GA 046 | Lean in Japan with Mark Graban

You're listening to episode 46 with Mark Graben. 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 with Gemba Academy and 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 training videos over@gembacademy.com now then, today I'm excited to welcome Mark Graben back to the show. Now we first met Mark on the podcast back in, I think it was March of 2014. And episode seven, Mark came on and talked about all the work that he's been doing in kind of the lean healthcare world. And Mark's written several books and he's a consultant and speaker and author and a great blogger over@leanblog.org so if you want to check out that, that first episode, just Simply go to GembaPodcast.com 7 and that's just the number 7. Now today, what Mark and I talk about is he recently went to Japan. He's actually been to Japan a couple times. And he went with Kaizen Institute to visit several different companies over there in Japan, Toyota was one of them. And he visited three different hospitals and several other companies who are kind of on the lean journey. And so Mark shares his reflections and his thoughts on what he saw over there, what was good, you know, whether or not, you know, it's easier to do Lean in Japan. He talks about some of the key learnings that he took away from the Toyota plants and also the hospitals, you know, we basically talked about, are they so called more lean than U.S. hospitals? And so Mark and I explore all that. And then since Mark's been on the show, I couldn't ask him the same quick Fire questions. So we came up with some new questions and Mark had never heard these questions before. And so I think that's going to be a fun part of the show for regular listeners that there's a new set of quick Fire questions. And I'll probably kind of use most of those when we have guests back on for a second time. And you definitely need to listen to the end because the last quick fire question is like nothing that you can ever imagine. So you'll have to check that out. And I think you're gonna really like what Mark had to say. So show notes for this episode can be found over@gembapodcast.com 46 and that's 4, 6 for 46. So gembapodcast.com 46 okay, enough for me. Let's get to the show. All right, Mark, well, welcome back to the show. So I guess, hey Ron, we last talked in, what was it, March of 2014 in episode seven. So it's one of the first ones we did here.

I can't believe it was that long ago.

I know, I know, I know. And so we talked about everything that you're doing and Lean Healthcare and all the rest of it. So I guess for those that didn't, didn't hear that show and maybe they don't know who you are. Mark, why don't you start by just giving us an overview of sort of work that you do.

Well, sure. My name is Mark Graven. I have been focusing on lean health care for right about 10 years. It'll be 10 years in August. My background originally was industrial engineering and manufacturing. So I guess now, boy I've been in healthcare just slightly longer than I was ever involved in in industry. But I work as a solo consultant and speaker involved in the software company Kinexus. I've had some books published, Lean Hospitals, Healthcare Kaizen and the Executive Guide that Healthcare Kaizen. And I've got a couple of different projects that I'm sort of looking at right now, maybe as like smaller ebook projects. That's one of my goals this year.

Give a quick just elevator speech on Kinexus.

Well, Kinexus is a company that's been on the market for about three and a half years. We are a web based software product for organizations that are looking for a system to help manage and accelerate their improvement and innovation activity. So we have a lot of customers in healthcare, customers who are healthcare systems and hospitals. We have customers in manufacturing and logistics and architecture firm. And it's really just interesting to see how people are using the web to help solicit ideas and implement them and track them in a system like ours.

Got it, got it. All right, well so today we're going to focus on a trip that you made recently, well I guess relatively recently in the grand scheme of things to Japan. Japan. And you went with various folks and organizations. We'll get into that here and in a little bit. But I guess to start with, I'm curious, you know, I've known you for a long time, Mark, and you've been practicing lean for gosh, what, 17 some years. I'm curious, what made you finally go to Japan or decided to make that trip?

Yeah, well, you know, and you know, this year is going to mark 20 years out of college. And I did my first trip to Japan just over two years ago in 2012, which was that 17 year mark. I'd never been to Japan at all as a tourist or as a professional in healthcare. It's been very increasingly popular, maybe even trendy in the last 10 years or so for health systems to send groups of leaders and people to Japan. Virginia Mesa Medical center does this. Seattle Children's Hospital does that, among other hospitals. I know people have enjoyed those trips, but it's always interesting to think of the pros and cons of do you have to go to Japan? My thought has always been, well, no, you don't have to, because here in San Antonio we have a Toyota truck plant that people could go and visit. You can go and visit great Lean organizations or hospitals or otherwise here in the US But I've kind of got to a point where frankly it was like, well, I wanted to go more so than feeling like I needed to go. And the two times I've gone, it's been a fascinating experience. And I kind of recommend to people it's still kind of in that category of like, well, if you want to go and you can pull it off, I certainly recommend it, but I wouldn't say it's required. I don't know. Is that a wishy washy? No, no, that's fair answer.

So who did you go with? Tell us about the folks that went and who led the trip.

Yeah, there's a lot of organizations or consulting groups that do tours. I went both times. Tours that were organized by Kaizen Institute, who obviously got strong connections with Gemba Academy. And Kaizen Institute organizes tours. The one in 2012 was the first tour they did exclusively for healthcare people. So everybody who attended was working in health systems in the US or Canada or Belgium or the Netherlands and a couple other countries. And we all rendezvoused in Japan and spent a week together. So, you know, we had, for those of us who had never been to Japan, we had guides and translators from Kaizen Institute. You know, they figured out where we would go, how we would get there. But then they set context about Japan as a country. Great discussions about Lean and then the basics of translation because a lot of the people presenting to us were presenting in Japanese because it was easier for them to go through a translator. We did a similar thing in 2014 where this group, 18 people were from mostly Asian countries. Singapore, Indonesia, Philippines. We had a guy from Czech Republic, from Denmark, from Canada. It's just really, it's fascinating for one to go to Japan and then secondly, it was really cool to have people from all these different countries to compare notes with about what we're doing back home and what we're learning and what we're trying to take back and accomplish. So, you know, I've really enjoyed those trips with Kaizen Institute.

Yeah, fantastic. All right, so the million dollar question is, you know, people want to know or I don't know if it's a Western kind of curiosity, but is it, let's say, easier to be kind of lean or practice lean in Japan? And what were your impressions, you know, of just how they went about everything over there?

Yeah, yeah, yeah. It's something we hear a lot in the US and Western countries. People will say, well, we can't do lean because we're not Japanese, or this would be easier if we were Japanese. My impressions from what I saw and the people we talked to, not just our guides, but the people at the hospitals and factories that we went to, a couple friends, classmates of my wife's from graduate school who were from Japan, confirmed or at least had similar stories about how lean culture, Toyota culture, if you will, are not really one in the same as Japanese business culture or Japanese culture as a whole. And it was interesting to try to hear people's stories or look for evidence of this. And there's one, one takeaway, I guess, looking at standardized work and the discipline that's required around standardized work and the creativity and the culture that's required for Kaizen. It seems, again, these are my impressions. As much as you can generalize that Japanese culture scores very high on the idea of standardization. It's a group oriented society. We see at stores or at restaurants, or you can see there's routines. I guess maybe this idea of a kata that you're taught a routine, you do that routine. There's a certain consistency and maybe discipline, there's a really strong sense of customer focus, I noticed in Japan. So maybe there's a third element ranked really high on standardized work and discipline, high on customer service. At a hotel, if you ask for something, people run. There's no good reason, but other than. I think it's just this kind of customer is king sort of mindset. But then I think there's the interesting elements around Kaizen and an andon system where we were taught that one of the predominant cultural forces in Japan is this idea of Harmony and maintaining harmony is so important. Disturb harmony. And often that means not standing out, not speaking up, not pointing out problems, that there's pressure to not do that. So in organizations where people are afraid to speak up, I don't know how you would do Kaizen if people aren't willing and able to safely point out problems or make waves. One of the visits, somebody said that this idea of speaking up doesn't come naturally to Japanese. And this is where I think it's interesting to think about the andon cord. This is sort of my theory that the physical action of reaching up to pull a cord is easier than speaking up. Now, in the factory you've got noise and there's other factors involved. But Japanese friends I've talked to said, yeah, that that maybe sounds right, that you're trying to create a mechanism and even a bit of ceremony around the process of speaking up. That's one way I think that Toyota has tried to very intentionally create a Toyota culture that's not exactly the same as Japanese business culture. Then I think that's part of the reason why you couldn't say every Japanese company is exactly like Toyota or that they all practice quite quote, unquote, lean. I mean, I think things like that were really interesting to sort of try to explore and I think I'll continue try to learn, trying to learn about through my career here.

So speaking of Toyota, which Toyota plant have you been to in Japan?

We saw two different plants. This last time we saw the. It was called the Tsutsumi plant, which does Prius and Camry. And essentially they have a different name for it, but the Toyota Avalon. We saw a different factory two years ago, but it's right, two years ago we saw a plant that had an andon cord. The Tsutsumi plant has. This is something I've blogged about. Toyota is shifting to andon buttons in some cases that they have these moving parts carts that move along with the car with the employees in their job cycle. And they decided, and it's probably some wireless technology I've heard, you know, just put the button on the cart because the cart is always convenient. But then there are parts of the plant like final assembly where they don't have parts carts. They still have the hanging and on cord above the line. So it's kind of interesting to see some of the differences or the evolution in the plants being a very consistent experience in terms of what you see on the tour. The plant in 2012, we actually got to be up, well, both plants. We were actually up on a mezzanine level. And in 2012, we actually had a pretty good period of time for like 10 minutes where we could basically just sort of stand and be stationary. And as an industrial engineer, I love to kind of like watch and observe the job cycles and see all that. Where here at the plant in San Antonio, you're on a tram on ground level, you don't see as much.

Yeah, I actually. I did this. The trip as well back in 2008. And I remember standing on the. On the mezzanine and the catwalk and. And. And I. And my one thing that I. I just love. There's so much to see. I just locked in on one. One guy and. And he was. His job was he kind of put the. I don't know what the. What. What do you call it on the door jam. Like the little. The deal that you. You push in on a door jam. He installed that, and then he jumped inside. Then he did some stuff like on a middle console or whatever. But it was just almost like watching a ballet or something. This guy.

You know, it was like I was. As I kind of replaying mental images here. I was gonna use the term ballet. You see, the synchronization of people, parts, equipment, that was one thing that was impressive to the healthcare visitors, of seeing the kind of like the army of support people that are moving parts and moving stuff, and the people doing the work get to focus on doing their work. And in healthcare, people often don't get that they are serving as their own nurses, are serving as their own material handlers, as their own assistants, as their own support staff. And that's an idea that seems very transferable from a toy at a plant. We're not turning a hospital into an assembly line, but we sure can support, support the people doing the work and create something like an andon cord so people can speak up and get help when they need it. In hospitals, we far too often leave people to kind of struggle on their own. We leave them on an island, and things like that are very noticeable, even in a relatively short Toyota tour.

So were there any other kind of key learnings that you took from visiting the actual Toyota plant?

Well, it's funny. We saw. We had a tour guide, and she was from a public affairs office. And one of the people on the tour asked her, because they talk about kaizen, they talk about all these TPS principles that they know people are there to learn about. And somebody asked her, well, do you get to practice Kaizen yourself? And she kind of smiled, and she said, I think she had done two that year. And she's like, yeah, we get to do kaizen, too. And she showed us that she was carrying a bag. It was kind of a large purse with her. And moving along the tour route, up on the catwalk, there were different stations with either a display or something to look at. And there was a little speaker and a microphone box. So she would stop at these stations. Well, they had installed, at her suggestion, a hook on the rail so she could hang her bag and instead of setting it down on the floor. And she was really proud of that. And it's a classic little tiny kaizen, right? They're not looking for an ROI or a cost savings. It makes her a little bit happier. And we asked her, well, what's the process? And she said, well, you talk to your supervisor and they think it's a good idea. They let you do it. And she contacted someone in maintenance, and they installed these hooks that cost a couple dollars. But I thought, well, what a great example of practicing what you preach, even for a tour guide, right? I mean, yeah.

All right, well, let's transition to hospital. So I assume you visited some hospitals over there?

Yeah, we did. We saw three different hospitals across Japan. You know, we'd gone to Toyota. We went to another kind of heavier, heavy industrial manufacturer that was clearly not an assembly line, so that was interesting to see. And then we went to a food services company, which is kind of a transition into being sort of healthcare ish. And then we went to the three hospitals while we were there. And personally, I think it's beneficial to see both because we learn different things. Some of the groups go to Japan and they only want to see factories even though they're from healthcare, which I think is interesting. I think I still like the idea of seeing both. I wouldn't go to see only hospitals because, for example, we were in the pharmacy of one of the hospitals. And the healthcare people who know about pharmacies, they're starting to look for all the details about how a pharmacy works instead of maybe really looking for the lean principles at hand. So I understand the benefit of getting out of your comfort zone, but to see the hospitals and what they were working on, what their approach was, what their leadership was talking about, what the hospital just physically looked like, that was all really interesting, really fascinating. The hospitals there, it's funny, they in a lot of cases are traveling to Seattle to visit Virginia Mesa Medical center and like, well, why don't you go and visit Toyota here in Japan? And they're like, well, we're not a factory. We want to learn from hospital. And so these ideas and the lessons, I mean, it's awesome that it keeps going back and forth, but it's interesting to see the bias even there that while we're a hospital, we want to learn from other hospitals.

So what about the Japanese hospital? Just in general, the same question I ask you with who's more lean as a Japanese hospital that you visited. Are they, Are they, how are they compared to say, the top U.S. hospitals?

There are pros and cons. I mean, you don't. I've seen five. Well, let's see four different hospitals because there was one repeat visit. No, we saw three hospitals in 2012. So I've seen five different hospitals, six visits. Sorry. You see artifacts and evidence of lean practices. I think I only once saw a value stream map. You see some examples of kanban systems or 5s or things that you would consider lean tools, if you will. I think where. And that's not really in and of itself impressive. I mean, you see a lot of areas that are just as cluttered or disorganized as an American or a Canadian hospital would be. So again, it kind of reinforces that, look, Japanese organizations are not magically lean. They don't magically do 5s. There's aspects of medical culture that are very similar in the US of maybe not always focusing as much on the process as they do the clinical side. But the good things we saw were that I think if American hospitals dabbled with TQM 20, 25 years ago and then quit, the Japanese hospitals and the other organizations have all basically been practicing TQM for anywhere between 15 to 25 years. So that lays a really great foundation of PDSA improvement leaders who are directly involved in quality improvement. Having everybody participating in quality circles. Quality circles were trendy in American manufacturing for a little while. These organizations all do quality circles, which are six month long, team based. They're kind of like dragged out Kaizen events basically. Now some of the hospitals are starting to do focused, dedicated two to three day Kaizen events. And then a couple of them are starting to do what, what one of the hospitals called everyday Kaizen, realizing, okay, we can't rely just on these six month long team based projects, but they're starting to incorporate, I think, some good, what you might recognize as lean practices on top of the foundation of tqm, which I think is a different starting point than where the American hospitals generally are. And some of them would say, well, yeah, we are quote unquote, you know, we practice Lean management on top of that TQM foundation.

Interesting, interesting. So what other. I mean, from just a general Kaizen perspective across all the organizations that you visited over there, what did you take away from the way that they are practicing Kaizen? Is it just really just more grounded in that TKM kind of foundation or there are other things that they're doing as well?

Yeah, I mean, there's a lot of similarity. So. And I think a lot of times when they talk about Kaizen, they're including the TQM activity and the everyday Kaizen. But you know, the leaders there, you know, they said things that remind me of what good organizations are here doing in the US like, you know, the idea that Kaizen is basically voluntary, that you encourage people to do it and you're trying to create an environment, but you don't set a quota and you don't force it. My co author Joe Schwartz's Health system in Indianapolis, they would love to have everybody participate. And the last couple of years it's been about 40% of people. They don't blame the 60% who didn't participate. And they don't try to force it because that seems to go against the spirit of Kaizen. But they're focusing on making work easier for people. They aren't doing big, huge cash rewards. They do kind of modest token point systems. The thing that's different and unique, though, that I think you rarely hear about in a Western organization, and this was very consistent across the businesses and the hospitals. They would all say the first goal of Kaizen is the learning and developing people. The second focus are the benefits that you can measure.

Interesting.

And that's very different than a Western approach where we think about cost benefit analysis, roi, results, results, results, even if they're harder to quantify, like results around waiting time or things you can't put into dollars and cents as easily. That was a very. That. That really stood out, that consistent philosophy.

Yeah. It's funny, I was speaking with a perspective Gemba Academy customer today, and this young lady was asking me if there was a way to a video that she could show to kind of convince her leadership to practice this stuff. And I was thinking to myself, goodness gracious, you know, it's like there's just like a magic video. Like just watch and turn somebody on to lead and what it came down to. And she needed results to demonstrate to these guys. So it's almost backwards, right? It's like, gosh, these leaders should be hungry for their folks to learn and develop and grow. But it's the other way around. These workers, if you will, are desperate to get better, but they're trying to find ways to convince their leadership to let them.

Yeah, I mean, it's tough. I mean, there's this principle or this idea that you have to meet people where they are. We are in Western cultures. There are those realities. I mean, I think you can sort of try to have it both ways. Where what I've seen in Western culture that yes, managers want results, but that doesn't mean. And you can measure cost savings or try to, but that doesn't mean you can mandate cost savings for every single Kaizen. I think you can demonstrate results and show that there's a percentage of Kaizens that do have a big financial impact, that those pay the way for. All of the others, try to make the argument that, look, if you want big, innovative, huge cost savings ideas, this is what one of the Japanese hospital CEOs said. He said, basically, as you do kaizen, you do more and more improvements, you increase your chances of finding big, innovative ideas. You stumble into them. I think you can try to say, well, we're going to measure cost savings and we'll get you cost savings. But that can't be the only focus. And it's got to be an end result of letting people work on things that they are choosing and motivated to work on for their patients, for their customers, for themselves.

Comes back to that need for intrinsic motivation. Right. Like Dan Pink teach that.

Dan Pink teaches dan Pink and Dr. Deming. And that's another thing about Japan. They still talk about Dr. Deming and one of the other Japanese hospital CEOs, he showed a slide. He had been here in the US at the Institute for Healthcare Improvement Annual conference, and he was so excited that somebody had Dr. Deming's picture on a slide. And he took a picture of that slide and he was showing us that, hey, great, you guys have discovered Dr. Deming, who is of course an American. But again, these ideas, they just keep going back and forth.

So do you think you're going to go back to Japan again?

Yeah, I sure hope so. I mean, I've learned something different every time. Partly because you go to different places, you have different people with you. On the tour. The second time here, I played a little bit more of a formal role with Kaizen Institute as a facilitator. Sure. I'm only half a step ahead of the attendees, so I guess that's a helpful perspective. I'm not a Japan expert and I don't aspire to be a Japan expert. But it's a lovely place to visit. You know, just it. It's. It's very different than the US So it's just kind of your eyes are open the whole time. It's just a very interesting place. It's a very welcoming place. The food is great. I just. I like the vibe of the country. It's both, like, at the same time. It's. It's crowded and hectic, but it's also somehow calm and peaceful.

Yeah.

Like simultaneously.

Yeah, I know what you mean. You know, my. My favorite memory. I don't think I'll ever forget this rest of my life. We were visiting the. The Toyota plant, and Brad Schmidt and I know, you know, Brad, he. He was our. Our guide and. Yeah, and he. We were on the bus and we were leaving the Toyota plant, and the young lady who was our, you know, our tour guide, the PR lady who. I don't know what her role was, but she was taking care of us that day. And he said. He said, watch her. So everybody, we're on this bus and we're watching her, and she bows, right? And she stays in the bow, right? And he's like, watch. And we're pulling away, and she's still bowing.

They will bow and wave and bow and wave until you're out of sight.

Yes. And it blew me away, you know, just that honor, that respect that she showed us. And it was just. That touched me, you know, that small act of humility or whatever. It was just something else. I'll never forget that.

Yeah. And the bowing does become a habit. And I think the level of customer service there is so good. Even if you're in an inexpensive local restaurant or something nicer or wherever you are, there's just this customer service orientation, and people are smiling and welcoming. And then I boarded my flight in Tokyo, which was on American Airlines. American flight crew from us, not the US Based flight crew. And I got on board and I wasn't even in my seat yet, and I heard the flight attendants barking at each other and complaining about each other and being snippy. And I'm like, oh, I'm home. Just for once, I'm like, could you please just smile and bow and create a pleasant environment for us? I wish I had a little bit more of a. A transition. That was kind of a rude awakening. Like, okay, I'm basically on US Soil now.

I got you.

And it's again, I don't mean the bad mouth. Look, I love. Obviously, things are great here, but there is a noticeable difference Sometimes where even if maybe there the customer service people are just putting a happy face on things. They might not all get along, but at least, I don't know, I think they're concerned about the environment they're creating for their customers. Where I think American culture says, well, hey, if I'm ticked off at someone, I'm going to express that. And that's my right. And I think that's the maybe the individual based culture versus group oriented culture. Maybe that's part of it.

And like you mentioned earlier, the harmony that they strive to live in is, I think, is underlying reason.

Yeah, I'm sure if there's disagreements, they are handled behind the scenes. Right?

Yep, exactly. All right, Mark. Well, so last time you were on the show, we ran through our quick fire questions that we normally do. And since you're a repeat guest, I can't run you through those.

So I thought I had gotten good at those questions the first time we had a second shot. No.

So here's the deal though, for everybody that's listening, Mark has never heard these questions. And I'm like, we debated on whether or not you at least see what they were, but you wanted to just go with it.

Let's go for it.

Let's see what happens. So. All right, so the first one I have for you, Mark, is if you look back on your own personal lean journey, if you could go back and do it all over again, would you do anything differently?

Oh, well, sure. Of course. Next question. No, no. I mean, one example, and I think early on, and maybe this is the engineering training or maybe it's just natural evolution, there was too much doing and not enough teaching. So I think of going through what was essentially lean Black Belt certification 11 years ago. I had to go do a project, I had to go solve a problem. And I looked at setup times and created a scheduling, visual scheduling process and a kanban and a supermarket. And I didn't focus enough on engaging and involving others. And maybe some of that was a matter of the environment I was in, but it was a lesson learned. And I've tried to be much better about not doing, but showing others how to do and getting things done that way. I wish I could go back and maybe do that a little bit differently.

Sure. All right, in your opinion, what's the biggest obstacle to effective lean transformations?

Lack of leadership. And it's not just lack of lean leadership. I think a lot of it is just simply lack of leadership.

Leadership as far as like wanting to get better or does leadership as far as the way that they engage their.

Folks or lack of. What is leadership. I think leadership is inspiring people to do things differently as opposed to managers who maybe try to tell people what to do. I mean, I think I can be more specific. I think in healthcare, sometimes there's just a lack of really dreaming big. People aren't willing for the most part to say our goal is zero patient harm. And I think that holds healthcare back. Lack of leadership in terms of we're going to do the right thing thing, even if it costs us today, but it's the right thing for the long term. So maybe being more specific, lack of long term perspective, lack of willingness to push people really kind of towards more radical goals instead of just getting slightly incrementally better, jumping to solutions, things like that. And I try to be empathetic because a lot of times leaders have 25 or 30 years worth of bad habits that they're trying to undo. That doesn't happen immediately.

Yeah. All right, next question. So what book or books are you currently reading?

I am reading and really, really enjoying a book that's going to be out in April called the Digital Doctor and It's written by Dr. Bob Wachter, who's at UCSF, patient safety expert. He's written books before on medical errors and patient harm and improving patient safety. This new book takes a look at information technology in healthcare and recaps of what's been going on in the last 10 years. What works, what doesn't work, how does it make things better? How does it sometimes make things worse, really? Including sometimes worse from a patient safety standpoint. It's been a really, really interesting read. I'm going to be interviewing him soon and yeah, I would really recommend that.

Book, the name of it again.

It's called the Digital Doctor and when.

Is it going to come out?

In April. It's on Amazon. I mean, someone could pre order it. I'm lucky enough to have an advanced copy.

Yeah. Okay. Very good.

Yeah.

All right, next question is what's your favorite blog or podcast that's not directly related to Continuous Improvement?

My favorite blog or podcast or anything like this.

Something like that.

Well, there's one blog. I mean, I read a lot of sports stuff. There's one blog that is sort of part of a daily routine. It's called Uni Watch.

Yes.

And it's about sports uniforms and trends and sports uniforms and kind of more esoteric discussions of sometimes the business that surrounds sports. And it's a blog. I mean, he's a writer part at least. Part time for espn, but it's one of these blogs. It's not really a blog that's run by a media conglomerate. It's basically a guy in Brooklyn who really geeks out on this stuff. Kind of like I geek out on Lean and so I like that connection with him and his blog. I don't always agree with them, but that's what makes this all fun. Right? I expect my readers don't always agree with me.

Exactly. All right, so the last question I have, it was funny that you were just talking about sports. So I know you're a huge American football fan, so I have to know, do you think the Seahawks blew it with that last play call at the end of the Super Bowl? And the second part, are there lessons that we lean thinkers can take from that sort of pressure packed situation where decisions are so critical, but man, they can be second guessed? Well, when they go wrong.

Yeah. I mean, so I mean, I mean the results were bad. Right? So, I mean, but you know, there's this lean dynamic of, you know, was it a good process, bad result or a bad process, bad result?

Yeah.

I mean, there's the play call and then, you know, I saw somebody yesterday talk about, well, there's been so much focus on the play call, but Russell Wilson really threw that ball badly. He threw it shoulder high. It should have been low. He completes that pass if he throws it low and the receiver has to go down to get it. So there's that difference. You might have a good plan. Bad execution, bad plan, bad execution. I think the one thing I noticed as the Seahawks were coming down in that final drive is that I thought they seemed disorganized. They had to call it timeout after a big play because they weren't ready in time. And I think a lot of that, I mean, the Patriots are known for planning and discipline and being organized. Pete Carroll, maybe it's perception. He's a little more free flowing, loosey goosey. Right. So maybe they weren't prepared. Maybe it was a dumb idea. Like I saw Pete Carroll say yesterday, like, well, we follow a process and we had a plan and we were going to throw the ball on one of those downs and think, well, maybe that was too scripted. Maybe they had too much of a plan. So it's always easy to second guess when there's a bad result. I think the lean lesson, and I think about in healthcare, sometimes we get a good result from a bad process and we need to be looking for that bad process instead of just reacting to bad result. And then blaming an individual. So it's tempting in the sports discussion, we're going to blame Pete Carroll or blame the offensive coordinator or blame Russell Wilson. In health care, I think we need to look for bad process or unsafe behaviors. This is one thing the patient safety movement talks about every. Unsafe behavior doesn't lead to harm to a patient. Sometimes you kind of just luck out or you get away with it. We need to do a better job of looking at bad process. Maybe that's easier to see in healthcare than in football.

Yeah, exactly. Exactly. All right, well, Mark, thanks again. Really enjoy talking to you. And I know you're super busy, so thanks for coming onto the show. Why don't you just wrap things up by telling people how they can connect with you on social media, websites and all that good stuff?

Sure. So probably one best way is leanblog.org I'm hoping one of your guests someday, if you ask them this blog and podcast question, that they might say mine. I've been blogging for 10 years now. I've been doing a podcast for almost nine years. So I'd invite people to come be a part of that community. At leanblog.org, you can find me on Twitter arcgrabin. You can also go to markgrabin.com, which has got links to my book websites and other projects. I'm pretty easy to find. G, R, A, B, A, N. I have a short name, but it's often and easily misspelled. But yeah, leanblog.org is probably easier to spell. And they can find me from there.

Yeah. And so everybody knows Mark was like the guy that's inspired me probably the most on this whole blogging and podcasting journey. You're like the grandfather, I think, of all of us. Okay.

I do have gray hair. Thanks, but no. You're doing a great job, Ron. I'm glad you're doing the podcast. And always try to be encouraging of others. And the one thing I love about this lean blog community that's been around for a long time is that, generally speaking, people have been really supportive and willing to promote each other's work. And that's what I really think a professional community should be about. We sometimes disagree, but we're not trying to step on other each each other or anything like that. Or I'm gonna take blog readers away from you. It's generally a pretty collaborative bunch.

Exactly.

It's always great to welcome others into that fold.

Exactly. All right, my friend. Well, take care next time you're up here in the Keller area. We need to go grab some coffee and hang out.

All right. Thanks, Ron. Thanks.

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