GA 253 | Building a Strong Lean Foundation with Mohamed Saleh

I think when you're starting in the beginning, there's a few things that you really, really, really need to know. And I think the most critical question to ask yourself is why?

Today I'm excited to welcome Mohamed Saleh to the show. Mohammad works as the senior sensei and executive director of the H3W Lean office at Hartford Healthcare. Now, during the show, we talk about the early days of how Hartford advance its Lean journey by first building a strong foundation before diving into behaviors and principles. We then had a really interesting discussion on their approach, including how they went deep versus wide, while also working bottom up and top down at the same time. Now we wrap things up by learning how their lean department is organized today and hearing a state of the union of where Muhammad believes they are today. And while today's episode is slanted towards healthcare, the WISD and advice Muhammad shares most definitely applies to any and all industries. The show notes for this episode can be found over@gembapodcast.com just look for episode 253. Again, gembapodcast.com and look for episode 253. And as always, you can check out Gemba Academy's full lean learning system over@gembacademy.com with a fully functional trial. Okay, enough from me. Let's get to the show. Mohammed, welcome to the show. How's it going?

Everything's going great. Thank you.

All right, so thanks for coming onto the show. We were chatting a little bit before we hit the button there, the record button, and talking about. I guess you and I kind of met over DVDs some time ago.

Yes, Ron, I have so much gratitude for both what the Gimba Academy does, but also what you've done in my own career. I've been following you for at least six or seven years now. I feel like a stalker, but you've definitely developed me and have provided so much for the lean community. So much to be thankful for you for.

Well, no, thank you. Thank you for your business and obviously thank you for the work that you do. All right, well, Muhammad, let's kind of get started. As you know, we kind of like to begin our shows with our guests sharing a quote of something that possibly inspires him. So you have one?

I do. I have maybe I'll say two. I've had the privilege of having a few mentors that really resonate with me and I'll talk about some of them as we go through this. But I think the two that stick out for me is Mark d' Luzio is really iconic in the Lean field. And really early on, he would always ask me, are you doing lean or are you being lean? And that really resonated with me. I think as I do more of this and I realize how much more I still have to learn, the more I appreciate that comment. Are you doing lean or are you being lean? So I would say that's one of my favorite quotes. And the other one I would say is Dave Stack, a personal mentor of mine and business partner, and I've known him as long as I've known Mark, if. If not longer. And Dave Stack would always ask me, how dirty are your gloves? And it really speaks to not just commitment, but also the level of participation behind it. So those I would say are my two favorite quotes.

I like it. I want to go back to that first quote and dig into it a little bit, because it's really interesting. Doing versus being lean. Talk about the differences.

So a lot of organizations have, I hate to use the word, but window dressings of lean. They look like lean. They have all the artifacts of lean. They have the lingo of lean, but when you really get down to the fabric, they're not really being lean. The element of respect for people isn't there. The. The cultural mindset hasn't really shifted. They have all the artifacts, but they're not really being, you know, what this culture is designed to do. They've done everything that the book said to do, but they really haven't converted their own mindset to think differently and drive that respect for people.

Oh, I love that. You know, it's. You know, it's why it's so easy to, you know, go on a benchmarking tour or go to Japan or go to wherever, which is all good. There's nothing wrong with it. But when you go with the intention of copying artifacts, I think you've really. I won't say you wasted your time because perhaps you still could learn something, but, yeah, it's much better to try to understand instead of what kind of. What kind of tape do you use on your floor? You know, it's better to understand why do you tape there on the floor, and what's the purpose of that. Right. The meaning behind that.

Absolutely. You know what? There's two other not quotes, but if anyone's familiar with the work Bobby Miliani has done, and he's also been a huge mentor of mine, I've got the opportunity to really get taught by him from a behavioral standpoint. And he would always talk about fake lean versus real lean. And I think that's the same as doing lean versus being lean. And if anyone had the opportunity to get school by Mr. Nikao, you know, he would always say the. Everything they need to. Everything. Everything that they need, they can't see. And that's really speaking to the fabric. It's, you know, I could give them everything I have. It's. That's not what they need. What they need, they can't see. Yeah, so. So that's awesome. Echoing what you said.

Very good. Very good. All right, so, Mohammed, let's dig in. Before we get into. Into the really, the main emphasis of the episode today, I want to know more about you. Tell us about your background, Muhammad, how you maybe first got exposed to all this lean stuff, and then talk about current day. What are you up to these days?

Okay, that's great. So I would say around 16 years ago. One, six. Not six. Zero.

Okay. No offense to some of our older listeners. Right.

Well, I'm not that experienced. I had the opportunity. I have my bachelor's in mechanical engineering from Central Connecticut State University. And during that time, I got into an organization. Started off as an internship with Franklin Products, which is a division of Boeing that does seats for airplanes. And I got really interested in it, and I realized that there's a lot of opportunities on the manufacturing floor rather than just the design side. So I got out there and I started understanding a little bit more about manufacturing. And the more I understood, the more I understood how I am contributing to the problem. And so decided to take a master's in technology management at Central Connecticut. And during that time, I got introduced to Dave Steck and Bobby Moyani and Mark d' Aluzio and Joe Murley. And all of them were. Are still iconic in the lean field. And Mark was really heading the Danaher movement. And Dave Steck and Bobby Lemani had just published the book Better Thinking, Better Results. And Joe was really, really big on the standard work movement. So I feel like I was lucky because I was just there. So I started interning, doing anything I can just to learn more about this. And as I progressed through the master's, the occupational health physician for Pratt and Whitney, Danaher and Wiremold happened to be Kent Stahl, who was really the reason I'm here today is he also happened to be the CEO of the medical group and had asked them to consider coming and bringing what Shingihitsu was bringing to Wyremold to the medical side. This is very early Virginia Mason was just getting started. Mr. Nakao is going out there. So it was very early in the journey. Having done a few cycles with them, they recommended me to be their director of continuous improvement for the medical group. I decided to leave manufacturing and move into or aerospace and move into the healthcare space. That was 11 years ago.

Wow, okay.

And so at that time, I spent five years in the medical group. Got a little bit more exposed to Joe Murley especially that I started the journey at the medical group with standard work and the evolution of standard work there. And then Dave Steck was my personal mentor and actually did a lot of consultative services for the medical group. Really helped the deployment of standard work. But the alignment of standard work and really got us to think more from a Hoshin Connery standpoint. I started building my muscles a little bit outside of the production side and starting to understand the management side a little bit more. And so from there, after five years in the medical group, I felt like they had a strong muscle and it was time for me to kind of expand my portfolio of gaps or fill my gaps. And so I decided to move into the acute space. And at that time, Jeff Flacks, our president of Hartford Healthcare, was kind of bringing everyone together as a system with the help of our CEO, Elliot Joseph. And they both had a really vision around leading this transformation and creating something that works for them. And so they started really crafting an operating model which is now come to known as how Hartford Healthcare works. And so I moved into the acute space, into the hospital space, got a few three years under my belt there. And then I moved with them into a system role to have oversight of the lean office. But during that time in the acute space, there was a lot of work that really started, I would say systematically in 2009, where Jeff and Elliot really started looking at our operating model as H3W. And that's the term that got used, the three Hs in how Hartford Healthcare works and became foundational. There were some elements that they ingrained into the operating model all the way back then, where every leader or every manager had to have what we call the HDW meetings, which incorporated a top down communication of the month of what the senior leaders are doing, a dashboard to measure progress. Idea generation had to be part of every month and making sure that if there's any kind of message that has to be given throughout the organization was given. There was what we call the plus delta reflection opportunity within that and a few other elements. But that became really like the fabric or the foundation of how this model started to work. And a little bit after that we recognized that we needed a behavioral aspect to it. And that behavioral aspect was really led by Elliot, who brought us in, and we had to start behaving differently. And so we started incorporating our 10 leadership behaviors, which are part of the fabric of our own at that time, with the partnership with our cao, Tracy Church. They're no different than any lean behaviors you would see. Like being curious, being in the moment, understanding separate realities, teaching, coaching and mentoring, modeling, high performance, core behaviors that we really needed to make sure we ingrained before we started embarking on lean principles. And those behaviors really became foundational to the point where in the late 2014, they recognized and our senior leaders that this is an opportune time now that we have driven respect for people into the organization, that we started embedding lean principles into our operating model. There was many pockets of excellence. There was a lot of lean going on, but other methodologies as well. And there's. And our president at that time really said, you know what? We have to do this with one methodology. And they committed all to doing lean.

Hey, real basic question. You mentioned how Hartford Healthcare. So is that how you refer to the movement, to the program, or is it Hartford Healthcare? Just a real basic question.

Hartford Healthcare is the organization. How Hartford Healthcare works is the name of our lean transformation.

Okay?

It's the H3W, the three H's and how Hartford Healthcare and then works. W. What's worse?

A W. I was like, what.

Works? Because we didn't want it to feel like a program. We wanted to feel like our operating system.

Lifestyle.

A lifestyle. And so they came up with that name because they really wanted it to be a lifestyle, like you said.

So just kind of summarizing what you just said, kind of almost three bullet points, if you will. More of a foundational. This is where the H3W kind of was born. Then you wanted, before you jumped into the principles of lead, you wanted to really solidify your behaviors, right? How are you guys acting? Treating one another, if you will. And then. And then our lean principle. So I assume the lean principles, this is going to be more of the, you know, learning some tools and things like that. Is that right?

The lean principles. Well, we have a mindset here where we could have went after the tools, and it felt like that was the right thing to do. But we took a step back and really got into Jeff Leiker's 14 management principles and said, if we could really, really ingrain those 14 principles in the organization and anchor our values around them, what systems would we have to design? We started Looking at a management system using what we call strategy, strategy deployment and daily management. And so we have that system in place. We started looking at our production system and really understanding how do we move from a vertical perspective to a horizontal perspective and what are the opportunities for flow or process opportunities within them. And then we also started looking at just the problem solving muscle and how are we building and nurturing that level of exercise, I would say so that we could grow and advance our leaders. So aspects like one on one coaching, kata coaching and stuff like that. So we started looking at the systems that we had to put in place. And from that we started selecting tools and actually evolving tools or actually creating our own tools that would help activate that system to drive those 14 management principles. So that was really the approach that we used at a high level because we were worried about going into the tool tools and not really understanding what it's enabling.

No, that's great. I mean, good for you. Because a lot of people don't do that, you know, and I've even failed at that many times. So. All right, well, so that's the background. Let's talk, let's kind of maybe dive just even deeper now and really talk about the approach that you guys took. And don't over, don't miss the beginning because many people hearing this right now aren't, you know, as established as you guys are and maybe they're just starting. There's still a lot of, a lot of organizations out there who haven't really begun this journey yet. So talk about the approach like maybe in the beginning and then up to present day.

Absolutely. So that's a really good question because knowing what I know today, there's many lessons that I'll talk about that we've learned and things that have become very successful. But I think when you're starting in the beginning, there's a few things that you really, really, really need to know. And I think the most critical question to ask yourself is why? Like why would you do this? It's such a commitment and there's so much that goes into it that if you don't really know the why, you might find yourself shortchanging yourself down the line. And I've seen leaders that sign up for this without understanding what it entails. And I've seen leaders do this because other people are doing it and so they just want to copy that. So I would say the first step if you're going into this journey is truly know the why. So we had a burning platform. Healthcare, as you know, is an evolving field. We had, you know, staff frustration, we had employee scores that we were doing great at, but we still had so much ways to go. We had a very strong burning platform for us. And without that burning platform, I think people aren't really driven in to make this type of change. The second thing I would say is when we started, we went really deep. First, meaning that we have nine different presidents and we wanted to engage everyone. But in the same time, we didn't want to just roll it out like something like top down, something like you'd seen in it, which is a software that would just go out across the entire continuum. We wanted to make sure that we understood what we were doing and underst the uniquenesses of our own organizational characteristics. And so we had to go really deep in the beginning. And a few of us in the beginning were trying to understand what is. If we're going to be. One of the leading principles is to really be customer focused. And if we really wanted to drive that home and create flow around the customer, let's follow a customer. So we picked an oncology patient and we picked a neurology patient. So a patient that comes in from, with say breast cancer, they go through a primary care doctor, then they go through a specialist, then they go to the hospital, and then they get some labs done, and then they go to maybe rehab afterwards. And so we followed that patient and every unit that that patient touched from the moment we actually communicated to them. So we even included strategy and marketing into our conversation until they actually went, who did they touch? And we found that they touched 14 different departments out of 850. And so we selected those 14 as what we call our demonstration units. Some people call them model cells, some people call them lighthouses. But we selected those 14. And that allowed for everyone around the system to have some kind of play in this. So if you're the president of the medical group or the hospital or community network with regards to rehab, you were able to create that model cell or demonstration unit. We spent an entire year with just those 14. We brought them all together. We created almost like a showcase where we put up different things around, different things around the room of different boards, for example, and allowed These leaders, those 14 managers and their directors to walk and shop and pick, you know, we picked things from the aerospace industry, we picked things from the healthcare industry. So we had things from like Medicare and Virgin Mason and Danaher and UTC and a lot of different areas and had them pick areas that they felt like were really going to prevent Helpful for their organization. And they got together, they designed a board, they created three different versions, and they went out there and they tried it for six months. And in parallel to that, we sent 40 of our senior leaders to Theticare to talk with John Toussaint, the CEO of theticare, and Kim Barnas, who was the COO of Theticare at the time, around. What does it mean for them, and what do they have to do, and how are they going to change their mindset? And they had really courageous conversations. We spent an entire day there, actually an entire week there. But one day, I was committed just to understanding what it means for them as leaders. And that includes our CEO, our coo, and our entire senior vice president staff. And so when they came back, they understood what it means to them, as well as designing something that works for us. So I would say going deep before you go wide was another huge aspect that really struck home.

Let me jump in. In real fast. You talk fast, my man. So I gotta get. I gotta jump in. I gotta be aggressive. I'm gonna be an aggressive interviewer here today.

Go for it.

You talked about these. These 14. 14 departments or whatever, right? That. That you focused on. But, like, what was your pitch to them in the beginning? Like, what problem were you trying to solve? Are you just saying, hey, we're doing this lean thing and come together and. And be lean, or what did that look like?

That's a great question. We did have to create a burning platform for them. And our burning platform was we have low satisfaction scores right now for our employees. We're not that effective at communicating. Our results are really not where they need to be, and our improvements have stagnated. And so we want to make sure that our employees really feel respected. If we're doing this because they should feel respected, this is a critical component for them. If we find that people are doing workarounds at the same time, our competition is becoming really tight, and then we find out our staff is being. Being frustrated and overwhelmed. We have a responsibility, and a lot of us have been doing a lot of improvements, and we're not able to sustain the gains. So we asked them for help. We didn't tell them, let's just go do lean. We told them that we need your help, and we're gonna count on the 14 of you to convince the 850 departments across the system what good looks like. And we'll give you all the resources you need, and we'll give everyone else the resources they need. But first, we need to make sure. That we get our learnings from you and we need their feedback. And we've revised our boards so many times before it went live with everyone else until we got comfortable with all of them. We had each one of them then sell it to their organization with our help, of course. But I think the biggest burning platform was we want to respect our staff. They're overwhelmed. There's a lot of variabilities and workarounds. We want our managers to be more involved and upper management to be more involved. And we're looking to you to create that chassis because we're not going to improve our patient experience scores or our patient outcomes without your help.

Got it? Got it. All right. So deep versus wide. Let's continue.

So there was. I talked a little bit about top down as an approach to this. When we selected those 14 areas, we required the director of that manager, the VP of that director, and the senior vice president of that VP to all go through a training which was comprehensive, four hours long every other week for six months. And every single person in that chain of command had to do it. So all the presidents with their vice president and all the way down to those 14 areas went on this journey in the beginning. And what we asked from the frontline managers to do with their staff, we asked our senior vice president to do the exact same thing. So we had a top down approach to it as we were building bottom up. So I think that's another thing that distinguishes us is that or distinguishes this approach is that we really tried to do it both top down and bottom up at the same time. And we required every single one of them to really go out there and like I said earlier, get our hands d. So our presidents were out there at the huddles, observing huddles, giving feedback to the managers being present in the workplace. We have what we call rounding, which has many aspects to it, but a lot of gimbal walks occurred during that time. And the other thing in the approach is we were worried that people would think lean is about the board. And because that's just an aspect daily management is just an aspect of.

It's an artifact, right?

It's an artifact. Absolutely. And so we started looking at what would good look like. And we had the opportunity to really explore the shingle model and really learn and understand and appreciate what does a bronze level look like, what does a silver level look like and what's a gold level look like? Now, we've never went for the prize. That's not why we, we adopted that mindset. But it allowed each department to understand the trajectory of their journey as if they were their own business. And it gave every leader their ability to own their own business. And so each one of our departments now they have the initiation which is daily management, but then they have certain bronze criterias that they go through to make sure that they have evidence that they're able to do standard work and able to do total productive maintenance and have a really good understanding and application of 5, both in physical and mental, as well as have Kanbans for inventory management systems in place. So these were all criteria and others, of course, criteria that we had to set in place as part of their bronze criteria. Knowing and appreciating that standard work was really the nucleus of that. And then a silver journey around really advancing all that that you've done, engaging your teams around it until the unit is 100% compliant with that, as well as living it day to day, but also starting to see performance results. And then gold becoming that best in class unit where other people around the country and the world could come benchmark you for that specific niche that you have. And so we started really converting the mindset that there's no end. In the beginning. People were asking, so when is this over? It's never over. And so we got out of the mindset of it trying to be a program where people see an end to it and gave each person a roadmap that could move at their own pace. There's no. They really don't have to run here. They could all move at their own pace. There's different kind of coaching styles that work for different people and people are sometimes faced with different challenges than others. Some people might move a little faster than others just because of the circumstances they're in.

Yeah, I love that. It's one of my passions is for people to kill their lean or Six Sigma continuous improvement programs. Just stop them. Because programs by definition, end. End, right? Yeah. Call it a movement, call it a whatever, man. I don't know, it's like, it's how you. It's like the air around you that you need air to survive. Right. And we need this stuff to, to prosper. We need these principles in this way of thinking and learning. So beautiful. So talk a little bit about Muhammad. Talk a little bit about you spent you. You've talked a lot about your leaders. But I'm curious to hear maybe how yourself and the leaders have maybe matured through this. I don't even like to call it journey. It's more like a safari. Right?

Yes. So I'll talk about from a leadership commitment standpoint. We had one of our presidents, Donna Hanley, and I'll use another president, Gary Havokin. These are two presidents, residents of two different acute settings. And I'm not leaving the rest of them out. They're all following this. But there's a level of commitment that people need to invest to mature in this space. And one of the things that we were very careful about is trying to justify an ROI behind it. This is not about that. This is about a culture transformation. And so when we started measuring or coaching our leaders to that, and I'm using them to a specific, they had to role model leadership behaviors. So every single one of our presidents had to live and breathe the leadership behaviors for a certain amount of time. And I'll even use myself, for example, Jamie Roach, who's my boss. I wasn't exposed to the leadership behaviors. I had to give feedback to my boss to tell them what I'm seeing different. So every after every one on one he would say, so how am I doing? What do you see different? And I would say, you know what, you're listening to me more. So you're more in the moment or you know what, I'm noticing that you're asking a lot more open ended questions and you're a lot more curious. I'm seeing that you are actually understanding my reality and not imposing.

And so not to push you on the spot, but what if there was something. I'm sure your boss is perfect, but what if there was something that was less than ideal? Were you able to share that as well?

Absolutely. One of the behaviors is having a courageous conversation and he would tell me, you're not giving me enough constructive feedback. What could I do differently? What could I do? And there's times it got awkward because, because he would sit there for like 10 minutes. And actually a few of the presidents did this to me. So it's universally awkward where they would just sit there for like 10 minutes waiting for an answer and I would really have to look into the mirror and say, okay, so if I really want this person to improve, what is the constructive feedback that I would give them that it would make it a win win, that it doesn't seem like I'm like badmouthing or punitive, but really respecting this individual, this person wants to be better and is asking me for help. And so that they spent a very long time doing that without showing the next tier those behaviors until we were able to see in action before it was exposed to us. Then we did that for our directs. With my senseis, I did that. And with the senseis with their facilitators, they did that. It was a very top down approach, but it really allowed us to role model the leadership behaviors and not just try to have people memorize it. The other piece that they committed to which I felt became very mature is anytime we had a conversation on kaizens or opportunities where not that many staff were needed in a certain area, the conversation was always where are we going to redeploy them? Not where are we going to eliminate them. I would say that wasn't the case when we first started and we've definitely matured in that space where now people are constantly thinking, okay, so if you're going to take these 50 people and bring it down to 40 people, where's the need for these other 10? And it's gotten to a point where maybe this ED doesn't need that many, but there's another ED that's struggling to get these resources and so really starting to think from that way. So I would say that's a huge commitment from the organization. Showcasing a 3S is another one that I feel like leaderships have really committed to and matured in, where they bring them to their executive leadership team meetings to showcase the staff that have completed a 3s or just leadership forums, which is. It's a bigger forum with all management.

Now are these A3s that the executive worked on or is it someone from their team?

Frontline? So it would be a few nurses and a few techs and physicians got together and they worked on A three with that manager and then it was completed and. And it was brought to the executive team to celebrate and be recognized for that A3. We struggled in the beginning. We had something called a no meeting zone. We definitely matured in that space where people were given time to go to the Gemba and actually perform what they needed to perform so that their management really is. Our management team is really on site and present. That took a while, took many years. I would say we're getting better at getting better at this point. But there is a commitment now where leaders, at least on a weekly basis, go to the Gemba and most of them go daily, but there's a minimum requirement of going weekly. And I use the word requirement now that lingo has kind of evaporated from organization. It's almost like awkward if you don't go versus if you do go. And so that tells me that there's maturity. Before people were like why is that president showing up to my unit? Or why is this vice president showing up to my unit? And now it's like if no one shows up, there's like, is everything okay? So I would say that's a maturity and it shows the commitment. And in the beginning we would do a kaizen and people would, you know, five day events are a big deal here. And in the beginning people, you know, they got short staffed and they wanted to pull people out of the kaizen because they were short staffed. And I would say in the last four to five years we have not pulled people out of kaizen and our senior leaders show up and participate and are there in the beginning at kickoff and they're there at report out, but they're also there sometimes in the end of each day they send emails to motivate the team. They're there during the planning to see what else they could do. And we've created this lingo here called the bat phone where if you're a sponsor of a kaizen and you get a phone call during the kaizen, that's it. There's nothing more important than that. And you step up and your job and only job is to figure out how to remove that barrier for us. Not to question what we're doing, not to veto things, to really just tell us, okay, so if you're calling me, then there's a barrier that you need removed. And that commitment has been huge. And I'm going to tell you there's one aspect that we had to change an FTE from one cost center to another, create a role, post for the role and fill the role within the five days. And it happened in one day. In one day we had the whole thing done. And that could have taken three or four months in a normal cycle. But everyone knew that this is a top priority and that speaks to our vital few mentality as well. We used to do five, six hundred things and now we really laser focus our efforts into the vital few. We still have some room to improve there and there's still aspects of innovative fatigue that happens because of how many initiatives we have. But I would say we're so much better than where we were. So I would say that's from a commitment standpoint.

So we're coming on to 40 minutes. So for the sake of time, I think it might be great to have you back onto the show down the road road because there's a lot more stuff I'd love to go into like mind shifts and, and things like that. But what I want to, maybe what I want to wrap up with here, Muhammad, is for you to kind of talk a little bit about how your, your, your organization is, is organized as far as, you know, continuous improvement, lean, that sort of thing. And then I would, I definitely want me to wrap up with, with kind of talking about current state, you know, like where are you, you know, how satisfied or dissatisfied, if you will, are you with the, with the state of your, your lean program and then maybe talk a little bit about what, what's next. But start with with how things are organized because I think that could be, add a lot of value to folks.

Absolutely. And we spent a lot of time thinking that through. So thank you, Ron, for. That's a, that's a great question. We're a centralized office. So I oversee the lean office and I have seven senseis that report to me, those seven senseis. Each of them are deployed in a business. So it's a decentralized deployment model, but it's a centralized vision and reporting structure. And each sensei is matrixed to a president or a few presidents. Some have more than one. And their job is that they oversee the portfolio that sensei oversees the portfolio of everything that president is doing and is their personal coach. But they're also the personal coach for that executive team that sits with that president. Then underneath that sensei, there's a group of facilitators that report to that sensei in that region or in that business. And, and they are focused on the directors and managers in that organization. Each one of them gets an approximately, I would say 40 to 50 departments that they oversee. By working with the director, they're able to build relationships with all their managers, but also are able to understand where each one of the managers are at. They're able to coach at a director level. So the director is doing the work. The director is the one that's coaching and advancing his team. But also they themselves are getting to understand that business really well so that their coaching is kind of tailored to that. So that's kind of how we're structured at a high level. We centralize our training so that part is not decentralized. So we have one centralized training that we call our immersions that leaders go through in that we have a cross functional mix of different facilitators and sitesites from across the system that get assigned to those trainings. We have our senior leaders that do the staff training, so we don't do that anymore. And most recently we've engaged some of our senior leaders and directors to Also provide immersion training. So that's something new that we're advancing in right now. And we also do centralized Kaizens system Kaizen so like an ED for all seven hospitals or we'll do a decentralized Kaizen if there's just a problem in one unique area that requires that based on whatever their strategy deployment indicates.

Got it, Got it. So talk about state of the union, if you will.

So things that are working well, I feel like the behaviors have advanced significantly. I think the organization as they look at like transforming or improving or advancing the patient's experience, they know that lean is the chassis to do. So there's a lot of collaboration that I see growing and maturing and is probably something I want to be better at personally, but also I feel as an organization we're getting better at is how to leverage each other. So what's HR's role in advancing lean transformation around capabilities? What is the strategy's role around formulating an actionable potion? What's the quality's role? So I feel like the collaboration between the different departments could be tighter, but we've advanced so much from where we were. I feel like there's a. If we're talking about like what's ahead and where we are today, the level of commitment and participation I think is needed more than ever now. And sometimes when you get really good at something, you feel like maybe you don't have to participate as much. They already got this, this or I don't have to commit as much because it's already a humming machine. And that's actually when things fail is when you start exercising. And so I feel like that's the state that we're in right now is how to reinvigorate the commitment, participation to a higher level, not to a lower level. And I think we're at a point where people are wanting to do more, not knowing what more is and at the same time questioning do we need to do more. They're good at this now. And so I think that's the state we're in. And that's. I would say on a scale of like 1 to 5, I would probably give us like a 3.

Wow, that's great. That's great. You know, so many folks are. It's real easy to come on and say how great you are, but I really appreciate how you're constantly. You truly have the mind of a lean thinker. Right. We could always be better. So that's really refreshing. So thank you for that.

No problem. I think there's so much to still learn. I think we have, like I said, we're getting better at getting better and that's something that our president, Jeff Flack says a lot and it just resonates because our leader standard work has a lot of, of room for improvement.

Very good, very good. So, Muhammad, what's the best way for folks to, to connect with you and, and maybe learn more about, about, about what you guys have going on?

I'm on LinkedIn, so if you look up Mohammed Moh a M E D Sal a S a L E H, I'm available for any questions. I'm, I'm happy, happy to be used as a sounding board. If people are doing stuff and want validating. If people are doing stuff and just want, you know, advice or if people have advice for us based on what they heard, that that would be the easiest way to contact me.

Got it, got it, got it. Very good, very good. Like I said, there were some things that I wanted to get to, but that we didn't. So I think maybe an encore episode down the road here might be, might be fun fun to do. So if you're up for it.

I'm totally up for it and look forward to it as well.

All right, all right. Well, keep up the great work. You know, leaning within the healthcare world, I'm not sure what could be more important, you know, so, so thank you for, for everything that you're doing.

Thank you, Ron. I very much appreciate it.

All right. You take care.

You too.

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