There are at least four conditions that trigger improvement: what we did didn’t work as planned, we disappointed a customer, there is an anticipated (or actual) need to get better, and what we do departs from the ideal.

In looking at Toyota, or any other example, for that matter, there is a choice been interpreting observations cultishly or scientifically.
A cultish approach is to determine that something was observed at Toyota, Toyota is the role model, so whatever was seen must be done too.
A scientific approach is to understand that actions have consequences in [...]

It would be a terrible mistake for Democrats to abandon comprehensive health care reform just because voters in the Massachusetts Senate race last week decided that they liked the Republican, Scott Brown, more than the Democrat, Martha Coakley.
– “Don’t Give Up,” NY Times, January 26, 2010
Does the NY Times think we had a popularity contest [...]

Read the NY Times or listen to NPR and you would conclude a little known state senator won the Senatorial seat long held by Ted Kennedy due to the faults of Democratic contender, Martha Coakley.
Not so. Scott Brown made one promise to vote against ObamaCare.  People listened, believed him, and he rode to victory.
The “Martha [...]

The question was asked; In times of budgetary pressure, what quality initiatives should be sacrificed.
Asking that asks the wrong question.  The right one is asking what can be done to better design and operate care critical processes to advance quality, affordability, and access simultaneously.
The first question reflects unwarranted arrogant pessimism, the latter better justified humble [...]