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Enterprise Excellence Episode 20: Mark Graban

How to achieve excellence in Healthcare


Welcome to Episode 20 of the Enterprise Excellence Podcast. I am so pleased to have Mr Mark Graban joining us for this episode. Mark helps others learn how to improve to sustain their performance. He is the author of "Lean Hospitals", "Healthcare Kaizen" and most recently "Measures of Success". Mark is the host of several podcasts, including "Lean Blog Interviews" and "My Favourite Mistake".

Let's get into the episode.


As an industrial engineering undergraduate student interested in manufacturing and operations, Mark was exposed to the TPS (Toyota Production System) by a university lecturer. Material flow and handling aspect of lean. He began work in General Motors and solidified his interest in continuous improvement. The culture was not lean: very traditional leadership, low productivity, morale, and quality. An inspiring leader then became plant manager, and Mark saw and experienced the positive change that a leader can make to an organisation. He then went to MIT and studied Lean more deeply in graduate school.

Mark talks about his journey into Healthcare. His relocation with his wife to Texas brought a fortunate opportunity to work for Johnson & Johnson as a Lean consultant for hopsitals. Healthcare became Mark's focus for the next 15 years and continues to find his passion there.

Mark began consulting in Healthcare in 2005 and saw the many challenges that face the industry. He discusses the global problem of patient safety, quality of care, high cost of care with low returns, and low staff morale.

In 2006, Mark started Podcasting. The late Norman Bodek gave Mark the suggestion to do a radio show, which Mark took to mean podcast. He now has over 400 episodes recorded! Well done, Mark.

In recent times, Mark has been invited to help engage at a more senior level. He helps leaders with day to day management, cycles of annual planning, and improvement in culture. This sounds easier than it is: leadership beliefs often do not change. How does Mark then create those moments where someone might discover a different, better way, rather than just hearing about it?

Leaders awaken through insight or discovery, and this is necessary for change. Experiential learning within safe environments: simulations and games, e.g. red bead game (W. Edwards Deming), effectively allows leaders to reflect on their management practices. This secure play and simulation encourage leaders to find their Aha moment, which will shift their behaviour. Mark uses games that demonstrate Kaizen principles: making an ice cream sundae smoothly or preparing a batch of mailers and envelopes. Mark and his colleagues are currently looking to develop simulations that can be accessed virtually.

How can leaders try to influence their culture? Don't spread yourself too thin or broadly. Begin somewhere, dive deeply into a value stream and find opportunities. Build collaboration across department lines. Start small with behaviours and culture change, and demonstrate the impact of Lean. Instead of talking about the theory, create the pull effect by showing the improvements in safety, quality, delivery, cost and morale.

How can leaders create the pull effect rather than the push effect?

Lead as if you have no authority—a slower, but more effective approach. Lead as a teacher, challenge people and set inspirational goals, e.g. "zero harm" (Mr Paul O'Neill). He did not have the answers for achieving this but set the goal to reach towards together. Celebrate the positive experiences of continuous improvement momentum- good feelings and positive feedback.

Mark shares some of the results he has seen in Healthcare through an excellence journey; dramatic improvements in patient safety, time savings and performance outcomes in nursing and accuracy and quality in operations. When it is time to review the goals, look at the systems, and create understanding together. Don't blame people, don't judge others.

Mark is now working to support clients virtually. He has subcontracted with Value Capture, a company founded by Paul O'Neill and others sharing his passion for safety and leadership. He is also working on a new Podcast "My Favorite Mistake", which asks people to share their favorite career mistake and what they learned from that mistake. He has released over 30 episodes at the time of this interview being released and has a broad pool of exciting interviewees.

Key takeaways:

The key takeaways for me from this episode are:

1. Collaboratively helping people set goals

2. Leadership behaviour – Leaders as coaches vs Leaders as mentors

I believe that empowerment precedes accountability. People like change and improvement to occur with them, not to them. When a leader collaborates with their teams and team members to plan for the future, they create empowerment and ownership, leading to motivation and accountability. This is a much stronger starting point for success than the alternative approach of telling people what they need to achieve and improve. The people doing the work, particularly if they are curiously engaging with their external or internal customers for feedback, are in a stronger position to understand what they need to improve to move forward. They know the day to day frustrations they and their customers face. They know what would make things better for themselves and their customers into the future.

In setting these goals and then helping teams and team members achieve these, leadership behaviour plays a large part. A leader is often placed in that position because they are an expert in what the team does. They have succeeded in doing the job in the past. Leaders in this position can suffer from what I call expertise. Their expertise can lead to a mentoring, dictatorial behaviour. Telling team members what to do, how to overcome an issue rather than helping them explore, think and grow.

This can disempower team members, limit their learning and lead to team members bringing every problem to their leader and waiting for their leader's directive before they do anything. This is your traditional command and control approach.

Alternatively, a leader, even if they are an expert, can practice a coaching approach. They use high-quality open probe questions that help teams, and team members focus on their goals, understand their current position and challenges and define ways to improve and move forward. This coaching approach empowers team members, creates ownership, motivation and accountability.

The team and team members are more likely to own and strive towards ideas and actions they have defined and committed to, than orders and directives from their leader or peer.

I suggest taking a moment to explore your past approaches concerning planning and ongoing leadership support to help teams and individuals achieve their plan.

Thanks again, Mark, what a great episode. Bye for now.Links


05:38min That was my eye-opener. I would never have imagined that there were so many opportunities in health care to improve quality, to improve patient flow, to create better workplaces.

07:57min The challenges, I mean, back when I was in manufacturing, we learned this mantra of, um, SQDC: safety, quality, delivery and cost. There are huge opportunities, sadly, in all four areas within Healthcare.

17:49min admitting and acknowledging what we don't know and that we should always be learners to learn how to get better at solving problems in an experimental way. Right? So, instead of just preaching what many would call PDCA, or, I prefer the language of Plan, Do, Study, Adjust, or PDSA, as a lot of people would say in Healthcare. You've got to model that behaviour first hand.

24:42min so, you know, I think leaders need to um, not just set demanding goals, but support their leaders and coach them. So again, it shifts from leader as an all-knowing person with all of the answers who can't ever be incorrect to a leader who is inspirational and supportive.

26:15min Lean leaders don't tell people, just ah, "you shouldn't be frustrated", or you just can't tell people "don't get burned out". We've got to try to prevent that frustration, and we've got to prevent that burnout, and try to help people recover from that in a collaborative way.

31:48min When you change the system, you can change performance. Don't ask people to try harder and be more careful within their existing system. We have to work together to change the system.

34:04min Let's start the conversation talking about the current condition, the performance gap between where we are and the ideal condition. Let's talk about why that performance or lack thereof, is important, and then let's understand the current state and the causes. Right? So, we build support along the way.

43:32min The power of let's say, checklists, or standard work. You can document your process, and you can run that process successfully many, many, many times. And then its when you stop using the checklist because you think you know how to do something error-free, is when the mistakes and the oversights start creeping in.


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Twitter: MarkGraban

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