Lean Blog Audio: Practical Lean Thinking, Psychological Safety, and Continuous Improvement

The revised, updated, and expanded third edition of my book Lean Hospitals has been sent to the printer and copies should start shipping by mid June.I'm happy to now be offering a free PDF of the revised first chapter.

recently saw some updates and new details related to some topics I've covered here on the blog, so I'm combining them into this batch update.In this post, we cover everything from a hospital NICU, to baseball, to healthcare waiting times and a scandal there that won't die.

As I guy who started his career in manufacturing before moving to healthcare in 2005, I don't get many opportunities to visit the "gemba" at a factory very often anymore. I get to occasionally visit a Toyota plant (in the U.S. or Japan). As I'm getting settled back into the Dallas / Fort Worth (DFW) area, I'm reconnecting with some of the people I know through our local "Lean DFW" network.foremanOne of those Lean DFW people is Rick Foreman, the VP of Lean Development at Federal Heath Sign Co. Federal Heath makes big signs for gas stations, restaurants, hotels, hospitals, and the like. There's metal being cut and bent, stuff being painted, structures being built, and lights being installed and assembled. Rick, pictured at left, is more of a khakis-and-polo-shirt guy (as he was dressed on Friday). Suits and ties exist daily in hospitals, but exist mostly in LinkedIn profile photos in manufacturing :-)

We had the chance to meet for a few hours on Friday morning to catch up andtalk about their Lean approach at Federal Health, across their different sites. Rick and the folks at Federal Heath have a very strong focus on developing people. As Rick says, "Doing Lean with people, instead of doing it TO them." They have mentoring and development programs tied to Lean, with leaders at different levels learning from each other in different ways. Their President / CEO is the chief advocate for Lean as a business strategy.

I love stories of humility and customer focus in healthcare. Let me share two such stories with you today. Oh, and, I ended up sharing a story of mine that's related and might just recount a few screw ups on my part... but I think I eventually did the right thing.

Today's post is an addendum from Saturday's post on the apparent death of a health system Lean program: "Why Would a New Healthcare CEO Kill a Lean Program?"If you read that post, there's an interesting comment from a Presence Health employee that doesn't shed too much more light on this:

"From the standpoint of a current Presence Health Employee~ my opinion is that the RIEs failed because they were aggressively site specific. At a time when PresenceHealth is "Becoming One" I do not believe the RIEs took the entire ministry into consideration when planning events. Decisions and "experiments" where being made and conducted through a site specific lens, and this was often in contradiction to the spirit of the new organization."

As I commented in response, I'm not sure why a goal of common processes or a health system that's actually a system would be a reason to stop with Lean. Unless hopefully they are really just re-booting the effort instead of killing it altogether.

As I alluded to in the post Saturday, there was a sad story about ahospital that I featured in the 2008 1st edition of Lean Hospitals that basically killed their promising program when a new CEO was hired from the outside. As Adam Zak, one of the top Lean-focused executive recruiters said, it's a shame that the board (apparently) didn't hire a CEO with Lean experience.

Apparently, the Lean journey at Presence, regardless of what form it was taking in late 2015, has not survived a CEO transition at Presence Health. A new CEO, Michael Englehart, took over about six months ago (just after that Modern Healthcare story was published).Here is the latest Modern Healthcare piece by Sabriya Rice:

“Presence Health rethinks its Lean initiative”

http://leanblog.org/audio131

Back in December, I wrote about a method called "Motivational Interviewing" (MI), something I learned about from a social worker who was also at the Lean Startup Conference. It's funny how these worlds intersect sometimes.I saw parallels between people being addicted to food, drugs, or what have you (the reason the MI method was created) and people being addicted to old behaviors in the workplace (such as blaming others, not planning, or jumping in to be the hero). I recently ran across Ron Oslin, who is an internal Lean coach at CapitalOne. He has been using the MI method and has trademarked the phrase "addicted to the status quo." It's apt.

I've chatted with Ron and will be doing a podcast with him soon.

Here is a video webinar of Ron giving a great overview of Motivational Interviewing:

As Patient Safety Awareness Week continues, thanks to all of you who shared this PBS News Hour story with me via email or Twitter. If you ever see something you think might be of interest, please let me know.On March 9, this story aired on PBS: After tragic mistake, rural hospital transforms into model of success.

http://leanblog.org/audio130

http://leanblog.org/audio129

I generally avoid politics here on the blog... In October, I broached the subject when I blogged about a company that uses Lean principles to make Donald Trump hats in New Jersey (and interviewed the owner of the company), but that was during a time when Trump seemed like a novelty or fringe candidate. It might be a "third rail" to even bring him up... but I'll limit my remarks to one particular context - his view of "leadership."As reported by FORTUNE and other publications, Trump said the following on March 3, when asked about his earlier comments about wanting the military to follow orders that violate international law and treaties:

"I've always been a leader. I've never had any problem leading people. If I say do it,they're going to do it. That's what leadership is all about."

No. Leadership is not about telling people what to do. What Trump calls "leadership" is an outdated strategy, the "command-and-control" model. That's a model that many call "Taylorist" -- a system where the boss thinks and gives orders,the workers just keep quiet and follow orders. The FORTUNE writer writes that Trump's "retro style is not set up for today's complex world."

Last Friday morning, I partnered with Chip Ponsford, DVM, a doctor of veterinary medicine, to give an introductory Lean continuing education presentation at the annual conference of the Texas Veterinary Medical Association.Our talk was titled: "What Veterinarians Can (and Should) �Learn From Toyota." That was Chip's suggested title... him talking to the vets, not me as the engineer telling them this.