Practicing Lean
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Practicing Lean

Learning How to Learn How to get Better... Better

About the Book

100% of proceeds given to charity! About the book: If we keep practicing, we might get good at it eventually. We all have a starting point in our personal "Lean journeys." Looking back at our first year of work in Lean or continuous improvement methodologies, we probably weren't very good at it. This is a compilation of those lessons and stories.

As of 7/1/2018, $3900 has been raised so far for the Louise H. Batz Patient Safety Foundation. The book can now also be purchased through the Amazon Kindle Store. It can also be purchased as a paperback book. Or, select the audiobook package here on LeanPub to receive MP3 recordings along with the eBook formats. You can get the book for free, but we hope you'd choose to pay, as 100% of author proceeds are being donated. If you get the book for free and like it, please consider donating directly the Batz Foundation.

Doctors don't "implement medicine," they practice medicine.

Lawyers don't "implement cases," they practice law.

Shouldn't Lean facilitators, consultants, managers, and the like, also "practice Lean?" 

When most of us start with Lean, the practices and principles are new. We might struggle to make change happen. I know I did. Our initial clumsy efforts hopefully turn into proficiency and mastery over time. We shift from "doing Lean" to "being Lean" and teaching others how to be Lean.

This book is a collection of honest and unvarnished first hand stories about learning, failing, and getting better at leading Lean transformation efforts. What mistakes have been made? What are the lessons learned? How do we "Plan, Do, Study, Adjust" our way to more effective Lean transformation models?

We ended up with a diverse set of 16 contributors - manufacturing, healthcare, software, startups, etc. - from across the United States, Canada, and the United Kingdom... a doctor, engineers, business owners, and other great leaders and change agents (although they'd be too humble to call themselves great).

Authors include:

Mark Graban

Author of the books Lean Hospitals and Healthcare Kaizen, blogger at

Nick Ruhmann

Director of Operational Excellence for Aon National Flood Services, Inc.

Michael Lombard

Chief Executive Officer of Cornerstone Critical Care Specialty Hospital of Southwest Louisiana

Paul Akers

President of FastCap, author of 2-Second Lean and Lean Health

Jamie Parker

15 years' experience in operations management / leadership in retail, service, and manufacturing 

Harry Kenworthy

Expert in Lean government after a long career in manufacturing

Bob Rush

Lean Manufacturing Group Leader for Tesla Motors

Samuel Selay

Continuous Improvement Manager for the Marine Corps at Camp Pendleton

David Haigh

David works at Johnson & Johnson Canada, the largest consumer healthcare company in Canada

Joe Swartz

Administrative Director, Business Transformation, Franciscan Alliance, co-author of Healthcare Kaizen

Cameron Stark

Physician and Lean improvement leader in Scotland

Harvey Leach

Principal Consultant with The Consultancy Company based near Oxford, England

Andy Sheppard

Author, The Incredible Transformation of Gregory Todd: a Novel about Leadership and Managing Change

Mike Leigh

President and Founder of OpX Solutions, LLC and former Lean leader at General Electric

Jamie Flinchbaugh

Lean advisor, speaker, and author, who has advised over 300 companies on their Lean journey

Lesa Nichols

Founder, Lesa Nichols Consulting and former Toyota leader

The book also contains relevant posts from Mark Graban's

Podcast About the Book:

Listen to Ron Pereira interview Mark Graban about the book as part of the Gemba Academy Podcast.

About the Editor

Mark Graban
Mark Graban

Mark Graban is an internationally recognized consultant, author, professional speaker, and blogger. Mark is also a Senior Advisor to the technology company KaiNexus. For his full bio, visit

Mark's newest book (2023) is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation.

He is the author of the book Lean Hospitals, which was the first healthcare book selected as a recipient of the Shingo Research and Professional Publication Award. Mark has also co-authored Healthcare Kaizen and was the editor of the anthology Practicing Lean, published through LeanPub. He published Measures of Success: React Less, Lead Better, Improve More in 2018, originally on LeanPub.


The Book

Just the eBook, in multiple formats

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The Book+ MP3 Audio Book

If you buy this package, you receive the full eBook, as well as MP3 audio book files. There are a total of 20 chapters, with 6 hours and 50 minutes of audio. The chapters by Mark Graban and Paul Akers are read by the author. Other chapters have been professionally read by a volunteer, Samantha Leigh). I thank her for initiating the audio book effort. Samantha is the daughter of Mike Leigh, who wrote Chapter 15. She is currently working on her undergraduate degree in neuroscience and psychology. Samantha enjoys recording professional voice over work and hopes to continue this interest in the future. She can be contacted at Intro music credits: "Thinking Music" Kevin MacLeod ( Licensed under Creative Commons: By Attribution 3.0 License


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    MP3 Audio Book files

    6 hours and 50 minutes of audio

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About the Contributors

Michael Lombard
Michael Lombard
Michael Lombard, MBA, PMP, is a seasoned leader in Lean Healthcare, currently serving as the Senior Director of Operational Excellence at Cornerstone Healthcare Group in Dallas, TX. He has a track record of helping hospitals and other care providers radically improve performance through continuous improvement. His specialty is enabling leaders, from the front-lines down to the c-suite, to develop strong Lean Management habits through proven coaching techniques. Above all, Michael is a lifelong learner, always looking to apply lessons learned at work and at home as a father and husband.
Jamie Parker
Jamie Parker
Jamie Parker practices Lean and is passionate about learning and sharing Lean leadership. She has 15 years' experience in operations management / leadership across retail, service, and manufacturing environments. Jamie serves as an internal coach to her organization's operations managers across the country while supervising P&L and operations management responsibilities for six commercial print plants. Jamie expresses passion for helping leaders break the habits of traditional management approaches to create environments primed for team member fulfillment.
Harry Kenworthy
Harry Kenworthy
Harry Kenworthy has authored articles on Total Quality in Quality Progress and Purchasing magazines and several articles in Government Finance Review: "Getting Started with Lean", "A Guide to Starting the Lean Journey", and "Blending Agile and Lean Thinking for More Efficient IT Development." He worked previously in several manufacturing organizations, serving as process engineer, general foreman, operations manager, division manager, group vice president, and lastly as vice president of manufacturing. Harry has worked in industries including copper & brass rolling, tube and bar mills; printed circuit boards; custom plastic molding; and his last tenure was 26 years at Rogers Corporation which served a variety of markets and technologies. He was responsible for the Rogers worldwide Lean Six Sigma effort and left to devote full time to his consulting firm in 2004. His consulting organization, QPIC, LLC, focuses on clients implementing Lean Management Systems in over 20 states with state government agencies, counties, cities, and large K-12 school systems. Harry has a B.S. in Materials Engineering from Rensselaer Polytechnic Institute (RPI), and a M.B.A in Finance from Syracuse University. Harry and his wife Elaine reside in Connecticut. This chapter is excerpted from his upcoming book: "Lean Government Now - We Can Do This!"
Lesa Nichols
Lesa Nichols

Lesa Nichols has spent over two decades guiding organizations to improved performance by applying the principles of the Toyota Production System (TPS) and Lean. 


As a key leader for Toyota North America, she led teams to analyze and solve the toughest operational problems within Toyota, including the preparation and launch of new vehicles, plants and production methods. After leaving Toyota, Lesa spent four years helping clients of the Greater Boston Manufacturing Partnership (GBMP) to achieve successful enterprise level improvements.

In 2013, Lesa created her own firm, Lesa Nichols Consulting (LNC). Currently, she and her team help companies understand how and why to utilize principles of TPS and Lean as a competitive operations management system.

Lesa lives in Louisville and can be found at as well as LinkedIn.

Paul Akers
Paul Akers
Paul Akers describes himself as an "entrepreneur, business owner, author, speaker and Lean maniac." Paul is founder and president of FastCap, based in Ferndale, WA. FastCap is an international product development company founded in 1997 with over 2000 distributors worldwide. A prolific inventor, Paul holds US and international patents. His company, FastCap, launches approximately 20 new innovative products per year and has won business of the year in 1999 and 2010. Paul and his wife, Leanne, have built FastCap from their garage into a multi-million dollar company in 13 years. In 2011, Paul wrote his first book about Lean Manufacturing, "2 Second Lean." In 2015, Paul published his latest book, "Lean Health," which you can download as a free PDF. Find info about the books at . Read his full bio online (PDF) -
Samuel Selay
Samuel Selay

Samuel Selay is the Continuous Improvement Manager within his organization in the Marine Corps at Camp Pendleton. He has worked in the field of supply chain and logistics for the past 12 years. For the last 6 years, he has managed his organization’s Continuous Process Improvement/Lean Six Sigma (LSS) Program. During this timeframe, he has facilitated/mentored 28 completed LSS projects or kaizen events. Additionally, he mapped and standardized 36 processes, conducted 90 process audits, and implemented his organization's Quality Management System, resulting in a 20% reduction in shipping defects. 

Along with project leadership, he has instructed and certified 481 employees as LSS Yellow Belts and 121 employees as LSS Green Belts. He is a certified Lean Six Sigma Black Belt from the University of San Diego, a certified Logistics Technician (CLT) from the Manufacturing Skills Standards Council, and a certified ISO 9001:2008 Internal Auditor from the World Wide Quality Network. He holds a BS in Management Studies from the University of Maryland University College and a MBA in Management and Strategy from Western Governors University. 

Jamie Flinchbaugh
Jamie Flinchbaugh

the lean guy…

I am best known for co-founding the Lean Learning Center with partners Andy Carlino and Denny Pawley in 2001. I did this after leading successful lean journeys with several companies and many operational roles. I also co-wrote The Hitchhiker’s Guide to Lean: Lessons from the Road, with Andy Carlino. I founded the lean websiteThe Lean Library, and write a column for Assembly Magazine titled “Leading Lean.”

the entrepreneur…

In addition to co-founding the Center, I also co-founded Rev! Motorcycles in 1999, and the investment and advisory firm Old Dutch Group in 2004. Old Dutch Group includes active investments in Flinchbaugh Engineering and Cobra Sport. I also serve on boards of directors and advisers, including S&S Cycle.

the education advocate…

I have always believed that an education, whether formal or not, is the best investment one can make. I chair the Board of Advisors of Oakland University’s Pawley Institute. I also serve along with my wife on the Lehigh Leadership Council. At Lehigh I have been an Entrepreneur-in-Residence, delivered an Honors Convocation Keynote Address, and began the Donald E. Flinchbaugh Memorial Scholarship. I was proud to receive the Lehigh University Alumni Award in 2004. My brother and I also support York, PA educational efforts through the Alethea and Graham Watts Memorial Fund.

the person…

I was born in York, PA where I have both friends and family still. After time in Michigan and Massachusetts, I am back in Pennsylvania in Bucks County. I have been married to my beautiful wife Jill since 1997. We have 3 wonderful children together, Emma, Jack, and Ben. Besides spending family time, I love playing and watching soccer, especially with my kids.

Michael Leigh
Michael Leigh

Mike Leigh is the President and Founder of OpX Solutions, LLC, a consulting company that specializes in helping manufacturers and other organizations pursue Operational Excellence through leadership development and process improvement.

Mike has spent most of his 30-year career in various operational leadership roles. Prior to starting his own business, he worked as a manufacturing leader and a Lean leader for General Electric, building industrial gas turbines and wind turbines for the energy industry. Before that, Mike served 10 years on active duty in the US Navy, specializing in surface warfare and nuclear propulsion. He eventually retired from the Navy Reserve as a Commander.

Mike has a B.S. degree in Computer Engineering from the Milwaukee School of Engineering, and a M.S. degree from Troy State University in Human Resource Management. He also qualified as a Nuclear Engineer in the US Navy.

Mike and his family live in Roanoke, VA. You can connect with him on LinkedIn.

Andy Sheppard
Andy Sheppard

Andy Sheppard helps businesses to transform their manufacturing operations, and serves as a technical advisor to Lean specialists. He is the author of The Incredible Transformation of Gregory Todd: a Novel about Leadership and Managing Change.

Nick Ruhmann
Nick Ruhmann
Nick Ruhmann is an ongoing student of "lean thinking", the Toyota Production System, and certified Six Sigma Master Black Belt currently leading the enterprise wide deployment of an Operational Excellence culture at National Flood Services, a leading flood insurance solutions provider and division of Aon plc. From 2010 to 2012, he worked in medical device industry for BD Medical, leading Continuous Improvement within their Diabetes Care division, but spent the bulk of his career with Tenneco Inc, a major Tier I automotive supplier to nearly every OEM including Toyota. During that time, Nick’s career has offered a diverse background, including both functional and leadership positions across Research & Development, Product Engineering, Process Excellence, Operations, Process Engineering, Quality, and Supply chain.
Bob Rush
Bob Rush
Bob Rush currently is a Lean Manufacturing Group Leader for Tesla Motors in Fremont, CA. Bob has over 35 years of operations experience and has had over 25 years of Lean practice. His experience is in companies ranging from start ups to Fortune 100 companies, and title levels that ranged from shipping clerk to VP of operations. In addition to Tesla, some of the companies he has worked with, and for, include Hewlett Packard, JDS Uniphase, and Idex Corporation. His journey includes 10 years of consulting experience, where he had only himself to blame if things didn’t work out. His Lean journey started with World Class Manufacturing, which led to Lean manufacturing, where he was fortunate enough to learn kaizen events from the Shingijutsu Consulting group. He continues to work with a love of kaizen as a way of life and has led more than 500 kaizen events over the course of his practice of Lean. He has been trained that respect for people is the most critical pillar of Lean and he shows it with all people that he works with.
Joe Swartz
Joe Swartz

Joseph E. Swartz is the Administrative Director of Business Transformation for Franciscan Alliance, a group of 14 hospitals in Indiana and Illinois. He has been leading continuous improvement efforts for more than 20 years, including 10 years in healthcare. 

Joe is co-author of the book Seeing David in the Stone: Finding and Seizing Great Opportunities. Joe has also co-authored the book, Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements, with Mark Graban, which was awarded the 2014 Shingo Research and Professional Publication award.  He also co-authored The Executive Guide to Healthcare Kaizen (Productivity Press).

Joe consulted from 1993 to 2005, working in automotive engineering, semiconductor manufacturing, industrial product manufacturing, pharmaceutical manufacturing, and aerospace assembly. 

Joe studied Electrical Engineering at Cleveland State University as well as Management at Purdue University, where he graduated as a Krannert Scholar for academic excellence in their masters program.  He lives in Indianapolis, Indiana with his three children.

Cameron Stark
Cameron Stark

Born in Glasgow, Scotland, Cameron Stark graduated in medicine from the University of Glasgow in 1985. After working as a junior doctor in medical and surgical posts, he spent four years working in Psychiatry in the West of Scotland. Stark then trained in Public Health Medicine and has been an NHS Consultant since 1996, first in Ayrshire and then in the Highlands. He has professional qualifications in Psychiatry and Public Health and postgraduate degrees in Risk, Crisis and Disaster Management (University of Leicester) and in Public Health (University of Glasgow). 

With research interests in public health, mental health and quality improvement, Stark has published over 50 papers in peer-reviewed journals. He has written four previous book chapters, co-edited three academic books and co-authored a recent book on the psychology of soccer coaching. 

He trained as a Lean Leader with Tees, Esk and Wear Valley NHS Foundation Trust, and now coaches staff who are learning about Lean in NHS Highland. Stark is responsible for the quality assurance of Lean training materials used in NHS Highland and works with their Kaizen Promotion Office manager to arrange events and develop training. 

Away from work, Stark is married with three children, and lives in Inverness, Scotland. 

David Haigh
David Haigh

David works at Johnson & Johnson Canada, the largest consumer healthcare company in Canada, and part of the Johnson & Johnson family of companies.

David started his career in the telecommunications sector, working at Research In Motion, and has worked in Lean and Six Sigma in the telecommunications, construction, automotive, consumer packaged goods, and healthcare sectors in Canada and globally since 2003. 

David has a BASc in Mechanical Engineering from the University of Waterloo, an MBA from Wilfrid Laurier University, and his Lean Six Sigma Master Black Belt certificate from Villanova University.

David and his wife Cindy currently reside in Toronto, Ontario, Canada with their son. He can be found on Twitter @Leanlearnlead and LinkedIn.

Harvey Leach
Harvey Leach

Harvey Leach is a Principal Consultant with The Consultancy Company based near Oxford, England where he works with around 30 colleagues to help clients "Make Strategy Happen" by applying his experiences of Lean thinking, change management and leadership development to help them solve problems and grow their internal capability to identify and implement improvements.

Prior to joining The Consultancy Company, Harvey spent 27 years with Rover Group and BMW Group, where he gained an impressive reputation for implementing improved ways of working in every team he managed, covering areas as diverse as Product Development, New Product Introduction, Production Planning & Control and Production Strategy. Alongside this, he acted as a trainer for a number of internal programmes to grow the organisation's Lean capability – Total Quality Improvement, Leading Management and Coaching for Performance.

Over the last 11 years, Harvey has applied and developed the skills he acquired to support clients in a range of industrial and public sector organisations, covering both operational and administrative areas. In addition to leading and facilitating improvement programmes for clients, he has developed and delivered a range of highly acclaimed public and bespoke training programmes.

Reader Testimonials

Brian Kerr
Brian Kerr

Think of this book as what you'd hear if you were stuck in a long van ride with over a dozen folks who learned the hard way about many wrong-headed, painful, or failed approaches to change the culture of their workplaces--but who also learned the hard way about how to practice and spread lean in a meaningful way.

L. Bryan
L. Bryan

This book is a great collection of interviews, stories and blog posts which illustrate the common threads joining the pieces of any Lean implementation. Improving quality, improving patient satisfaction, respect for people, all easing to vastly improved performance. It’s a great read and I’d recommend it in any Lean practitioners arsenal.

Harish Jose
Harish Jose

The personal experiences in the book make it an easy read. They are all something you can easily relate to. It is also humbling to learn from the “failures” and “successes”. From a philosophical standpoint, this is about epistemology – how each of the authors came to attain their knowledge about lean. Their personal journeys make the book quite enjoyable to read. Some of these authors were familiar to me from LinkedIn and from the Gemba Academy podcasts. This is quite a diverse group of authors.

Mark Welch
Mark Welch

interesting and practical experiences from Lean practitioner/thinkers. Definitely worth the read.

Bob Rush
Bob Rush

If you have been in the lean world for awhile you will most likely identify with some of the chapters. If you are new to lean you will learn a lot of what can go wrong when you first practice lean. I have been in the lean world for some time now and I learned several things that I hadn't thought and have applied them to my work with people new to Kaizen.

Amazon Customer
Amazon Customer

Mark writes in compelling prose, weaving in his own personal story of transformation from a more traditional industrial engineering role to a continuous improvement pioneer in health care. Both his humility and expertise are evident throughout the book as he describes the limited effectiveness of his early approaches, what he learned from this, and how he improved himself and those he served. I particularly enjoyed the stories from other lean thinkers that are included.

Table of Contents

  • Welcome to the Book!
  • Chapter One - Mark Graban
    • Identifying Problems is only the First Step in Improvement
    • Inexperience and Ignorance or Incorrect Knowledge?
    • Lean Means Always Learning
    • If We Keep Practicing Lean, We’ll Get Good At It
    • Is it Lame to Call Situations L.A.M.E.?
    • Let’s Reflect
  • Chapter Two - Mark Graban
    • See One, Do Some, Teach a Bunch
    • My Early Days in Manufacturing at General Motors
    • Some of My Early Mistakes and Lessons in Manufacturing
    • Early Mistakes in Healthcare
  • Chapter Three - Nick Ruhmann
    • Timing is Everything
    • Starting Out with Six Sigma
    • Bucking the Trend
    • Leaning Out of Six Sigma
  • Chapter Four - Michael Lombard
    • Into the Learning Zone of Parenting
    • 2006-2010: Discovering Lean, Practicing L.A.M.E.
    • 2010-2012: Getting Clinical with Lean
    • 2012-2015: Practice Makes Permanent
  • Chapter Five - Paul Akers
    • Every Day is a Massive Revelation
    • Lean Thinking – It Never Ends!
  • Chapter Six - Jamie Parker
    • Bike Ramps: Crashing and Burning
    • Diving in Head First… in the Shallow End
    • The Hammer or the Screw Driver
    • Standards for Standards’ Sake
    • A Five Letter Word
    • West is Best
    • Beliefs Drive Behavior
    • The Tortoise and the Hare
  • Chapter Seven - Harry Kenworthy
    • My First Job - Trial by Fire
    • Learning on the Next Job
    • Connecting with a Great Mentor
    • Really Learning about Union Relations
    • Learning about Accountability and Getting Stuff Done
    • My Experiences with Dr. Deming
    • If I Only Knew Then What I Know Now
  • Chapter Eight - Bob Rush
    • Everyone is an Expert
    • I’m Now the Old Guy
    • My Firefighting Got in the Way of Progress
    • Lean Without Respect Isn’t Lean and Will Fail
    • Learning From an Expensive Mistake
    • The Gleam in Her Eye
    • Lean Champions
    • My First Kaizen Event
    • How Did I Get Here?
  • Chapter Nine - Samuel Selay
    • Learning Continuous Improvement: Reflections on Practicing CI in the Marine Corps
    • Cultural Roadblocks to Deploying Continuous Improvement
    • Lessons Learned from Japan
    • Practicing Continuous Improvement
    • Problem Solving Process
  • Chapter Ten - David Haigh
    • Lean From The Source
    • Isn’t Lean Just a Bunch of Tools?
    • Financial Waste Isn’t Always Muda
    • You Can Use Lean to Grow
    • Don’t Forget Your Lean Value Proposition
  • Chapter Eleven – Joseph Swartz
    • Go To the Coalface
    • We Didn’t Have Insurance
    • Touch and Feel the Output
    • Pride Cometh Before the Fall
    • Oops, I Shouldn’t Have Said That
  • Chapter Twelve – Cameron Stark
    • Looking for Lean
    • Clinical Audit
    • Service Planning
    • National Collaborative
    • Knowledge Transfer Partnership
    • Finding Lean: Virginia Mason, Tees, Esk and Wear Valley, and NETS
    • What Now?
    • Turning Process Gains into Improvement Gains
    • Embedding Improvement
  • Chapter Thirteen - Harvey Leach
    • “I don’t know anything much about Lean!”
    • An Industry in Turmoil
    • An Introduction to Some Different Thinking
    • Reflections
  • Chapter Fourteen – Andy Sheppard
    • Learning from Others
    • Technical Insight
    • Change Management
    • Leadership
  • Chapter Fifteen – Mike Leigh
    • A very lucky guy
    • Lesson 1: Leadership and culture is trump
    • Lesson 2: Be believable
    • Lesson 3: Promote the journey – the results will come
    • Lesson 4: Promote the philosophy – not the tools
    • Final Thoughts
  • Chapter Sixteen – Jamie Flinchbaugh
    • What’s wrong with your pull system?
    • The Boss
    • The pivot and the lesson
    • The solution
    • The learning
    • What’s next?
  • Chapter Seventeen – Lesa Nichols
    • 1. Beware the documents – see the work
    • 2. Standardized Work documents are THE WAY to lead to improvement – but only if they change
    • 3. Even the best SW Documents aren’t enough
  • Chapter Eighteen – Summation
    • The Habits of Lean
  • Chapter Nineteen – Related Posts from
    • Lean or “L.A.M.E.”?
    • This WSJ Article (as do Many Organizations) Misses the Point of 5S
    • Bad Lean/5S Hits the UK Media
    • How My Blog Rant Helped Keep an Office 5S Initiative from Being “L.A.M.E.”
    • Run Fast if You Ever Hear This Phrase from a “Lean Six Sigma” Instructor
    • Can’t Always Believe Somebody Saying “Toyota Would Tell You To…”
    • Where Do Hospitals Get the Idea that Lean is Only About Cost Reduction?
    • The Emperor’s Sacred Cow’s New Clothes – “Flexing” Hospital Staff
    • Be Careful With “No Waiting Rooms” Just Like “Zero Inventories”
    • Is it Lean’s Fault or the Old Management System’s?
    • “Has Lean Ever Been Fully Implemented and Not Worked?” What About Yoga & Veganism
    • Fighting Against “The Way We’ve Always Done It” – Before Lean or With Lean
  • Thanks for Reading the Book!

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