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On 20 April ISHM‐Benelux held its 1988 Spring meeting at the Grand Hotel Heerlen. This meeting was totally devoted to implantable devices, in particular to the technologies used for these high reliability, extremely demanding devices. For this meeting ISHM‐Benelux was the guest of the Kerkrade facility of Medtronic. Medtronic (headquartered in Minneapolis, USA) is the world's leading manufacturer of implantable electronic devices. Apart from the assembly of pacemakers and heart‐wires, the Kerkrade facility acts as a manufacturing technology centre for Medtronic's European facilities.

This chapter is an exercise in speaking, letting individuals speak for themselves insofar as possible. As Marx famously put it, “they cannot represent themselves, they must be represented.” The “they” were peasants, potato farmers in 1840s France, and by extension peasants, workers, and other lower class groups, not to mention women and minorities who rarely made it into the historical record, and even more rarely in their own words. To give “voice to the voiceless,” as the now old new social historians of the 1960s and 1970s put it, I consciously include here numerous speakers, arranged in two sets of different voices: quotes in the text and endnotes to further document and amplify points. With this plethora of voices, the aim is not to complicate but to speak clearly, listen carefully, and engage respectfully. To multiply the speakers speaking is the single best way to make two primary points concerning what is most important about the Chief Illiniwek mascot controversy: that the sheer number of individuals speaking out is in itself significant, and that this community colloquy all comes down to identity – who we are, individual identity, communal identity.

This study aims to highlight the system-wide potential relationships between forms of human bias, selected Lean tools and types of waste in a manufacturing process.

A longitudinal single-site ethnographic case study using digital processing to make a material receiving process Lean was adopted. An inherent knowledge process with internal stakeholders in a stimulated situation alongside process requirements was performed to achieve quality data collection. The results of the narrative analysis and process observation, combined with a literature review identified widely used Lean tools, wastes and biases that produced a model for the relationships.

The study established the relationships between bias, Lean tools and wastes which enabled 97.6% error reduction, improved on-time accounting and eliminated three working hours per day. These savings resulted in seven employees being redeployed to new areas with delivery time for products reduced by seven days.

The single site case study with a supporting literature survey underpinning the model would benefit from testing the model in application to different industries and locations.

Application of the model can identify potential relationships between a group of human biases, 25 Lean tools and 10 types of wastes in Lean manufacturing processes that support decision makers and line managers in productivity improvement. The model can be used to identify potential relationships between forms of human biases, Lean tools and types of wastes in Lean manufacturing processes and take suitable remedial actions. The influence of biases and the model could be used as a basis to counter implementation barriers and reduce system-wide wastes.

To the best of the authors’ knowledge, this is the first study that connects the cognitive perspectives of Lean business processes with waste production and human biases. As part of the process, a relationship model is derived.

This chapter describes the efforts of a team of health care workers to make a sub-acute health care facility (SCF) serving profoundly damaged children into a high reliability organization (HRO). To obtain this goal, the health care team implemented change in four behavioral areas: (1) risk awareness and acknowledgment; (2) defining care; (3) how to think and make decisions; and (4) information flow. The team focused on five reliability enhancement issues that emerged from previous research on banking institutions: (1) process auditing; (2) the reward system; (3) quality degradation; (4) risk awareness and acknowledgment; and (5) command and control. These HRO processes emerged from the change effort. Three additional HRO processes also emerged: high trust, and building a high reliability culture based on values and on beliefs. This case demonstrates that HRO processes can reduce costs, improve safety, and aid in developing new markets. Other experiences in implementing high reliability processes show that each organization must tailor make processes to its own situation (e.g. BP, U.S. Chemical Safety and Hazards Board, Federal Aviation Administration, U.S. Navy Aviation Program, and Kaiser Permanente Health Care System). Just as in the flexibility called for in organizing for high reliability operations, flexibility is called for in deciding which HRO processes work in specific situations.

Purpose – To offer a theoretical explanation for observed physician resistance and rejection of high reliability patient safety initiatives.

Design/methodology/approach – A grounded theoretical qualitative approach, utilizing the organizational theory of sensemaking, provided the foundation for inductive and deductive reasoning employed to analyze medical staff rejection of two successfully performing high reliability programs at separate hospitals.

Findings – Physician behaviors resistant to patient-centric high reliability processes were traced to provider-centric physician sensemaking.

Research limitations/implications – Research, conducted with the advantage that prospective studies have over the limitations of this retrospective investigation, is needed to evaluate the potential for overcoming physician resistance to innovation implementation, employing strategies based upon these findings and sensemaking theory in general.

Practical implications – If hospitals are to emulate high reliability industries that do successfully manage environments of extreme hazard, physicians must be fully integrated into the complex teams required to accomplish this goal.

Social implications – Reforming health care, through high reliability organizing, with its attendant continuous focus on patient-centric processes, offers a distinct alternative to efforts directed primarily at reforming health care insurance. It is by changing how health care is provided that true cost efficiencies can be achieved. Technology and the insights of organizational science present the opportunity of replacing the current emphasis on privileged information with collective tools capable of providing quality and safety in health care.

Originality/value – The fictions that have sustained a provider-centric health care system have been challenged. The benefits of patient-centric care should be obtainable.