GA 044 | Beyond Heroes with Kim Barnas

You're listening to episode 44 with Kim Barnas.

Welcome to the Gemba Academy Podcast, the show that's focused on helping individuals and companies achieve breakthrough results using the same continuous improvement principles leveraged by companies such as Toyota Del Monte and the U.S. department of Defense. And now, here's your host, Ron Pereira.

Hey there.

This is Ron Pereira and I'd like to welcome you to another edition of the Gemba Academy Podcast. As always, thank you so much for taking time out of your day to listen to the show and for watching our Lean and Six Sigma trading videos over@gembacademy.com we definitely appreciate each and every one of you and I do want to give a quick Gemba Academy update. I'm very happy to announce that we've just released a brand new course that is without question like nothing we've ever produced before. Now, we call this new course the Culture of Kaizen, which sounds pretty lean, I guess, since we use the word kaizen. But the thing that separates this course from anything that we've ever done before is that it's pretty much 100% focused on the human person. Now, during the course, we make the case that the tools of continuous improvement are obviously very important. That's why we have more than 500 videos covering just about any Lean or Six Sigma tool you can imagine. But here's the thing. If you don't know how to respect, motivate and effectively influence others, I don't care how good you are at value stream mapping or SMED or anything, any other tool, you will fail to build a long lasting, sustainable, continuous improvement culture. So in this course, we focus on topics like respect and motivation and how to drive out fear and anxiety throughout your organization. And we also talk about things like how habits are formed and how certain brain chemicals essentially control the emotional aspects of our lives. And while I'm obviously a little biased, I think the course turned out great and I'm really excited to hear how it affects others. All right, well, today I'm excited to welcome Kim Barnas to the show. Now, Kim is a former senior Vice president at the ThetaCare Hospital and she also is the author of a book called Beyond a Lean Management System for Healthcare. Now we're gonna talk all about Kim's background and in her book throughout the rest of this episode. Now, during the show, Kim and I chat about many things, including what the so called hero approach to problem solving is all about. And we also talk about how to approach highly specialized and trained do along the Lean journey. And even if you don't work in the healthcare field. I think the things Kim and I explore will add value to you. And obviously we're all potential customers of the healthcare profession, so it's good to know that there are folks like Kim and our good friend Mark Graben out there working so hard to make improvements.

Within the healthcare field.

Now, show notes for this episode can be found over@gembapodcast.com 44 and that's 44444. So gimbet podcast.com 44 okay, enough from me.

Let's get to the show.

Okay, Kim, well, thank you so much.

For coming onto the show. Where are you calling in from today?

Well, I'm calling in from a cloudy and cool Appleton, Wisconsin.

Oof. Appleton, Wisconsin. Yeah. Wally, are you going to get pounded with all this snow, you think, or.

Well, we got a little bit, but not like the east coast, so.

Okay, all right.

We're getting a little reprieve.

All right, all right, all right. Well, why don't you tell us about your background, Kim, including how you were first exposed to lean thinking?

I'm a healthcare executive who worked with ThetaCare for 20 years, and I joined the system in 1994. And as I moved through the organization in about 2003, the decision was made that we were gonna use the lean methodology as our problem solving methodology. Our CEO at that time was John Toussain, and he brought in a consulting group that actually was going to lead us through the lean journey. I was a vice president at that time within the hospital division. So I was responsible for surgery, women's services, and cancer, which became major service lines of the hospital. And so I had a lot of access to our consultants. One of the lead consultants, Jose Bastillo, was new to health care. He'd been in manufacturing for a year, but this was his first healthcare assignment. So he and I made a pact that I would teach him healthcare and he would teach me lean. And it served us very well. We still have a wonderful relationship today, and he helps me think through some of the issues as we move through them. So having that sensei one on one support is really where I developed my. My lean knowledge. I wouldn't say expertise, because I consider myself like a third grader in the lean world.

Okay. Who's also written an awesome book. So a third grader. All right, all right. Okay. So, well, one thing that we like to do, Kim, is have our guests share a continuous improvement or leadership slanted quotation that inspires them. So what quotation inspires you, Kim?

I Think this is a wonderful question, especially since where I really found my niche is in continuous improvement. And so when I wrote the book, I was looking at what is it that inspires me? And I came across a Winston Churchill quote that says, success is not final, failure is not fatal. It's the courage to continue that counts. And I think the lean journey and daily continuous improvement take discipline and courage. So that's the quote that resonates for me.

Yes, I love that. Very good. All right, well, I've got some specific questions about your book that I want to get into, but why don't you just give us a quick overview of what the book's all about?

The book really evolved to solve a problem. So when we were beginning this lean journey, we were doing extremely well with our value stream analysis, our kaizen events, and implementing action plans. And we were seeing really strong results. And some examples in my service line of cancer were for three years in a row, we saw 30% improvement in access in our radiation oncology department, we saw 28% productivity improvement year over year. But I began to wonder as we were doing that, how we were going to sustain it. So as we started to see the sustainment and the continuous improvement level off and plateau, I began to be concerned that we were going to see declines. In addition to that, I had several managers of those departments coming to me saying that they were feeling overwhelmed and frightened because we had changed the way the work was done, but we had not changed the way we managed. So we began, and if you've read the book, you'll know I'm a big proponent of experimentation. We began an experiment where I pulled Jose, my sensei, and another sensei together who had worked in industry and said, teach me what it looks like in industry. What does a management system look like? We also read one of my favorite books, David Mann's Creating a Lean Culture, and that sort of began the underpinnings of what is lean management. And so the book is the solution to that problem. It's what we found, worked to create an infrastructure to sustain our improvement from our other lean work, to connect daily improvement to the value streams and the strategy of the organization, and to find a way to have our employees feel empowered to continuously improve processes throughout the organization.

Love it.

All right, so in the book, you.

Talk about a hero approach with quotes around the hero approach to problem solving.

What is that?

Well, I think we talk about that a lot at ThedaCare when I was there. And we talked about how we have, you know, 7,500 highly intelligent, well prepared heroes that come to work every day in medical school and nursing school. You're taught to do whatever it takes to get the job done. And so you create a lot of workarounds. So when I talk about heroics, I don't mean it in a derogatory way. I mean it to suggest that if we give people better processes that remove defects and waste, we can streamline their work, make it more satisfying and productive, and not involve that adrenaline rush that you need to have a workaround and make things effective in a heroic mentality. Now, there is a mentality where I do want a hero, and that is if I'm in the operating room and something isn't going well, I want a hero to do everything he or she can to save my life. There are times when heroics are important, but they're much less than on a day to day continuous improvement process. They should be the exception, not the rule.

But how?

I mean, okay, so here's the scenario. I'm this incredible brain surgeon doctor who's like a genius, right? I mean like I'm good as there is in the world, okay. And I just saved someone's life or whatever. And now you're coming to me about 5s, right? Or whatever it might be. I mean, I mean, how does I mean in fairness to that doctor? I mean, how, how do they, I don't know, how do they balance that? Because it's gotta be tough, isn't is tough?

And it is an interesting question because my husband is a physician and so I talk to him a lot about this and he's not a physician at ThedaCare, so he has a different experience, experience in the world. And 5S is a really good example. I'm not going to expect my neurosurgeon to 5s the or I'm not going to expect him to 5s his process. What I'm expecting is that my team around him has five S' ed everything so that we bring him what he needs, when he needs it, where he needs it immediately and efficiently. And so he actually is going to like the result. Now if I come to him and say I'm using this lean term called 5s and we're going to 5s, you, I am going to immediately get resistance if I use it as a tool with the team around him, I'm going to get him embracing the process because it's going to improve his experience and his ability to do what he's trained to do.

Yeah, yeah. Okay, well, what are alternatives to the hero approach.

The alternatives are that we sit down and we look at the processes that we do process improvement and that we have teams make changes. So I keep saying we use A three thinking and then we use projects and kaizens to solve those problems or value stream mapping. But what we're really trying to do is be sure that we're solving a real problem, either a clinical problem or a business problem for the organization that everyone agrees is a problem. So if we come to that and we remove the defects, we remove the waste, and we make the process smooth, and we know that if we follow it, we're going to get this outcome every time. And that we can reduce, by reducing that variation, we can improve the process over and over again. When people start seeing those results, they feel less inclined to have to be heroic.

Do you have any examples of problems that you can share? And maybe you have to change some things up or whatever, that's fine, but some examples of problems that you solved?

Let's think here. Let's talk about flow, patient flow. So when you're talking about how, you know, I used to say, I know how we get patients in the hospital, I'm never really sure how we get them out because there's so many steps to the process. We, through our collaborative care value stream, which is an inpatient model, really looked at the patient flow from the doctor, the nurse, the ancillaries, the pharmacy perspective, and came up with a new flow that admitted patients with a triad. So the nurse, the physician and a pharmacist admit the patient with their family and develop a single plan of care, rather than a doctor plan, a nursing plan, a pharmacy plan. They work from one plan of care that has toll gates throughout the plan. So the nurse in this model now becomes the captain of the ship rather than the physician. And as the patient moves through the plan of care and they're hitting their toll gates, she's keeping the team involved, but if they don't hit their toll gates, she reassembles the team and they reassess the plan. It eliminates all kinds of problems in terms of phone calls back and forth, multiple to multiple disciplines. It creates a stable flow and a better patient care experience. In addition to that, it reduces the length of stay of our patients on an average of 1.5 days, and it reduces the cost of care, an average of $1,500 a case. So we're not only improving the experience for the patient, we're reducing costs and we're improving satisfaction.

Wow, Fantastic. So you obviously Talk a lot about ThetaCare in the book. And one of the things that you talk about is how they're constantly experimenting with their lean management system. But again, they're obviously busy saving lives. So how do they balance experimentation with saving lives?

Well, that's a great question because as we implement the management system, we're always acutely aware that the only reason we are there is to change lives and save lives, to make the patient experience the best it possibly can be under uncomfortable circumstances. So one of the things that Jose, my sensei taught me early on was a model cell approach. And so as we experiment with our processes, we always try it in one model cell, then we adjust the standard and we try it again and we spread it to two model cells. And if it works in two, we study and adjust again, update the standard work and spread it to four. And when it works in four and we've got the standard work pretty well adjusted, then we begin the spread throughout the organization. So experimentation doesn't mean you change the whole workflow of the whole organization. It means you start in pockets and you learn, improve and spread.

Nice. Now in the book you also talk about Trude north metrics. So for those that aren't aware what that means first, let's start there. What does it mean? True north metrics?

Well, the way we define our true north metrics, which are by the way, board approved, they are a few selected enterprise wide goals that guide all of our improvement work. So whether you're doing a value stream, a Kaizen event, or you're doing an improvement project on the individual unit, they all have to align to these particular goals which we call true North. So at ThedaCare, those goals and targets are selected annually and fall into five categories. So we have safety, quality, people, customer service and financial stewardship. So at any time you're doing work, you have to have a metric on the unit level or the system level that ties to one of those five true north categories. And when it comes to visual management, you will always see those five categories represented. Always starting with safety and quality, moving to how do we take care of our people and our customer and ending with financial stewardship so that we recognize that although this is a business and the finances are important, you know, no money, no mission. Our top priority is always safety, quality and people first.

Talk about financial stewardship. What is that all about?

Well, one of the things in healthcare, you know, you've got these highly intelligent, compassionate people working at the front line and they don't think of themselves as a business But a lot of the decisions they make have financial impacts. So every day we talk to the Frontline staff about what are we doing today that's going to impact our finances. Have we improved a process that makes us provide smoother care? Have we reduced a cost or an expense? And so it'll be things like we changed the drapes in the operating room, and it's going to have a, you know, $250,000 cost reduction over the next 12 months, or it's. We have more patients than we thought we were going to have this week. Our volume is up, so we're going to be. Although we're going to have overtime, we're probably going to be okay because our volume is up and our revenue is higher. So we actually talk to our Frontline staff about the business performance, the financial stewardship of the organization.

Very good. All right, so the last question I have in this section, you know, there's someone listening to this podcast right now, Kim, and they're in a healthcare world, and they're thinking, gosh, this sounds fantastic and must be wonderful having John Toussaint and Kim running, you know, their hospitals. And. But maybe this person doesn't have that luxury. What advice actually just speak to that person as to how they can better engage their leadership in this important work.

Well, John and I have started doing some work with many organizations that are interested in understanding Lean and what it's all about. And so we come at this from a perspective as this is a way to improve value to the customer. The customer is always first. So when you're talking to physicians or you're talking to board members or nurses, everybody can get around that. We're going to improve the experience and the outcome for the customer. But the next step of that is to really make it a productive value proposition. We believe that by increasing quality, we can also decrease cost. And so when we come to organizations that are interested in this, it's really talking to them about that value, how that value plays together. And there isn't a CEO or a chief operating officer around here that can't get behind improving quality and decreasing cost. But the big question then becomes how? How do we do that? And so as we look at our. Their strategic plans and we develop a strategic A3 to help them identify that, we start looking at where their biggest opportunities are, and we begin our work with them there. We recognize that as people start this journey, they need coaching at the executive level, and they also need boots on the ground. And oftentimes that started with consultant as they develop their own internal abilities. So when I show a coo, I was the president of the hospital. If I show the CEO, my commensurate partner at other organizations, how we reduced our cost by $25 million in the first two years, you get their attention. At the same time, we improved our employee engagement and our. Our patient experience scores. And so they're big attention getters. Especially in this environment where we're seeing, you know, accountable, the Accountable Care act, have impacts on us in terms of we're seeing more patients, we're seeing people that have insurance for the first time. We're seeing a reduction in our reimbursements at the same time. So we're seeing more people, but getting less money. We're all very interested in how do we do that, how do we reduce our cost structure so that we can remain solvent as we meet the needs of our national and local communities.

Yeah, very good. All right, Kim, so let's go ahead now and transition into what we call the quick fire section. So this is where you get to share your thoughts and wisdom, which you've obviously been doing. But now we're gonna just really focus in on Kim. Okay.

Uh. Oh, trouble.

Yeah. All right. This is the good stuff. All right, so the first question I have is, we lean thinkers spend a lot of time talking about the two pillars of lean Continuous improvement and respect for people. But the respect for people can really be hard to kind of put our finger on. Like, what does that really mean? So what does respect for people mean to you?

So when we developed our A3 around creating the lean management system, in the book, our objective, our goal became to develop our people to solve problems and improve performance. So for me, respect from people means that we give them meaningful work, that we don't ask them to do wasteful work, that we continue to teach and train them and listen to them, and that we have a development plan for each employee that gets them to the next level of critical thinking or the next level step in their career path.

Nice.

So it's about meaningful work to me.

Yeah. Very good. What's the best advice you've ever received?

Okay, I have two pieces of advice. They both came from Jose. One was, as you're developing a continuous improvement program and you develop your first model cell, be sure that you have people around you that you can trust that you can trust. I mean, you trust most of the people you work with, but the people you can trust to fail in front of, because you're going to create some vulnerability as a leader, which is A good thing. And you need to be around people that can change the direction on a dime and that you can trust to have the real conversations, not just tell you what they think you want to hear. And then second, the second best piece of advice I ever received was about model cells. So Jose, and I remember I said he was going to teach me lean. So we went out for dinner every other week for two hours to talk about lean. And he drew me this picture every week, every two weeks for a year. And I didn't understand what it meant. He drew a square on a napkin and said, kim, this is a cell. And when things work in one cell, you spread to two, and when they work in two, you spread to four. And if they work in four, you can spread them everywhere. Every time. I'd say, that's really nice. Thanks for drawing that picture, thinking, what the heck is he talking about? When we got to actually developing the management system and using model cells, I recognized even more today than I did then that model cells are critical to spreading the lean work throughout the organization. And so now that I've been on the road with the book and consulting for the last year, I see this over and over again, that the best piece of advice I could give to any lean leader is develop your lean program using model cells.

Nice. You know, you've been talking about Jose a lot. So I don't know if Jose's life listening to this podcast right now, but if he is, I need to talk to you, Jose. We need to do another, another podcast interview with Jose because I'm sure he's got some stories of you, Kim.

I'm sure he does, but he's quite gracious.

Yeah. All right. Do you have a personal productivity habit that others might benefit from?

I do and it has to do with time management for me. So as we're developing this system, everyone says, how are you going to be be able to implement this? Where do you create the capacity in your organization to do this? So two things. One is we created a no meeting zone and it's between 8 and 10 in the morning and we do have meetings, but they're very specific. They're related to stand up meetings in front of your visual management, talking about the status of your business and the defects that you're seeing on a daily basis. Or they may be a conversation with a physician standing up around a problem. But between nine and between eight and 10, I don't want to see a staff meeting, I don't want to see a sit down meeting. I want us to be working on improvement in the hallway. So that was the first one. The second one was I went into my meeting agendas and made sure that we had standard meeting agendas for every meeting. And as I went through that process, I recognized that I was invited to a lot of meetings where I wasn't really needed. And so if I'm not on the agenda, I need to understand why I need to be there. Because. Because if they need me there, I am 100% there. But if they're inviting me out of respect, that's disrespectful of them. And so I really believe in standard agendas. And be sure that you're utilizing the talents of the people in the room for the right purposes.

Nice. All right, now, this is always a hard question for you authors, but I have to ask it anyhow. So if you could recommend one book related to continuous improvement or leadership, what would it be and why?

Okay, I'm gonna have. I have lots of books, but I have to tell you, the first book that caught my attention was Andy and Me.

Oh, yes.

Pascal Dennis book. That's one of my favorite books.

Yes. And another one's Joe's Garage. You ever read that book?

Yes.

Yeah, I know. Yeah. Oh, goodness.

So Andy and Me, and then I have to believe for continuous improvement again. David Mann has come out with another edition of Creating a Lean Culture, and I think that's an exquisite book. In addition to the Liker books, the Toyota Way, and the. The Womack books. You know, I've read all of them and I learned something different from each one. But the one that really captured my attention, I have to admit, it was Andy and Me.

Nice. I love it. That's the first time Andy and Me has been mentioned on a podcast, and I'm so happy. I guess it's a great book. Sometimes all these great thinkers over simple overcomplicate things. Man, you seem to get back to Andy. You know that's right. Okay, so I'm going to modify this last question a little bit just based on your background. So I want you to imagine that you've been hired as a chief operating officer of a hospital who's needing to improve their processes and way of working. But unfortunately, you've now discovered that many of the senior leaders that you're dealing with aren't quite. Quite as enthused about all your lean thinking mindset and ideas as you are. So with this said, what would you do and why?

First of all, you can only push people as far as they're ready to be pushed. So you want to create a pull. You want them to understand what it is that you see in this methodology and this philosophy, if you will, that will take them to the next level. So that's the second step, showing them what's in it for them. As I said earlier, if you can demonstrate improved quality, increased employee and patient satisfaction, and decreased cost, you're quite a way down the road. So you want to expose them to results and expose them to what other organizations are doing. So through reading or through bringing in others. But I think the most important piece that evolves after that is having an opportunity to take them to see what good looks like somewhere else. And so there are examples around the country from, I would start with health care if it was a health care work CEO or COO. And so I'd take them to ThetaCare or I'd take them in Canada. I take them to St. Mary's or SickKids. There's places like University of Massachusetts that's doing some awesome work. I would take them to see and talk to people at their same level about what they're doing and then, you know, begin with rapid value streams and rapid improvement events to show them the breakthrough results and then followed quickly by a management system. So I think it's not something that someone on their first day can see and observe and get their arms around. It takes a few months to really get hold of what we're talking about here. But it is a very powerful opportunity to improve an organization. And we have to show them that they can improve their, you know, they can develop their people and they can solve problems. And by doing that, they will improve performance.

Yeah. Love it. All right, well, Kim, thank you so much for taking time out of your busy schedule to chat with us today. And why don't we just kind of wrap things up with you sharing some final words of wisdom and then why don't you tell people how they can connect with you on social media or your favorite website?

Well, I guess some of my final words of wisdom is start by reading something simple like Andy and me. Many of you who are listening to this are already on a lean journey. Identify what good looks like for your organization. Go find a place that can help you see it begin somewhere. I didn't get into the details of the management system, but there's. There's some specific underlying elements that are probably pretty critical, like understanding your daily flow, being able to identify defects and solve problems at the frontline level. Start somewhere, continue to learn, bring in others to help you and put one foot in front of the other and get going.

Very good. And how can they connect with you?

They can connect with me. I'm on LinkedIn. Kim Barnas. That's the best way to get a hold of me. And you know, the book is called Beyond a Lean Management System for Healthcare. It isn't just specific to healthcare, as Jim Womack has told me, that this is the opportunity that manufacturing can come back and look at another way of structuring themselves for daily improvement as well. So just because you're not in healthcare doesn't mean there isn't an opportunity for you to take some nuggets away from this, this book.

Fantastic. Fantastic. All right, well, thanks again, Kim. And you stay warm up there.

All right, thank you. Thanks, Ron. Have a good day.

Thanks for listening to the Gemba Academy podcast. Now it's time to take a free, no strings attached, fully functional test drive of Gemba Academy's School of Lean and Six Sigma over@Gembaacademy.com gain immediate access to more than 500 Lean and Six Sigma training videos free of charge at gembacademy.

Com.