GA 169 | How to Develop Lean Leaders into Coaches with Elizabeth Fingado

You're listening to episode 169 with Elizabeth Vengado. 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 and 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 Elizabeth Vengado to the show. Now, Elizabeth is a director of Strategic Support Services at Denver Health. Now, as she'll explain, Beth has been in the healthcare world for pretty much her whole career, but had transitioned into the continuous improvement side of things and has gone on quite the journey. So today, what we really kind of of focus our conversation on is developing Lean leaders to be coaches. And so Beth shares all kinds of insight into how they've approached that and how they've gone from a team of around eight folks who act as coaches to coaches, if you will. And so she shares some strategies of what they've done and also kind of talks about some of the things that they've learned and if they had to do things over again, what they would try differently. And. And it's not always been easy. And so she also shares some of the struggles that they had. So I think you're gonna really enjoy the show. Beth has a great energy about her, and I really enjoyed chatting with her. So links to everything that we talk about can be found at the show Notes, which you'll find over@gembapodcast.com and you'll look for episode 169 again, gembapodcast.com and look for episode 169. Okay, enough from me. Let's get to the show. All right, Beth, thank you so much for coming onto the show. Where are you calling in from?

Calling in from Denver Health in Denver, Colorado.

Beautiful. How's the weather? I have a friend that just moved to Colorado, and he's raving about how awesome it is right now.

It's amazing. It's mid-80s and just beautiful summer weather.

Yeah, yeah, yeah, yeah. He lives well. Obviously, you're used to altitude out there, but he was telling me the crazy story about he goes to the grocery store and then by the time he gets home, like all of the bags of chips or whatever want to pop because of the, the altitude change. It's like some different problems that we have in Texas, I tell you that, but. Very cool, Very cool. Well, hey, thanks for coming onto the show. I know you're busy and I'm really excited to kind of to get, to get into your journey. But as you know, Beth, we like to begin all of our shows with our guests sharing a quote or two of something that possibly inspires him. So do you have one?

Great. Yeah, sure. So really, this is pretty topic specific, but we have it up on our visual management board. And it's really. Maybe I'm condensing a little bit of Yoda talking about, you must unlearn what you have learned.

What's that mean to you?

So really, as I have moved into my lean journey, initially I thought that this was all going to be about learning tools and learning about different ways to look at flow and sort of the more tactical, practical pieces of lean. And as that evolved and I really thought about how to create a lean transformation or be in that type of transformed organization, I realized we as leaders have learned a lot of things that have made us really successful, and not all of them really make the organization successful, in particular when it comes to some of this lean work. And so really just trying to understand that we've got to put some of that old stuff away and bring in some new. And so we really have to unlearn and then relearn, which is a big challenge. It's a big learning challenge.

Sure, sure, sure. Okay. Well, Beth, why don't you tell everybody a little bit about your background, how you first got into this continuous improvement world and then what you're up to these days.

Sure. So I'm Beth Fingado. I'm the director of Strategic Support Services at Denver Health. I've been here for about three and a half years. Prior to that, I was in a similar role, but have been in continuous improvement for many, many years in more of the quality world for a long time. So back in the TQM days, back in quality circles, sort of in the early 90s, was some of my first exposure. But when I left more of the clinical world and got into operations, there was just like, it felt kind of like the Wild West. And I wasn't sure how decisions actually got made and what data we were using to do those. And sort of through that journey came upon lean at an IHI conference. And you Know, the heavens opened up for me and it suddenly made sense and I just knew like I had to be involved in that world. And so we brought that back to the organization I was at. We spent a lot of time trying to really explore what that meant and I've been doing that work ever since. That was in about 2005.

Wow. Okay. Now have you always been in healthcare then?

Yeah, yeah. So I was a med tech for many years, worked in the clinical lab, never thought I would leave a clinical role and got into improvement work just by working on processes inside of the laboratory and then just decided I loved improvement work and have been in that world since about 1996.

Wow. Okay. Well, so today, Beth, we want to kind of the angle I guess we're going to take is more of a how do we enable leaders, lean leaders, to be coaches? So let's just kind of start at a really high level. When you say a coach, tell me what you mean.

Great. Well, so as I mentioned before, when I used to think of lean, I thought of people on the front lines deploying certain kinds of tactical tools to try to figure out how to make flow work better, how to increase value to the customer. All those really good things about lean that help you find a lot of improvements. As I moved forward in that journey, what I realized is that these frontline folks, these managers, are working with people and those people know how processes work, they understand what the work is, and in order to effectively dueling, they actually needed coaches as leaders instead of tellers as leaders. And so here at Denver Health, we've been really working on that notion of trying to figure out how do we create leaders that don't tell, but know how to coach to the improvement work and help people get further in the work where they're experts and not be the experts. So really trying to create some different skill sets inside of our leadership rather than being the ones that know all and know all the answers.

So I want to understand like strategies and so forth. But to help me, I guess understand your situation, talk a little bit about how you're set up. I mean, do you have like a, I don't know, so called lean organization, lean team, or is it everyone is practicing or how does that work?

Oh yeah, so sure. Yeah. So Denver Health has been doing lean improvement work for many years, one of the pioneers in healthcare. And so they created an office of lean folks to help support the journey many years ago, back in probably 2006, 2007. So we have a lean team and we help support leaders for many years when they did lean here, there was some focus, a lot of focus on doing some really great improvement work inside of events. And they also had a black belt program which was really helping people at the local level start to try to figure out those problems and how to be a problem solver in their local areas. Since then we've been really working on trying to through the central lean office, create sort of coaches of the coaches and have been sometimes helping support things like facilitation of improvement events, but really focused at a level of more like at the elbow coaches that come out of the central office and go deploy out locally to try to help people figure out how to move forward in their management system work.

How many people are on your within a lean office?

So the people that go out really do this kind of work, there's about eight of them. But that being said, we also inside of my office have organizational development and learning. And so we have a lean academy that has some external facing components, but also really is internally focused to help get people through basic courses like you know, just fundamentals of Lean. How do you coach? What does that look like? What's different about being a lean manager versus a traditional manager? How do you think about analytics? So we have organizational development and learning people helping support classes and they also will help with things like team dynamics as we go through this change stuff. It's pretty challenging work at times. And so we have organizational development folks that will get out and help people figure out how to develop more capability inside their teams, how to work through change things of that notion. So we've got some people kind of more on the tool side. How do you create a visual management board? How do you think about your huddles, all those pieces? And then we have ODL professionals who are thinking more around the some of the people capabilities and the people processes.

Yeah, no, it does, it does. Okay, well, let's talk strategy. So like what have you done or how have you tried to deploy the supporting lean leadership development program?

Well, so I guess one of the very first things that we did strategically was we first identified some what we call high impact areas. So places in the organization that were going to mostly impact our strategy and our strategic plan. So areas that were driving volumes or were driving certain quality initiatives. And we focused on those areas first to really try to get that core capability created. So those folks all went through lean management systems training, they all got assigned a coach and then we created a system of GEMBA walks with their next level leaders and the CEO and Just making sure that it was understood that this was an expectation inside the system, but also really a well supported activity.

Can you give me an example like, of like something specific that they did?

Sure. So let's see. I would say if you thought of a place like Perioperative Services, we would bring in their leaders so that could look like their nursing director, their administrative director, their medical director, all coming together with some of their frontline managers and some of their team members and taking this Lean Management Systems coursework and then assigning them a coach who would have a relationship with them and sort of sign an agreement that said this is what our coaching looks like and this is how often we're going to get together and sort of what we're going to work on together in terms of both the goal inside that area but also in terms of behaviors that we were expecting would drive better performance. So they might be working on something like on time starts and just say, you know, this is where we really want to focus. We're having issues with that. We might help them in that instance consider an A3 or we might consider like a daily management board where they could track the numbers of cases that started on time, things of that nature. So depending on the area and depending on their focus, we will choose sort of a learning while doing problem that they want to address and then try to figure out how that coach can help support them in growing capability around that particular problem.

Got it, Got it. Now, have there been any, I don't know, different kind of models that you've looked at? I mean that was more of it on a strategy side, but I don't know, like on a deployment side. Have you experimented with different types of models?

Sure. So we've been reading a lot of Jeff Leiker books and so we were really looking at like the Toyota way to lean leadership and we were looking at developing lean leaders at all levels where there's this notion that you have some core capabilities around team and coaching and then you get more into sort of the tool set and daily management and then you start to be able to align that work to strategy. So we've been using that sort of model of how do we develop a leader. So we have a bunch of criteria we call the fully functional criteria. And if you're a frontline leader, we're going to have a conversation with you about how are you doing at asking your team open ended questions. How much safety do you create in the environment that makes it easy to surface problems? How do you use visual management to understand your business and to communicate the important priorities of the organization, things like that. So we have multiple criteria inside of that model that help us know that we're driving the behaviors that we feel will drive their ultimate performance inside of the more practical things they want to do, like changing flow inside of the periop services and things of that nature. So it's a pretty behaviorally based methodology where we're saying if we can get you to follow these types of behaviors, you should be able to solve any number of problems inside of your organization or in any sort of problem you're trying to help the organization with.

So I don't know, is it like an assessment sort of thing? Like a checklist of things, things that you're auditing the folks on or coaching them on or how does that work?

Yeah, that's exactly it. So there's a whole list of criteria and when we first meet with them, we review like these are the behaviors that we think lean leaders have. And let's do a self assessment and walk through it with you in terms of sort of yes, no questions. Do you do this most of the time or only some of the time? And if it's a they do it most of the time, they get an always kind of rating. And if they feel like they're not super consistent on that, we'll start talking about, okay, so over the weeks and months, how can we help you develop that skill or start to demonstrate that behavior? So there's just a whole slew of those behaviors. We go through it with them and then at six month intervals we go back and reassess with with them and their teams how well they're doing on those behaviors and their leaders until we consider them to be what we call graduated or fully functional, which means they're pretty proficient at the behaviors that we would say belong to a lean manager. And we feel pretty confident that they would be able to solve any number of problems using those behaviors.

Now, I don't want you to share any, you know, the dark corner of your facility or anything like that, but I'm guessing there's going to be times where the folks that you're coaching aren't always, you know, totally happy about all this stuff or I don't know, maybe not totally. Yeah, yeah. I mean, I mean. So how do you overcome that? If you had, if, you know, maybe meet some resistance to change for lack of a better. We decide to a guest on who talked about change management and the various facets of that, like how do you approach that?

Sure. Well, so because our initial work was in areas that we considered strategically important, and it wasn't necessarily people that felt like, yeah, that's exactly what I want to sign up for. We certainly had times where we encountered some challenges, some, you know, just resistance, or people just really, I think, for the most part, feeling kind of over overwhelmed with the dailiness of their current lives. So I guess, like, one of the very most important things is when the coaches go, their first priority is to really help figure out how to put this work in the path of what they're already focused on and what's already, you know, a burning platform for them. So in the instance of on time starts as an example, that would have been something that was selected by the client to focus on. And then we try to figure out how to make these methods and these behaviors work for that particular challenge. So trying to keep it from feeling additive is sort of one of the most effective ways we have. For the majority of people that struggle, they're just trying to find time to do this work. So if we can figure out how to help it accomplish the work they're already doing, that helps the very most. But certainly there's a spectrum. So some people are really showing up where they can't see the value outright. So there's some instances where we've just had to say, this was an organizational agreement. And if struggling with that, we might need to see if this is the wrong time or what your leadership kind of thinks about that. Or we might go in and really help them with people issues. Because a lot of times this is where we would run into things of, you know, I'm fine, but my team doesn't agree with this. And so how do we help them get buy in from their teams? So there's a whole lot of different strategies we use, but probably the very first and most important thing really is to try to get them to pick problems that resonate for them right now.

Yeah, well, like, why are we doing this? Right. By helping them identify problems, it's very clear we're doing this because we want to improve these problems. Right, right. Good. So any insights or lessons learned with this model?

Sure. Like, well, so many, many, many lessons learned. I think one piece really would be that it's when you're trying to learn new behaviors inside of a system that has a lot of old behaviors, you have to provide support maybe longer than what it would normally take. Because people are somewhat living in two worlds. They're trying to learn this new, new pattern of how do they coach and Engage others, How do they think about this? Work in a different way? And then they're supposed to show up for the next meeting being the expert. Right. So there's a piece of understanding that they're living in a little bit of a dual existence. And so you need to come in and really probably stay with them longer. So many of our coaches have been with us for 12, 18 months, really trying to get this as a way of being. And also sometimes if you walk away and you say, well, now I think you're good, and now your leader's going to be coming around and checking on you instead of us, sometimes that doesn't necessarily happen the way it needs to. And so we've really tried to figure out how to move that up into the chain of command. So it's not just the poor frontline manager who's trying to act and behave differently, you know, it's every level of the organization trying to figure out how to empower these folks that are working directly with our clients and our patients.

Yeah, very good. So the last question I have for this section, Beth, is let's say someone's listening to this right now, that maybe they're just starting with their journey. You obviously have been on the journey for quite some time, but if you could go back and kind of to your beginning and maybe reassess how you went about it or perhaps give that person some advice on how to get started the right way, what would you say?

So there's sort of the things that I would do in terms of implementation with others, and that would be, again, to not see this as a tool journey, but to see this as a people journey and to figure out how to support and create capability inside of our leaders. Rather than first starting with let me show you how single piece flow works, or here's an A3 go try to play with that thing. So one is really probably starting around these principles of what people need to be effective at this work would be where a great starting point. I think for me personally, one of the things that I realized about myself was that I too, had been raised with these same behaviors that I was from a system that was encouraging me to know all the answers. And so one of the biggest reflections I've had is that the only way that my coachees are going to respond to me helping them is to show them that I too, am on a journey and to really figure out how I can be different helps me figure out how to help others be different. And so I think there's a real personal component to this that every leader needs to look at and really understand that this is tough stuff. But back to Yoda's quote, Unlearning and relearning is really, really hard.

Yeah, it sure is. It sure is. Very good. All right, well, Beth, let's go ahead and transition into the reflection section. And this first question really kind of perfectly aligns with everything that you've been saying. And, you know, within lean, we spent a lot of time talking about those two pillars. One is that continuous improvement, the tools, the things that we can touch and do. But then that other pillar is respect for people, and that can be a little bit harder to wrap your arms around. So I'm curious, when you hear the words respect for people, what does that mean to you?

Well, again, so I think one of the biggest things that I've learned certainly within this coaching model and just generally speaking, is, you know, you need to make the work meaningful for the challenges that people, the very real challenges people are having, and to not assume that, you know, that there's some easy button. And so really recognizing and acknowledging that people have a lot on their plates, a lot of big challenges, and that, you know, you need to help them with real world problems and not some sort of more esoteric approach. And I think just being gentle with each other, you know, it's tough stuff. Healthcare is changing a lot. The environment in which we practice is changing a lot. And so just to really have empathy that we're all in this together, I think is super important.

What's the best advice you've ever received?

Well, probably again, back to this sort of personal journey of mine was to look at my own self and thinking about how did I contribute to the culture that I felt was important to change? And as soon as I was able to really deeply reflect, oh, I have these behaviors, oh, I have these things, and I need to learn how to undo them so that I can be sympathetic for the folks that are also trying to go through that. It was excellent advice. I never really thought, I thought I was going to be the concern who showed people how to do the work. I didn't think I would simultaneously be the person who had to learn how to change, to help other people change. And I had a great mentor who really emphasized that. To me, you don't ask for other people to do things that you yourself aren't willing to explore.

Can you think of an experiment or a project or an event that didn't take turn out quite like you planned? And if so, what did you learn?

Well, Again, I would say many. So, I mean, that's the beauty of experimentation. Right. And so I think just putting yourself out there, testing and trying things is really important. It's super easy in this work to want to just plan, plan, plan, plan and make sure you have the right things. So you actually really need to do and you actually really need to follow up and find out what worked and what didn't work and really think deeply about that. Like what would you do the next time? What were the failure points and how could you readdress them, but get going.

Yeah, I don't want to put you on the spot, but I'm curious and I know it's healthcare, so it's sensitive, but can you think of an example.

Where I myself had a failed experiment? Sure. So even inside of this coaching model, trying to figure out how do we get a blend of people who are required to do something versus how do we get people who, who want to be engaged trying to find that right balance. I think initially we were, you know, everybody has to be that's in this journey has to be strategically lined up in one of the most important areas of the hospital or we don't want to, you know, take the time or resource there yet. And now I'm starting to realize inside of my own experimentation that you need to have some folks who are excited and ready to jump in on the journey and show others what right look like in addition to yourself. And so that was a big learning for me is to say I also want to bring other people to the table who want to try this work, even if their work isn't maybe the most strategically impactful.

Yeah, got it. What are you most proud of as it relates to your journey?

Well, both at my last organization and at this organization, I have incredible teams. I have just some of the most amazing facilitators who think deeply about this work, who care, really. They're super passionate. It's meaningful and it matters. And watching them go out and do this excellent work has been just amazing for me as a leader. Letting them be the talent and letting me figure out how to help empower, enable them has been something that I'm extremely proud of.

So have you read any good books lately or perhaps I don't know, it doesn't have to be continuous improvement related.

Well, my team would probably tell you that those are almost just the kinds of books I read all the time.

Okay.

So yeah, I'm that person. But again, I'm going back with the, the developing Lean Leaders with Jeff Leiker And I'm like, on my third time listening to it. It's just a fantastic book. And in fact, we've even made several book clubs here around just going through chapter by chapter and really diving super deep into each one. So I just can't say enough about how great that book is.

Awesome. Awesome. So you've been at this for some time, Beth, and you've learned a lot. Unlearned some things. Relearned some things. But is there a, perhaps a knowledge or skill area that you still feel you need to improve in order to become a better lean thinker?

You know, I guess I would just always point people back to humility in this work. We're kind of in a culture and we all work inside of organizations where, you know, it's easy to inadvertently try to take credit or try to. To win. And so I focus a lot on this notion of humility, and that if people don't necessarily see our fingerprints on things, that's actually really a great thing. If I'm the wind beneath people's wings, I've been successful, as opposed to me needing to have that acknowledgement. So humility is one that we all sort of circle back multiple times inside of our team with.

Yeah, got it. Very good. I really enjoyed chatting with you, Beth. Let's go ahead and wrap things up with maybe you sharing some final words of wisdom. And then why don't you tell people how they can connect with you?

Sure. So, you know, I talk to my team a lot about how you can go into this work and really think about sort of your true north and the beautiful things that lean can. Can do on this very strategic level. But that really, the power of what we do comes in, like, the dailiness of doing that work. And it's really that one foot in front of the next and really jumping out there and putting yourself into these experiments and doing that is what gets you moving forward and not just thinking broadly and sort of in a disconnected way from that. So I really encourage everybody to think about, you know, every single day, what are the things that you can do to move your work forward.

Yeah.

And then I guess just in terms of contacts, I'm on LinkedIn and anybody could email me at Denver Health. I'm Elizabethvengadoenverhealth.org and we love connecting with folks. We love interactions, interacting, and so any and all contact would be welcome.

Very good. And we'll link to everything in the show notes. So it's Elizabeth Fingado on LinkedIn, I guess.

Yes.

Okay. Yeah. And we'll link to it. So the show notes for everyone is GembaPodcast.com and this will be episode 169. 169. So GembaPodcast.com so Beth, thank you again for coming onto the show. I know you're really busy and I know it's in the interview room and all of that and people are trying to probably beat the door down and do the next interview, so.

Well, thank you so much for speaking with me.

Yeah, it was great. All right. Well, hopefully we can meet up face to face at a conference someday. But until then, keep up the great work and thanks again.

Great. Thank you. Take care.

Bye Bye.

Bye bye.

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