GA 231 | How to Think Scientifically in Healthcare with Maurene Stock and Katie Melching

We came back and began practicing immediately and have seen incredible results around our processes. But more importantly is the learning and thinking, the reflecting and growth of our leaders and staff.

Today, we're going to turn our attention to the world of lean health care as we visit with Maureen Stock and Katie Melche, who both work at Mercy Health and Muskegon, Michigan. Now, as regular listeners already know, lean thinking has most definitely landed within the healthcare world. Sure, there's still lots to do, but you can say the same thing for any industry. Now, on today's show, Katie and Maureen explain how Mercy Health started their lean journey and how they eventually learned to think scientifically. I had so much fun talking to these two lean thinkers and can't wait for you to hear their story. Now, show notes for this episode, which will include links to everything we discuss, can be found over@gembapodcast.com and just look for episode 231. Also, be sure to check out our AME conference page over at gembacademy.com AME we can save you 10% on the registration cost. And most importantly, you can also RSVP for our annual cocktail party we're doing at Sally's Fish House and Bar. Now, we're going to be doing that party on Tuesday night, October 30th. Trust me when I say hanging out with a bunch of lean thinkers on a beautiful San Diego evening is going to be a good time. Again, that's gembacademy.com Ame okay, enough from me. Let's get to the show. Welcome to the show. Maureen and Katie, how is it going?

Really good, thanks.

Thanks for having us on. Ron.

Where are you guys calling in from?

We're calling in from beautiful Muskegon, Michigan, which is on the shores of Lake Michigan.

Okay, beautiful. Beautiful. Yeah. This is the perfect time of year to be there, right?

Oh, yes. Yeah.

Awesome. Awesome. All right, well, hey, you know Steve, Steve Kane, a Gemba Academy colleague of mine, met you guys at a recent conference and said we had to have you on and so really, really excited to learn more about your journey there at Mercy Health. So let's start with you guys just telling us a little bit about yourself, your backgrounds, how you first came to learn about continuous improvement and then tell us a little bit about Mercy Health.

Okay, this is Maureen and I started personally learning about problem solving and lean methodology, doing some research. I'm a nurse by training and I did research in interventional cardiology years ago, but really dove deep starting around 2010 as we learned more about what Thetacare and Virginia Mason were doing with lean, and in 2013, we started our own department here. Got it.

And this is Katie. I recently, I would say I am the newest member of our team. I've been practicing process improvement work for about five years, and everything that I've learned has been through my colleagues here. And also just reading all the books and listening to your podcasts. And my original background is actually in health communications, which is more the PR public relations side. So I really love continuous improvement work and learning every day.

Very good, Very good. All right, well, we're going to dive deep into your journey, but before then, ladies, as you know, we like to have our guests share a quote or two, or 20, perhaps, whatever you have. Do you guys have something you want to share?

Yeah, we did kind of bring it down to 20, so I hope you have some extra time in the podcast for these 20.

We're just kidding.

Just kidding. So our quote, I think, is a favorite quote within the Lean community is specifically the Kata community, which is where we're focusing our work right now. And that's by Albert Einstein. And it says we can't solve our problems with the same thinking we used when we created them.

What's that mean to you guys?

For us, I think we in the hospital, and I would assume in other industries, everyone says, well, we've done it this way forever. That's why we do it this way. And for us, using CADA to help them deeply think about and deeply understand their processes. In a hospital, processes are invisible. And so using the Toyota Kata methodology to really use that scientific thinking tied with deliberate practice, to truly have a new mindset and approach problems or obstacles in a different way.

Yeah, yeah.

Also like to add to that, I think we also go about our own approach and continuous improvement. As you know, we may have done things a couple years ago a certain way, a certain methodology or practice, and we do a lot of reflecting on that, and what can we do better and how do we need to think differently? So I think we also internalize that as a department for sure.

Katie, I think you're right.

Yeah, beautiful. Beautiful. And I think the thing that I love most about that quote and just really what you guys have said is there's one word in particular that just stands out, and I hope it just doesn't fall on deaf ears, and that is the word think. Right. And. And that's. That's the power. Right? It's thinking. It's thinking differently. And that's, you know, for many of us who have come up through the. Through the. I don't know what you call it. Traditional continuous improvement world. You know, we've all tried to do this. You know, whether it be pdca, Domic, whatever. There's. The thinking's in there, but it's just not always deliberately done. Right. It's some, oh, let's just run and do this Kaiser event or. Which is fine and good things will probably come from it. But oftentimes there's just not deep thinking involved, which means there's not deep learning involved. Right. And I think that's what Kata does so wonderfully. All right, well, hey, so let's just jump at the beginning of your journey, perhaps even pre Kata. I don't know. I don't know what your journey is. I'm curious to learn. How did you start and why did you start?

Great questions, Ron. Really, we started for two big factors. Health care was changing in the mid 2000s, 2008-13. There were changes in the way we were paid. And that really started to put some pressure on us to look at the way we did our work and to look at how industry had improved. The second thing is we're in a community that had two hospitals that have merged. And we are today building a new patient tower to bring those two campuses to one campus. And as we looked at bringing and building this new campus, we really wanted to make sure we didn't bring bad processes or poor or weak processes into our new building. And so that really was the impetus for us to begin the journey in Lean.

So how did you. What did that look like in those early days? Was it a Kaizen event here or there? Removed 5s or what was it?

Yeah, so we started like everyone else. We did. We taught Lean principles, we taught waste removal, we taught A three thinking, we did value stream analysis and mapping, we did dozens of rapid improvement events and had all these A3 thinkers from our class. I think we had over 600 A3s and we had some results, Ron. Some that have sustained, but others that did not sustain. And more importantly, we didn't see a change in the way people thought about the processes they worked in. And we didn't see like a deep need of people to understand those processes. And as we were, we and our team were like, what? We're missing something. We found Kata. We actually attended a class in Chicago put on by Lei and Beth Carrington, taught it, and we came back and began practicing immediately and have seen incredible results around our processes. But more importantly is the learning and thinking, the reflecting and growth of our leaders and staff.

And I would like to add to that as Maureen and another colleague of ours came back and they were energized and ready to go with this kata. The transition wasn't easy for us here at the hospital, especially internally in our process improvement department as we were so rooted in that rapid improvement event thinking and workshops and going through value stream analysis. It was a little tricky to get on that bandwagon. But Maureen started off with a manager, director and one of our VPs and really focused on teaching and learning the improvement kata. Coaching kata. And from there we saw the results and the impact and also the change in their behavior and learning that it definitely sparked this interest. And I think Betty from Zingerman says it the best. It truly released the kata. So we're full on board now and see the beauty in it.

You know, I can only imagine people sometimes that listen to this podcast and maybe they haven't explored kata. They probably get really sick of people like you and me, you know, kind of. And the reason I say that is because I think there's a tendency that people think that, well, Kaiser events are bad and kata is good, as if they're opposing forces. Right. And I think what we've got to be able to do is say, you know what, Kaizen events are great. You know, I mean, they can really add tremendous value to your organization. The problem I see, and I have seen in my personal experience is that there's oftentimes no direction or no real. What's the word? Like.

Strategy.

Strategy, yes. Thank you. Right. And that's where kata comes in. Right. So Kata in and of itself isn't this magic system. Right. It's just this way of deliberate thinking. Right. And, and, and then in the Kaizen events, I mean, I'm. I don't know, I'm curious. Like I'm. Most folks have it, don't give up on Kaizen events because they start doing kata. When you come against an obstacle that says, hey, that obstacle, I could wipe that out with a three day event on XYZ Tool. Right. Or whatever. That's when the events come in. Right. But it's almost like we. The cart was before the horse.

Right.

For many of us, for many years. And now this horse called Kata has kind of showed up. Right. And now it's pulling us. I don't. Is that what you guys have seen? I don't want to put words in your mouth.

Right. I would agree, Ron. We still do Value stream analysis to help us with determining a strategy for a Specific value stream. We're doing, I would say, much better in our leadership system using kata. We continue to do rapid improvement or kaizen events, but we've changed them a little. They're kind of like a quick beginning to potentially a kata board.

Yeah.

Where we do some. The last one, our colleague Kelly Gorbach did, she used. She didn't teach kata, she just used the kata language. And they did seven experiments, much smaller, much quicker, within two days of their rapid improvement event and were able to, as they did their report out, talk about what they learned and how that learning led to their next experiment. And. And so we're learning from that. Instead of having five day events, we're having like two days and then a week or two for them to do some additional experimenting and bringing them back in. We're always. We use kata as a verb. We're always kataing our work.

Yeah. Which means you're thinking and you're experimenting, right?

Yeah. Yes. Yeah.

I would add on to Maureen's comment about the leadership system. I would say in the past we implemented. Implemented, and I use the word implemented because it was an implementation leadership standard work, and no one was really using it and they didn't find the value in it. And when we started learning CADA and that thinking, almost the leadership standard work became this personal kata for them so they could use that documentation and that thinking to then improve upon themselves. So we think the coaching kata, the reflection of that has really played a huge part in other components that we use and tools that we have within our toolbox.

Again, we really see CADA as developing our people. And I think Brandon Brown always says, if you focus on the people, the numbers will come. If you focus on the numbers, the people will go. And we're finding that as we develop people, we're getting pull from all areas within the hospital and outside of the hospital, within the healthcare system, even up to our parent company. Our parent company is Trinity Health and several members were at the presentation we did where we met Steve and they've said, we want to learn more about kata. It's funny you mentioned kata is the horse or when we first brought kata to our leaders, what they said was, this is the secret sauce. And I was standing in front of them all and I said, well, it definitely is the secret sauce. If you think of secret sauce as exercising every day and eating right for the rest of your life, because it's practice, it's deliberate. Every day we're learning more.

Yeah, yeah. I mean, because the horse can stop moving, right. And then the cart doesn't go, right. Yeah, yeah, yeah. So I want to actually go back a little bit and just hear a little bit more pre kata. I'm curious to know. You mentioned A three thinking and which is, you know, I think it's a. It's a very similar concept to what we are trying to do or what we are doing with kata. But for some reason people thought that this piece of paper was this magic weapon. Right? When in fact it was just a thing that you wrote a story down on. Right? You told your story on the piece of paper. So whether it was practical problem solving, eight step, you know, Toyota business practice, whatever it was that you were using to kind of move through the A3. The A3 in and of itself is just a piece of paper. But I'm curious to hear like how that went, you know, how was A three thinking? I'm using air quotes, but we're doing audio. So you can't hear me or see me. I do that all the time. Like, yeah, people can't see your hands. Ron, how was that A3 thinking and Kaizen events? How was that orchestration happening?

That's super interesting you asked because one of the slides we shared in our presentation is so we in Process excellence would go and help understand their current state. And in fact there were often times where we knew more about their current state than they did. And when we looked at the time we spent from in a rapid improvement or Kaizen event based on our work and the work of all the roles within the room, and we looked at our standard work which was I think over 90 days, we found that we were putting in that whole team 164 hours of work to have a rapid improvement event. Then we compared that same time frame using a KATA methodology and we found that we reduced the time we needed to for that whole team to be involved by over 50 hours, which was really interesting and eye opening to us, it also allowed us to think about moving into more areas because we had more time to support more areas using CADA. And when we think about the A3s, you're right, it tells a story. I think it's limited in that it has that action plan list and then you leave that learner and they go off and do their action plan and it works or it doesn't work and they don't know what the next step is. And with kata and the coaching, Kata particularly those questions help them say, okay, that didn't work or it did. What's your next step?

Yeah, no, exactly. Yeah, it just brings you along. Right. I don't know how else to say it. Right. It helps you keep moving forward and learning. Right. And there's no failure. Right. That's what's kind of cool about it. It's like, well, I. What was your last step? This. What did you think was going to happen? This. What actually happened? Oh, my goodness. This is what actually happened. What did you learn? You know, it's just beautiful. There's this beautiful rhythm right. To the learning process. So. All right, well, tell us a little bit about. And obviously you guys are really leveraging kata, but talk a little bit more about your current approach. Like, do you have, I don't know, storyboards all over the walls? Like, how are challenges come up with? You know, like, who's doing that? Is it the senior leadership and then hospital? Yeah.

Okay. So we're working within the hospital in all different disciplines. We are within the nursing area. We're working with the physicians in the hospitalist group. We're working with pharmacy, we're working with the rehab group. We have boards and coaching going on.

In lab, human resources, imaging, recently in the primary care network, which is our.

Physician offices or your physician offices, you know what I mean? So, yes, we have boards everywhere. We are developing our directors into coaches, and we in our process excellence department are second coaches, or in some cases, we are modeling coaching as people are developing into coaches. So we kind of elbow to elbow out there with them, working with them, with their learners.

And I would say we're also still in the learner role too. As we practice, we're realizing, you know, we still need to be in that learner role and continue learning ourselves. So we each have our own. We call them kata lane. So we each have our own kata lane that we're working on individually within our department.

And we've kind of. Katie called it Elaine, Mike's storyboard, Mike Rother's storyboard. We did not use that layout because we had done a lot of work before we found kata. And so our lanes are vertical at the top. It tells the strategy that the learner is working under. Then it has their challenge and a challenge outcome metric, like how they're doing both on their strategy and that challenge. It then has the focus, process and target condition, actual condition. We also have moved the obstacles above the PDCA cycle and we continue to talk about that. What we found is our obstacles at times were becoming stale. People weren't reviewing them. And so we actually have them go through their obstacles before they talk about the one Obstacle they're choosing now. So it looks a little different. I think Mike Rother often says it's a DYI, and we've DYI'd Arcata boards to meet our clients needs.

And going back to our history a little bit, the main reason why they're vertical instead of the actual storyboard is we had a management system that we had ruled out, and the lanes were set up as specific lanes, and they had the Pareto and they had an A3 in it. So we just fit kata into the structure that we were already working in to meet our leaders, where they were at.

And the interesting part of that original lane that had. It had strategy, it had a Pareto, it had an A3 on it. And then a daily metric, when we looked at that, like, 75% of the lane was stagnant, we weren't working on it. And 25% was dynamic. It was that daily metric. And when we flipped that lane to use kata within it, we. We found that 25% is a static, which is really that strategy and the challenge. And then 75% of it is dynamic. They're working it every day. Yeah, it's really cool.

Okay, so I have a real. This is for the kata geeks out there, a real technical question on how you guys practice kata. I had a great conversation with my buddy Mark Rosenthal. You guys know Mark?

Oh, yeah, we're in love with him.

Yeah, yeah, yeah, yeah. So. So Mark and Mike are my. My go to kata guys, right? When I have a question. And. And so. Okay, you got a challenge, Right? So someone's. Someone gives you the challenge, right? Your boss gives you the challenge. All right, great. Achieve this in the next, whatever, nine to 12 months. Cool. Okay. What's your current condition? Well, okay, well, currently, as it relates to that challenge, this is. This is where we're at. Right? Okay, that makes sense. Now, what's a target condition? Where can you be in two weeks? You know, and you set that. And what obstacles are in your way? Which one are you going to go after? Okay, now we're off, right? We're off and running. We're going after that one obstacle. Now, when you come back for that coaching, let's say you're, I don't know, two months now into the journey, right? And you're getting ready for a coaching kata session when you start talking about the actual condition. Right? So. So I'll say, hey, Maureen, what's your. What's your target condition? Well, blah, blah, blah, is my target condition. Okay, well, what's your Actual condition. So then at that question, what is your actual condition? You're going to obviously speak about how you are in relation to that target condition. Right. Because that's what we're focused on. But how often do you go back or have your learner revisit the overall challenge and how we're, how we're doing on that longer term goal? Does that make sense?

Oh, yeah.

Yes.

How do you guys handle that?

I would say, well, we do recommend that the challenge has a run chart and that's updated monthly. But I think what we're learning is in the beginning, we weren't great at going back to that current condition and reassessing where we're at overall with our challenge. So we've started being more deliberate about focus processes. And then when you move on to your next focus process, we're going back and reassessing that current condition. And also if we're struggling with setting that new target, following another target we had just completed, we use that current condition summary in order to understand where we need to go next.

Yeah.

Oh, I would say it would be nice if we could visit that current condition more often.

But I would say for me. So we have a little variation in practice. I ask them that question every time and it stays the same, you know, for the month.

Yep.

But they also say they, I think, you know, we're really doing well on the target. I think next month it's going to be better.

So you, so you're really assessing the, your current condition, actual condition in two realms as it relates to the challenge and as it relates to that shorter term target condition. Is that what you're saying?

Yeah. We added three anchoring questions to the five question card, which is like nine questions. So we added three questions and that is what is your people centered metric? Those are our strategies. What is your challenge and what is your focus process? Because we really feel like we're trying to change this behavior, to change their mindset. And as we bring more and more teams in, they want to say, they want to say they understand what they're working on and how really that frontline, how what we at the front line are doing to impact that overall strategy.

Yeah.

I would say adding that focus process question has also helped us kind of scope the work so we're not taking on that whole challenge at once. And it almost makes it easier to set that target.

Yeah, now, exactly. You know, it's been really interesting for me kind of teaching people about this is when I'm working with folks who have, let's say more of a. More of, say, a Six Sigma background. This whole, like, keeping track of the challenge to them, it's like breathing. They're like, why would you not do that? You know? But the lean folks out there, like a run chart, unfortunately for some lean people, is like, whoa, that's pretty amazing, you know? You know, and so this is where the two disciplines, I think can and should meet. You know, like Six Sigma guy is like in love with their. His or her graphs and, you know, prime metric graphs or whatever it might be. Whereas the lean guy or gal is out there, whatever, you know, not necessarily. Even though guys like Mark Rabin are out there preaching SBC and we should be in the lean community, unfortunately, it's just not where it should be. So I think this has been a great step forward for the broader lean community, I think.

And I actually had a conversation with one of our co workers a week ago, and he's going back, he's getting his black belt and he's like, you know, within kata, we don't do enough analysis. There's not enough analysis in that current condition. And it's just this struggle of thinking. So where we're coming from, we're like, well, you know, you have your challenge, you have a future of where you're going. Do you really need to spend so much time where you're currently at? Because you're going to be setting these targets in order to move forward. So I think that's interesting that you bring that up.

Yeah.

And it's a balance with everything. Right. Because the Six Sigma person can like just diet minitab and not. Not leave their desk. You know, that's no good. Right. So I think there's a balance right between. Between the two disciplines there.

I think we are looking at our challenge metric and changing it monthly. Physicians are very driven by data, and so that really helps us get their support and their buy in.

Yeah.

And our executives as well.

And our executives, yeah.

Now, my next question. You guys have already addressed this a little bit, but perhaps you have some more to share. Just talk about the overall impact. I don't even want to use the word kata anymore. We've been wearing it out. Just scientific thinking. How has scientific thinking impacted your hospital?

Again, I think we've had a lot of people, development people are now thinking scientifically and approaching problems differently. When we are in meetings, the way they speak is different. Different than it was two years ago. They've changed their mindset. They really have this new habit of thinking about things scientifically. As far as results, I wish I could show you some slides. We have incredible results. Although I always go back to. It's about developing these people. But our results have been great. We have. I'm trying to think of something. I should have brought a PowerPoint with me. So I know within our acute rehab unit, they do something called a FIM score, which is a functional criteria. They look at someone who comes into their unit and if you had anyone, like a parent or a loved one who's sick in the hospital, and then they go to an acute rehab unit, they go there at a level of low functioning, potentially in the way they walk or talk or their strength. And the idea is that three weeks later they are able to go home instead of a nursing home. Our FIM scores when we started were below the national average. And using KATA to eliminate obstacles and better understand the work in the process, we are well above the national average. Actually, we're bringing the national average up.

Wow.

So that's one great story. I mean, I think in the presentation Steve saw, we probably put out eight, nine slides of the impact that we were having. Happy to go through some of those, if you want to hear them, and then choose the ones you like.

Sure.

Okay. So when we first started this, the way we brought Kada in was we did that training. And when we got back, we were looking for opportunities to try it. And we were in a meeting that we had been in for six to eight months, and we were looking at length of stay. And this committee met month. Excuse me, this committee met once a month and looked at the data and said, oh, you know, we need to do something about length of stay. And during the time that committee was meeting, our length of stay was slowly going up. And so one day we walked out of that committee and I said, I'm not going back in there. Let's try KATA on this. And so we began to do kata. We looked at three different processes that we believed would impact length of stay. One was echo turnaround time. So an echocardiogram is a test that is a non invasive test that tells you how your heart is working. We looked at that. We looked at avoidable days. Avoidable days are days where you could move to the next level of care, say a nursing home or go home, but we keep you in for some reason. And then the third thing we looked at was the discharge process, specifically the time from a discharge order being written by a physician until the patient left the hospital. All three of those using CADA, the echocardiograms we were on any given Monday had 34 or more patients waiting greater than 24 hours for an echo and physicians wouldn't discharge those patients because our outpatient echoes were 65 days out. Using deliberate practice, using scientific thinking and the Toyota Kata, we were able to eliminate barriers. And at the end of that work, which continues, but I can report to you now, our 24 hour turnaround for Echoes is at over 80%. When we started it was under 40 and our outpatient Echoes are. We can get you one in less than 10 days. Wow, huge for patients. Our time from order to discharge started at over five hours, close to six. And with the work they did, it's now below three. And actually we kind of focused in on our orthopedic floor and their length of stay when we started was close to three days and now we're at 1.7. Wow, some great work and avoidable days to nursing homes. We dropped from. And I don't have this in front of me, so I guess I'm not going to tell you that one. So. But we have had a reduction, but I can't remember that one off the top of my head.

I would say my most favorite metric that we've improved is we have press Ganey survey that measures engagement results of the colleagues within our organization and all the areas that we have been really focused on doing this improvement work. And using cada, we have seen an increase in tier and so their tier has increased. So meaning that the focused work that they've been working on has bumped them up a specific tier level and there's three tiers and for majority of the departments have moved from either tier 3 to a tier 2 or a tier 2 to a tier 1 and tier 1 being the highest score. So our managers and leaders are learning a lot about their colleagues as they go throughout this coaching kata and improvement kata.

Right. So we're engaging these colleagues and they are happy to be engaged. It's interesting, Ron. Healthcare has I think statistically the highest academic credentials of any business. And up until our use with cada we really weren't using those people. You know, if you talk about respect for people, we weren't using those people to their fullest ability. And using this scientific thinking tied with deliberate practice has really helped us engage people in a meaningful way. And so what Katie said is we're seeing it on their surveys, they are happier working because they're involved in improving the processes that they work in.

When it circles back to what you guys mentioned about Brandon, you know, and focus on the people and the processes and the results will come, right? And so clearly, I think you guys are perfect examples of that. So, listen, ladies, this has been a fabulous conversation. If we're not careful, we'll be on here for four hours, and it'll be like a Joe Rogan podcast or something, you know, so. Which just might be kind of cool to do one day. I don't know, but I want to kind of tie this last question together, and perhaps you can both chime in however you'd like. But I'm curious to hear. I can hear a lot of joy and excitement and passion in your voices. So obviously you're having a lot of fun along this, but maybe you could talk about maybe what do you enjoy the most about this whole approach to continuous improvement that you guys are taking? And then I want you to speak to the person who was like, all right, I've heard about this Kata stuff enough. I'm going to give it a go. Like, talk to that person, perhaps they're even in healthcare, and give them some advice on how you would encourage them to get going.

I would say the impact it's had on our leaders. And I think during the talk, I shared a story about Linda. Linda is one of our senior directors. And Linda used to. She's very good, but her way of working was do it all, get it all done. You know, she was busy on weekends. She didn't know specifically who was, you know, where people were working or what they were working on or where they were at with that work. And using Kata, she now is. Instead of working hard, she's developing her people. She knows what they're working on. She actually has used Mike Rother's recommendation of a coaching summary board. So she's seeing these great results. More importantly, Linda stopped me in the hall recently and thanked me for giving her her weekends back. Because with Kata, she knows what her staff are working on, how it's impacting the overall strategy, and she's excited to come in and see how the experiments came to fruition.

Yeah, Yeah.

I would say for the approach overall, it creates a safe environment where it's okay to fail. I think in the past, leaders were afraid to fail because of what would happen if they didn't have the right answer. I think with the coaching Kata paired with the improvement Kata, we're able to have the accountability, but also the safe environment where they can learn from their obstacles or learn from an experiment and fail gracefully and learn from it. So I think that's. That's what I enjoy Most about this approach is people are coming in and excited to try new things.

And we have had plenty of failures. I mean, I don't think. I don't want to paint this as a picture like, oh, use kata. And it's perfect by far. I mean, today I was at. Before we began speaking, I was at four, five different boards. Boards. And four of them went really well. And one, the learner is really struggling. So really asking these questions with kindness and curiosity. I always say I come to the board with wonder, not judgment, and help them begin to learn the scientific thinking. And we do it. We go to these boards at least twice a week. We don't want to be weekend warriors. Right. We don't want to just do it once a week and then not remember anything.

I think that's a good point, Maureen. Some people are struggling more than others with the. Either the coaching side of it or the improvement approach. And while we keep doing just to keep them motivated is just being there with them and saying, you know, okay, great. What can we try next? And just keeping that positive environment to know it's okay to move forward and to not always succeed.

Right. Because I think, you know, the last question on the card is how quickly can we do what we've learned? And so we are there shoulder to shoulder, helping them out, holding them up. Sometimes they're holding us up. So. And if you. And you had asked, like, if I was giving advice to someone that started or is starting, I would say start. Start somewhere. Start small. You know, we did. I think Mike refers to it as an advanced group. Two people from Process Excellence. And I literally kidnapped our cno, our chief nursing officer, to go to the initial training. I told her there is an IKEA other end of the parking lot of our hotel. And she. Having a senior leader that really is committed to it was very helpful. I would say. One of the things we probably, in retrospect, should have had one of her directors with us, because it really is along the chain of command, but we've overcome that. So we learn every day, which actually I've been in the workforce for over 30 years, and I come in every day excited to learn.

I would say the same.

Yeah, yeah, that's beautiful. Beautiful. Katie, do you have any advice for someone just getting started with kata?

I would just say, echo. Just get started. And there's a great Kata community out there. You could reach out to anyone, and they would be happy to just sit down and talk about maybe some of their struggles or where they're at with their Kata Journey and just open yourself up to that. I mean, there's all these kata communities and on websites, also LinkedIn. So I think find a coach or find somebody that you can just work with as you go through the process of learning and just get started. It's not as daunting as it seems. Just.

And I think as part of that community, the person that's also accessible is Mike himself. You know, I mean, go to a conference and watch. And watch Mike, you know, he's walking down the hallway and there's no one that he, you know, kind of gives the hand to, like, you know, stay back. I'm Mike Rother. You know, the guy is like talking to everyone, you know, and like. And I'm not mean just talking like, he'll stand. I saw him and we were in Winnipeg few months ago at a conference together and I saw him, I wanted to say hi. And he's walking down. Next thing, he stops to someone. Twenty minutes later, he moves on and he stops at another person 15 minutes later, I'm like, okay, maybe in two hours Mike will make it the next 30ft. But it's just a fantastic guy and I think it just represents this community. Right. And it's just people who. Because I think he. I think if you were asking him, he's learning as well. Right. And, and, and that's why everyone's so passionate about this.

Right, Yeah, I would agree. The community has been so welcoming and supportive and encouraging. Mike himself, you know, Skip Stewart, Brandon Brown. Yeah, that's. So we had the chance to present at Katakan in February and one was so welcoming.

Yeah, it was the best conference.

Yeah.

Yeah, I think. I say again, having worked for a long time and been to multiple conferences, I would say that was probably the best conference I've ever been to. The learning that occurred, it wasn't just lecturing, it was learning.

Yep, exactly. Exactly. Yep. All right, well, very good, ladies. How can folks get in touch with you? Is it social media? LinkedIn? What's the best way for them to connect with you?

This is Katie, and I would say LinkedIn. I can be found at katiereganmelching. And I believe I'm the only Katie Regan Melching on LinkedIn.

So go ahead and spell that in case people are just listening. Only they might spell your name out. Katie.

So it's Katie, K A T, I, E, Regan, R E, G A, N, and then Melching, M E, L, C, C, H, I, N, G. Got it.

Okay, Maureen.

Yeah, this is Maureen, and I can be reached on LinkedIn. Maureen Stock. And then also my email is stockmmercyhealth.com.

Got it. Okay. We'll link to everything up in the show notes. I guess we're not allowed to link email addresses anymore. I got in trouble for that. So the spam. The spam bots out there. But people can listen. But we'll link to your LinkedIn as well, for sure. And so show notes for this episode will be GembaPodcast.com. this will be episode 231. So, yeah, fantastic, ladies. I've really enjoyed it. Hopefully we get to meet face to face one day. Maybe we'll come out and do a Gemba Academy live at your hospital. That would be pretty epic.

That would be great. We did a Kata practitioner day, which was incredible. We just met so many wonderful people and shared stories from people from Michigan, Ohio, Indiana, and Illinois. So we'd love to have you, Ron.

Anytime you let people from Ohio in.

Well, some people. Others didn't.

I'm just kidding.

As long as they didn't wear red. Yeah.

Yeah. You may not know this, but I'm actually from Ohio, so I always have to be careful with all you Michigan people. And I told. I told like, Mike and, you know, there's liker. All these guys, like the whole lean world is from Michigan. What's going on, man? You know?

Well, our doors are open to you.

All right, very good. Well, thanks a lot, ladies. This has been a great conversation and keep up the great work and maybe we'll check back in in six months or so to hear even more amazing stories.

We would love to hear from you, Ron.

Yes. Thank you for this opportunity.

All right, you guys take care.

Bye Bye now.

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