GA 156 | The Current State of Lean in Healthcare with Mark Graban and Joe Swartz

You're listening to episode 156 with Mark Graben and Joe Swartz.

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 in your week to listen to the show and for watching our Lean and Six Sigma training videos over at Gembacademy.com we definitely appreciate each and every one of you. Now today, I'm excited to welcome Mark Graben and Joe Schwartz to the show. Now, longtime listeners have definitely heard of Mark before. Mark's been on our show several times and he also has his own Lean Thinking podcast. Mark blogs over@leanblog.org and you can find his podcast over there. And Joe works at Franciscan Health in Indianapolis, Indiana. Now, we visited Franciscan about a year and a half ago and we, in fact we did a full Gemba Academy live episode where we kind of followed their, their journey and learned and talked to all kinds of nurses and administrators and different folks within the hospital system. Really just talking about the Arlene journey and really, really blew me away the work that they're doing. And so today we kind of revisit where they're at at Franciscan and then quite a bit about just the state of Lean within the healthcare world. And Mark and Joe obviously are very involved in that work on a day to day basis. And so it was really interesting to hear where they think things are and where they're going. Now Mark and Joe are also putting on a workshop May 24th and 25th at Franciscan in Indianapolis. And this is for folks that want to come see what Joe and the team at Franciscan are up to, what what a culture of continuous improvement really looks like. And by the way, there's been people that aren't in healthcare go to this. So, you know, if you're in a manufacturing organization or service based organization or anything that's not, you know, healthcare related, it still applies to you. Now I do believe they are almost sold out. So you may not get into this particular one, but what we do in the show is really talk about what they're doing and how you might be able to go about doing something on your own even if you can't make it over to Franciscan. Now, if you want to learn about that, the workshop, you Simply go to kaizenlive.com what a great URL Mark and Joe found for that. Kaizenlive.com and you can learn about that now. Last thing I want to say is I've known Mark for a long time. Mark's one of the main reasons that, honestly, I do what I do today. He. I followed Mark and his blog leanblog.org for many years before Gemba Academy was even a thought. And Mark's been podcasting and so forth, so it's always exciting. And Mark's a good friend and so is Joe. And so I'm really excited to have Mark on. You know, he's this big, prolific podcaster. He's been doing lean podcasts longer than probably anybody. And so I was all excited, and then all of a sudden we get on and guess what? I had all kinds of audio problems with my gear. In fact, I couldn't even get this microphone to work properly. So I was kind of frantically trying to troubleshoot on the fly. And of course, Mark and Joe were very patient and they were, they were fine and great guys. But anyhow, the episode I actually had to record using the microphone on my, my monitor. So the audio quality is not going to be fantastic on this, but we did the best we could. Of course, as soon as the show was over, I did some root cause analysis and guess what? It was a loose cable that I discovered and I fixed it. And so I learned some things. But unfortunately, you know, we, me and I have, you know, the best quality audio that you've, that you've, you're getting.

Used to here on the, on the show.

So apologize for that. But I do thank Joe and, and Mark for their patience. Again, show notes for this particular episode can be found over@gembapodcast.com just look for episode 156. Again, gembapodcast.com and look for episode 156. Okay, enough from me. Let's get to the show.

All right, Mark and Joe, thanks so much for coming onto the show. Where are you guys calling in from?

Hey, Ron, I'm in Orlando.

All right. Hey, Ron, this is Joe. I'm in Indianapolis, Indiana.

All right, very good, very good. So, well, thanks for coming on. Mark, you've been on the show several times before, so really appreciate you carving out some time to come back on. And Joe, it's a pleasure to have you on, and we've visited with you there about a year and a half ago when we came out and did our Gemba Academy Live episode out there at Franciscan. And before we get too far into it, I want to make an announcement if anybody is interested in watching that full episode that we did with Franciscan. I don't. It's like 20, 30 videos that we ended up producing, kind of covering their journey with Lean. Just shoot me an email ronimbaacademy.com and we'll set you up with a free trial so you can watch those videos because it's a really, really good episode. So let's just start, guys, with you telling us a little bit about your background, maybe how you first came to learn about Continuous Improvement and then how did you get into to Lean within the healthcare world? Mark, maybe let's just start with you.

Sure. So I've worked with Lean and Continuous Improvement, different organizations, really my whole career since 1995. I started at General Motors and in manufacturing. I thought that's what my career path was going to be. I'm an engineer. I studied business and engineering in a master's program because I thought that was going to be my career path. But then in 2005, I ended up with the opportunity to start working in healthcare. Wouldn't you know, I've been in healthcare longer now than I was ever in manufacturing. I really appreciate the opportunity to do that. I think the people in healthcare are great. They want to do the right thing for the patients and everybody involved. A little bit of process improvement, systems engineering, and I guess I would say a lot of culture change really makes a meaningful difference in healthcare.

Yeah, Good stuff, Joe.

Oh, similar to Mark, I was an engineer and started working in 1994 with my dad, who was a consultant, and we worked in General Motors similar to Mark. And then in 2005, like Mark, I got into health care and Norm Bodak introduced us to each other and we started a dialogue way back in because way back then because we were both new to healthcare and trying to understand healthcare and our background in manufacturing and how it translates into healthcare. So there you go.

Good, good. Well, let's go ahead and kind of begin to level set folks on Franciscan's journey with Lean. Joe, just give us a high level overview of the journey. When did it start kind of, you know, what's gone well, what have you struggled with and maybe where you're at today.

Okay. We're a 14 hospital system. We have two hospitals in Illinois and the rest are in Indiana. There's three hospitals in Indianapolis where I originally started back in 2005, and we started with Six Sigma mostly with some Lean, but we got help from a local university with some professors, and it was pretty heavy. Six Sigma and I kind of figured in the first year we weren't going to reach all employees. And when I was hired, I was asked to help them transform the organization. And we weren't quite going to transform the organization using the methodology and approach we were using. So I went back to my manufacturing days and pulled forward this whole Kaizen approach. And in 2007, we introduced Kaizen to the St. Francis facility there in Indianapolis and started growing it and have grown it since then. We like it because it's a real simple approach and can be widely accepted by all employees in healthcare. And Mark and I have documented that journey in our book we wrote together called Healthcare Kaizen.

And I want to obviously we'll get into more of your journey there, Franciscan Mark. I thought it would be interesting. You've been on several times now on the show and we'll link to the to all those past episodes in the show notes. But I thought it might be I asked Skip Steward recently. We were I was interviewing him and Brandon Brown at Katacon Conference a few weeks ago, and one of the questions, I believe I asked them or asked somebody recently to kind of give a State of the Union address, if you will, on, I don't know, on where you see lean within healthcare. Obviously it's real easy to be, you know, discouraged or point out all the things that are going wrong. But gosh, when I hear from people like Skip Stewart and then Franciscan and ThetaCare and there's a lot of great things going on within the lean healthcare movement. But I thought maybe you could just, I don't know, catch everybody up. Where are we in 2017?

Well, for one, I had a chance to meet Skip and Brandon recently. I had never met them, but we were all at the Society for Health Systems conference a couple of weeks ago in February here in Florida. So really appreciated the chance to meet them. And you're right, there are people doing some really great work out there. I include Franciscan in that category. I do get discouraged. I said, well, focus on the positive. But there are shining examples out there in the darkness, the vast darkness of space. It's still, I think, really rare and unique when you have people really working toward that culture of continuous improvement. When you have somebody like Skip at an executive level. I recently got to visit a hospital here in Orlando that has the chief operating officer talking about the need for culture change and how that starts with him. And he came up through the old style of management and is doing his best to change and encouraging others to change. There are bright spots at the Society for Health Systems conference. There's people talking more about management system and culture change instead of just tools and projects. I was in Belgium for a summit recently. There were people there from 20 different countries. And you have some really bright spots across Europe where people are doing that work. I think Lean, where at the point, I think part of the state of the union lean is proven to work in healthcare. I think it's not credible for somebody to try to say it doesn't apply, it doesn't fit, it doesn't work. At the same time, that doesn't mean that it's easy. It doesn't mean that everybody is going to make it successful. And I guess that parallels what we saw still see maybe in manufacturing.

Compare it to five years ago.

Well, like I said, I think there's been more focus on the management system and the culture. I think people are realizing that while 5s can be incredibly beneficial and save time for staff and improve the environment, that alone or any number of tools doesn't really transform an organization. So a bunch of week long improvement events, while those can drive results. John Toussaint last week was kind of sharing his recollection that doing a lot of week long events wasn't changing the culture at ThetaCare. So others are learning from ThetaCare about changing the way we manage, trying to change the culture and that that starts at the top as opposed to something that somehow delegated or just have the executive wave and say, well, I support Lean. Where this really, where this really works is where the executives are really directly involved in learning and changing and working on the culture.

So when someone says that the, and I totally agree, I mean just running events after event again can make positive changes, but it's probably not going to turn a dial from a culture perspective. But what does in your opinion, Mark? Obviously leadership's got to be fully engaged. Let's say they are leadership's fully engaged. Then what, like, what do you think are the, some of the best practices that you've seen for organizations like Baptist Memorial, like Franciscan, like Data Care, these organizations that are doing great work.

I mean, I think one of the reasons I always point to the work that Joe has led at Franciscan along with his executives is the idea of starting small. You know, there are so many, there are a lot of big problems in health care. I think the culture is one where people have generally shot for the moon, try to hit home runs, try to come up with big ideas, big projects. I think there's just a proven pattern out there that starting small with. Whether you call it Norm Bodek's quick and easy Kaizen approach, that has influenced me and Joe, whether you call it Toyota Katana, I think these are different flavors of the same sauce. Starting small, engaging everybody, being supportive as a leader in facilitating and coaching and not trying to do it all yourself as a manager, I think that's what gets the flywheel in motion. Trying to engage everybody starting off with small improvements, and then they'll eventually build the capability and enthusiasm for larger change. I should let Joe talk about this because they've certainly lived this.

Joe? Yeah? Do you have any thoughts?

Yeah. I mean, this is a people business, particularly healthcare. Our biggest costs are people. So engaging them in improving the work they do is. This is a challenging thing. And you have to engage them where their interests are. And in this business, you know, if you push something on people, they push back. And they'll let you know pretty quickly that they don't want to be told what to do. They want to. They want to do it the way they want to. So Kaizen is just a methodology where we engage them with small improvements and get them trying stuff, testing stuff, and growing that capability over time. And they gain confidence when you kind of push them out there. Give them the coaching they need, give them the tools they need, line them up with the right people to get it done, help them make sure it gets done.

What's really interesting coming off of this Katacon conference, where obviously a lot of the focus was on Toyota Kata on the other side was TWI of the conference. So it was really good. But to your point, Mark, of how sometimes it's different stuff packaged different ways. And I think the beauty of the Kato approach is just what you said and what you guys are saying is that it does kind of force you to take things in small experiments, right? Like, what's your next step? What do you expect to happen? And when can I find out?

Right?

So you're kind of almost helping people just do those rapid PDCA experiments, right? And I think that that is. That's why it's so successful at places like Baptist Memorial and why Joe and those guys have been successful at Franciscan, because you're constantly doing these. These small experiments and learning and not these. I mean, y' all know, I mean, I'm. I'm a. I believe in Lean, Six Sigma, whatever you want to call it, but a downside of more of a traditional, say, DMAIC type Project is while they're great and they're very useful in certain situations, it can take you four or five months right before you kind of reach the end line. And boy, that takes a lot of effort, a lot of persistence, a lot of perseverance to make it all the way through that. And sadly a lot of people don't, but you can. Most people can say, hey, I'm going.

To run this experiment.

We just had a call this morning at Gemba Academy, sales ladies are going to run a little experiment on one little piece of our business. And we're going to report back at the end of the week on how it went. It's beautiful, right?

Yeah.

Yeah, well. And I think there are patterns and parallels if you look at medicine. I was the only non physician co author on a white paper recently. John Toussaint from formerly of ThetaCare, now at Catalysis, which is their organization, and Dr. Jack Billy from the University of Michigan, they articulate so clearly how this experimental improvement process is so much like a diagnostic thought process that doctors are taught. You understand the current state, you look at the symptoms, you try to understand maybe there's a deeper underlying cause, you propose some countermeasures. And a lot of cases, you have to think of that as a test and evaluate and see what's working, what's not working, what's created a side effect. Let's adjust. In a lot of ways, it's PDSA cycles or it's KATA cycles or it's good medicine.

Yeah.

Beautiful. Beautiful. Hey, so one thing I want to talk to you guys about. I know you're putting on an event here coming up, I think just. So everybody, this is not a sales pitch. I think you're pretty much almost sold out, right? So. But I'm more interested in the approach of what you guys are doing and how other people can maybe learn and do maybe even something similar on their own. But. So it's kaizenlive.com, right? I think that's the website that people can go to to learn more about this specific event. But talk about the event and what is it? What's the approach? And how do you. How do you see people getting value from this type of activity? And I'll let you guys tag team how you were on Ash?

Sure. I mean, Joe, I mean. Do you want to go first, Joe?

Sure. I was doing some emergency room work and we got to the place where we improved all the work that nurses do, but. Or most of the work nurses do. And we got down to the work that Physicians do and struggling with getting them on board, getting them engaged, until I finally decided to take a few of the physicians to another hospital to see, to show them what they were doing in another hospital. And that was the catalyst that got them on board. It was a hospital, Ochsner in New Orleans. And one of the physicians at the end of it turned to me and said, Joe, you know, to be honest, I really came here for the food, the New Orleans style food. But he said, you know, having seen this in a hospital working, he says, I think this would apply Franciscan. I said, well, if you think that, then you need to help me engage the rest of your physicians. And he did. He agreed to. And that was a huge turn for us, that once we got the physicians on board, then everything else went really fast and we turned an ER from one of the worst performing in the area to one of the best performing and an award winning er. That taking them to see how another hospital was doing this successfully really helped. And I hope that's what happens when those people come in to see us and see what we're doing at Franciscan. They can see it really working in a hospital system and they can take it back with the idea of transforming all of healthcare.

Yeah, well, I mean, I've seen collaboration and learning on a lot of levels going back to say 20. The first time I ever saw a hospital that was practicing lean was in Scottsdale. We had a local lean networking group. Once a quarter we would go meet, do a gimbal walk, talk about what we were doing in our different companies and somebody, one quarter said, hey, let's go to this hospital. Because there's two women who left Motorola and they're doing Lean and Six Sigma work there. So on that level, there was the learning, there's the inspiration you have. Your eyes opened when I was working with the Lean Enterprise Institute and the ThetaCare center for Healthcare Value, which is now called Catalysis. One of their core initiatives was something called the Healthcare Value Network, where organizations from around the country would go and do what they called a Gemba visit. Spending a day and a half, very little time in conference rooms or auditoriums, spending most of the time going out to the Gemba and seeing firsthand and talking to people and asking questions. One thing we always learn from those Gemba visits is that the host organization ended up learning a lot based on the reflections and questions of the visitors. I learned a lot from that model and I'm thankful that Joe and I have tried to create something similar here with his organization.

Joe, one Question for you is what's in it for Franciscan? Why do you guys do this?

One thing I liked about healthcare, moving from manufacturing into healthcare is healthcare tends to share more. And they may not share their business strategy, but they share their practices quite a bit. I was able to learn early on from other hospitals and that was a huge benefit to me. So I think it's my duty then to share with others when I learn something. And I think this Kaizen stuff was something I decided early on that all of healthcare really needs to know this. And I was further challenged in a leadership class. I told them what I was doing, I was transforming healthcare at St. Francis. And they said, why just St. Francis? And I thought, that's a good question. He said, why not all of healthcare? And I said, wow. And that's when I decided to partner with Mark because I knew he had access to all of healthcare. I thought this is a message we need to communicate to all of healthcare. But we're part of the Indianapolis Patient Safety Coalition and our hospital has been part of that for years. And we as a city of Indianapolis, we decided not to compete on patient safety and we, we share amongst each other in Indianapolis what we do to help patient safety. So we've kind of become a sharing organization through that effort and our leadership is quite open to sharing whatever with whoever because we always learn a lot in return.

Mark, obviously you do a lot of speaking at conferences and different things like that. And so I'm curious, you know, conferences have their place in the kind of the learning world and the networking that occurs is really powerful. But what's different about this type of, I don't know, go to Gemba style workshop versus maybe a traditional conference?

Well, I mean, I think it's a deeper dive. I mean, I'm certainly not anti conference, but I think there's a time and a place for that. I mean, with the conference you get the advantage of hearing from a lot of people from a lot of different organizations all in the same, are all there in the same place. I think the advantage of something like this is you get that deeper dive and get exposed to frontline staff, frontline managers, directors, VPs, executives. You get a different slice through the organization of what Kaizen means to leaders at different levels, how their roles, what the similarities are, what the differences are between what they do at different levels. And I think the other thing you get out of going to the GEMBA anywhere is there's this sort of intangible sense of what this culture is like. It's one Thing to hear somebody describe it or to hear about people's intrinsic motivation and their smiles and their pride. A lot of organizations will ask questions, leading questions, or based on their old mindsets that, well, we need to set targets or people won't participate in Kaizen. We need to give them incentives or they won't participate. I can say, well, it doesn't necessarily have to be that way because if you lead people, if you coach them, if you listen, if you tap into their intrinsic motivation, amazing things happen. It's one thing to hear it, it's another thing to actually go to an organization and realize, wow, okay, that is very real. Anybody can go to a conference and perhaps spin a good story, kind of putting the shiniest light on things. But when you actually go and take a deep dive into an organization, I think you see, even though things aren't perfect, nobody's perfect. It's very consistent and it's real.

Yeah, it's real. That's what it is. Yeah, it's real now. So this is, I believe, the third year you guys are doing this event, is that right?

Yes.

So how many people come?

Well, one thing I learned from the Healthcare Value Network Gemba visits is to keep it relatively small. So it's always been capped at 25 people because there's more benefit from the interaction amongst people in the room. One thing that's always fascinating to me is not just the mix of organizations, but the mix of industries that end up there in the room. And people are sharing and learning from each other and getting to know each other.

So it's not just healthcare folks.

No.

We've had people from architecture firms and a bus manufacturer people from. We have somebody from a utility company coming this year because it's. I'm preaching to the choir, maybe with this audience, but I think it goes to show Lean. The Toyota production system in Lean, it's not a better way to build cars. It's a different way of doing things. And the good news then is that we can learn across industries. I think people are people. We can learn from each other in that way. And by being able to break up into small groups and go to the Gemba. It's just if we had 100 or 150 people in an auditorium, it wouldn't be the same experience.

If folks aren't able to make it to this one, I know it's almost sold out, but what advice do you have for them to practice something similar? Seek out some lean thinking organizations in the school visit or what do you suggest?

I mean, I've been a part of, through my wife's career, we've moved a lot. So in the Dallas area, we have a group there. It's an informal, it's not super active, a group called Lean DFW. We have a LinkedIn group so people can find each other and communicate. Occasionally do a networking event. Hopefully this year we'll do a site visit somewhere. When I was in San Antonio, San Antonio and Austin was starting to develop a lean healthcare network where people were hosting visits once a quarter at their organizations in Orlando. Now I'm kind of part of some similar attempts at building a collaboration network between Orlando and Melbourne, Florida and parts in between. So I think part of it, I think for one, LinkedIn is a really powerful tool to search and see who's doing work in your area, reach out, try to form some sort of online presence and then see who's willing to organize an event. Sometimes that's the challenge. Everybody wants to participate, but it's, it's time consuming to organize something, but it's possible. It's certainly, it's beneficial.

Right, right. So let's talk a little bit about your books, guys. Lean Hospitals and Healthcare Kaizen. How's it going with those?

Well, to me here I'll talk about Lean Hospitals and then let Joe take the lead on Healthcare Kaizen. My book Lean Hospitals was first published in 2008. The third edition updated and revised and expanded and hopefully better edition came out June of 2016. That book is a broader Lean 101 overview for health care organizations. I'm hoping is a good first introduction.

And what's Healthcare Kaizen, Joe?

Oh, it kind of documents some of my experiences at Franciscan and some of Mark's experiences throughout other hospitals in healthcare. And it's really about the engaging all employees in small continuous improvement. I mean, that question you asked before, how do you get started? I think you have to find high leverage stuff that delivers results for leadership. So you got to do that, but at the same time you have to engage employees because if they don't see the benefit, they're not going to engage. So you got to engage a number of different people. You got to engage the executives and they got to see results, but you got to engage employees so that they see benefit and then you got to engage the physicians so that they see how it benefits them. If you can do all three of those things, you're going to start developing a momentum that can snowball. But if you miss one of those three things, it's going to hamper Your startup and your journey. So Kaizen's really about engaging all employees in simple daily type improvements, everybody, every day, right?

As Mr. Amai says.

Yes.

Well, and the way I would connect the books together is that Healthcare Kaizen is a deeper dive into this idea of creating this culture of continuous improvement and engaging everybody and leading differently. I think part of why we wrote the book is even though in Lean Hospitals I try to talk about that culture, the Toyota roots of respect for people and continuous improvement, I think part of the motivation was to try to spread these approaches. Because in 2012, when the book came out, or 2011 when we were writing it, I would see a lot of organizations that would say we are implementing lean or practicing lean, and they weren't really going through any sort of process to engage everybody in improvement, which I. I think you'd step back and ask, well, is that really. Is it lean without continuous improvement, or is it full lean if it's just tools and projects and not engaging people that way? So I think we wrote the book to help push ideas out there, not because we did any sort of market analysis or said, oh, people are really searching for Kaizen now. So let's write a book about was something that was a shared passion of ours and something that we were. I think we wrote the book to be advocates for Kaizen and help people kind of incorporate that into their lean journey.

Something that was interesting. One of you mentioned that Lean Hospital is actually, I hope it's okay that I say this outside selling Healthcare Kaizen by quite a bit.

I'm curious, why is that?

Do you think?

I see data from Amazon every week. Joe and I get a big batch report twice a year from our publisher. It's funny, Amazon shares data weekly. That's a different story. But yeah, I mean, it's something like a 10 to 1 ratio of lean hospitals outselling Healthcare Kaizen. And in a way that's disappointing. The book has been almost out five years now. People say the book is good, they say it's helpful. But I think if you were to dig into Google search metrics and phrases people are using, there's more people searching for lean. Lean is more of the buzzword. I think Joe and I really agonized over the word Kaizen. Would that word turn people off? Should we title the book Healthcare Continuous Improvement or what have you? It's hard to do a root cause analysis of why the book hasn't sold better. The word Kaizen, that could be part of it. It could be just that people aren't Searching as much for a method to engage everybody in improvement. I don't know. All I have is theories about that.

Yeah, yeah.

Well, I mean, they're both great books. I've read them both. And thank you guys for sharing all of your wisdom with folks, like on podcasts, but also, obviously, in your books and your workshops. So kaizenlive.com is the website folks can go to. How else can people connect with both of you?

Well, our book's website is hckaizen.com and you can find information about the main Healthcare Kaizen book. There's a companion book called the Executive Guide to Healthcare Kaizen people, if they want to go to markgrabin.com, they can learn about some of my other books and projects. You had me on the show before to talk about Practicing Lean. That's a book that I was spearheading. That book is now basically done and also available not just as an ebook, but in paperback form. Sixteen authors, including Joe, including a number of people who have been your podcast guests, I'm sure. Jamie Parker, I know, has been a guest of yours. Michael Lombard, I bet, has been a guest. People from different industries sharing some of their reflections. And we're doing that book that's a fundraiser for the Louise Batts Patient Safety foundation, so I'll stop plugging stuff.

Very cool. And you forgot to mention the best one of all and how really helped me get started doing what I do today, honestly, is leanblog.org and that's like, Mark, I think, is if you're not the original Lean blogger, you're real close to one of the originals.

Well, I was early on. I can't claim to be the first. Sort of like, look, I wasn't the first person to do Lean in healthcare either, so there are a lot of innovators who I was inspired by too. And so, yeah, I've been doing the blog for 12 years and the podcast for 10 and a half or 11 years.

Yeah.

Yeah.

Well, thank you, Joe. How can people connect with you through Mark?

Really? I'm employed by Franciscan.

So are you on LinkedIn, things like that?

Yes, LinkedIn, Facebook, and all the other kind of things.

Joe's got a profile page on our website. You can contact one or the both of us also through the website if you want.

So that's the HC kaizen.

Hckaizen.com. yeah.

Okay.

And we'll link to everything in the show notes. We've got a lot to link to, so, folks, just go to Gemba if you Want to remember one URL go to GembaPodcast.com and then look for episode 156156 GembaPodcast.com we're going to link to everything. And again, shoot me an email. Another thing to remember. But it's easy. Ronimba academy.com and we'll set you up with a free trial so you can watch the Franciscan Gemba Academy live episode. It's pretty special and I think you're going to enjoy even if you're not in the healthcare world. It's pretty fascinating. I think. I think my favorite story there, Joe, was the. The applesauce in endoscopy. I mean, wow, what a story. Yeah, I'll just leave it at that. A little teaser. You want to learn how applesauce and endoscopy go together, you gotta watch the. Watch the episode.

Yeah, that's a great story and it's a, it's a great team at Franciscan. So always appreciate what Joe and everybody there is willing to share.

Yeah.

And good stuff. All right, well, thanks again guys for coming on. And Mark and Joe, keep up the great work and I know our paths will cross again soon, but really, really appreciate both of you.

Thank you, Ron.

Thank you, Ron.

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