GA 068 | The Model Line Approach with Lee Fried and Kris Box

You're listening to episode 68 with Lee Fried and Chris Box.

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 Genda Academy and I'd like to welcome you to another edition of the Genda Academy Podcast. As always, thank thank you so much for taking time out of your day and your week to listen to the show and for watching our Lean and Six Sigma trading videos over@gembaacademy.com we definitely appreciate each and every one of you. Now before we get going, I want to just give a quick shout out and reminder of the upcoming AME International Conference which is going to be held in Cincinnati, Ohio this year on October 19th through the 23rd. Now we are media partners with AME and have a great relationship with them. This AME conference is my personal favorite conference of all and Gemba Academy is going to have a really nice booth. So if you are going to be there, please come by and say hi and pick up some free swag. I think we have some of the best swag at the conference. Also, if you are planning to attend and you haven't bought your ticket yet, we can save you 10% by using the coupon code GEMBA15. Now all the details for how to register and how to get that 10% discount can be found on a special webpage we set up called the URL is gembaacademy.comame so gembacademy.comame also on that page you're going to see a link to RSVP for Gemba Academy's cocktail party. Now we are, we did this last year and we're going to do it again this year. It's going to be on the Tuesday evening from I believe it's 4:30 to 7:00pm it's going to be really close to the conference at the Hyatt, which is I guess right next door to where the conference is going to be. It's free drinks. We're going to have beer, wine, cocktail, soda, water, whatever you like to drink. But there's no sales pitch, there's no presentation. We just want Lean thinkers to come together and hang out for an hour or two and enjoy a drink on us. So again, gembacademy.comame for all the information about that conference. Now today I'm excited to welcome Lee Fried and Chris Box to this show. Now, Lee and Chris, as you'll hear, are lean consultants who primarily work in the lean healthcare industry. And they'll tell you all about some of their projects that they're working on right now. Some really exciting stuff at Stanford University. So I'll let them kind of explain that. But the, the focus of today's episode is going to be on the concept of a model line. Now, this is really, I guess, popular in manufacturing environments where we, we set up kind of model areas, model lines, and test out new ways of producing product and whatnot, and then do some experiments and, and whatnot. And then if it works, then kind of copy and paste that across the organization and. Well, what Chris and Lee are going to be talking about is how they use that same model line concept primarily in the healthcare industry. So even if you are a manufacturing person, I, I think you're gonna get a lot from it, but you're definitely get a lot from this if you're not a manufacturing professional. So really excited for the show. I think you're gonna like it. Show notes for this episode can be found over@gemba podcast.com forward/68. And that's six, eight for 68. So gembapodcast.com 68. Okay, enough for me. Let's get to the show. All right, Lee and Chris, thank you so much for taking time to visit with us. Where are you calling in from today?

Hey, Ron, thanks for having us. We are calling in from the beautiful Northern California campus of Stanford University and the hospital system.

Nice. Okay. All right, well, thank you for taking time to visit with us. So let's just go ahead and start with your background. So maybe tell us about a little bit about your continuous improvement background and then what you're up to these days.

Well, so my background is actually in lean and healthcare. So I started working in the healthcare field back in 2004 at organization in Seattle called Group Health and have had a chance to join Chris about five years ago. And we focus solely on healthcare transformation with serious clients. We've got great clients and helping them from a consulting perspective across the west coast of the United States.

And I've been doing lean by various names for the last 30 years. Started out as a grand experiment to understand the change that was going on in the private industry because it was affecting parenting groups that I was running as a psychologist and I never came back.

Very nice. Now, what's the name of your consulting company?

Our company is called Triad Results and folks can find both Chris and my bios on LinkedIn. But we tend to just stick with our clients and word of mouth. So you will not find a website. But the company is Triad Results.

Okay, what's the story of that name? Triad? There has got to be a deep meaning behind Triad. What is that all about?

There should be a deep meaning behind Triad. Actually, it was just that I was standing at the counter where we applied for the business license and we didn't have a name. So we decided that thinking about the customer, the cost and the quality, simultaneous solve for Lean would be our name. So we came up with Triad Results.

I love it. See, that's a perfect example for all you entrepreneurs, people out there who will get all hung up and spend months and months about, what are we going to call ourselves? You're standing at the counter and you came up with it. I love it. Right. Well, as you both know, we like to start all of our episodes with our guests sharing a quote or quotation or quote or quotes, depending on if each of you have one that possibly inspires you. So, Lee, why don't you go first?

Yeah, sure. So I actually pick this quote out. And I picked it out because Chris actually recommended a very long time ago that I become a disciple of Peter Block. And so it's not a lean technical quote, but Peter Block is my favorite author, and I think I've read Flawless Consulting 500 times, so. And Chris used to always teach, and this quote was from her quoting Peter Block. But the quote is, understand that the task is to shift the demand from the right answer to the search for the right question. Really something that I've reflected on a lot. I'm very quick to bring an answer. And this has been not only a quote that's important to me, but I think a lot of feedback and advice around how I can be a better Lean consultant to the clients.

Very good. I like that one, Chris.

I share that, the feeling about that quote. I tend to want to solve problems, as all people do who are in professions of helping others. So that is my mantra.

I love it. I love it. Yeah. John Miller and myself, we've been going through a series on practical problem solving, and John is just fascinated with the topic, as I am. And you're right, it's just we always jump to solutions before we even clarify the problem. Right. So, very good, very good. All right, today we're going to talk about model lines. And let's just start with at a very high level, kind of generic level. What is a model line or model line approach.

And I would say that we're actively doing two model lines here at Stanford right now. So it's a really popular approach because it's a very measured approach. So it's looking at the selection of an area, an entire business unit, so that you can actually design and implement the complete lean systems. And by that I mean the production system as well as the management system with all of the supporting functions. In order to be able to see lean applied in a small place inside a larger organization. It tends to be an active learning laboratory for the development of leadership and lean leadership skills at all levels. So we understand what the challenges may be that would need to be seen scaled for a larger transformation. And it is resourced rapidly with highly skilled people. So we tend to want to take the best and brightest to give the experiment the best opportunity to be run. And it is always actively monitored, watched, observed, and learned from by the senior leadership team. They have to be the ones who own that model line area.

So now when you say that you're actually working on two of these right now, don't need to share details. I'm just curious if you could maybe share the highlights of what you're working on.

Yeah, I'm currently working on the cancer center model line. So there's been a very generous donation here to actually change the way cancer care is delivered so that it is more patient and family friendly and easier to navigate. As one of the patients says here, we'd really like to spend more time living whatever time of our life we have rather than in your clinics. So our challenge has been how to make every visit efficient and effective and only those that are required. So in Stanford, they have 13 cancer care programs. We selected two small of those two cancer care programs to actually run the experiment to say, how would we change that patient experience by changing the clinical team's choreography and operation? How would we change it so that scheduling is done more efficiently, so that we get more patients in? Access is always a problem everywhere. And finally, how would we remove all of the administrative burden from the clinical team to be able to do only those things which they are licensed to do? And in that, how do we build that management system so that we don't just bring solutions, but we bring the way of thinking so that the physicians and the administrators collaborate together to continue to improve that system? So we're actively building that in two of the cancer care programs right now, as well as on the primary care side. Looking at how would you actually use a model line approach to integrate practices which you've acquired who tend to see themselves as island of their own. But how would you create a common chassis or a platform, if you will, that you could call this is the standard of primary care for Stanford and roll that out as part of an integration strategy for Integr in these new acquisitions.

Okay, well, let's just. I want to maybe come back and dig into this even more because I'm fascinated on the specifics and people love specifics. But let's come back out for a bit and let's talk about why do organizations choose to do model lines just in general?

Yeah, so I'll take that one, Ron. There's several reasons. One is that it can be less threatening or intimidating when you really first start out. And so part of it is a risk mitigation strategy, or could be. And so you don't have to try to do a full enterprise level commitment or transformation before you have a proof of concept within your own walls. I would say also that it's a chance that you can really do active experimentation and adaption to make sure the approach, the principles, the practices fit into your culture. When we did the work at Group Health and then the Palo Alto Medical foundation, it was very important that those organizations and their model lines could point to their own examples of a full transformation and not look at Boeing or Toyota or another healthcare system. So having that experimentation, that real example of your own. The other reason I would say is it can create a lot of momentum and curiosity. And so you get people involved, you bring the experiments forward, and you have a promotional set of activities. You're really intentional about what leaders get involved, and pretty soon you'll start to see if you do this right, that others are raising their hand to say there's something going on over there and it's of interest to us. And then finally, I would say it can give license. And this isn't always the best answer from an organization that's committed fully to transformation. But the reality is there's always going to be major cultural barriers or system barriers, whether it's how you pay your physicians or scope of practice policies or your capital planning. If you organize around a model line, a lot of times you can get freedom from some of those specific policies. You can negotiate a smaller agreement with the union in advance, et cetera. So you're limiting some of the risk of those types of barriers.

Very good. Now what about. So obviously you've touched on some of the advantages and perhaps there are some more. But I'm more curious on what are the main Challenges that you guys have come across as you're doing this and then perhaps how did you overcome them?

Well, I think the first challenge that anyone is going to face is choosing the right business unit. And that is always the hardest question to answer. Many people will be raising their hands because anything that is going to get a lot of attention or rug time with the bosses is usually something that people raise their hands for. Anything that's going to be resourced well is something that a hungry organization is going to be raising their hand for. So you really have to look at the business unit. Do they own a product or a service end to end? Do they have the infrastructure for the supporting mechanisms like finance, planning, marketing, et cetera that would make it a business unit? And the most important thing of all is what is the current capacity of leadership, what is the current skill of leadership and what is the courage of the leadership at the helm right now? Because it is going to take a courageous set of leaders to align and to see a better place. Because people around the organization are going to be wanting to knock them off of the pedestal and prove why it can't be done. So that is the biggest challenge that you're going to run into, is picking the right business unit. When you have picked the right business unit, any other challenge that follows from that is totally within your reach of solving because you have put the right leadership grouped together with the right business unit. So that's the one that I would focus on. And how do you overcome it? You really make it a transparent process. So you need to be really clear what is the. The business unit of an ideal would have what characteristics and those have to be spelled out for people. And then you take nominations, even self nominations, because we want it to be an equitable and transparent process. And then there is rigor around the actual visiting of those business units to evaluate where they are in terms of the characteristics that they see. What do we see? So you need to take experienced people out to look at these business units and conduct that assessment and have conversations with the leaders and describe for them what they are signing up for if they go down the model line point of view. And then all of that information goes back to that senior leadership team, which will be the owners, if you will, or the instigators of this model line and they will make the final selection. So that's how you handle it, is make it transparent. Don't make it a secret.

Now Chris, is it safe to say that if, you know, you get into a situation, you're kind of looking at an area and you see that the leadership isn't totally bought in, or maybe they're just kind of giving lip service, but, you know, the heart's not really in it. Is it better to just kind of politely pass on that opportunity?

It absolutely is. If a leadership or a leadership team or key members of a leadership team are too new and they don't know their business unit, and they don't have long established relationships, you will walk away from that model line, that business unit, if you will. If they are raising their hand because they see it as a reason to make their career advance, but they don't really have the intention of engaging in the changing of behaviors and disciplines that will be called for, then you walk away from that. So you have to be really clear that leadership is the most important thing about it. Many of the business units you look at will have all of the technical requirements. That is, they own a product or service from beginning to end, they have the support services around them. It is currently well staffed, the leaders have been in position. So then it becomes a matter of what are the leader characteristics that we see in this organization? And what we're looking for, of course, is are these leaders who understand the cause and effect of their organization, do they have a track record of making improvement, being able to sustain them, do they have a vision that they're leading towards? What are the last three things that they've done that have taken courage outside of policies or cultural norms that they have gone to battle for to actually change on behalf of the patient or the customer? So we're looking for key evidence that this is the right leadership team to carry this.

I would also add that a really important characteristic of that leadership is their willingness to fully embrace and then help bring others along. So one of the gentlemen we've worked with for many years, James Hereford, who works at Stanford, has been really masterful at being able to partner with the key leaders in different areas and then help with them, bring broader transformation to the organization and enable them, bring them, help support them with the resources, but also be able to pick the right leaders that can be advocates and people are going to follow. And so there's a lot of characteristics that go behind that, But a lot of times they have to be experienced, which means there's a lot of people don't want to embrace this level of change when they have that much experience.

Yeah, I bet. All right, next question I have is related to standard work, Obviously within lean, standard work is extremely important. So how does that balance of Adoption of standard work, kind of work in harmony with adaption of a model line.

Yeah, it's a really interesting balance and something that we've worked with a lot of organizations just recently. I'll tell a story around this. At the Palo Alto Medical foundation, which is a big ambulatory group in the Bay Area, they really did probably the best job I've seen of an organization that balanced this. So you have one team that you form. They picked a clinic over in Fremont, California, and the clinic worked really, really hard. Amazing leadership group. And they came up with a set of flows, a management system. But everybody else in the System, the other 25 clinics, their initial reaction was, wow, that standard work. Yeah, it may work in Fremont, but our patients are different, the system is different. And so what James and then Michael Erickson and other leaders in the organization did was they developed a pilot in each of the regions outside of the Fremont region. And they set up a strategy of meet or beat. Here are the principles. We're going to give you some resources to practice, but we want you to start with the Fremont work. You can't step away from the principal, but we'll give you the best practices they've defined. Each of these other clinics in the region came together. They learned from Fremont. They used the standard work. And I would say 95% of the time, they actually adopted the standard work. The 5%, probably half of that was justifiable because there was some sort of variation that couldn't be accounted for due to something else, whether it was, you know, the rural clinic versus the urban, whatever it may have been. But it was, it was really remarkable because that approach, the different approach would have been, all right, we've already proven this, now you all take it. And it would have been a battle from the beginning. And so, you know, set up a meter beat, focus on the principles, allow people to get immersed in the practice. And most people given the same information, the same problems, will choose a smart path that somebody else has developed. I'd say the last thing, and it's kind of the big however, is if you're going to get into the adoption versus adapting of standard work, you know, having a process to do that is really, really important. Important focus on the principles, but the leadership processes. That is, the management system should not be allowed to have a high level of variation between sites, between units to start. And so if you're going to start to do this, spread the production systems, don't allow the variation to exist in the management practice because you're really setting the wrong example then. And so if we're going to have a daily management system, the key elements need to be the same everywhere. They shouldn't be adapted because the management processes should not be different site to site, business unit to business unit.

So for example, one site said well we don't actually think we need to do Gemba walks and do link check ins around the outcomes. We really think we should just have that done in a conference room and call all of the management together and they can report out. And that was really important to hold the line to teach the behavior and the discipline of you go to Gemba, you have the conversations. It is not about reporting, it is about improving the thinking of leaders. So where you hold that standardization is really important and we tend to let the production system variation go based on a principle, but never the management system because you will not have an online and integrated management system.

Interesting. One question I just thought of where does do you. I guess this not really a green field per se when you do these model lines or perhaps it is, but have you ever implemented like more of a 3P approach to this with you know, cardboard boxes and so forth as you're slowly developing and forming a production system or not really production system, but you know what I'm saying, an operating system.

Absolutely. We have a couple of examples right now. So I'll take Stanford, but there's other clients that we've done this work with. So for the future of the Digestive Health Institute at Stanford, as well as their faculty based primary care, they are both implementing a new clinical model but also they're looking at the new facility design. And so we're simultaneously using 3P and we call it integrated facility design to walk them through defining the future processes, the future management system and then what is the technology and the physical space that needs to support those. So next week for example, I have a 15,000 square foot cardboard mock up of the future primary care clinic. And James has really challenged us for primary care that we need to get away from the bricks and mortar. But we still need a space for the team to practice. And so we're going to be running simulations with about 25 people all week next week to think about the flows design, the facility design, the virtual medicine. All of that is through prototyping and simulation.

Wow, that's awesome. But no, so I guess Chris, like the work that you're doing right now with the cancer treatment there at Stanford, that's not necessarily like a 3P approach.

Or is is not it's very much A brownfield. We are changing it while they operate on a daily basis.

Yeah, yeah, yeah, very good.

So can I just comment around the difference between the model line and potentially the, you know, 3P or integrated facility design.

Yeah, yeah.

I think they definitely can come together in a mature organization. But if you're designing completely from new like we are with the primary care faculty practice here with, you know, or the Digestive Health, it may be too radically different from what the current system is. To stake it as a model line in terms of being able to show what the differences are in the management practice. Being able to make people look at it and say, wow, that really is our system. It really does reflect us. It doesn't mean it's not a good approach. It just depends on the maturity of the organization.

Yeah, yeah, for sure. Actually just recently interviewed Dr. Sami Bari. I don't know if you're familiar with Dr. Barry. He's a dentist in Florida, the so called lean dentist. And he talked a lot about how he transformed his dental practice. So obviously it was more of a brownfield situation. But sounds like much the same things that you guys are describing here, just kind of making small iterations and changings and seeing how it works.

Yeah, I think either both approaches are valid, just understanding what the risks are. So we're doing kind of the full greenfield change right now at Stanford for example, but we're also doing a lot of the Kaizen everyday type of.

Yeah, got it, got it. Now when we are talking about model lines, how long should they operate before they transition into normal? I don't know, everyday business, probably longer.

Than they usually turn out because everyone is excited to get started on their model line and to have these improvements their way. But a rule of thumb is certainly it's going to take you 12 to 18 months to put in a full model line and actually do some cycles of PDCA to find the problems with original design and do the fixes and the improvements before it starts spreading to others.

Yeah, I would say that there's going to be. There's an interesting thing that has happened with organizations that we've worked with with model lines is after 12 or 18 months there's a lot of pull for the organization to focus its resources in other parts of the organization, etc. So how do you keep that model line out ahead and support them because you want them to continue to be a catalyst for change. But each organization is going to have to make a calculus, a decision around what that continued investment is. So it's tough the other Challenge is many of the leaders that you develop in the model lines, if you're successful, are going to want to be promoted. They should be promoted, or the organization is going to want to move them to help transform other business units. So being intentional about that is important, and I think sometimes organizations are not.

I would say that the most amazing transformation we've seen is at the Palo Alto Medical foundation, where from the time the model line started to the conversion of all of their entire clinics, the 26 clinics in their system took 14 months.

Wow.

So it's a very fast pace. When you have a really robust and energized management system and leadership that is willing to fight the battles and carry the charge, it can be done quickly. But again, back to that original. What's your biggest challenge? It is choosing the right business. Business unit, which comes down to the right leadership.

Yeah, yeah. They have to want to change, right?

They have to.

Now, obviously you guys do most of your work in. In healthcare, but what about manufacturing? I mean, I know I've. I have personal experience with model lines in a manufacturing environment, but I'm curious if you have any war stories for the folks out there building widgets right now?

I'm gonna have to hand that one back to Chris, and it's from experience from a long time ago, but Chris, do you have any?

Yeah, well, back in the day, we started out in our consulting firm at the time, deltapoint Corporation in the Bellevue, Washington, working with Boeing. So we worked with Boeing and all of their suppliers, including, you know, steel mills and mom and pop shops of any nature. And the approach at Boeing was putting in model lines. So actually looking at one of their products, 73747, and saying, what would a model line look like? And actually beginning to do that. And that then spread to their suppliers, and their key suppliers would then begin adopting the model line approach. So, yeah, there's a lot of war stories with manufacturing as well.

Yeah, for sure. All right, well, the last question I have for this section is what happens if the obstacles are just too great to initiate a model line approach? What are the alternatives?

Well, so I think that, you know, the. The model line is a big commitment. A lot of organizations at first are not willing to make the same level of commitment on the management system side as they are on the production side. So often the way we approach that is really kind of a proof of concept type of approach. And so there's really two parts to how we typically would approach the proof of concept. One is have the organization pick one or two Value streams that are really important to that organization. So it may be really important clinical area or maybe a support system, but one where you can get fairly cross functional group together so that you can see the problems in between the core departments. So have them commission charter value streams and then run Kaizen events to support the future state. Never have it more than a year in terms of implementation. At the same time, this is really important that you're doing the current and future state improvement. Make sure that you have enough leadership commitment that they're involved and that they're in parallel learning about Lean, about the approach to Lean, checking and participating in enough of the value stream change that they can become educated and have enough of an investment to see that this can be more than just a project change. We have lots of examples where the first steps people say, well yeah, that model line, that sounds awesome, but it's really kind of scary. What would be the first step in order to move the organization in that direction? Yeah. Any adds to that, Chris?

Yeah, no, I think you've covered it really well. But I think that the problem around a model line, when we go to the proof of concept, is that the senior team needs to be the one who decides that Lean is the operating system of their future. And if they don't know what that is, they are not going to want to embrace it and make an informal informed consent decision. And for us, it's really important that it is informed consent. You can't just say you want Lean, but then a year into it say, you know, this Lean stuff, I thought I was actually getting something different. I want to change it because Lean is what it is. It is a set of principles, the tenets of it. It doesn't change, the practices change. So really taking a more moderate approach around a proof of concept where people can learn simultaneous and while improvements are being made, is usually a way to introduce an organization. I know there's a lot of questions by most of our clients and people who talk to us of how do we get our leadership to be engaged and endorsed and committed to this Lean transformation. And it is all about them learning and piquing their curiosity. So a proof of concept approach is a great way to do that and bring it to life and make it tangible. Because on our side of the business here, where we're working in the service industry, healthcare, for example, it's fairly intangible. You can't go out and touch a widget and count it and then watch the transformation of it. It is a slower process that needs to Be given life in a very tangible way.

Got it. Very good, Very good. All right, well, Lee and Chris, let's go ahead now and transition into what we call the reflection section. And the first question I have is, you know, within TPS and Lean, we spend a lot of time talking about continuous improvement and respect for people, with continuous improvement being the tools and methodologies and so forth. But respect for people is a totally different animal, for lack of a better word. And so I'm curious if one of you or both of you would like to speak on what respect for people means to you.

Yeah, actually, I would like to speak to that because that's one of those phrases that has become so trite and so cliche.

Yeah.

In many cases it has lost the meaning for what respect for people is about. So for me, respect for people is, you know, the hard on process, easy on people is to say, you know what? These people are full grown adults. They manage lives, they make big decisions, and every day that affect themselves and their families, we should expect them to bring that same capability and expect them to find and solve problems and to make the experience of the patient better every day because they bring their brain to work and we should not back down on that requirement every day. We should not tell them what to do. We should not give them the answers. We should demand that they bring in thinking selves to work and to unleash that experimentation and that creativity that can really make an organization be what it aspires to be.

Beautiful response. Thank you for that, Chris. All right, I'm curious if either one of you could speak on the best advice you've ever received.

That's a funny question, because I think the best advice I have received I would go back to. So Chris has been my sensei forever. When I was very early on in my consulting career, I spent a lot of time trying to be somebody that I was not. And so I came off as really with leadership teams, being highly energetic but insincere. One time, after a really rough event or a rough night of an event, Chris said, stop being who everybody else wants you to be and actually take advantage of why people like you in the first place. And so I beat myself up on that one for a while. But, you know, be who you are in terms of your personality and be true to that, and you'll be a lot more successful than trying to be what you think other people need you to be.

So I want to understand this a little bit better, if you don't mind, Lee. So what do you mean like, you were being, like, happy, go lucky, and that's not really your style or what was going on.

Yeah, I was actually probably the opposite to some extent. I was in the middle of. I think it was my third or fourth rapid improvement workshop, and we were doing. Day two is the most intense day where the team is defining the vision. And I got very, very serious. I had my scripts and for my facilitation plan. And I wasn't joking. I wasn't having fun with the team. And so it wasn't who I am from a personality perspective. And the team really pushed back on me. And so, you know, it was. And so we had a really rough night. The team didn't get to where they needed to be, and people left frustrated. And a lot of it was because I was trying to manage to a plan without any personality.

So what'd you do? Did you pivot, like, mid event?

Yeah, I got pivoted, I think, for a minute from Chris, and then took the marker and asked me to sit down for a couple times. But, you know, you learned from that. But no, no, no, that's not it. You know, I came back the next day and I. Yeah, I came with a different track. I think I kept Chris up half the night with me thinking through and, you know, started back off by telling, you know, getting more involved in asking questions, laughing, you know, still a driver. I'm still a pretty intense guy, but if I'm having fun with the group, I'm gonna do much better with them.

Love it. All right.

Actually, Chris. Chris, you have any reflections? You know what I'm talking about? I do know this is 12 years ago, so.

Yeah. Yeah. It was a bit like wearing a pair of shoes that didn't fit. So, you know, being. Being a consultant is no more than being the best you that you can be and helping people to see that. So. No, I understand what you're talking about.

Yeah. In the end, you can know all the tools and whatnot, but if people can't stand you or hate to hear your voice. Yeah, yeah. You're going to be in trouble. Yeah, exactly. Okay. What about a personal productivity habit? Do either of you have one that others might benefit from?

I think both of us do, actually. The one that I use and have used all of my professional career is schedule grooming. I go through my upcoming week or two weeks, usually depends on what's going on, how far out I'm looking, and I look through everything that I have on my calendar to prioritize against what I need to get Done this week around the deliverables that are important to the clients that we're working with. And I will actively manage my calendar and take things off so that I am not scrambling at the last minute to make things happen.

What if you have too much and they're all customer requirements? Then what do you do?

I say no.

Okay.

So I think that's a really important lesson that everybody needs to learn. The best productivity tool in the world.

Yes.

Know what is the most important, because not everything is the most important. And to say no to the things which can be said no to or to delay them for another time or give them to another person who would love to have that opportunity but has not been asked.

I love it. Yeah. I actually just recently read the book Essentialism, and that's what the whole message is, is say no. Yeah. Trying to get my wife to do that.

That's a whole different cast.

Yeah, yeah, yeah. Quit over committing.

I can't give you any advice on that one.

Yeah. Okay.

All right. So my personal productivity tool is. One of the colleagues I worked with and learned from was a woman named Hope Willianan. And I would always take on too much. So it's very similar vein, but she said, all right, every Sunday, I want you to write down the three things you're gonna get done in that coming week. And every day, write down the three things that you're gonna do that are gonna contribute on that morning. And so every Sunday, I write down my. Just a couple paragraph or outline. I'm a list maker of this is what I have to get done this week. And then each day, I wake up and make sure I'm checking to that plan or I'm intentional about how I'm progressing to that plan or if something's changed, what my countermeasures are. And that's really helped me because I would always have 25 things and not get the three things I had to get done. And so I stay and I get those three things done. And so if you look at my spiral notebook, you can follow the history of the last probably two months in terms of weekly and then daily.

So. So I understand. So Sunday, you write this. The three main things for the entire week. And then Tuesday morning, for example, you have three other things that kind of support those three things. Is that right?

Got it. Three for the week and three each day. Done. And that's. That's my marker, so I can reflect and say, okay, how am I doing? I've gotten much better about sizing how I handle work because having that discipline, love it.

So do either of you have something that surprised you during this past year of practicing lean?

I gotta. You know, the thing that surprises me that I guess it shouldn't, but I just. I love is if the continued support. You know, for example, we're working with a doc named Matt Hernandez, who was internal medicine physician at Palo Alto Medical foundation, that's now a major leader in the organization. But with continued support and even just the littlest amount of coaching, if you have the right type of leadership and the committed leadership, they will continue to grow leaps and bounds. And so I'm just. I'm really impressed with just how capable people can be and how far they can continue to progress with just a little bit of encouragement over time. And so there's a lot of people we're working with that just. They don't plateau, they don't slow down, and they continue to get better all the time. So that shouldn't be a surprise. But it's. It's kind of. It's. It's exciting.

Yeah. No, very good, Very good. All right, what about. Let's imagine a situation where things haven't been going well, and we talked about your experience 12 years ago, but let's pick a different topic, Lee. But let's say just you're in a rut, Things aren't going well. Do either of you have a routine or ritual that you follow to kind of get out of that dip?

You know, I. For me, there's two things that I do. One is I really seek the advice of the people that I really, truly that can help me. And there's a small group of folks, you know, James is one of them, and Chris, that I'll go and be a sounding board. I just usually need about five minutes, and I can usually get back on track. The other thing from a personal perspective is just get away for a little while. So, you know, walk around the block 10 times, put the. Leave the iPhone at home. And so being able to get some space that's outside of, you know, what it is that's stressing me out.

I think there's also systems that you set up. So with every client that we work with, we set up the practice, the routine, the ritual of collegial consultations. So every team or every individual who is leading an improvement effort brings their work forward and brings key questions that they might be struggling with or challenges that they don't need, that they don't know how to overcome. So you bring the power of the. The group in terms of energizing you back up and seeing another perspective. So you have to build systems in to renew people because anything can become a rut if not really challenged and looked at from many points of view.

Got it. Love it. All right, so last question I have is, I'm curious. You guys have been around for a long time and you've learned a lot and done a lot, but is there a knowledge or skill area that you feel you still need to improve in in order to become better lean thinkers?

Ron? I would say that there's actually nothing that I don't need to continually learn and improve. And if I answer that question any other way, it is time for me to stop practicing.

Yes, that was a good answer.

That's beautiful. Yeah, I love it. It's so true, right? I mean, the minute that you think you've arrived, you're set to fall.

And I think that working with really, really smart folks all the time and this, this is just, you know, it's a blessing. And you know, when Chris talked about the respect for people, that's absolutely. I mean, the people here are just so, so smart. It shows you. I mean, there you can learn in almost every situation you're in. And I love working in those professional environments where people are so committed to, you know, their patients and family. And so there is no end to the opportunities, both from a lean practitioner perspective, but also from, you know, how to make a more effective organization, healthcare organization, et cetera.

Okay, so I have one other question that just popped into my mind that I'm just going to throw out to both of you. It's not one that has anything to do with the reflection section per se, but I actually just, I have a friend who has been in manufacturing all his career, risen to the very top, you know, senior level kind of manager of continuous improvement manufacturing and so forth. But he's really interested and really intrigued, honestly, with the whole lean healthcare movement. What advice do you have for someone that's only known manufacturing, but just can't stop thinking about possibly applying, you know, their gifts to the healthcare world? What do they do?

I think they need to talk to people and get involved in networks that are actively committed to the transformation of healthcare. So there are many of us out there and of course, Lei, with our arm around the healthcare focus is certainly one of them, but we have seen many manufacturing people come into the healthcare setting and them bringing their point of view, their perspective, and many of them really their technical expertise because they've applied it in so many more repetitions that are easily available in healthcare has been a huge bonus, I would say the challenge that most of the manufacturing people that I have known and seen come into healthcare, the biggest challenge for them is learning the culture, because the culture is so different in healthcare than it is in any manufacturing environment in which I've worked. So back in the day when we were working at Boeing with the Delta Point Corporation, and we got a phone call from our first hospital client, we said to them, you know what, you guys, we don't know anything about healthcare. And they said, that's fine. We know healthcare, you know, lean. We will collaborate and learn together. And the biggest learning we got out of that was, number one, every principle applies. Number two, you need to have a different socio kind of psychosocial cultural stance in a healthcare environment than you do in any manufacturing environment that you've ever met.

One of the things that's an interesting reflection of healthcare is, and it's different, but the highest paid, often folks that have had the longest education, the most training, the most development in their education are your frontline employees. And so, you know, it is different because of that. And so.

And the culture of medicine is one of collaboration. And I have been trained in a particular way and I have a particular expertise, and it really must account for all of that. So there's a continual stress around the collaboration versus standardization that goes on in healthcare. That is the antithesis of manufacturing.

Yeah. And I would say that, you know, there's been a lot of folks, most of the colleagues that we work with, that have had a successful transformation from the manufacturing setting to the healthcare. But there's a lot of folks that have come and then gone back because they've been really frustrated, one with the pace, so things do not happen fast or quickly in healthcare, and secondly, just how siloed and potentially broken the systems are. So even some of the furthest along manufacturing organizations have been doing more Kaizen type of improvement as an industry than 99.9% of healthcare. And so the starting point is often so far in the past. And so.

Mm, that's true. Yeah, tell him to come on in.

Well, I'll be sure that he listens to this episode, so. All right, very good.

And it is really broken. So there needs to be some smart people that can help bring the really smart people together to help do some of those changes.

Yep, exactly. All right, well, Chris and Lee, thank you so much for taking time to visit with me today. Let's just wrap the show up with you guys sharing some final words of wisdom. And then want us to remind people how they can connect with you, you know.

So, Ron, thank you so much for having Chris and I and Triad on. We've had really amazing opportunity to work with some amazing clients, whether it was Palo Alto Medical foundation, the Everett Clinic, Group Health Stanford. So we're really standing with and on behalf of a lot of incredible leaders in those organizations. In terms of getting a hold of us, LinkedIn is the best opportunity. My last name is spelled fried, but it's Freed. F R I E D. And, you know, Chris is also on LinkedIn. You will not find us on a website because we try to keep our business and the organization within the leadership network. Word of mouth. So the people that we're working with and the people that they associate with.

Yep. But we welcome all contacts, so we'd love to keep the dialogue going. Thank you, Ron.

Yes, you're welcome. All right. You know, and I was also thinking as we were talking about that whole transition from manufacturing to lean healthcare, perhaps we need to do a roundtable sometime with you guys, Mark Graven, Mike Lombard, some of all these folks that have kind of made that transition. That might be a really fun video or something that we could do. So perhaps we need to think about that.

That would be fun.

That would be fun. Yeah.

All right. All right, well, thank you again and take care.

All right, thanks, Ron.

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