GA 048 | The Hidden Brain with Mark Jaben

You're listening to episode 48 with Marc Jabin.

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 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 and your week to listen to what we're up to and for watching our videos over@gembacademy.com we definitely appreciate each and every one of you. Now then, today, I'm excited to welcome Mark Jabin to the show. Now, a few episodes ago, we had Mark Graben on, and Mark Graben actually introduced me to Mark Jabin. And as you'll hear, Mark Jabin is a medical doctor, and he's really into studying how our brains work. And as you know from past episodes and Gemba Academy's most recent course, Culture of Kaizen, we're really into the whole brain science thing and really talking about, you know, how our brains work and how they kind of influence really everything that we do in life, not just continuous improvement. So during this episode, Mark and I really kind of get into things such as how our hidden brains work and how they're associated with our prefrontal cortex. And then. And then how sometimes once you get past that prefrontal cortex, you know, you can get into the creative side of our brains. And Mark's gonna really walk us through that step by step and really make sense of it. We're also gonna talk about, you know, what we can do to become better problem solvers. And obviously, no matter what kind of continuous improvement you're practicing, we all wanna be able to do that. And then Mark's gonna kind of talk about his take on, like, things like respect for people, which is very insightful, and he really gives an answer that we've never heard before on the show. So I think you're going to really enjoy what Mark and I talk about. This is a bit of a longer episode, so I would really encourage you to listen in chunks if you need to. But there's some really good, powerful stuff that I think everyone will benefit from hearing. So show notes for this episode can be found over@gembapodcast.com 48 and that's 4, 8 for 48. So gembapodcast.com okay, enough for me. Let's get to the show. All right, Mark, well, thank you so much for taking time to come onto the show. So where are you calling in from today, Mark?

I'm calling from Waynesville, North Carolina, in the heart of the Smoky Mountains.

All right. Are you a Tar Heels fan or.

Yes. Gotta be careful about that. Don't alienate anybody.

Oh, yeah, okay, no problem. All right. You know, it's funny. I pinged our mutual friend Mark Graben before the show started, and I just sent him a quick email. I said, does Jabin rhyme with Graben? And he said, yes, laugh out loud. So I want to make sure I get your last name right. But we've had Mark Graben on many times and now we have Mark Jabin.

Right. And I owe an incredible debt to Mark Graben because without the confusion of our names, I would be nowhere in this world. I got asked one time to speak at a conference, and I won't embarrass the person who put on the conference, but they contacted me and were very excited about having me come talk. And as we discussed this over several calls, it became clear that they thought they were talking to Mark Graben. Oh, boy. In fact, they were talking to Mark Jabin. And so there was this moment of angst where I had to call the person up and say, I just want to make sure that you. I mean, I'd love to come talk at your conference, but do you really know who you're talking to? And there was silence and the person disappeared. And they're shuffling for 30 seconds and they come back over and said, I am so sorry, this is so unprofessional. And I said, no, no. I said, you can do one thing for me. I said, let me send you a two paragraph email about why you should still have me talk at this conference, figuring that I would never hear from this person again. And about four months later, they called back and said, well, you know, we've had a cancellation. Would you come? And so Mark Graben and Mark Javin got to be at the same conference together. It was the kickoff of my career. So thanks to Mark for that.

Well, fantastic. I actually, we recently had Mark back on for a second time, and I made sure he knows that he's the godfather of all of his bloggers and podcasters in the lean world. So Mark's a fantastic innovator for our community.

Yeah, most certainly.

All right, well, hey, Mark, so let's go ahead and start with. Why don't you just share your background and tell us maybe just kind of how you Got started in playing around in this whole lean thinking world and then what you're up to these days, right?

So by training in residency and practice, an emergency physician, I've worked for almost 30 years, primarily in small and medium sized rural and community hospitals. And I got my connection to lean actually in 2008 when I had the opportunity to go to New Zealand and live and work. And the little hospital I dropped into was trying to use Lean methodology to improve. And they were struggling with sort of getting started. And maybe because I was the outside American or just I had a funny accent, they sort of asked me what I knew about Lean, which at the time was not much. I read a couple books, I talked to a few people, and we just sort of started. And one day the medical director of the hospital said, you know, we should try doing some of this stuff. And I said, okay. And he said, do whatever you want, I'll support it. So that became sort of a fellowship year for me to try and trial this. I was also fortunate during that time to really get to know people like John Shook and David Meyer, some other folks, and that was just, you know, they took in this fledgling doc, trying to make sense of all this stuff, and that was just, you know, priceless. I had gotten to this point because I'd worked in a place for about 20 years and we had always worked hard to improve our emergency department. And then suddenly we lost our jobs and we were left looking back saying, well, gee, what the heck just happened? How can you work somewhere for 20 years and have it end like this? And it got me thinking about change. And we manage change or don't manage change well. From there I went to work at a bunch of different places and realized that everybody was struggling with the same sorts of things. Nobody was doing change well. And that sent me on a journey to sort of try and figure, figure this out and understand it better. That got me to New Zealand after a while. And when I came back from New Zealand, I was convinced that there was much in Lean that could benefit American health care. I was also happy that when I came back from New Zealand, I guess before I went to New Zealand, if I had mentioned Lean to somebody, they would have said Lean Cuisine or something like that. I was pleased when I came back that now the words at least gotten some pretty widespread play. And if people didn't exactly know what Lean was about, they were familiar with the term. So since that time I've been working with small hospitals. I've continued to practice and really applied this Lean methodology. Not only to my personal habits in practice, but also to organizational things. And that got me to the brain stuff, because even with following the lean methodology, there were times where it was great and times where it didn't work well. So if it always works, why didn't it always work? And that got me thinking a little bit deeper. I came across some articles, talked about sort of brain science and how our brains work in making decisions. Read a couple of books, and over time, pieces of articles would appear. And it sort of put together the pixels enough for me to make a picture of how I see this framework and how I think it really can support our improvement efforts.

Fantastic. All right, well, I can't wait to get into the brain science stuff because as we talked before we came on, I'm fascinated with the topic, so. But before we get into that, Mark, we like to start all of our shows with our guests sharing a continuous improvement or leadership slanted quotation that inspires them. So what quotation inspires you, Mark?

Yeah, actually, I'm going to give you two, if that's okay, Ron. The first one is from Taiichi Ono. Yep. And it says, due to your own misconceptions, your method of production adds unnecessary cost. And the second one comes from Dan Florzone. As a manager or leader, if I'm not getting pushback, I'm not doing my job. And I don't know if you know Dan. He is currently, I believe, the deputy education minister in Saskatchewan, previously the deputy health minister, sort of charged with bringing Lean to the province of Saskatchewan.

Nice. Okay, well, fantastic. Great. All right, well, let's get right into it. I can't wait. I'm so excited for this episode. So let's just start off the bat with why should people care about all this brain science stuff? I mean, it sounds pretty medical. Sounds maybe a little bit boring to some people. Why should we care?

Yeah, we're too geeky. Yeah. You know, I think that whatever organization you're talking about, whether that's Toyota or your hospital or your office or your factory or wherever you work, what we're really talking about here is change. And hopefully change that represents an improvement. Toyota was really interested in how to make cars better. But it's fascinating to me that what they really figured out by keenly observing how people work and how they work together is how to achieve an organizational goal while enabling each person to be successful in their individual work. Really, what they discovered was how people relate to each other. And the secret they found, I think, lies in how humans interact and that, of course, takes us to the brain.

All right, well, so when it comes to improvement in general, how do our brains work?

So it's really interesting. Your brain is really tasked with a simple problem, and that problem is how to act in the face of uncertainty. And it functions with two basic criteria. One, to survive, and two, to use the least amount of energy possible in doing so. So in the near term, what that means actually is acting in the face of the immediate threat. And for the long term, it means to have enough energy to persevere. So to achieve both, your brain doesn't spend the time or energy to gather all the data it needs before it makes a decision. Rather, it just amasses enough. Just enough data from what it observes to have something it can act upon. So the way that we know about this, there was surgery in the 1950s, referred to as split brain surgery. You familiar with that, Ron?

No, I'm not, no.

So this was surgery that was developed for people who had seizures that couldn't be controlled. And what they actually would do would be to take a knife and cut the connections between the two halves of the brain. Actually, it's a really simple procedure, believe it or not, and it didn't particularly work well for seizures. But what it did do is leave a whole bunch of people who now had their right brain and left brain split apart and no longer communicating. So, for instance, that's how we figured out that your vision, for instance, is crossed. What I mean by that is everything off to your left is not just being seen by the left eye. It's being seen by the inner half of the left and the outer half of the right, everything off to the left and vice versa. So there are parts of the brain that remain that work together. But now in these split brain patients, they were separated. So they would do these research studies where they would show a picture off to the right, which goes to the left half of the brain. The left half of the brain is where you assign words to images. So in the classic study, they would put a chicken coop out to the person's right visual field, and they would say, do you recognize it? And they go, yes, that's a chicken coop. And then they would put a series of pictures in the other visual field, and they would ask the person to pick the one that was the most appropriate. Now, for you and I who haven't had split brain surgery, our brains are communicating side to side. They're looking at all these pictures and they're figuring out which go together. But these people couldn't do that, the classic response would be a shovel. And the researcher would say to the person, well, chicken coop in one side, shovel on the other. Why did you pick the shovel? And the person's answer would be something like, well, I've got this chicken coop. It's full of chicken poop, and I've got to clean it out, so I need a shovel. There was never any mention of chicken poop. There was never any mention of having to clean it out. What their brain did was concoct a story that fit the available data that it had. Never mind that the story was right or wrong. That's how your brain makes a decision, saw just enough to do that. And the really interesting thing is when the researchers challenged the subject about why they got that story, the subject defended that story like it was the absolute truth and would not waver from it. So what this means is that our brain acts by making plausible explanations, a likely possibility, a perfectly reasonable judgment based on the information it has at the moment, and then treats it as a truth so it has something it can act upon. So our brain makes a story and then looks for a way to fit the facts to that story. So what this means is you can't really trust that what your brain is telling you the way it is is actually the way it is.

Okay. Goodness gracious. So, I mean, what kind of repercussions does that have to us as continuous improvement practitioners?

Well, yeah. What does it mean? It means that the way that I see something is not the way you see something. The way I observe what's going on at that time, say, on the factory floor, is not necessarily the way you observe it. How I interpret it is not the way you necessarily interpret it. And that gets us into trouble because that leads to conflict. But there's another part to this too, Ron, which is. You ever watch Wheel of Fortune?

Yeah.

The first thing they do is they start a game where they put up a phrase with blank letters. The first contestant who gets the phrase wins. And then what do they do? They start to letters one by one. And at some point, this contestant sees enough to put that together. They see a pattern, and when they see enough, they shout out the phrase.

Yes.

If they're right, they win. But often the contestant is wrong. So their guess looked possible. It just wasn't right. Yes. So this gets us in trouble because we believe that that's the truth. But sometimes it's wrong. And this is really the fundamental reality that underpins improvement work, because if you're sitting around a table with People, and everybody's got their view of how it ought to be, where is that going to go? But if everybody is at the table understanding that their view may not exactly be correct or right, or may not be the best option at that moment, then that opens the door to an honest discussion about options and finding something that works. Oftentimes, when it comes to improvement, we talk a lot about what we do. What should the standard be? What are we going to put in place? What's our action plan? What's our time frame? But if we've not gotten together on what that story is, then we're going to be going in very divergent pathways. As you can see, we each have our own story that our brain concocts. Now, how about the conserving the energy part of that? How does the brain go about actually concocting this story? I guess so the brain does it with a tiered response because it doesn't want to spend any more energy than it has to. So to best understand this, I like to have people imagine the following diagram in your brain. And just keep this in mind as we walk through this. So think of this to your left, the hidden brain. Arrow over to prefrontal cortex. Arrow over to creativity. Okay? Because this is the pathway that our brain follows when it comes to making decisions and choices. It's what it follows when we talk about improvement work.

Just so everybody knows, a prefrontal cortex has to do with, like, where decisions are made. Right.

Well, we're going to get to that in just a minute so people will understand what it actually means. But just hold that diagram in mind. So as I say, so, whether you're making decisions or choices, whether you're doing improvement work, whether you're trying to be creative, it all follows this same pathway. And that's the framework we'll discuss. So the reality is that although we are rational creatures, we are capable of gathering data, analyzing, and acting upon it. It's just not how we make the overwhelming majority of our decisions. So that happens in the hidden brain, and the hidden brain is called that because these are functions and processes that are outside of our awareness. We don't know what goes on in there, and we really don't know how it works. We do know that it works by applying patterns of recognition and response. And if you're familiar with Charles Duhigg's.

Book, the Power of Habit, Basal ganglia.

Right. I mean.

Yeah, exactly right.

Those connections between the cue, the response, and the reward, which is what he talks about, they can be quite unfathomable they can be really mysterious and don't make much sense. We don't know why our brain makes necessarily the connections that it does. Yes, and the other thing of interest is that that hidden brain is made up of a bunch of different areas, each with their own interest, each telling you what you should do from its perspective. So, for instance, you go into a store and you want to buy a shirt, and you look at that shirt and you like the color, you like the way that shirt looks. Well, part of that brain is saying to you, oh, you don't want to buy that. That's way too much money. And part of your brain says, oh, that looks really cool. You really want that. And part of your brain is saying, well, you know, but you already got all these other shirts. Maybe you don't. And so this is all going on, each area of interest sort of shouting at you, telling you what you should be doing, what you come away with, the feeling or intuition you get is really the decision that your brain makes. And it's rather than being a mediated settlement, it's the loudest voice wins. And we're set up that way because we don't have time to negotiate. We've got to be able to act in the face of that immediate threat. So that's how it's set up. And the amazing thing is that this works actually quite well, probably because your hidden brain is really good at incorporating your values and beliefs into its decision. So if that response is judged to be satisfactory, meaning that it's likely to lead to success, then our brain is fine. That's what we do. And we don't spend any more energy and go on. And this works really well, except for when we face a new or novel situation for which there's no pre existing pattern, and then try to force a pattern into a situation where it doesn't exactly match. That's where we get to mistake and error and a choice that might not be the best one possible at the moment. So that now is the job of your prefrontal cortex. The job of the prefrontal cortex is to monitor those hidden brain choices. So this is the second tier. It takes a bit more energy to do that. So the prefrontal cortex is on the lookout for these patterns and responses that don't seem quite right. Some of that takes place inside of our awareness, but much of the prefrontal cortex work takes place outside of our awareness. What the prefrontal cortex is really good at is focusing on a specific issue and bringing its vast powers of Analysis, but it's not very good at factoring in your values and beliefs. And the problem with the prefrontal cortex, it has a very limited capacity. Research indicates that it only can handle four to nine variables at a time, which is why multitasking is a myth. Your brain can really only do one thing well at a time. Yeah. And it's why interruptions wreak such havoc on your ability to get anything done. The prefrontal cortex really appears to do its work not by making the best choice of the options, but by eliminating the options that don't fit the criteria it's using for success.

So if we're running, like, experiments or anything like that, this is all prefrontal cortex, is that right?

That's right. And if you think about pdca, what are we doing in pdca? We're putting together experiments. We're trying them. Not so much to find out what's going to work, but to find out what doesn't work. And in that way, reveal the best options, essentially, how your prefrontal cortex is working.

Yeah.

Is it? Right. So then once your prefrontal cortex, if it cannot find a satisfactory response, only then is the brain willing to spend, to go to the third tier and spend even more energy to make new and novel connections that heretofore did not exist. So that's what creativity is. But the brain is not in the frame of mind to spend this energy unless there are no other good options. So when we talk about innovation and creativity and fostering creativity in ourselves and our organizations, there's a specific pathway to get there. It runs from the hidden brain, the prefrontal cortex, to this creativity. You can't skip steps and get there. You can't short circuit the process, because your brain is just not interested in going there unless it absolutely has to.

Wow.

Yeah. So there's a lot that has to go on before we can tap into creativity, right?

Yeah. Yeah.

Right. And then there is this concept out there of the emotional brain, the reptilian brain, the primitive brain, that it's out there trying to hijack us, and that only if we can tame it with our rational capacities, then we'll all be better off.

Yes.

And, you know, interestingly, this dates from the time of Plato. It just happens to be wrong in terms of how your brain works, because there are cases of people who have had the connections between their emotional brain and their prefrontal cortex, between their hidden brain and their prefrontal cortex either cut or damaged, and those people lose the ability to make effective decisions either they make choices that are risky or not in their interest, or they're just not even able to make a choice. So we know the better image to me is the image of a scale. So that what's going on in your brain is a constant rebalancing, moment by moment. The prefrontal cortex weighing the observed circumstances against its sorting criteria to decide whether to defend the story that's coming from the hidden brain or challenging. Challenging it either looking for a response that's more likely to be successful and only if none is successful is it willing to then tap into the creativity to find another option. So I like this image of the scale. It's a constant balance. We need our emotional brain, we need our hidden brain because it helps us factor in our values and preferences. We need our prefrontal cortex because we don't want to get off track and be led astray. And the other thing about this whole pattern, Ron, is that once you identify a successful pattern, the brain wants to move it to an area of lower energy. And that's why we practice to incorporate the new pattern. Because as those connections become stronger through practice, that's what's referred to as neuroplasticity. It can be moved out of an area that requires so much attention and focus and then moved to an area of lower energy, hopefully to the hidden brain where we don't have to devote so much energy to it.

It's where habits then are developed. Right. Good and bad.

Right. And also why we want standards. Right. Because they help us, they help us preserve that limited capacity of the prefrontal cortex.

Sure, yeah. Now I've got kind of a little bit of a random question here. So I recently attended a Daddy daughter retreat with my 12 year old daughter. And during the retreat the girls went off for a little, there's a little talk or whatever. And then all the dads stayed and had a talk as well with a speaker. And the speaker went on to explain about, she was talking about the prefrontal cortex generally, she was saying that it's not fully developed, especially in children. But until we're around the age of 25, this prefrontal cortex, like making decisions, choices and so forth, it's not fully developed, for lack of a better word. And that's why young people and even say college age students oftentimes make some just really boneheaded decisions. And fact of the matter is, in some cases they might not be able to help it. I guess my question is, first of all, do you agree with, agree with that? And then if so are there other ways that our brains kind of evolve, for lack of a better word, as we get older?

Yeah, I think that's correct, according to the research. You know, if you think about kids with ADD, for instance, oftentimes they will outgrow that ADD by their mid to late 20s, early 30s, because so much of that is related to the. Their prefrontal cortex not being as well developed as it needs to be. So, yeah, most certainly. I think that's right. Our teenage kids make boneheaded decisions just like we did. And I guess the good news is most of the time we survive them. But it's also, there's some research that almost indicates that 25 isn't really sort of the age of maturity for your prefrontal cortex. Sometimes it's even later into your 30s. So I think it's.

Yeah, I mean, is there something you can do to, like, accelerate that? I mean, I got some kids here, Mark.

Well, there actually is, and we're going to talk about that a little bit more, because I think the very thing that would help in that situation is the very thing that would help us when we work with others in our organizations trying to manage and work through change, how we interact with each other. So we'll get to that in a minute. But I think there are some things that you can. Doctor, the other question you asked is, are there other things that happen as we age? And I think that there are. What I find is that it's much harder for me now to not be distracted by things that come up. So for me in the emergency department, this is really important because I might have several patients to take care of, and if I'm thinking about a particular patient and a lab result, another patient pops up on the screen, I need to keep my focus on that patient. Right. We talked a little bit ago about how your prefrontal cortex is limited and how interruptions really impact your ability to stay on task and be productive. And I find it way harder now to not get sucked in by that thing that just popped up. So if you talk about being at work and emails pop up on your screen or you get calls and interrupted in the middle of doing an important task, your brain just cannot go back to that very quickly. And what I find over the last few years is I'm having a harder and harder time really keeping that prefrontal cortex focused where it needs to be. So I think about people who are in leadership positions are generally in the latter parts of their career. And so the distractions just have that Much more of an impact. I heard a podcast just recently by a woman who's written a book called the Teenage, a neurologist, I believe. She's up in Massachusetts. She said in her work, the studies indicate that the point in our life where we are the most energetic, the most capable of managing many things, the most case of staying on task and not being distracted, really, is your late 30s, early 40s. And after that, it becomes harder and harder.

Oh, I'm in the sweet spot then. I'm 41, man, so I guess it's my prime.

That's right. So get it done. Get it done now. Okay.

All right. Well, let's kind of transition now. So we've talked a lot about how our brains work. You know, some of the challenges that we have. But the people listening to this right now, they're problem solvers. They're continuous improvement practitioners. So they need to know, and I want to know, what can we do to improve our brain's ability to be good problem solvers?

Yeah, well, I think the first thing is, you know, we've talked about how the brain works, ideally, right? How if you have a hidden brain that has good patterns and effective habits so that you can keep up with all that's going on around you, and you have a prefrontal cortex that's well rested and well watered and well fed and uncluttered, so it protects us from doing something dumb. And if we have creativity that we can count on when there is no apparent path to success, this is the way your brain is made to operate. And it's actually a pretty ingenious system. But there are a few little problems there. There was a study by Gregory Burns, who's a neuroscientist and a physician at Emory. They took people who had very fixed beliefs about something, and they put them in a functional MRI so they could see what parts of their brain were lighting up. What they found was these people with very fixed beliefs. What lit up was their amygdala. Now, the amygdala is sort of your flight or fight stress response area, as I was talking about before. Your hidden brain is made up of all these different areas, each with their own interest. The amygdala is focused primarily on your individual survival. It doesn't care about anything else. It just wants you to survive and will do whatever it takes to get that. So then they took these people out of the functional MRI and they asked them a question. They said, if I pay you $100, will you vote differently on a survey than what you Just expressed some people would and some people wouldn't. They took the people who were now willing to answer differently on that survey, they put them back in the functional mri, and they found out that now they were processing in their prefrontal cortex.

Hmm.

So what that means is forget having a fruitful discussion with someone who's processing from their amygdala. They're just not in the frame of mind. It's just not going to happen. So, you know, the other way that I watch this all the time is if you have kids that play soccer.

Yeah, I do.

Okay. So the benches are on one side of the field. The parents are made to be on the other side.

Yes.

Good decision, right?

Oh, yes.

Right. And there's two groups of parents following each of their kids teams. So the referee makes a call. And what happens when the referee makes a call? One group of parents are irate. That's the worst call ever. The other parents are going, yep, seemed that way to me.

Yep.

And then you got the poor referee out there standing in the middle of.

All this, who's 14, you know.

Right. Yeah, exactly. And so what's happened here? So you've got all these people who've looked at the very same thing.

Yes.

But they've interpreted it totally different.

So one is using their prefrontal cortex and one is using the hidden brain, the amygdala. Is that right?

Well, no. What's happened is that their amygdala is looking at it from, I want my kid to survive. I want their team to win. And so they're going to look for the circumstances. They're going to observe what supports their story.

Okay.

That's what the brain does.

Yes.

At the same time, their prefrontal cortex is catching this story coming from the hidden brain, saying, oh, do I believe that? Do I agree with it or not agree with it? It's taking the observed circumstances, it's applying its criteria for success, and then it's modifying, defending, or challenging that story. So what's happening here is you've got this. It is the perfect example of this scale that I mentioned before, this constant rebalancing moment by moment. And if two people look at the same circumstances and see something differently, their decision is going to be different. And even if they look at the same circumstances and agree that they're seeing the same thing, if they're applying different sorting criteria to what's important to them, they're going to have a different decision. So if you think again about sitting around a table with a group of people Trying to work something out if you're not seeing it the same way and you have different risks that you are concerned about. Right now, my amygdala is concerned about my survival and success. The thing that I'm the most scared about right now is what's going to be the most prominent. If there are different risks at that table and different views, decisions are going to be really different. But you know what gets worse than that?

Great.

So there's a study by some Dutch researchers where they took they. Well, I guess first I should say, are you familiar with mirror neurons?

A little bit.

Okay. So mirror neurons are special neurons in the motor and sensory area of your brain. And they work by, for instance, if I raise my left hand, you can't see me raising my left hand, but the neurons that would raise your left hand are now firing. Just because we're talking about this, Mirror neurons are really important because that's how we learn, by imitation. There are some people who feel like our ability to live together in communities. Mirror neurons were an evolution of that because you got to be able to take other people's needs into account. And this was a way for us to factor someone else's needs into our brain's data set. It's why, if you look, if you drive by the road, you see and there's an accident, what happens? The cars grind to a halt, everybody's rubbernecking, maybe getting into their own accident. Right?

Yeah.

Guns are mirror neurons at work. They are living, in a sense, that experience of what they're watching by the crashed cars on the side of the.

Road makes you wonder if that's why people are so addicted to tv, you.

Know, so these Dutch researchers, and you can see these mirror neurons fire on functional mri. So these Dutch researchers, they took people and they put them in situations, in scenarios where they had more and more power control over each successive scenario. And what they found when they put them in the functional MRI is that with each degree of increasing power and control, their mirror neurons were less and less active. So what that means is if you think in terms of leadership and management or even dealing with your colleagues, if it's important, if we're looking at things differently, if we have different criteria of what the risks are that are important to us, and we're trying to work in a group to come to a mutually acceptable decision, we have to take into account all those risks if we're going to find something that really works. So the definition of the word or the translation of the word kaizen change for the Better with the connotation that it's better for all. If you're going to make it better for all, then you have to incorporate everyone's risks into whatever you're going to do. But what this study is suggesting to us is that we're less inclined to do the very thing we need to do in that situation, which is incorporate what others sees and incorporate the risks that they're focused on. So when you form your story, you're not paying so much. The more power and control you have, you're not listening, you're not paying attention, you're not factoring in the other stories. And once you form your story, you're less able to modify it from what you learn. So think about how we move up through hierarchies and organizations, how we promote people, how people get there. So when somebody on the front line looks at the manager or the leader and says, man, you just don't get it, or something gets suggested about how it should be done, and the people in the front line just sort of shake their head and saunter off. But what they're saying to us is, man, they just have no idea. It's not the leader's fault necessarily. It's the way their brain is working. So unless we do some things to counteract that, we fall prey to being too focused on our own story, treating it as the truth, and not recognizing that there may be stuff missing from that story.

Mm, fantastic. You know, when you were talking earlier, you. You, you just. You said two words, and then you quickly moved on. But you talked about the brain's need to be well rested. And I'm curious if you could maybe, you know, kind of, we're coming back to what can we do? What can we, as problem solvers, do to be at our best? And I'm assuming, as basic as it sounds, getting enough sleep is going to be an incredibly important part of this journey, is it not?

Well, yes, it is. And if you out there get to work late hours, like I do in the emergency department, there's an interesting thing that happens about three in the morning, which is if somebody shows up with a box of donuts, they don't last very long. Now, these are people who are generally pretty healthy people, pretty healthy conscious people, and they eat well. But at three in the morning, that donut looks pretty darn good. And what's going on is that my prefrontal cortex is not able to fend off the voice coming from my hidden brain saying, eat that donut. You need some calories. So there's no question that we need our prefrontal cortex to be functioning well. It's the oversight manager for what's coming out of the hidden brain. It's weighing the balance about whether it should defend the story it's getting or challenge the story it's getting. It is sort of the central hub of this whole decision making process, and yet it's also the most limited in its capacity. Remember, I said before, it can only handle four to nine variables at a time. So, yes, if you're not well rested, if you're dehydrated, if you're not well fed, your brain only works on two things. Glucose, sugar and oxygen. Sugar and oxygen, that's all that it works on. So if it's depleted, the most sensitive parts get depleted first, and that's your prefrontal cortex. So late night meetings, working all night, coming back to the office early in the morning. We think we're getting more done, but we're really wasting a lot of time and energy in doing so.

Yeah, yeah. Oh, fantastic. Well, gosh, I could talk about this all day long, but, you know, this is supposed to be about an hour long podcast. Not careful. We'll be on here for three hours. But I guess the last question I have in this section, Mark, is if someone wants to learn more about just how our brains work in general, and they don't want to necessarily resort to medically based books or anything like that, or textbooks, what advice would you have for them?

Well, there are a couple books out there that I think are good places to start. One is a book called How We Decide by Jonah Lehrer. And the other actually is a book that I'll be putting out this summer. Not to make a plug for myself, please do. But it's an attempt to really take this information and put it into a usable format and a framework that people can use. So I think we'll talk about that maybe a little bit later, how people can connect to that.

What's the name of your book?

Well, it's interesting.

You don't have a name yet.

Yeah, well, we're between two, so maybe what I'll do, Ron, we could throw this out to your listeners and people can respond with which they think is more appealing, which they think is best. And we can acknowledge that in the book.

There you go.

So what are the choices? So the choices right now struggle over, change how your brain gets in the way and what to do about it. That's one choice. The other is unfreeze the brain. Why organizations struggle over change and what to do.

For me, it's easy. I love the second one to me, but maybe that's my. I don't know, my hidden brain or that.

Exactly.

Yeah, yeah. All right, well, listen, Mark, Fantastic. Let's go ahead and transition now into. Into the Quickfire section. And. And as I mentioned to you before we started, I got a few new questions that I'm going to kind of gonna sneak in here on you. So. So let's see, the first one, though is, you know, we Lean thinkers, we spend a lot of time talking about, about the two pillars of continuous improvement, Respect for people and continuous improvement. The two pillars of Lean, if you will. But, you know, continuous improvement is pretty easy to put our fingers on. You know, all the tools, just in time, so forth. But what about respect for people? It can be hard to put our finger on what that means. So what does respect for people mean to you, Mark?

Well, I'm going to define it for you, but first I need to do a little bit of background. So we have a few minutes. We can sort of delve in just a little bit.

Definitely.

Okay, so I'm going to start off by giving you an example, and we're going to transition this example to understand what respect really means, I think. So. The example are metrics. So if you think about metrics, they're very concrete, they're very certain. It provides something that's certain that your brain can grasp hold of. That's why we like metrics so much. But the problem with a metric is that any metric is really just an incomplete approximation of a desired outcome. And if you've two comments that I remember from Dr. Russell Acoff, the contemporary of Dr. Demings, if you know him. One is, you should not improve a part unless it improves the whole. And the corollary, you can be guaranteed that you will not improve the whole if you only improve a part. Well, what happens with the metric? We become focused on the metric. We're just improving a part, and our brain wants to do that. And so if we lose sight of what the desired outcome is, that's attached to that metric. There's where we get into conflict. There's ambiguity there, right?

Yes.

And remember, as we started, the fundamental premise at the beginning of our podcast is that we each have our own view, right? We each have our own story. And unless we're on the lookout for what's missing from our story, then we miss an opportunity to really make our best decisions. So if two people are looking at this metric differently, or they have a different way to achieve that. What's the result? It's going to be conflict. And we all hate conflict. We think that conflict happens when somebody did something wrong or I did something wrong. We hate to take it on. We try to run from it. But in fact, conflict is exactly the way your brain works. If you think about what's going on in the hidden brain with these varying voices, if we think about the prefrontal cortex trying to sort through various options and find the one that's left. And so this is why the respect for people principle is so foundational, because conflict is not an outlier state. Conflict is the standard, and it's what we should expect. And resistance, pushback is what we observe in someone who's in conflict. That's how they're expressing their conflict. That resistance is likely the only reliable indicator that you might have that a different view of the circumstances exists or that there are risks that you're not factoring into your story.

That's so hard, though, right? It's so hard.

It is. So if you think back to the comment, the second quote I took from Dan Florzone, if I'm not getting pushback as a manager, I'm not doing my job. But that's not easy because resistance can take many forms. Right. Certainly people can say no and have their arms crossed and it's pretty obvious. But what about when somebody just doesn't follow through on what they've agreed to do? What about when you're sitting and you propose something and there's silence? Yeah. What about suggestions? Even suggestions are a form of resistance because the person wouldn't be making a suggestion if they were pleased with what was going on. So we need to embrace this resistance to find out what's missing in our story. But the kicker is that you can ask all you want, but nobody's going to share with you unless they believe you're a credible partner in what's going on. Unless they believe you have their success in mind, because otherwise they just see you as a threat. And where does that put somebody? In their amygdala. And as we know from the burn study, if you're processing your amygdala, forget having a fruitful discussion. So the key there is we have to be credible. We have to be seen as a credible partner. And like a nickname, you don't determine your own credibility. Somebody else determines whether you're being credible or not. That's determined by the other person. So how do we be credible? There's good sources for that. The Point of this is the only way that you're going to get useful information to help you find out what's missing from your story is to get to this resistance. And unless people feel that you're respecting them, they're not going to be willing or even able, if they're in their amygdala, to share that. So to me, the practical application of respect lies in how I deal with your resistance. If. If I'm seeking compliance to a standard and accountability because it's something I want you to do for me, how do you feel about that, Ron?

Yeah, right, yeah.

On the other hand, if I'm seeking compliance and accountability as tools to find out the circumstances where the standard doesn't work, thereby finding ways to expand its scope and make it better, how does that feel to you? That feels really different. So respect is really the. It is the way to open up the possibility going forward. And of course, as we talked about, you're not going to get to creativity innovation unless you've worked your way through what your hidden brain and what your prefrontal cortex are doing. So to me, that's really why respect for people principle is so foundational and fundamental.

It reminds me back in my corporate days, I had a boss who told us, I was. He had, I think, eight managers that reported into him and I was one of them. And he said, he used to tell us in his staff meetings that, you know, if all eight of you agree with me, I have seven too many, or something like that, you know, and that's. I guess that's what he was getting at, you know, is we have to stand up and challenge the status quo. That's how progress is made, I suppose. Right.

Well, if you think about Abraham Lincoln, what he was famous for was he had a cabinet of. I forget what the title of the book is now, but he had a cabinet of people who were just coming from very different angles. And he welcomed that discussion because that helped him sort out in his own mind the full array of risks and a full and honest appraisal of what the current situation actually was.

Yes, Mark, what's the best advice you've ever received?

I was thinking about that question, I think while I was living in New Zealand, I had the opportunity to attend a lean conference in Brisbane, Australia. And it's where I met John Shook. And I love this to be advice from John. He's given me so much advice, as I'm sure he's done to so many people. But the story that I remember is I was sitting across the street in the National Museum in Brisbane, in a gallery that was an Aboriginal art exhibit. And I was sitting on a bench in front of this really interesting picture, very interesting colors. And I was kind of looking at it, and all of a sudden I realized there was somebody standing next to me. And I turned to look, and it was David Meyer, who was also talking at that conference. And we got to talking, and it was pretty clear I was from the States. And he said, well, God, jeez, what are you doing all the way here? And I explained to him that I was actually living in New Zealand. He asked me why I was at the conference. I was at the conference to learn about lean. But I was also at the conference because I was really struggling with a particular issue in our emergency department back in Taupo. And I just couldn't get my head around even what the next step ought to be. And so he listened to me, and he listened to me talk about what this was, and there was just silence. And he said, so, what's the problem? And when he said that, it galvanized all the things rumbling around in my head. And I got up from that bench and knew exactly what I needed to do to go forward. And it reminded me that the hardest thing for our brains to do when we're in the middle of something is to pause even when we recognize it's not going well, and go back to the very beginning and revisit all the way that you got to where you got to to make sure that you are truly on track to where you want to go.

So when you said, what's the problem? Meaning what problem are you trying to solve, is that what he was getting?

Yeah. What that question did for me is it took me back to the very beginning, a whole path there, and allowed me to rethink and think of it in a different way. I made new connections. I was able to be creative because it got me past my block. But what it did is it forced me to go back to the beginning, and that is really tough for our brains to do. It's hard to do in diagnosis with patients. It's hard. It's tough for us.

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

Yeah. Again, I think whatever we can do to support and unclutter and unburden our prefrontal cortex is what we really need to be focusing on. For me, one of the things that I've done in the emergency department is if I've got 10 things to do for seven patients all at one time, I'm way past my prefrontal cortex's ability to stay focused on any one of them. So what I do is I sort of chunk things together. I'll take the next 15 minutes and I'll say, all right, these are the three or four things I'm going to accomplish in these next 15 minutes. Short of somebody coming in, needing to be actively resuscitated, they're about to die. I generally can chunk that 15 minutes, get that done, and then look up, reassess where I am, what new has come in, what's different, do my next 15 minutes. I find that if I really focus myself that way, I get through all of that, work way more effectively, way less stressfully. That's one of the things that I've done that's really, really been helpful to me.

Love it. Yeah, that sounds similar to this pomodoro technique where, you know, it's kind of a 25 minute burst of just turn everything off and do one thing for 25 minutes, you know, and then refocus and to take a break or whatever you might need to do. But, yeah, that's a fantastic tip. So I know you've already mentioned some books, and so it's always tough to ask again, but if you could recommend one book related to, say, Continuous Improvement or leadership, what would it be and why?

Yeah, I think Michael and Freddie Ballet's book lead with respect. I think that Michael and I have had some conversations about this sort of stuff. He doesn't necessarily buy into the neuroscience aspect of it, but what's very interesting to me is he's come at this from his experience, which is quite vast. I've come at from this neuroscience and we've gotten to the same point. It's one of the comparisons that I make in my book is I take his diagram and really explain that from this brain science side. So I think this is really, really something important. They are describing the practices I'm going to bring to this, the underlying connection that really gives this some substance. So to me, when I read that book and talked with him and saw the diagram and heard him speak a few times about it, I really think that's spot on.

Okay, so let's diagnose Michael Ballet right now. So he. He's not a. I'm not mean to pick on Michael. We've had him on the show before, great guy. But someone like that who has got, you know, tremendous background, tremendous lean experience, real practical world experience doesn't buy into, say, brain science or the way that, you know, what we've been talking about. What is it about? That type. What is it about? And again, I'm not trying to pick on Michael, but like his. His brain and everything that we've been talking about, what is it? Where is the struggle happening where someone can't adopt a new way of thinking? Because that's also at the heart of getting others to just buy into continuous improvement in general. Some people might just not buy into it. That's got to be a brain situation, isn't it, doctor?

Most certainly. So if we go back to the Burns study, someone processing from their amygdala is just not in the frame of mind to consider other options.

They.

They're defending their survival. When people have made a decision that they don't want to do something, they look at this lean stuff and say, this is not for me. For instance, what's happened is in their brain. Their hidden brain has given them a story and a plausible explanation of how they can be successful.

The shovel.

Right, Right. They've given them an explanation of how they can be successful. And that prefrontal cortex is looking at this lean stuff, and it's not buying it in the balance in the scale. It has decided that for whatever reason, whatever risks it's paying attention to, that this is not likely to be a more successful path than what I'm doing right now.

Yeah. Or to your point about how they can only handle six to nine things at one time, maybe they just feel like this is just one more thing and I just can't have another thing. Get this lean thing out of here.

Right.

I don't.

Well, you think about what we do to people with all the metrics that we have to the accountability, you know, in healthcare, with electronic medical records and all this other sort of stuff, all we've done is overloaded people's prefrontal cortex and keep them from doing the thing we want them to do, which is to think deeply about the complex patient problem, whatever they have in front of them.

Yeah.

So, you know, so if we talk about helping that. So the trick is, how do we get that person now to balance that scale in favor of challenging the story and saying, hey, maybe there's something here with this lean stuff. Maybe I do need to investigate this. That is the real trick in the book. One of the things that I put forward is, again, what I'm calling the engagement kata, for lack of a better name, really designed from this brain science stuff. What are the questions that we need to delve into for them and for us so that we can get ourselves to a balance of that scale that is saying, hey, let's take a look. Maybe there is something here. Because once you're there, now we can employ all the lean tools and techniques. People are willing to participate and be engaged. Up until that point, you're talking to a dead wall because they're just. They've decided that in that balance, it's just not worth devoting the energy to go there.

Yep, all brain science, right?

That's what I believe.

All right. Hey, so this is a new question that we have for the Quick Fire. So do you have a routine or ritual that you follow when things aren't going well and maybe you just need to recharge and refocus?

Are you talking about like an individual encounter with somebody or just. I'm looking at my work world and I'm kind of overwhelmed.

You know, it's Wednesday and you're like, golly, man. I just feel. I feel unaccomplished right now. And. And I need to. I need to. I just need to recharge. I need to refocus. Maybe when you were writing your book, I don't know, maybe you've gotten to a point where you were in a rut and you're looking at this blank sheet of paper in front of you, you needed to do something.

Well, I'll say two things. I found that I had to take a dose of my own medicine, and I tend to do my best work late at night. And I would be writing and trying to get a segue between two ideas and two paragraphs. It just wasn't happening. It just was quite lame. And I would just go to sleep knowing that when I wake up in the morning, it's going to be there. Because I had reached a point where all my options, none of them were satisfactory. My brain was ready to tap into that creativity and uncluttered by sleep, it was able to provide that to me again. I think when I find myself on Wednesday that way, and of course, as an emergency physician, my Wednesday might be Monday, Saturday might be 2 o' clock in the morning. But I find that getting things on paper is really beneficial. I have, in essence, a personal kanban, which is my list of all the things I've got to do on the left column, the things I want to do today on the right column, and the stuff that's in the holding pattern in the middle. There's lots of places that have talked about that. But what I find is when I'm just overwhelmed and stuck too much, that again, helps me to focus and say, all right, what's my next 15 minutes? What's my next two hours? What do I want to get done? Not just what I need to get done, what I want to get done, that's what I want to do. And I think that's really, really important.

When you were talking about how you decide that you just need to go to sleep, I thought you were going to say you decided you need to go find a donut.

Well, no, that's before I go to sleep.

Just kidding. Get that glucose. Right, right. All right. So what's one knowledge or skill area that you feel you need to improve in order to be more successful at practice?

I think that even knowing what I know and even believing what I believe, out of all this, I still have to try. When I face resistance, to pause and say to myself, that is an opportunity to find out what I'm missing from my story. What am I not taking into account that is so hard for us to overcome that function of our brain? And so I'm constantly. And we have so many opportunities. The good thing is we get lots of practice. Right. There's so many opportunities in the day where we face resistance, but it is really, you know, that's the benefit of Akata, which is to have something to fall back to and to practice it so that it becomes more routine and more valuable to you. But I still find that even with this, I have to really be attentive to pausing myself and saying, oh, that's my hidden brain coming through. And I need to sort of pause and let's just sort of. Let's deal with this the way that we can deal with it fruitfully and productively for everybody. Yeah.

And I think that just about anybody listening to this, and myself included, if anybody says that they're good at dealing with that resistance, I think they're not.

Well, I'll tell you, there's an interesting thing that I've observed throughout my career in medicine. When I talk to my colleagues, it happens to them, too, which is just about the time that you're doing a really good job and you think you've got this dialed in. Look out, the screwball's coming.

That's it.

Yeah.

Oh, Mark, I really enjoyed talking to you today. So let's go ahead and just kind of wrap the show up with, why don't you share any final words of wisdom that you might have, and then why don't you tell people how they can connect with you over social media, websites, anything like that?

Yeah. So the best way to get in touch with me two ways. One is an email jabinmmol.com so it's J-A-B-E-N-M-Maol.com and the other way is mjabinleadership guru G U R U. So my book has been an evolution from the Lean Leadership Institute folks with George Churchillis. It's going to have a forward by Jeff Leiker. We're going to put the book up as a PDF for a while on that website so that people can have a look, think about what's there related to their experiences, give us some feedback, maybe try the engagement COD if they're so inclined and give us their feedback about that to make it sort of an open source thing and we'll include that in the book and give people acknowledgement for that. So really looking to make this sort of an evolutionary thing. So through the Lean Leadership Institute website, that's the other way to get in touch with me. Either way, people have questions, fire them off. I love to talk about this stuff and love to hear about your experiences with all this.

Fantastic. Well, I can't wait to read the book myself and really enjoy talking to you Mark, and keep up the great work and hopefully we get to meet in person one day and maybe we'll sit down and do another interview.

I'd welcome that. That'd be fabulous. And listen, I'm honored that you had me on and hope that this has been helpful to folks.

Yeah, fantastic. All right, take care.

Alrighty.

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