T-Minus 101 Days Until the 6th Annual Lean Healthcare Transformation Summit – Acting Our Way Into a New Way of Acting?

I had the good fortune of being asked to present at the Society For Health Systems Process Improvement Conference.  I could not stay for the entire conference, but I can see by the Twitter feed that there were lots of great comments and energy around the presentations.

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I like to start my presentations with a Tweet and short video.

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This was my 3rd year presenting, and I will likely come back because there is a lot more work to be done.  A little ingredient is missing, but it is absolutely vital – profound knowledge.  I was pleased to see that I was not the only one who mentioned the important contributions of Dr. W. Edwards Deming.  James Hereford, COO at Stanford Health Care was also a presenter.


I guess the primary point I tried to make at the conference is summarized in this slide.

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It took years and years and years of learning and experimenting for companies like Toyota to develop their philosophy for continual improvement.  People see the things on the surface (tools, methods, events, value stream maps, etc) and they want to copy, but they don’t know what to copy.  That’s what Dr. Deming said in 1980 when he was featured in the 1980 NBC program “If Japan Can, Why Can’t We?”  We think we can merely copy the tools, methods and systems and plop them onto the framework of our way of thinking.

What’s “under the surface” matters.  And what is under the surface of our current way of managing is things like:
– Short term focus
– Focus on the numbers
– Focus on results
– Focus on the person
– Blame and shame
– Divide the organization into parts and manage the parts (an additive view)
– Manage from the office, conference room and board room
– Belief in competition
– Win-lose mentality

We believe that by copying the tools and methods of others that we will get better, sustainable results.  And it will simply not work.  This is because our current way of thinking (see list above) will only produce: fear, heroic efforts, work-arounds, fire fighting, command and control, competition, cynicism and “flavor of the month”.

It’s built in … guaranteed.

If you would like to learn more about what is really needed, come to the 6th Annual Lean Healthcare Transformation Summit in Dallas, TX June 3-4, 2015.

T-Minus 108 Days Until the Healthcare Transformation Summit: Beyond Copying

Some healthcare organizations are trying to learn from other industries.  They are realizing that what apparently worked for them in the past will not work in the future.  Some of the signals are: rising costs, waste, poor quality, bad outcomes, decreasing customer satisfaction, and decreasing reimbursement.

Some are trying to learn about “lean”.  They are reading books, attending courses, going to seminars, visiting organizations and engaging with consultants.  This is promising, but what how likely is it that the outcome will be a true transformation of management and transformation of healthcare.  Not very likely in my opinion.

Many people are trying to copy what they see, and what they read about in books or see in courses.  They are copying the things on the surface, but they don’t know what to copy.  The important things are “under the surface” and take time and effort to find and to learn.

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This reminds me of Dr. W. Edwards Deming‘s quote from the June 1980 program on NBC “If Japan Can, Why Can’t We“.  This program explored why US companies were having difficulties competing in the world market.  Dr. Deming was featured in the last 10 minutes.  He said, “People in this country expect miracles.  They go to Japan to copy, but they don’t know what to copy.”

I think that what he meant was that it took years and years and years of learning, and trial and error (a lot of error) in order for companies like Toyota to create a philosophy of continual improvement.  Japan invited in new knowledge from Deming, Joseph Juran and others in the 1950s and beyond after World War II.  Companies like Toyota used this new knowledge to create a sustained philosophy of continual improvement.

Eastern and Western cultures came together in the years after World War II to help create something special and different.  Companies like Toyota learned how to make use of scarce resources, to eliminate waste, to expand the market and to compete around the world.

Western management did not take this path after World War II.  Companies in the United States were experiencing an expanding market and high demand for goods and materials.  Their problem was not quality it was quantity.  Western management believed that their success was due to their methods (command and control, central management systems, performance evaluations, merit pay) when in reality it was mostly luck.

In recent years some Western companies have realized their error and have sought out the new knowledge that Japan embraced decades ago.  Some are creating sustainable philosophies, others have tried to implement programs.  The programs eventually fail and become “flavor of the month”

Healthcare is no longer experiencing and expanding market.  More hospitals, more doctors, more clinics, more equipment, more competition will not solve the problem.

If you want to know what will solve the problem, and go beyond the surface tools and methods, you’ll want to be at the 6th annual Lean Healthcare Transformation Summit in Dallas, Texas June 3-4, 2015.

T-Minus 114 Days, this year’s countdown to Summit #6

Each year we co-host the Annual Lean Healthcare Transformation Summit in collaboration with the Lean Enterprise Institute.  Each year I try to help get the word our about the Summit in the form of a countdown.

The registration for the Summit went “live” for the general public today.  Up until now, it has been open to Healthcare Value Network and Clinical Business Intelligence Network members.  They had a chance to be the first to register.  Now it’s open to anyone.

Summit #1 was held in Orlando, Florida.  I had started working at the ThedaCare Center For Healthcare Value as a volunteer several months before the Summit.  There were about 300 people in attendance.  It was a big experiment.  If we held it, would they come?  The answer is “yes”, and the Summit has gained momentum and quality each year.

Summit #2 was held in Seattle, Washington.  More people came this year, and we ran more experiments.  One experiment was a 2-part education session for HVN members to learn our Shingo-based assessment model.  It was a collaboration between Seattle Children’s Hospital and Group Health Cooperative.  It proved to be successful.  We have now conducted 23 of these 2-day sessions in healthcare organizations around North America.  Just under 500 people and from 40 organizations have learned about and used the method.  We wrote a white paper on the method.  As I write this blog, I am on my way to the 24th educational offering in the 41st organization.

Summit #3 was held in Minneapolis, Minnesota – my (current) home town.  This was a particularly memorable Summit for me as I volunteered to serve as the Master of Ceremonies.  In the closing session featuring John Shook, the fire alarm sounded and we had to evacuate the room.  I thought this was part of Shook’s presentation.  You can’t make this stuff up.  This was also the first Summit where we tried (what I call) the “15 Minutes of Fame” presentations.  The official title is “Experiments Around the Network”.  We gave 10 people 15 minutes to tell an improvement story.  It worked.  It’s been wildly successful and popular.  We now do this at each Summit.

Summit #4 was back in Orlando.  This was the year we tried something new – a breakout session for CEOs.  I call it “the Summit within the Summit”.  The session was a success and it is now something that helps to assure engagement and commitment at the top of the organization.  That’s the only way that transformation will work – from the top.

Summit #5 was in Los Angeles, California.  At the previous Summit, our CEO (John Toussaint) brought his trumpet and gave an impromptu performance.  At Summit #5 he had a band.  I’m sure this will be a built-in part of each Summit to come.

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Summit #6 is in 114 days.  It is in Dallas, TX.  If you want to be one of the 600 people wha are in attendance, you’ll need to register now.  For more information about what you will see an experience, go to this link.

2014 Hansei – Tending A Network

I tried something last year with a reflection on 2013.  I am giving it a go again this year.

Here’s what I learned about Hansei.  It is my understanding that “Han” means to change, turn over, or turn upside down.  “See” means to look back, review, and examine oneself.  I understand that there are 3 elements:
1. The individual must recognize that there is a problem – a gap between expectations and achievement – and be open to negative feedback.

2. The individual must voluntarily take personal responsibility and feel deep regret.

3. The individual must commit to a specific course of action to improve.

tending the garden

The theme for this year’s reflection is “tending a network”.  This is a term I learned in 2014 from Brint Milward, a professor at the University of Arizona who studies networks.  His research is around networks that are organized around both good things (like our Healthcare Value Network and Clinical Business Intelligence Network), and bad things (like terrorist networks).  I like the term “tending” a network because it reminds me of “tending a garden”.  As in gardening, there is always work to be done, but at the same time there must be a willingness of “letting go”.  It is the balancing of opposites.  You don’t manage a network like you operate and improve a machine.  Anytime there are people involve, you need to allow for free will and creativity.  You need to count on it.

As I reflect on 2014, with the idea of “hansei” and “tending a network” in mind, here’s my “top 10″ list.

10. Similar to last year, I’m preparing a paper to present at the 21st Annual International Deming Research Seminar, March 23-24 in Washington DC.  I blogged about this year’s topic previously.  I’m learning a lot about current state in some healthcare organizations.  Writing is a good way to learn, and to try to get clear on thoughts and questions.  But it takes time, and when I’m writing, it means I can’t do something else.  Something’s gotta give.  It starts with a paper, and may become a book.  An idea I am working on with friend and colleague, Mark Graban.

9. My “number 8″ item last year was the idea of Regional Group Meetings for Healthcare Value Network Members.  Last year it was just an idea.  People benefit greatly from face-to-face interaction, but not everyone has time or dollars to travel to our traditional 1.5 day gemba visits.   Those who are interested can come and go in the same day.  We have tested it a few times, and it seems to be getting some traction.  We had one meeting in Scottsdale, AZ, another in Cleveland, OH, one in Allentown, PA and most recently, one in Boston, MA.  I blogged about this idea here.  This seems to be a useful addition to our offerings.  The reflection on this point is that all of our Network members are busy people.  Everyone has a “day job”.  Planning and convening these meetings won’t work if we do this FOR people.  We need to do this WITH people.

8. My “number 7″ item last year was the progress we have been making on education about and application of our HVN Assessment Model.  This continues, and is gaining more traction and utility.  When we got into this work in 2009, we saw this as a model for “assessment”.  Now I think we are seeing it as a model for transformation.  Not THE model, but A model.  All models are wrong (in some world), but some models are useful.  I think we are finding this model to be very useful.  Here’s one of my blogs on this topic.  Here’s another.  The reflection here is continued learning about the model and making it accessible and useful for others.  We need to keep the “pracademic” view (term I learned from friend and colleague, Jake Raymer).

7. We helped our member organizations host 12 gemba visits in 2014, and we provided access to 7 non-healthcare visits.  We tested the idea of a virtual gemba visit where we provided access through videos to see the great work going on at one of our member organizations in Ohio.  Work is in process to provide similar virtual visits from videos taken in 2014.  We learned that this takes a lot of work once the videos have been shot, and we need to build the expertise (and allocate the time) to editing if we continue in the future.

6. We offered 35 webinars to HVN members in 2014.  The topics have been wide-ranging, and we have learned that it is a good way to share the great work our our Network members.  We’ve learned a lot about what works, and doesn’t with the webinar platform, and we’ll be testing some changes in 2015.

5. We have 2,349 people who are signed up on the private HVN Collaboration website.  Last year that number was 1,964.  We made some adjustments to this tool, and more will be required in 2015.  We’ve gotten more comfortable with the Ning platform.  I have found the book “Ning For Dummies” to be quite useful.

4. Last year I described how I was trying to feature some of the great work that is going on every day “in the trenches” on this blog.  There were many mentions in 2014: New England area members, an example of a leader, the ACT Fair in Scottsdale, AZ, Oregon Tour, Survival Is Not Compulsory, Learning About Principle-Based Lean Transformation, Southern Illinois, Vancouver, BC, Dancing With the (Lean) Stars, Board Of Directors Huddle,Kitchener, ONT, Best Conference Ever (Till Next Year), T-Minus 20 Days, Small Improvement/Huge Impact, Constancy Of Purpose, Tucson, AZ, It’s About the Patient … Period, Saskatchewan, What Needs To Transform?, One Example of the HVN Assessment Process.

3. Our Network Team works with other value streams at the ThedaCare Center For Healthcare Value, and this work helped out Network member organizations, but has also helped to bring about transformation in healthcare.  Some key achievements and learnings from these areas include: Connecting lean thinking and Clinical Business Intelligence, and It’s the System (the book by Kim Barnas).  We’ve also seen the introduction of a tool into our CEO Site Visits that takes what we’ve learned from our HVN Assessment work and helps people see beyond (beneath?) the surface tools, and helps them understand systems and principles.

2. My “number 2″ item last year was a desire to continue to help Michael Grogan and the people at CCBRT with their effort to get some “boots on the ground” help for their work in Tanzania.  Our CEO, John Toussaint, MD was able to travel to Tanzania and see first-hand the great work that they have done.

1. Some days it feels like great progress is being made, other days it feels like two steps back.  People are working hard, and many people deserve a hug for their efforts and their courage.

What is your hansei for 2014?

So You Want To Be A Healthcare Value Network Member? Massachusetts, New Hampshire and Delaware Style

I had the good fortune to visit several of our Healthcare Value Network member organizations the past 2 weeks.

Harvard Vanguard Medical Associates hosted a meeting of HVN member organizations in the New England States.  Every organization provided background information about their lean journey.  Here are some images of the visit.







I then visited UMass Memorial Health Care the following day.


We toured a few of the areas that they are planning to feature on a Network gemba visit.



I particularly liked this board (below) which was made by the nurses on the unit to show how they were doing relative to a nursing care measure.  They depicted this as a horse race, and coded the nurses with numbers.   Each nurse knew where they were individually.  I saw this as a good example of real visual management, made by the staff themselves.


Nemours Children’s Health System recently opened their new facility in Wilmington, Delaware.  Every day, management has a huddle around a large white board to discuss the current state of the facility, issues, problems, and status.


We toured a few of the units and one area agreed to let me share this video of how they measure and improve patient flow.

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Top Management Sets The Cultural Climate In An Organization – Example of Leadership In Nursing

My mom was a nurse.  I blogged about her before.

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As I mentioned in that blog post, I am pretty sure that she worked herself to death, at least the work system was a major contributing factor.  She died much too young.  She was a leader.  She was always optimistic and cared deeply about the care of the patients.  She set the tone (the climate) when she was at work.

What do I mean by the climate?  The diagram below shows one way to think about an organization’s culture using the metaphor of an iceberg.  This visual is handy as it shows that “what you see is not all there is”.  The things you see on the surface (artifacts in this case) are not the only component of a company’s culture.  There are “values” (along the water-line).  The stated values are what we see on the posters on the wall.  The un-stated values (what we really value) trump the stated values.  The 3rd component is “behavior”, including the behaviors of top management (CEO and those who report to the CEO), middle management and the front-line (or associates).  These are the primary components of a company’s culture.  I learned about these ideas from my friend and colleague Jacob Raymer at the Institute For Enterprise Excellence.

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The climate (or mood) in a company is set by top management, and it “trickles down” and affects the mood of others in the organization.

I provide this context to tell you about a person I met this week who understands the importance of climate and what she does every day.  Her name is Breana.  She’s a nurse and a manager.  She oversees a department of nurses and support staff on an inpatient nursing unit.  She told about how she tries to be conscious of the mood she sets on the unit – what she says and does, and her overall attitude and demeanor.  She told me how she shares stories about being a nurse and encourages her staff to share their stories as well.  She does this to help remind herself and her staff that it is all about the patient, and why they decided to work in this profession.

I was impressed with one of her stories and she let me video-tape it.  Click on the image below to hear her story.

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Breana is an example of a leader.

So You Want To Be A Healthcare Value Network Member? Ideas Are The Beginning Of “Improve”

I had the good fortune to visit a few of our Healthcare Value Network member organizations this past week.  After doing some work with Tucson Medical Center, I had the opportunity to stop in and see what Scottsdale Lincoln Health Network was doing.  I’m glad I took the extra time to visit.

They were having and ACT Fair (ACT is not an acronym, it basically means “act” or “take action”).  These fairs are held at a number of the Scottsdale Lincoln Health Network facilities, and have been going on for a while.  On the day I visited, the ACT Fair was being held at the Osborn Medical Center Campus.  The ACT team process is fairly new to this campus, but I think they have a great start.

I happened to have a video camera with me, and the teams agreed to let me capture their good work for others to see. Click on the image below and watch a summary of what I saw:

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Sometimes we get hung up on the precision of the improvement methodology.  We find ourselves asking questions like:  Are we following the steps right?  Is this problem-solving?  What’s the problem we’re trying to solve?  How do we know if we have made things better or worse?

I like what the staff at Scottsdale Lincoln Health Network are doing.  They are trying to engage everyone in the improvement effort.  Getting everyone involved in generating and testing ideas is a great start to the improvement journey.  The details about how we do it, and how our improvement efforts are aligned to the goals of the organization will come when the employees are ready.  In the case of Scottsdale Lincoln Healthcare Network, the are already taking that step by lining improvement ideas to one of the strategic pillars (i.e. quality, safety, delivery, finance, people, growth, patient experience)

“Engagement” needs to come along with “improvement”, if not before.