T-Minus 66 Days Till the Annual Lean Healthcare Transformation Summit – The “Other Summit”

Last year we created a video explaining the benefits of coming to the Annual Lean Healthcare Transformation Summit.  The experiment went pretty well, so we are doing it again.  Click on this image to watch the video.

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I just returned from the 21st Annual International Deming Research Summit.  I blogged about that a week ago.  Here are my “top 10″ learnings from that event:

10. Executive Director of the Deming Institute, Kevin Cahill (Dr. Deming’s Grandson) shared several “ah-ha’s” including a lesson from his grandfather that we need to realize that people learn in different ways.  This is management’s job. If management is too quick to assign blame to the individual (let them go from the company), then management is at fault.  He also learned that Deming would not provide answers, but direction.  Kevin was asking for advice and his grandfather simply said, “150”.  Kevin learned that the direction he needed could be found on page 150 of Dr. Deming’s book.   Which one?  Kevin would have to figure that out.

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9. Fred Warmbier, President of Finishing Technology, Inc., is an example of a leader.  He leads with humility and learns continually.  He has a series of blog posts in the NY Times titled “You’re The Boss“.  I highly recommend them.

8. Terrific presentation by two middle school teachers who are making a real difference in their lives and the lives of their students.  The presentation was “The Change In The Game – Two Beginner’s Approach To Transforming The Lives Of Middle School Students Through Deming’s Philosophy”.  What was the number one thing that student’s wanted from their teachers?  Tell us that you love us.


7. Example of application of Deming’s management philosophy in healthcare – treatment of diabetes mellitus in Tabasco, Mexico.

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6. Full automation in the clinical pathology laboratory may be good for the pocket-books of the equipment vendors, but it will not help employees cope and it is not cost effective.  Semi-automated system costs $0.55 per slide, versus $2.51 per slide.  That’s a no-brainer.

5. Another great presentation featuring Deming philosophy applied to education.  A teacher and principal from Leander School District.  They have a book that tells their story.  Start somewhere, you don’t need to have everyone “on board”.

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4. Great presentation from Inova Health System – “From Personal To Organizational Transformation – When The Student Is Ready, The Teacher Will Appear.”   Use strategic coaching to create the critical mass, do not “train the masses”.


3. Gordon McGilton and team from Jet-Hot Company.  Deming taught people to see their organization (and their place in the organization) as a system.

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At Jet-Hot, they designed a way for everyone to see how they are doing “right now” as a part of the system.
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2. Another guy talking about importance of understanding variation – Tim Clark “The Deming Paradigm For Reducing Variation: Unknown By Most, Misunderstood By Many, Relevant To All”.  He wrote a book, which I plan to read.

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1. Jim Benson (personal kanban guy) provided a brilliant presentation “Overwhelmed Is Under Thought – Reducing Overload To Create A Balanced Worker”.  Click on the image below to watch a short video.
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As far as my presentation “Understanding and Misunderstanding Variation In Healthcare”, I am pleased how that went.  As I told the audience, “I think I am about 50% there as far as writing this paper”.  I have some more ideas to add, and some more people to talk to.  I also have some ideas about topics for next year’s research summit.

T-Minus 73 Days Till the Annual Lean Healthcare Transformation Summit – Transformation Or Metanoia?

Last year we created a video explaining the benefits of coming to the Annual Lean Healthcare Transformation Summit.  The experiment went pretty well, so we are doing it again.  Click on this image to watch the video.

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Today I am on my way to another annual conference, the 21st Annual International Deming Research Seminar. I presented a paper last year on the topic of “Understanding and Application of Deming’s System of Profound Knowledge in Healthcare“.  This year’s paper is a continuation of that theme – the absence of discussion (or understanding of) managing variation, which was one of the fundamental bodies of knowledge that Dr. Deming spoke and wrote about.  I blogged about this year’s paper here.

What I am thinking about today, is the word “transformation”.  We say that we wish to transform healthcare, and that transformation of management is necessary for that.  But what do people mean by the word “transformation”?  My hunch is that there is variation in what they intend to mean, and variation in how others interpret the meaning.

Anyone can put the word “transformation” into an internet search engine.  I did just that, and obtained this:

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Definition #1 doesn’t tell me much (act, process or instance of transforming).

Definition #2 doesn’t sound like what I want (false hair worn by women).

Definition #3 looks promising (operation of changing), but it seems to be primarily related to mathematics.

Definition #4 (genetic modification) seems off the mark.

So it’s back to the internet, and I find the following related to “business transformation”:

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Well, that seems closer, but is it really what we are talking about?  Is it really what is needed?  Change does not always equal improvement.

I remember Dr. Deming talking about this in the late 1980s and early 1990s.  He spoke (and wrote) about “transformation of management”.  What did he mean?  If you read his 1993 (2nd Edition) book The New Economics, you’ll find this advice in Chapter 4:

“The prevailing style of management must undergo transformation. A system can not understand itself. The transformation requires a view from outside. The aim of this chapter is to provide an outside view-a lens-that I call a system of profound knowledge. It provides a map of theory by which to understand the organizations that we work in.

“The first step is transformation of the individual. This transformation is discontinuous. It comes from understanding of the system of profound knowledge. The individual, transformed, will perceive new meaning to his life, to events, to numbers, to interactions between people. Once the individual understands the system of profound knowledge, he will apply its principles in every kind of relationship with other people. He will have a basis for judgment of his own decisions and for transformation of the organizations that he belongs to. The individual, once transformed, will:
Set an example,
Be a good listener, but will not compromise,
Continually teach other people,
Help people to pull away from their current practice and beliefs and move into the new philosophy without a feeling of guilt about the past.

“The outside view. The layout of profound knowledge appears here in four parts, all related to each other:
• Appreciation for a system
• Knowledge about variation
• Theory of knowledge
• Psychology

“One need not be eminent in any part nor in all four parts in order to understand it and to apply it. The 14 points for management (Out of the Crisis, Ch. 2) in industry, education, and government follow naturally as application of this outside knowledge, for transformation from the present style of Western management to one of optimization.”

If you were to get your hands on a copy of the first edition of The New Economics, you would see that Dr. Deming thought the word “metanoia” was more appropriate.  Metanoia is a Greek word (from metanoiein to change one’s mind, repent, from meta- + noein to think, from nous mind) that has been associated with “spiritual conversion” of the individual.  Deming described this change as a reorientation of one’s way of life to apply the principles of profound knowledge in every kind of relationship with other people.

I don’t know why the wording about “metanoia” was removed from the 2nd edition.  I need to talk to some people who may know the answer to that at this year’s Deming Research Seminar.

David McKenzie has some interesting thoughts in his blog post “Leadership Metanoia – Transform the Way You Think.”  Here are a few excerpts from his post:

Metanoia is to leadership, as exercise is to a healthy body.
Metanoia occurs when a current belief that motivates actions is superseded by another stronger, deeper truth.
Effective leadership requires constant metanoia, constant transformation in thinking.
Here are some examples of leadership metanoia.

  • Previous leadership belief: ‘I am responsible to…’
  • Metanoia transformation: ‘I am responsible for…’


  • Previous leadership belief: ‘I should get all the praise’.
  • Metanoia transformation: ‘I should give praise generously’.


  • Previous leadership belief: ‘I must know everything.’
  • Metanoia transformation: ‘I need others to know the technical stuff whilst I deal with the leadership stuff’.


  • Previous leadership belief: ‘I hold all the power’.
  • Metanoia transformation: ‘Shared power builds strength across the team.’


  • Previous leadership belief: ‘I am the problem-solver for everyone.’
  • Metanoia transformation: ‘I need to empower people to solve their own problems.’


  • Previous leadership belief: ‘Everyone should listen to me.’
  • Metanoia transformation: ‘I should listen to others.’

Work Emphasis

  • Previous leadership belief: ‘I work in the business to improve the business.’
  • Metanoia transformation: ‘I work on the business to improve the business.’

Interestingly the word metanoia is translated into the English as the word ‘repent’. Repent does not go deep enough for this rich Greek word. Repent only implies a sadness and regret for previous behaviour. True metanoia sees the error of thinking and replaces it with a deeper truth. That deeper truth is transformational and changes actions.


This makes me think about the “white coat leadership vs. improvement leadership” lists that Dr. Toussaint includes in nearly every one of his presentations.

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We have been taught, trained and treated from the behaviors in the left-hand column. For most of us, it started in first grade.   These actions come from beliefs and assumptions that must be thrown overboard.  If we think that merely changing the forms, structures and things on the surface, then I think we are falling short.  Some may say we are transforming, but has the thinking changed?

Screen Shot 2015-02-14 at 8.06.13 AMWe use this iceberg metaphor to explain the relationship between how we think, which drives our understanding of guiding principles, which affects the kinds of systems and structures that we put in place.  Systems drive behaviors.  We know this to be true.  In order to truly and permanently affect what we see on the surface (behaviors, outcomes, results), we need to decide to change the way that we think.  We need to learn about the knowledge behind the behaviors in the right-hand column.  To move from the left to the right is difficult, hard work.  I think that means more than transformation.  I think I see the wisdom about Dr. Deming’s use of the word “metanoia”.

No matter what you call it, you will learn a lot and see yourself as part of the critical mass that is moving from the left-hand to the right-hand side.  Join us – at the 6th Annual Lean Healthcare Transformation Summit.

T-Minus 80 Days Till the Annual Lean Healthcare Transformation Summit – Hockey Masks & Lean Thinking

Last year we created a video explaining the benefits of coming to the Annual Lean Healthcare Transformation Summit.  The experiment went pretty well, so we are doing it again.  Click on this image to watch the video.

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We also made some short video testimonials from Healthcare Value Network members.  These did not make it into the final version of the video, so I’m sharing one of them here.  Click on this image to hear from Alpa Vyas from Stanford Health Care.

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Have you every wondered how the evolution of hockey masks can help explain the evolution of lean thinking (and supply chain management in particular)?  Watch the video below to learn from Robert Martichenko, CEO of LeanCor and author of several books including, Everything I Know About Lean I Learned in First Grade.

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So join us, at the 6th Annual Lean Healthcare Transformation Summit.

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T-Minus 87 Days Till The Annual Lean Healthcare Transformation Summit – Join Us

Last year we created a video explaining the benefits of coming to the Annual Lean Healthcare Transformation Summit.  The experiment went pretty well, so we are doing it again.  Click on this image to watch the video.

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We also made some short video testimonials from Healthcare Value Network members.  These did not make it into the final version of the video, so I’m sharing one of them here.  Click on this image to hear from Dr. Elizabeth Warner from Bronson Healthcare.

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What are examples of what you might learn about at the Summit?  We have many examples of the application of lean thinking in healthcare going on around the Healthcare Value Network.  Here are just a few:

Wellness Team at Parkview Health:

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Construction huddle for new hospital at Akron Children’s Hospital:

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Patient flow board at Nemours Children’s Health System:

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Daily huddle for all hospital managers at Presbyterian Health Services:

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So join us, at the 6th Annual Lean Healthcare Transformation Summit.

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T-Minus 94 Days Till Annual Lean Healthcare Summit – Best Efforts and Hard Work

Just 10 days ago I attended and presented at the Society For Health Systems Conference.  I blogged about that here.  There was an interesting luncheon panel discussion that I attended.

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The panel was discussing the current state of recommendations made to the President of the United States by the President’s Council of Advisors on Science and Technology (PCAST) on the report “Better Health Care and Lower Costs: Accelerating Improvement through Systems Engineering.”

Here’s a quick summary of that report:

In May of 2014, the President’s Council of Advisors on Science and Technology (PCAST) identified a comprehensive set of actions for enhancing health care across the Nation through broader use of systems-engineering principles. Informed by the deliberations of a working group consisting of PCAST members and prominent health-care and systems-engineering experts, the report proposed a strategy that involves:
(1) reforming payment systems,
(2) building the Nation’s health-data infrastructure,
(3) providing technical assistance to providers,
(4) increasing community collaboration,
(5) sharing best practices, and
(6) training health professionals in systems engineering approaches.

It sounds great, but it won’t work.  And the report has had little apparent impact on actions or behaviors.  The panel discussed some of the reasons for the last of action and traction.  The discussion about root causes and ideas for action went around and around with the usual suspects of causes and excuses.

Here’s why (in my opinion) the report to the President and the suggested action steps won’t work – the thinking is not guided by profound knowledge.  The thinking in the report comes from the same prevailing style of management that got us unto this mess.

Let’s look at this point by point:

  • Recommendation 1: Accelerate the alignment of payment incentives and reported information with better outcomes for individuals and populations.  Yes, all consumers need better real-time data to know the quality and cost performance of providers and healthcare systems so we can make our decisions based on value.  The way providers are paid needs to be based on value, not volume of work done.  But the question is “by what method?”  Fortunately, there is some work being done in some parts of the US to experiment with different payment methods.  But it is slow going.
  • Recommendation 2: Accelerate efforts to develop the Nation’s health-data infrastructure.  More data and more information will not solve the problem.  Information is not the same as knowledge, and we need knowledge to know what to do with the information and data we have.  I blogged about this last September.  To date, all we have managed to do is put money (lots of money) into the pockets of electronic medical records vendors.
  • Recommendation 3: Provide national leadership in systems engineering by increasing the supply of data available to benchmark performance, understand a community’s health, and examine broader regional or national trends.  Leadership, yes, but in what areas?  More data? No.  We have too much data.  Benchmarking performance?  No.  Comparison of performance measures will not lead you to profound knowledge.  It does lead to copying without theory, which makes matters worse.  Understanding a community’s health?  Yes, that would be great, and it could lead to entire new systems built on improving and maintaining health.  But that is not the same as improving health care.  Currently, providers are incentivized to do more healthcare, not keep people healthy.  There is no profit in health.  Examine regional or national trends?  Yes, that could help, but you would need knowledge about how to understand variation, and understanding of a system to make sense of what you are studying.
  • Recommendation 4: Increase technical assistance (for a defined period—3-5 years) to health-care professionals and communities in applying systems approaches.  More technical assistance won’t do it.  The problem is not in the technical side of healthcare.  The problem is in the board room and in the conference room.  The problem lies with the way top management thinks.  And they way they think is a product of how they were educated, treated, rewarded and recognized.  Until they gain “appreciation for a system” (not the same as systems engineering), and of “understanding and managing variation”, “psychology of people, groups, organizations and society”, and some understanding of “theory of knowledge” they will continue to pursue best efforts and yield frustration.  Until they see how these 4 bodies of knowledge interact and provide guiding principles for excellence, they will continue to dabble, tamper and make matters worse.
  • Recommendation 5: Support efforts to engage communities in systematic health- care improvement.  Yes, the focus needs to expand to optimizing the system and including the entire local community.  The focus must be on health, not health-care.  If this is done, it could be that some providers may not be needed, or they will need to do other things.  Will providers collaborate for the good of the community?  Or will they continue to compete and will government policy continue to support the failed notion that competition will bring about excellence?  The goal must be win-win.  There is no “win-lose”.  Competition without collaboration only produces “lose-lose.”  I recently learned about some work being done to encourage collaboration in communities.  Perhaps there is hope.
  • Recommendation 6: Establish awards, challenges, and prizes to promote the use of systems methods and tools in health care.  Making rewards, challenges and prizes is our typical approach but it takes us in the wrong direction.  The goal becomes the prize, not improvement.  The problem started in First Grade when we developed and taught this failed belief in ranking and rating performance, assigning grades, awards and punishments.  We need to understand the destructive forces of the use of extrinsic motivation.  The problem occurs inside organizations as well in the form of the archaic and destructive performance evaluation system.  I blogged about that here, and here and again here.  My question is this: How is performance evaluation still a thing?
  • Recommendation 7: Build competencies and workforce for redesigning health care.  It depends on what we mean by competencies.  Look up the word “competency”.  What do you find: “the ability to do something successfully or efficiently”.  The synonyms are: capability, ability, proficiency, accomplishment, expertise, adeptness, skill, prowess, mastery, talent.”  Mere competencies (skills) will not suffice.  The real effort needs to start with top management, and identifying and focusing on competencies won’t do it.  The problem at this level is an understanding of the difference between knowledge and skills.  What many people pass off as competencies is what Dr. Deming described in the left-hand side of the table below from his book The New Economics.  Skills only required.  With these “competencies” a manager could work in one organization, or the other and contribute nothing to either.  The right-hand side of the table points to the pursuit of new knowledge.

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Do you want to learn about what is really going to transform healthcare?  Come to the 6th Annual Lean Healthcare Transformation Summit, June 3-4, 2015 to find out and participate in the real “gang tackle” to transform health and healthcare.

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.