The most expensive leadership lesson I’ve ever learned didn’t happen in a boardroom. It happened standing beside a cube of Chardonnay!
As both a winemaker and an Improvement Scientist, I’ve learned that organizations and wine have something important in common.
Neither tells you immediately when something is going wrong.
At first, our Chardonnay fermentation looked perfectly normal. The numbers weren’t alarming. The cube was active.
Nothing suggested we were headed for a problem.
So we kept moving.
But over the next few days, subtle changes began to appear. The fermentation wasn’t progressing the way we expected. The cube wasn’t as airtight as we had thought! What should have been a straightforward process slowly became a recovery project requiring additional monitoring, corrective decisions, extra labor, and valuable time we hadn’t planned to spend.
The wine was recoverable. But recovery came at a cost.
That experience changed the way I think about leadership.
Not because something went wrong. But because I realized the greatest expense wasn’t fixing the problem.
It was fixing work that never should have needed fixing in the first place.
In Improvement Science, we call that rework.
And I believe it’s one of the most overlooked forms of organizational waste.
We often imagine waste as excess inventory, unnecessary meetings, or inefficient processes.
Yet rework quietly drains organizations every day.
In healthcare, it looks like repeat imaging because the first study wasn’t sufficient. It looks like duplicate documentation, repeated patient handoffs, or correcting preventable errors that consume clinical time.
In business, it appears as presentations rewritten because expectations weren’t aligned.
Projects restart because assumptions were never tested.
Leaders spend hours clarifying priorities that should have been clear from the beginning.
None of that work creates new value. It simply attempts to recover value that was already lost.
So why does rework become so common?
Because leaders are often rewarded for action.
We’re praised for making decisions, launching initiatives, and moving quickly.
What receives far less attention is what happens after the action.
- Did the decision produce the outcome we expected?
- What unexpected signals emerged?
- What assumptions proved wrong?
- What should change before we scale further?
These are the questions behind the “Study” phase of the PDSA cycle; the phase I believe organizations skip most often.
The biggest mistake leaders make isn’t failing to act.
It’s failing to study what their actions produced.
When we skip learning, we repeat mistakes.
When we repeat mistakes, we create rework.
And rework quietly becomes one of the largest leaks in an organization’s capacity, profitability, and momentum.
Today, whether I’m tasting Chardonnay during fermentation or advising executive teams through organizational transformation, I ask the same question before making the next decision:
“What is the system trying to teach us?”
Because continuous improvement isn’t about avoiding mistakes. It’s about learning from them before they become expensive.
Where is rework quietly costing your organization more than you realize?
This is the lens I bring to systems transformation. I don’t start by asking who’s underperforming. I start by asking what the system is perfectly designed to produce.