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Hi and welcome to Be the Flagship with our podcast host Jeff Parsons.
This is where we tackle the day to day talent management challenges you face, particularly
in hospice and small healthcare organizations.
And now over to our host.
Take it away Jeff.
Hello there and welcome to Be the Flagship.
I'm your podcast host Jeff Parsons.
So let me refresh your memory.
If you'll recall from last week's episode, I have designated January of this year, and
happy new year by the way, but I've designated January episodes each week to the topic of
process improvement and healthcare.
So regardless of whether you're a hospice, home health, small hospital, large hospital
for that matter, the topics for each of our episodes in January are on how to improve
your processes and how to improve the performance of your organization.
We started last week with an introduction to lean healthcare and our guest speaker,
Terry Norris, did a marvelous job in explaining what lean was, how to apply it within a healthcare
environment, talked about some of the basics of lean such as the two pillars of lean, talked
about the types of waste, the various types of waste, and also about standard work and
what that is and why that's so important.
So we did a great job last week.
We brought him back again this week and this week's topic is why lean initiatives in healthcare
fail and what we can do to prevent failure in our organization.
So again, we are thrilled to have Terry with us again today.
So let's take a quick break and then we'll come back with Terry Norris.
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To learn more, contact Jeff Parsons by email at jeff at FlagshipTalent.com or by phone
at 1-800-530-4189, extension 101.
All right, we're back.
So last week, I gave you a fairly lengthy introduction to Terry with his bio.
I mean, he's done so much in his career.
He's a lean consultant, but just a little more about him.
He earned his MBA.
He also is a certified lean master black belt.
He's trained over 1,800 hospital leaders and 150 plus hospitals.
He's trained them on lean concepts, principles, and specifically on how to lead a lean transformation.
I wanted to add a couple of additional things about Terry.
As I mentioned last week, he served in the Air Force for 25 years.
So again, thank you for your service, Terry.
But here's an interesting fact about him.
Plolly was in the Air Force.
He was promoted to the Air Force's top 1% and became one of the youngest chief master
sergeants in the Air Force's history.
How about that?
He resides in beautiful East Tennessee, enjoys spending time with his wife and children.
As I mentioned last week, he's the author of the book, How to Make Lean Work in Your
Hospital or in Your Department.
I'm looking at a copy of the book right now.
So great how to book on lean and how to implement lean within your organizations.
I highly recommend it.
You can easily find it on Amazon.
So again, Terry, thank you so much for agreeing to join us again today to talk about why lean
fails within organizations and what we can do to prevent it.
Thank you, Terry.
For sure.
Thanks for the opportunity.
So let's just jump right in, Terry.
Now lean initiatives in healthcare or in any organization fail at times, correct?
Yes.
So Terry, tell us based on your experience why lean healthcare initiatives fail within
organizations.
Okay, sure.
And there are more than the reasons that I'm going to talk about, but these are three of
what I think are three of the biggest reasons why they fail.
And I'm convinced that the number one reasons that lean fails when it does is that senior
leadership doesn't lead the transformation.
And even to be more specific, it needs to be the CEO.
So I started saying not delegating it to the COO or to a different individual in the chain,
but it needs to be led from the very top of the organization.
From my experience, that is the number one reason.
Then another close second, and you could almost contribute it to the first a little bit, is
that lean is widely misunderstood.
When you talk to people about their concept, their idea, their thoughts about what it is,
a lot of people really don't understand it.
And these are people sometimes that are trying to implement it into their organization.
So it has to be understood of what lean actually is.
Because if it's not the expectations, they're incorrect.
And the plan that you make to get to where you think you want to go is not going to be
aligned with what it should be based on your misunderstanding of what lean is.
And the third one is really when you have a leadership that's involved and people kind
of understand what they need to do, there's no daily management system of any sort.
There's nothing that ties the organization together.
So an example, one part of the organization may be really busy doing work, trying to make
things better, but the 90% of the rest of the organization is not doing anything.
And then maybe months before they do anything, there's no system, a daily sort of system
that ties that together.
So those are what I think are probably the three biggest things.
And how to remedy that is senior leaders do need to lead.
The senior leader, whatever the organization or whatever the title is, generally CEO, president,
whatever, whoever that person is, they need to lead by example.
And of course, understand the things that you're trying to do.
When I talk about leading by example, too, I've said the comment I'm getting ready to
make I've made in front of well over a thousand leaders in hospital at different hospitals
and no one has ever pushed back.
So in my opinion, the idea, the concept of leading by example has became somewhat of
a cliche in our society.
People are familiar with the phrase, but they're not always lining up.
Either don't really understand it from lack of training.
For whatever the reason is, there's not a lot of it happening.
And that's not to say that nobody is, but the general population of leaders that I have
worked with, they don't do that.
And there's a reason I believe you have to put an emphasis on it.
You have to do it on purpose.
For example, if you believe that being involved in a rapid improvement event is important,
you know, given 100 percent as a leader, you have to show that you're 100 percent willing
to do that.
If you think attending the daily huddles and you know, the required daily huddles is important,
you need to be at the daily huddles.
If it's being on time is important, you know, you need to be on time.
It's the basic, but still it's worth, I think, saying that if you want to lead by example,
you have to on purpose.
You have to set in your mind what do I want everyone else to do and to be like and to
behave and then behave in that way.
And anyway, that helps lead by example.
And it's especially true when you're asking people to change and do things differently.
And then understanding what you're trying to do really and getting down the most basic
level, we're asking people to change their work habits.
And you think about it even for yourself.
And I say that for everyone, including myself.
But why?
Why would I?
What's my motivation?
I've been doing this for 10 years or 15 or 20 or 30.
Why do I want to do it differently now?
You know, because you're saying we need to do this stuff.
So there has to be a reason for people to want to change their habits, their work habits.
If you don't show people what's in it for them, people just generally will have a very
difficult time ever doing it.
When you lead in transformation to expect resistance, I mean, people are going to push
back some people in different ways, some people more obvious than others.
But when I've had the opportunity to talk to senior leader teams, the leadership team
together and the CEO or the plant manager or whoever brought me in, I tell them as that
group I said, you should expect resistance and you should expect resistance from people
in this room.
And of course, you know, in my mind, I'm like, I follow up kind of quickly with saying, and
that's normal.
So they don't just throw me out, you know, but it's true.
People will resist.
The senior leadership will resist.
Others in that, on that team will.
So the point is, if you know that in advance, it can help as you move forward.
You won't be surprised.
Understand the two lean tenants that we talked about in the previous podcast, continuous
improvement, the idea that everyone thinks that way and the respect for people treating
your team like a sports team, for example, where you're challenging them and it's not
optional.
You're going to help make them better.
You're going to do the things that helps them become more better at whatever it is they
do in their professional and their professional lives.
And then one of the last things I like to talk about just in general and then maybe
get a little more specific on some of the things, but it's time management.
And I've talked to a lot of people about that and sometimes I almost feel like people are
like, oh, you know, I've got that.
But honestly, when you're thinking of time management and the lean or really anything
important, most people, a lot of people, I say most managers I've worked with anyway,
they don't really do a good job at it.
I use the Eisenhower matrix in the book that I wrote and I talk about things that are urgent
and things that are important.
Well, a lot of this lean work, specifically anything with your strategy, it's really very
important, right?
But it's not always urgent because if you don't do it in the next two hours, nothing
happens.
You don't do it for 24 hours.
Nothing seems to happen.
So all of this really important stuff that's not urgent, you have to schedule time for
that and you have to like set time aside just to specifically do certain things.
So anyways, that's a little tidbit on time management, but it's a very important one.
And then I guess as we're looking at the daily management, because one of the things that
I said other than the lack of leadership, the lack of understanding is really there's
no glue that ties it together.
So to remedy that, I recommend that there's daily huddles, that every unit, every department
has a daily huddle.
And the daily huddles could really be a podcast itself, but the idea is that you're communicating
within five or 10 minutes the important things of the day.
Make sure you're ready for the day, but also what are you working on to improve?
It's not a training session, things like that, but it's really focused.
It's a very focused short meeting every day.
Having improvement boards that are actually used, tracking and looking at the things that
you're trying to work on and understanding where you're at in the process now are very
important.
Something called is Gimba walks.
Again, which is another topic of its own, Gimba, meaning the place where the work is
done, the place where the truth is told, it's a Japanese word, but it's very commonly used
in the lean environment.
That senior leader is going out into the organization where the work is actually being done and
going with purpose.
And a lot of people, this is actually a major point of failure.
Even senior leaders that seem to buy in, they buy into everything until it gets to that
point and then they don't want to do that themselves.
So I find that interesting that anyway, it's a point of failure.
Last couple of things really is measure what's important, be careful.
Back in the 1990s when we had this TQM movement, total quality management, I was in the Air
Force at the time, but it happened in industry as well, but people were measuring everything.
The measuring became more important than what you were measuring, at least that was my experience.
So only measure what's important and make sure you understand what those few metrics
are.
And then the last piece that I would say that ties it together and helps is to establish
a culture of accountability and audit.
If you don't audit what's happening, like standard work for saying you put that in place,
you must audit it.
You have to check, make sure that it's being done.
And then if it's not being done, then you have to hold people accountable.
You know, and you obviously, I say obviously, but maybe it's not.
You start out encouraging, you know, asking why you didn't try to encourage them to pick
it up and to do it on their own.
You know, you don't start out with necessarily disciplinary actions, especially if it's something
new and different.
But people have to do it.
So they have to be held accountable and you won't know if they're doing it or not unless
you do those types of audits.
But those are some of the things in a summary, you know, in a big kind of a big summary in
general that could help prevent failure in a lean transformation.
Well, and that makes sense, Terry.
Thanks.
You know, and it's interesting when you mentioned metrics, you know, and making sure you're
measuring the right things because you get what you measure, right?
And so if you're measuring the wrong things, you may see some success, but in areas that
aren't going to give you the biggest bang for your efforts.
Yes, yes.
That's very well said.
So Terry, oftentimes, in my experience, at least, I have heard concern from people within
an organization when you mentioned lean and that lean means less, right?
In fact, we had a fairly serious employee relations situation in one of my sites when
I was in corporate HR and it was all about lean.
They thought they were going to have mass layoffs and all that sort of thing.
So have you ever experienced that in your work?
Oh, yes, for sure.
That's something I hear frequently lean just by the very nature of its name lends itself
to thinking layoffs less people, things like that, skeleton bruise.
And I've had colleagues that I've worked with in the field that have said in front of groups
that we're working with that they came, I said, we were really lean back when I was
at such and such place because we only had, you know, this many people.
And I remember thinking, no, don't say that, you know, because that's not lean at all.
How do you dispel that, Terry?
Well, I just try to explain that, you know, I understand how the word lean is used in
that context, but I usually say that I wish that it wouldn't have been called that for
that reason only.
And some organizations have actually got away from that.
They name it their business system, whatever, whether it's Virginia Mason Business System
or somebody else's.
So they kind of get away from that word.
I try to explain by what we mean by lean is standard work.
It means problem solving, it means a culture of continuous performance improvement where
it's really happening.
It means a daily management system, some way that you can connect everything together and
understand what's going on in the organization.
But that's what I try to explain what lean means.
It doesn't mean a skeleton crew working with less or eliminating folks.
And I will share this too.
Years ago, when I was just getting going, I was working in a manufacturing facility
and I noticed up until lunch there was a lot of resistance, you know, even more so than
the norm.
There's always a little bit of anxiety and whatnot.
But these guys, they all felt like that if they were successful while we were doing,
they were going, they could potentially lose their job.
So I talked to the engineer that brought me in and we went in and talked to the plant
manager and I asked him, I said, do you plant land people often?
He's like, no.
I said, will you please come in and tell everyone after lunch, you know.
So he came in, he said, listen, you know, if for some reason we have 12 people doing
this and we can do it with eight, you're not going to get fired.
We'll just move people around within the facility.
So anyway, it put people's mind at ease.
But when they heard lean, they thought the same thing.
And it really, and you think about it.
I mean, if you implement a lean program and you're still going to lay people off and things
like that, who would want to do it?
If you're going to potentially lose your job or people, you know, some of your friends
are going to lose theirs because you did a good job, you know.
So you almost have to make a policy that you're not going to, otherwise people won't want
to participate.
Logically so, right?
That's right.
Yeah.
In fact, in the experience I reference, the plant manager there, you know, made a commitment
to all of the employees, you know, that not one person would be laid off as a result of
lean.
And to your point, he said that people might be repositioned, you know, where they can
bring more value and jobs that might be more fulfilling and that sort of thing.
So it's really a communication thing.
And I think my experience is one of the reasons again, and I think you mentioned it earlier,
one of the reasons organizations fail at lean is that they don't do an adequate job of communicating
what it really is and what it means to that organization and to the employees in the organization.
I think so for sure.
Yes.
So we've talked about clinical, you know, lean in healthcare as it refers, as it impacts
clinical, because, you know, that's obviously operations within healthcare and that's where
you find, I'm sure the biggest opportunity for improvement.
But lean is also applicable to the administrative functions, correct?
I mean, finance and HR and things of that nature, correct?
Yes, sir.
Yes.
So a lot of, anywhere you have a process, honestly, where you have a first step and
a last step and something happens in between, you can apply the principles to see where
you can eliminate waste, make things flow, develop standard work, make things consistent,
and you can see really big improvements in those areas.
Some examples in healthcare particularly is supply.
Supply chain has its own.
I mean, actually supplies is probably, you could say, well, that's operational too, I
guess.
It's kind of, you know, it's stuff instead of people.
Right.
But there's a lot of money tied up in that and, you know, some organizations bring in
people that are just specialized on nothing but supply chain because it's such a big deal
and there's just so much money in it.
Anyway, so that's one.
Accounts receivable, getting your money faster is a big one.
And if you know anything, which I know you do, but about healthcare, you know, the way
people get paid and all that is a big deal.
You have to chase the money to make sure you get what you're supposed to get.
Right.
So the money trail revenue cycle is a big deal.
Some companies out there just do revenue cycle.
That's all they do.
I mean, that's it.
But lean is a good place for that.
Less write-offs, denials, things like that, that comes into play.
I've done events where specifically the whole thing was to decrease the amount of surgeries
that are given, that are performed before pre-search done.
Then you find out the person didn't have the insurance and you just write it off, you know,
and that happens frequently throughout the country in different hospitals.
So yes, there's definitely back office application and, you know, well, this is beyond your question,
but I definitely do like to work toward those as we're trying to implement a transformation
throughout a system.
Gotcha.
So can you give us an example for those who may still be sitting back saying, I'm just
not sure.
Can you give us an example of one of your successes in implementing lean in healthcare?
And when I mentioned successes, I'm talking about the deliverable.
You actually saw a tangible deliverable from lean applications in healthcare.
Sure, sure.
And one of, so to give you the setting, this is a major metropolitan hospital, large OR,
and we're working on, actually it's not an OR, it is the ER, the emergency department.
And they are apparently overstaffed, it appeared to us, you know, but to them they were understaffed
because they were so busy and all this.
Anyway, we worked through a full cycle of lean with them.
We mapped out things.
We looked at how the patients were brought in.
We looked at screening, they call pods, but they're cells where you'd have a physician,
a technician, a nurse, you'd have the EKG.
Everything you needed would be like for four rooms and then it'd be another four rooms
and another four rooms.
But all of that work over time decreased the amount of time people had to wait, about 40%.
And this was at the time that we stopped working with them, 40% decrease.
And this is the real kicker too, over that time they were able to do a 40% decrease in
wait time with 13 less people.
Nobody got fired.
People worked somewhere else in the hospital, but they were able to do that work with 13
less people.
So that was a big success, a big win.
Great example, Terry.
Thanks.
So let's take a quick break and then we'll be right back to wrap things up for this episode.
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Okay, we're back.
So Terry, as we're wrapping up our discussion, are there any other things that you'd like
to add or feel that the listeners should hear?
Yes, I think so.
We talked a lot about why lean fails and we did talk a little bit also about what we can
do to prevent that failure.
But I guess to go a little bit more into that might be helpful for people because again,
a lot of implementations, as a matter of fact, 80% probably-ish fail for very specific reasons
though.
One of the things to keep that from happening is make that commitment as a senior leader
that you as the CEO are going to lead this.
There's a lot of specific ways in which you can do that.
As you work your way down and your leaders, your different levels, directors, whatever,
lead by example.
I've said this in front of over a thousand folks and nobody's ever really pushed back
on me too much.
Leading by example, nobody's ever pushed back.
I should say it that way.
It has become kind of a cliche in our society.
We just say it, but there's not that much of it happens.
I say that knowing that there's some great leaders out there.
This isn't for every person I worked with, a lot of really strong, good folks, good leaders.
But in general, if you want people to follow standard work, you have to follow it.
If you want people to be on time for your daily huddles, you have to be on time.
You have to make it a priority.
I say these things and some people say, well, that's obvious.
What may be obvious, but it's still one of those things that doesn't always happen.
It is a big deal to lead by example when it comes to this kind of stuff.
Another thing is understand what you're trying to do from a hundred thousand foot view.
You're trying to change people's habits.
You're asking people to do things differently than they did before.
Think about how hard that is in your own life and how it is for especially at work when
you have to do something different.
You've done something for 10 years or 15 or 20 and now you want me to do this different.
Why?
You know, people have to see what's in it for them and they have to get in the habit
and they have to do it over and over and over a period of time, it just becomes the new
norm.
I'll just throw this in while I'm talking about that.
If you hire somebody new and they come into your organization and they're doing huddles,
they're working the daily management, they're looking at things, they're processing improvements,
they're talking about it, that's just the norm.
They don't resist it.
They don't fight it because that's what the new company did.
But where your challenge is is when people that have already been working in the system.
So people understand what you're trying to do is changing the habits like that.
That is also a big part of it.
You want people to be able to.
You have to be dogmatic as a leader.
You have to get to where people are getting in the habit of doing things a certain way
or they want to change the habit.
And this is another big E too, really just expect resistance.
When I've talked to senior teams, I'm talking about the CEO, the CFO, the COO, the CNO,
the group, the leadership team.
I said expect resistance and not just from people out there.
I expect people from resistance in this room.
And when I say that, I'm quick to say, and that's normal, so they don't throw me out.
But I'm like, we're going to push back on this.
I mean, even if they may be covert or overt, but they're going to push back.
So if you understand that going upfront, that makes it a lot easier.
So Terry, let's go back to your comments regarding habits.
As you mentioned, you're trying to change habits.
And oftentimes the CEO, the senior leader walks in, announces we're going to do lane
and then walks away and expects it to happen and doesn't understand that you're trying
to change habits and incorporate it into your culture.
So when you bring a new hire in, part of their onboarding is also educating them on what
you're doing to continuously improve your processes.
So that really hit a nerve for me.
It's really changing habits and that's a difficult thing and it takes repetition.
It takes constant communication and open communication on the part of the senior leader.
I agree.
And also something I tell people too, I tell leaders all the time, I say, if you line up
your new department managers and you say, okay, this is who I think is my number one
all the way down to 20, whatever.
The one that's going to be successful with lane is the one that's dogmatic about it.
They're like, you know, we're going to do it.
They're going to resist that when people push back and they're like, you know what, we're
so busy and you expect me to do this.
And a lot of people just give up, but the ones that are successful are dogmatic.
They're like, well, we're just going to do it.
I know, I know, but we're going to do it.
And if you can get past that point and then you can help people get in those habits, you
know, and then you can start changing that culture.
But it's, that part is not easy to lean the concepts, the things you learn, all that is
relatively easy, but the actual get people to do things different, that's a big you.
All right.
It's all about change.
And you know, people say change management, I like to think of it as change leadership,
right?
Being a change agent within the organization.
Yes, very good.
And also, you know, people think about a lean transformation and along the same lines, I
say, well, listen, it's really a people transformation because we're asking people to do things differently.
We may change some things around, but it's really getting people to think differently.
So it's a people transformation.
Do you have anything else to add, Terry?
Just a couple things to mention, you know, when I talk about this to teams, leadership
teams, I talk about time management for success.
And I use the Eisenhower matrix.
And it basically just talks about the four quadrants and it's easier to show than it
is to tell.
But I'll just give a general overview.
You have things that are important, you have things that are urgent.
And the things that fall into the lean quadrant really are those things that are really important,
but they're not urgent.
You know, kind of like our health sometimes.
It's the same kind of thing with, you know, developing strategy, focusing your leadership,
developing standard work.
Well, we can kind of not do that right now because it's not in our face pushing us.
It's not urgent, although it's very important.
So the only thing I'll say is about it for this kind of stuff, you really have to be
successful and lean.
You have to set time aside to do it.
It's not just going to happen.
And you have to think that way.
And then as a senior leader, last thing I'll say is you have to participate.
You know, I found what I thought was super good leaders I've worked with, they're great
people and they were dogmatic about making their folks do certain things.
But when it came to going out to where the work is being done, what we call gambo walks,
to doing the daily huddles themselves, to holding people accountable, actually taking
time themselves to do it, it's quite different and it's quite difficult, you know, and it's
almost like, and I get really close to some of these folks, but they're like, you know
how busy I am, you know, with all the meetings that we have and things like that.
And I see that for sure.
But if you're going to lead this and you want to be successful, you just really have to
do those.
You just have to set time aside and do those things and make it a priority.
And that's part of that leading by example we talked about earlier.
Right.
You know, this is leading by a positive example, right?
Yeah.
And that takes a level of emotional intelligence as well.
You know, you have to be able to regulate your emotions and the way that you communicate
with people and understand again that it's not going to happen overnight, that it takes
time and it takes commitment to doing it.
For sure.
Anything else you'd like to add, Terry?
No, I mean, I think that's, the things that we talked about are the things that I think
can help people be successful.
So you know, I'm always willing to answer questions and do what I can do to help people
when they're trying to be successful.
So I again, appreciate the opportunity to share these things and I hope people find
it helpful.
Well, it's certainly been helpful and we'll give them your contact information shortly
and they'll, if they have any questions, they can reach out to you.
But before we get to that, I'd like to wrap up this episode, if you don't mind Terry,
with a quote.
And the quote is by the author of Tom Sawyer and Huckleberry Finn, the one and only Mark
Klain.
Continuous improvement is better than delayed perfection.
Again, that's by Mark Klain.
So Terry, how can our listeners get in touch with you?
Probably the best way is to go to leanhospitalswork.com and from there you can reach me that way.
You can get more information about myself and a particular book that I wrote on the
topic.
But leanhospitalswork.com is the best way.
Perfect.
And the great news is that Terry will be joining us again next week, correct?
Yes.
That's right.
And even better news, Terry will be joining us for our remaining January episodes where
we're focusing on process improvement in healthcare.
And even better news is for our remaining episodes, Terry will be focusing on specific
tools you can use to actually increase your organizational effectiveness and achieve operational
excellence.
So, thank you again, Terry, for your thought leadership contribution and see you next week.
All right, great.
Thank you so much.
And to our listeners, I look forward to next week's episode.
Make sure you bring a notepad and a pen.
Goodbye.
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