing them and this blog post is not meant to replace future chats. Those conversations tend to cover the same ground: whether the idea is worth a […]

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