Five minutes for one doctor. Over 400 minutes for another. Same emergency room, same shifts. That is the scale of door to doc variation one Lean Six Sigma team found inside a Veterans Affairs hospital. However, the real story is what happened next. They fixed it, and then the fix died the moment the team walked away.

In this episode of the Why They Fail Podcast, Kevin Clay sits down with Lacee Koerner (MSN, RN, CEN), an emergency room and quality nurse. Together, they walk through an honest account of a project that worked on paper but failed in practice.

At first, Lacee and her team set out to reduce Left Without Being Seen rates. However, during their early Gemba walks, they found something uncomfortable. The numbers leadership trusted were easy to bend through simple workarounds.

Therefore, the team changed direction. Instead of chasing a metric staff could shape, they moved to door to doc variation. As a result, they captured what was really happening rather than what the reports claimed.

Next, they ran a careful Measurement System Analysis and applied statistical process control. Consequently, the swings became visible. One doctor answered in five minutes. Another took more than 400. Once they found those outliers and set up controls, response times dropped in a way the data could prove.

So the fix worked. Nevertheless, it did not last. In this candid talk, Lacee explains why the project went dead on arrival once her team stepped back.

Because there was no supervisor buy-in, no steady backing from leaders, and no daily support system, the gains faded fast. Within weeks, the department drifted back to old habits. In other words, nothing held the change in place.

Furthermore, the staff were hearing two messages at once. On one hand, leaders asked for strict compliance. On the other hand, they asked nurses to speak up and own the work. Therefore, this episode lands on a hard truth. Data and tools can solve the technical problem. Only leaders and culture can keep it solved.

Above all, these lessons separate a fix that holds from one that quietly slips away.

First, uncontrolled door to doc variation hurts patient flow and care quality. Second, a careful measurement system analysis stops teams from trusting numbers that have been shaped. Third, top-down orders without supervisor buy-in create pushback, and eventually the project falls apart. Fourth, even a proven win will go dead on arrival unless something is built to hold it. Finally, lasting improvement happens when leaders match what they ask for with how they actually behave.

Over 90% of continuous improvement programs fail within eighteen months. In his book, Kevin explains exactly why, and what to do instead. Therefore, if your last project slipped back, this is a good place to start. Get a free copy of "Why They Fail and the Simple Key to Success" here:

• (00:00:00) - Intro and Framing the Contradiction
• (00:01:15) - Meet Lacey Kerner and Her CI Journey
• (00:04:03) - Does VA Culture Embrace Data?
• (00:05:36) - Bureaucracy and Data Access Struggles
• (00:07:22) - Frontline Nurses' Resistance to the Project
• (00:09:31) - Lack of Infrastructure and Sustainment Challenges
• (00:11:43) - Cutting Through Red Tape for Data
• (00:13:57) - Executive Sponsorship and Leadership Buy-in
• (00:16:07) - Top-Down vs Frontline Empowerment Paradox
• (00:18:47) - Did the Improvements Stick?
• (00:19:34) - Defining the Door-to-Doc Project
• (00:22:58) - Data Analysis Errors and Discovering Variability
• (00:25:13) - Wild West Variation and Finding Focus
• (00:26:37) - Closing Thoughts and Show Wrap-up

Fire the employee who made the mistake and the next person in that seat will make the exact same mistake. That is the uncomfortable truth behind most operational failures. Leaders who want real improvement must stop blaming workers for mistakes and start diagnosing the systems that produce them.

In this episode of the Why They Fail Podcast, Kevin Clay sits down with continuous improvement expert and author Mark Graban. Together, they explore Dr. W. Edwards Deming's management philosophy, the stark contrast between command-and-control leadership and the Toyota Production System, and why treating Lean as a cost-cutting gimmick always fails.

When organizations operate under a culture of fear, employees learn one lesson quickly. Transparency leads to punishment. Consequently, workers begin hiding defects, delaying communication, and smoothing over metric variation just to protect themselves.

Dr. Deming demonstrated that roughly 94% of all workplace problems are built directly into the system. High-level decisions about suppliers, equipment maintenance, staffing levels, and management expectations dictate performance far more than individual effort ever could.

Therefore, firing an employee without fixing the broken workflow accomplishes nothing. The role stays the same. The process stays the same. The failure repeats. Moving forward requires leaders to stop blaming workers for mistakes and build genuine psychological safety at every level of the organization.

Mark Graban reflects on his early career at General Motors, where toxic management practices produced catastrophic quality issues and dismal morale. However, GM's joint venture with Toyota at the NUMMI plant told a completely different story. The same workforce, under a collaborative management system, achieved world-class results.

The famous Deming Red Bead Game illustrates this vividly. When the system itself forces defects, no amount of slogans, targets, or yelling will change the outcome. Instead of reacting emotionally to daily metric fluctuations, effective leaders use process behavior charts. As a result, they can distinguish normal system noise from genuine statistical signals worth acting on.

Lean is not a toolbox for short-term headcount reduction. When executives reduce it to cost-cutting, they sacrifice employee engagement, product quality, and workplace safety in the process.

True operational excellence pairs Lean problem-solving with data-driven Six Sigma analytics. Together, they eliminate unnecessary complexity and remove waste at the root. Furthermore, when leaders listen to the process instead of blaming people, they unlock sustainable capacity, higher quality, and lasting organizational success.

Mark Graban is an internationally recognized author, speaker, consultant, and entrepreneur who works with leaders to improve qual...

• (00:00:00) - Why They Fail
• (00:00:53) - Why They Fail: The Lean Startup
• (00:09:38) - The Toyota Way: A Culture of Excellence
• (00:13:20) - GM's 'command and control' culture
• (00:19:03) - GM's 'Lean' Program
• (00:23:59) - Does Lean Matter?
• (00:31:10) - How to Prevent and Learn From Mistakes?
• (00:36:38) - Control Charts for Process Behavior Charts
• (00:43:10) - Why They Fail

Fifteen minutes between cases does not sound like much. However, across a standard daily schedule it compounds into 150 minutes of lost room capacity. That translates to an annual revenue bleed between $1.3 million and $2.2 million. Eliminating operational friction in surgery centers is one of the fastest margin recoveries available to any ASC leadership team.

In this episode of the Why They Fail Podcast, Kevin Clay sits down with Sylvie Fortier, an operations leader whose career began during the foundational rollout of Six Sigma across Motorola's global enterprise. Together, they examine how hidden delays between cases quietly drain both revenue and organizational culture.

Ambulatory surgery centers function like high-stakes pressure cookers. Top surgeons operate with extreme clinical precision every single day. However, the true bottleneck is rarely the surgical procedure itself.

Instead, uncoordinated turnover minutes cost facilities thousands of dollars daily. The gap sits between patient discharge, terminal cleaning, and sterile pack setup. Consequently, a delay of just 15 minutes per case costs a typical facility between $5,500 and $9,000 every day.

Furthermore, the root cause is usually information asymmetry rather than individual performance. Scheduling, anesthesia, and materials management often operate with different information at different times. Therefore, the friction is architectural, not personal.

When surgical turnarounds lag, leadership often responds by tracking more variables. They purchase new dashboard software and add more metrics to the reporting stack. However, adding data to an already overwhelmed environment creates decision paralysis rather than operational control.

Execution rarely stalls because of missing data or missing standard operating procedures. Instead, processes break down because leadership lacks the filters needed to separate actionable signals from background noise. As a result, teams see everything and act on nothing.

Most operational breakdowns stem from human and strategic misalignment rather than simple process errors. In healthcare specifically, clinical founders focus on case complexity and patient outcomes. Meanwhile, financial partners prioritize fiscal margins and throughput.

Therefore, bridging that gap requires a visual strategy tool. Hoshin Kanri and the single-page X Matrix map strategic goals, tactical projects, and resource ownership onto one agreed document. When leadership can see all three on a single page, cross-departmental friction drops sharply. Consequently, teams establish genuine operational sovereignty over their own outcomes.

Sylvie Fortier is the founder of Phoenix Praxis, where her work centers on a single idea: making the invisible visible. She helps ambulatory surgery centers and complex organizations surface the operational friction that neve...

• (00:00:00) - Why They Fail
• (00:01:14) - Why They Fail: Six Sigma and Continuous Improvement
• (00:06:01) - How to Build a Continuous Improvement Culture
• (00:07:10) - Operational Friction Points in Ambulatory Surgery Centers
• (00:12:27) - How to Get the Leadership Group On the Same Page
• (00:18:30) - Healthcare Operational Data Overwhelm
• (00:21:44) - The Importance of Outside Perspectives
• (00:22:51) - Choosing a food with a clean label
• (00:26:47) - How to Eliminate Operational Friction in Surgery Centers