GA 263 | Using Lean to Make Life-Changing Decisions with Tyson Ortiz

My experience has really made me convinced of and compelled by the idea that management by means. You know, where a manager is a teacher, sort of of the scientific method of whatever the necessary skills and mindset are, a manager's role is to teach that to their reports in a sort of wholesome and mutually beneficial way.

One of my personal beliefs is that done correctly, the principles of continuous improvement can and will change the world when fully understood and practiced deliberately. And when I it'll change the world. I mean, all aspects of our lives. You see, we CI practitioners spend most of our time talking about how lean thinking improves our professional work. But some may argue that lean thinking's greatest impact may come outside of the workplace, as it can positively impact our personal lives in profound ways. And as it turns out, this is exactly what my guest today is about to share. His name is Tyson Ortiz, and as you're about to hear, Tyson and his wife.

Wife.

Have used lean principles to work through an extremely serious healthcare situation with their newborn son. And when I say serious, I'm talking about the decisions they made had life and death consequences. So to be sure, if you've ever doubted the power lean thinking can have, please settle in and give this entire episode a listen. I'll show notes for this episode which will include links to any. Everything we talk about can be found over@gembapodcast.com just look for episode 263. Again, gembapodcast.com, look for episode 263. You can also check out Gemba Academy's Lean Learning system over@gembacademy.com with a fully functional trial.

Okay, enough from me. Let's get to the show. All right, Tyson, welcome to the show. How's it going?

I'm doing great. How about you, Ron?

Oh, I'm doing well, thank you. Doing well. So we are really excited to have you on the show, Tyson. You know, we. I guess we first crossed paths. What was it? Golly. When was Katacon? It was a year ago.

I feel like not a couple months.

A couple months ago. So we had a great time catching up there. Had a fantastic dinner with. Who is that you. And Lombard. And who was our special guest? It was.

Well, we brought in. We brought in Pat Lee from North Shore Medical Center.

That's right, Pat.

That was fun.

Gemba Academy people. And Billy. Right? Billy.

Billy.

Yeah. Good year. Yeah, he came with us.

That was a lot of fun.

That was a great dinner.

Yeah.

So. Well, hey, Tyson, as you know, we like to begin all of our episodes with our Guest sharing a quote of something that possibly inspires him. So do you have something you want to share?

Yeah, you know, it's not something I would have thought of a month ago, but it's been on my mind. It came up at a conference I was at a couple of weeks ago, but somebody quoted Aristotle as saying, quality is not an act, it's a habit. And I feel like I really like that. I felt like that kind of represents the sort of trajectory that the lean movement or maybe different movements are going these days away from sort of functions, doing acts to people and their processes, back towards working with those people on habits and mindsets and skills.

Yeah. I don't know if you actually caught last week's episode, but we had James Clear, he wrote the book Atomic Habits on. And so I think I opened the show actually using that quote myself. So great minds think alike, you know.

I'm gonna. I'm gonna write that down. I didn't realize you had him on. I'm gonna go dig that up.

No, it was a really good one, man. It was last. Yeah, last week's episode. So. Yeah, what was it? Number 261. For folks that haven't gotta listen to this one first, but then there you go.

Listen, I've got it written down.

Good. So. Well, hey, Tyson, let's go ahead and kind of just jump right in. Why don't you tell us a little bit about yourself, Tyson. Tell us about your background, maybe how you first got wrapped up into all this continuous improvement stuff and then tell us what you're up to, professionally speaking, these days.

Yeah, so, you know, I came out of school about 10 plus years ago. I was a sort of technical math guy. I gravitated back towards my job in quality that I had as a temp, you know, when I was finishing school. I think I was too lazy to go get anything else and they were willing to hire me. So I started out in quality, sort of as a quality engineer and did a few years, did that for a few years, ended up doing some pretty interesting work in the defense industry, but got really kind of burnt out with it in terms of having to work the same problems day after day and processing parts with non conformances because there was no time to go fix the problems and you know, this kind of schedule first thing. And that really turned into a grind. And so, you know, I came across a guy there at this rocket company, Rocket Motor company, who had been doing sort of traditional Kaizen event based lean for 10 plus years. And he was kind of getting Burnt out on watching his, you know, doing his Kaizen events on the struggling process, making things way better. And then, you know, kind of the old story, he move on to the next project and over the course of the next few months or year or whatever, watch all the gains that he had made kind of start to erode because, you know, the sealed story that the people in the process and management aren't able to or aren't focused on sort of sustaining or building on that improvement. So this guy, I went to work for him, he wanted to experiment with Toyota Kata. This is back maybe 2012, 2011, he wanted to experiment with Toyota Kata. He saw it as a missing link to get better impact and sustainability out of process improvement by transferring responsibility for driving improvement to the process owners and the inline management rather than having improvement weight for the once a year when there was a Kaizen event, you know what I mean? So he gave me this pitch of I managed to scrape together some budget and I don't know if this would be around in a year or two, but if you're interested in trying something new and doing some good stuff, then I'll teach you how to do lean and we'll try using this new Kata thing to do your training. That sounded appealing to me, so I kind of jumped at it. I learned lean by practicing seeing the improvement kata piece of Toyota Kata. And so over the course of about three months, this is the summer of 2012, I had a daily experiment that was applying the improvement Kata pattern with coaching, daily coaching in between each step. And so it was actually really grueling for the first month or so. I was kind of regretting my decision to jump ship from quality because over there I had been really effective and well regarded and felt pretty good about myself. And the first month or two of improvement conduct practice can be really awkward. And in the case of this manager, he was really tough on me in terms of just beating the flaws out of my technique. Not just my technique, but my mindset even, because, you know, he, what he needed is for me to be able to learn this stuff deeply enough that I could help him teach it. And we found that I kind of had brought over some, you know, maybe habits or mindset from my quality engineering work that weren't necessarily helpful when you're trying to apply the scientific method. You know, the scientific method is about knowing, knowing when you're wrong and using that to advance towards your purpose. And sometimes in our work lives we get, I think, used to not being wrong or insisting that we're Right. Seeing things as black and white when they're not. And so there were a lot of mindset obstacles that we found in my early practice. And so, yeah, at first it wasn't fun, but as we kind of developed trust over a few months, I came to see that he wasn't just, he wasn't just being a jerk. He was actually trying to help me in a way that was best for both of us. So it ended up being really transformational for me personally. And over the course of a few months, I really had a little bit of a mindset shift and definitely developed some skills around the PDCA applications that the improvement cod is trying to get. Yeah.

So professionally, what are you up to these days, Tyson?

So these days I'm basically a lean consultant. I'm actually kind of, I've gravitated towards healthcare and I'm sure we'll dig into that a little bit here. But that's what I am. What I'm doing these days is trying to sort of navigate towards some interest I've developed in healthcare.

Yeah, got it.

Sort of based on that KATA experience.

Yeah, for sure, for sure. All right, well, I want to jump right into kind of the topic of the day. And, you know, I first heard, heard this at least part of the story that night at dinner with, with you and our friends here, and you really kind of opened your heart to us about, you know, the, the way that you're applying scientific thinking, improvement kata, coaching KATA to arguably, I can't imagine a more important, you know, part of, of any of our lives, especially those of us who have children. So with that opening, why don't you just kind of jump in and talk a little bit about, about your experience with your, with your, with your child and how scientific thinking, how Toyota Kata has helped you.

Sure. So that, that summer of 2012, while I first started practicing the improvement kata, you know, coincidentally my wife was pregnant with our second, our second child. And at the, you know, the 20 week ultrasound, normally find, is it a boy or is it a girl? We found out that this baby had only a single ventricle heart, basically half a heart, which is not what you want. I didn't know anything about cardiology at that point, but the doctors told us that basically this kid is going to have about a 50% chance of seeing kindergarten. And it was a pretty bad diagnosis. We spent that summer pretty, pretty, you know, pretty devastated. And it was, it was hard, you know, it was hard to do my KATA practice at work. But, you know, I kind of fought through that. So I. But I had this kind of parallel experience of, you know, in my professional life, I was learning that improvement is best done by a process owner who's sort of using the scientific method to navigate uncertainty towards their goals. Whereas here in my private life, I had this horrible challenge of, you know, what do we do with this situation? So I think the professional stuff really spilled over into how I engaged with the personal stuff and the medical care after that, maybe an initial month of paralysis, where my wife and I were just trying to figure out what do we do with ourselves. We started to say, okay, the system's given us, you know, these odds of how things are going to go. You know, we. If, you know, our vision for our kid is a long, healthy life and, you know, ideally, the obstacles of the fact that he's got this horrible condition and we're not medical people, you know, those are just obstacles. Right? And so, you know, we started kind of taking the mindset of, okay, if we want better outcomes, if we want to get the best possible outcomes, then we've got to help drive that and, you know, and sort of grow into the role of managing his care. So, you know, at first, our. To put it in kata terms, you know, our first challenge was basically just to, you know, to survey the landscape around this condition and its treatment and pick a surgical center and a surgeon who would have, you know, give us a great shot of getting through this first planned surgery. You know, his condition included three stage series of surgeries, and our first challenge was just to know who we wanted to do it and have a logistical plan to be located there. When my wife went into labor, she had had a tough induction with our first kid, and we didn't want to repeat that, so we wanted a logistical plan to be located at that center. And so that was. We had a few months to go figure that out.

How many months pregnant was she at this point?

So we got the diagnosis. It took a month between the time that we found out something was wrong and knew what it was.

But I guess I'm curious, and I don't mean to probe too personally, but it was at. Was she like, first trimester, second trimester, or. I'm just trying to get a feel for the timing here. When.

Yeah, I think the. So the ultrasound was what, the middle of the second trimester? Is that right?

Okay.

Yeah. I don't know. I'm not good.

I got seven kids. I should know, but I don't know.

So, I mean, we had probably four months, you know, but before the due date. But at the time, we were thinking about, okay, we need to start to take the reins as best we can.

Let me, let me stop you there real fast, Tyson. I'm sure it's really interesting, you know, that you felt like that you needed to take the reins when maybe some folks, and I'm not judging, I'm not saying one's right or another's wrong or anything like that. I'm just throwing it out there. It would seem some folks would just rely 100% on the so called, you know, medical professionals who, you know, hopefully know what to do. So it's interesting hearing you talk about how you guys wanted to, you know, take, take the reign, so to speak.

Well, and, and it's, you know, it's, it's, it's not that the medical professionals don't know what they're doing. I mean, they're incredibly capable and they're incredibly good people. But still the system produces the distribution of outcomes that it produces. So I think that this is where the kata practice had a really big influence is because my mindset, I think, had started to shift. If it had been a year before, I probably would have just said, would have had that more functional, expert oriented mindset of, I'm going to let the experts do what they're going to do and I'll do my part. But at this point, I had been kind of, I think my mind had started to shift a little bit from the practice to the idea that nobody has actually got the answers. The uncertainty is always there, and the best thing you can do is try to characterize that uncertainty and experiment at your threshold of knowledge towards your goals. So I had had enough success, I think, with the kata work at that point, where I think if kata practice is going well, at one point you'll be standing and facing a challenge where, where it's daunting and you don't know how you're going to beat it. And then at some point, a few months later, you will have made really good progress and look back at a path that you would have never predicted, but you kind of discovered along the way.

Absolutely.

And so the intent there is to develop this sort of comfort that you don't have to know the answers as you look ahead at your challenge, but you're confident in your ability to sort of discover the answers through that. Chunking out to a target condition and then daily PDCA to get towards your target condition. It really builds confidence when you can feel it be successful. And so I believed that my wife, when we first got the diagnosis. She did a ton of research on Dr. Google to go see what does this look like? And she found outcomes that were all over the map. Some families had really bad outcomes and miserable experiences, but other families had these amazing kids that were just treasures to the family. And one outlier was this young woman who had just run a half marathon with only a right ventricle, which is. So it was clear that the possibilities were there was a huge possible upside in all this if we could bend the odds in that direction. So that was really our focus. So that first challenge of just picking a surgeon in a center and knowing how we were going to be there, that really left a lot of work still to the professionals. We showed up where we were supposed to, when we were supposed to, to get echocardiograms or labs or whatever done, and that was all delegated to them. We knew we didn't know enough to kind of interfere there. So our challenge was calibrated to our capability at that point. But it still made a big difference. And it felt really good for us to kind of get a. To go from being totally shocked and bewildered to having the ability. Having a job, having the ability to have some little bit of self efficacy in this picture. And we were successful with that. We met our challenge. We picked a surgeon in the center that had really good results. It was 90 miles from home, but we made arrangements to be located there in time for labor to start naturally. And things worked out. We got through that first surgery, and before we knew it, we were bringing home a really, really sick little baby.

Okay, at that point, what was the plan?

So the plan was to keep him alive until his second surgery, which is usually about six months of age. So the way that this series of surgeries works is they kind of iteratively rewire the plumbing as pressures change and things grow so that that one poor little ventricle can take care of the whole body. And so you need to. The current standard is a set of three stages. The second stage is about six months. So the name of the game is keeping them alive and growing until then. And that really means weight gain, because the current knowledge is best. Current knowledge is that weight gain correlates really tightly to outcomes. So we got home and we found that he had horrible feeding intolerance is what they call it, which means vomiting. So, okay, you know, your current condition in the cottage sense, your current condition is always changing, right? Yeah. And so we got home with the sick kid. But we had learned a lot about how to. How to deal with him. You know, I could place my wife and I could each place an NG tube through the nose, you know, for feeding. We could run the feeding pumps, we could do the meds. You know, we could do dressing changes on his sternal incision. We were starting to kind of get a little bit more comfortable. It was a new world, but we were starting to get more comfortable. And then we found that, okay, he throws up half the food that we give him and wasn't gaining weight. Our second challenge kind of presented itself as getting him to that second surgery at a good weight without doing some things that could set him back in other ways. So for instance, the gastroenterologist, the GI docs who were, who get delegated the responsibility of figuring out feeding intolerance, he wanted to try administering this really strong med that had side effects that were really, really serious. And it wasn't clear to us that it was even indicated. And so we kind of questioned that. And we started to get in the habit of digging into the thinking of the clinicians that were looking at the case and making recommendations. And when things didn't seem to fit the facts and data the way that we saw them, we would challenge it. So that second kind of challenge of getting him to a second surgery at a good weight was really mostly about experimenting with his feeding regimen. At home. He was tube fed. And so we were running a pump. And so what you put in the. What you put in the tube and how fast you run it and how much you run it at a time are all these different parameters that you can kind of vary. And so we did all kinds of experimentation to figure out what combination of food and breast milk and fortifiers at what feeding rates and volumes and sort of pattern of administering the feeds, what works best. And we learned a lot of stuff. We learned that this one particular formula was if we used it to fortify breast milk, that he kept that down better than the other things. And certain combination of feed rate and volume worked better, seemed to work better. And if we could get him to stay asleep through a feed, then he was more likely to keep it down. So we started arranging our schedule so that we could maybe one of us could hold him through a feed so he would fall asleep on us or something like that. And so, you know, we.

Did you write these experiments out and like really kind of. Were you systematic about it? Like, maybe you're back to your quality days with design of experiments and things like that. Like, how did you approach it?

No, not. We were not deliberate like that at all. And you know, when I first started, when I, when I first really started thinking about that we were applying the improvement kata pattern, I was kind of, I felt guilty a little bit about not being deliberate about it, you know, with the storyboard and whatnot. And could we have been even more effective if we would have been more deliberate about it? But I've kind of decided to go easy on myself. The intention of the kata practice is for that rigor and that structure to fade away and to become less necessary over time as you sort of ingrain those neural pathways. And I think that looking back on it, that's what was happening, is we were sort of naturally doing target condition based, challenge based experimentation, daily experimentation against obstacles, without a storyboard and without the deliberate stuff because the practice and really the coaching had been effective. I've come to realize that I had just had this amazing coach for my stuff at work and that a really effective coach can achieve that, that skill growth and that mindset shift, I think. And so I think I owe a lot of that success to him. And honestly, sometimes I think during that first year when things got really crazy, sometimes, rather than doing the sort of coaching on the process work that I was doing, I was so distracted by the stuff at home that my manager would still, he would call me into his office and he would ask me questions about what was going on with my son and what were the doctors saying and what was, what was I planning and you know, you know, what was, what was I working on today? And I realized that he was realized down the road that he was actually applying that same coaching kata to you. Yeah, right. But he, he had kind of shifted gears, made it less formal and was, but was applying the same coaching pattern in a setting where, where my attention was right. So he, you know, kata practice has to be, you know, skill development has to be something that the learner thinks is important. They have to be focused on it and find it meaningful and you don't be engaged. And so I think he, when he saw that I was disengaging with the work stuff, you know, he was able to kind of, you know, skillfully shift gears to coaching something where I was engaged.

Well, there's a reason, you know, there's a reason Mike has changed the terminology from, you know, kata to start starter kata, namely. I think Mike even said at the last katacon, he's like, if I turn up somewhere two years into the Arcada journey and the guys are still reading the five questions from Card, you know, he may Do a little bit of a, you know, face, palm kind of thing, you know. Right. And so I think it's. It's natural and it's. It's good, you know, that. That you guys evolved and. And it's. It really. It kind of comes. Becomes like we're breathing, you know, so we think this way. Right. Scientific thinking is. Is just the way that we go about life. Right. So. Yeah.

So.

Okay, so let's. Let's jump back in. So you. So I guess how did that challenge, as far as, you know, having him gain weight and so forth, how did that work out?

That, actually, it went great. You know, this. The second surgery is supposed to be about six months. Six months of age. We had. One of the other things where we had taken the reins is we had set up a sort of home monitoring system where we had a pulse oximeter and daily weights and stuff that we were doing at home based on a sort of advanced model from another center. And our cardiologist had said, no, don't worry about that. You don't need to do that. But we did. And it turned out that the data that we were seeing at home and the sort of patterns and nuances in the data ended up bringing in his surgery by a month. So he had his second surgery at only five months, but at that point, he was a pretty good weight. We'd been really successful with the feeding adjustments and figuring out how to get him to keep food down. At one point during that admission for the second surgery, one nurse had to go ask. Find another nurse to do a blood draw because he was so pudgy on his arms. So, you know, it was like. That was like a little. A little victory for me of, you know, oh, I can't do this. I need to go find somebody who's better because he's. Because of this fat in the way. Yeah. So, yeah, he's not very fat these days, but, you know that. I was excited about that one.

Okay. Okay, good. All right, so what was next?

Well, so then he started having complications. The second surgery went well, and we went home. But not very long after, he started having a vow valve that was leaking pretty badly. And that's a really bad thing in that situation because in his case, blood was passively going through his lungs with no pump to push it, and the pump was only pushing blood out to the body. And so it was just kind of sluggishly moving through his lungs. So when you have the pressure dynamics of a leaking valve, then that makes things much worse. And on top of that, his aorta. This is the blood vessel that comes out of the heart and goes to the body, had to be basically surgically built during his first surgery because it was so tiny coming out of the heart, since he had no left side there. And that reconstructed aorta was having some problems. It was getting tight and constraining the blood flowing through. So we had a couple really serious complications to deal with. Meanwhile, due to some politics, I think at the center where we were, his surgeon had basically just picked up and left the center without even leaving contact information. So the hospital couldn't get ahold of him. Like, the only way that anybody could talk to him was through an assistant who had worked with him in surgery. And she was there, and she'd get him a note. And so we got him a note about what should we do with these complications? And the response came back, basically, he wasn't worried about it. He wasn't going to deal with it. And so all of a sudden, we had to go surgeon shopping. Oh, my gosh. We had been tied in with support groups at this center, and through Facebook connections, we had been seeing some bad outcomes from the new surgical team that had been brought in. And I think the politics were related to the center wanted to start a transplant program, and it had brought in a new chief, and it was. Center was trying to grow, but in a way that the surgeon didn't appreciate. But the new team didn't seem to be getting very good outcomes. And when I got the new chief on the phone to ask, what do we do with this kid? And what's going on with these outcomes we're seeing, he was mostly interested in criticizing the old surgeon and talking about what he should have done in the second surgery and explaining how he wanted this hospital to be. Be a full service center who didn't turn kids away because they couldn't treat them. And I'm sitting here thinking, like, come on, guy, you got to know your audience. If you're. I got one kid with one condition. If I. If you guys aren't the place, I want to hear that not be. Not be told. Yeah, come on in. We'll, you know, we'll put them under. So, you know, we kind of ran from that place. And so we basically went shopping for a surgeon that would be good with this valve repair and found a surgeon at another center in the area who. Who was known for his valve work nationally and agreed to take him. And so sorting through all that was our sort of second challenge of how do we get this kid you know, how do we recover from these. These complications? I say second challenge. That was the next.

Yeah, yeah, right.

That was the first.

Probably the 40th, really, at that point. But, yeah, for now, let's call it the third for the podcast.

Yeah, right. So that's kind of how the. How the. The first year wrapped up was getting through that third surgery. And it. We were told that it went well. Our son certainly seemed better, but it turned out that it actually hadn't gone that well. The valve repair failed pretty quickly, and the repaired aorta ended up having a new problem. And so the next six months were kind of oriented around that. For a while we thought that our challenge was to get him ready for that third surgery. But before we knew it, we were seeing symptoms and seeing issues at home that were telling us something was wrong. But the cardiologist couldn't pinpoint any kind of cause on the echocardiograms. So long story short, towards the end of the second year, we had found that. But his case had evolved to the point of being so complex and the problems so hard to surgically repair that we needed to get him across the country from. We were in California, and the only people willing to do the repair that we felt needed to be done was the chief surgeon at Boston Children's. So our next big thing was with a surgical date in Boston a month and a half away, and a health plan that was flatly refusing to even consider sending us. How do we. How do we get them out there? So, you know, that was. That was our sort of our next big. Our next big thing where we, you know, we were trying to drive it ourselves.

So. Okay, keep going.

So, yeah, the. I mean, that was, you know, the situation there is. This would have been summer of 2014. At that point, you know, the.

You're in California or you're in Boston.

Now we're in California. And it's clear that. It's clear we had learned enough about his physiology and the condition and the trajectory of how these things can go to feel that the plan that we were getting in California wasn't going to be good for him long term. We were getting a recommendation that was really straightforward and being sold as, we'll just get in, we'll fix this stuff. He'll be ready for his third surgery in a few months and everything will be fine. But it just seemed wrong to us. We ended up checking with. We got second opinions, third opinions from Boston Children's and Texas Children's. At the point, these were sort of the top two ranked surgical centers for cardiology, pediatric cardiology in the country and got the surgeons on the phone after we sent them all the images and whatnot, and they more or less confirmed in the discussions that, yeah, you're right, that's a bad plan and you need to go do this other thing that's more, more challenging, you know, with a higher risk of mortality in the surgery. But would, would set him on a better path if it was successful. And so we felt that that was important.

You know what, what's interesting, Tyson, is, you know, yesterday I was talking to my, my business partner, John Miller, where I'm actually doing a little root cause analysis kind of training in, in person training. I don't do that very often, but going out to a, to a, see a client tomorrow in fact, and, and you know, we were, we get really talking about, you know, root cause analysis and how, how, you know, scientific thinking isn't traditionally, I guess, taught, you know, as part of that. It's more like ask why five times, you know, and it's like, okay, but.

At the end, then just sit there and write down the answer.

Right? But at the end of the day, you don't know, right? I mean, you're guessing, right? And, and so back to the threshold of knowledge, right? The flashlight only runs so far and you can't see beyond on the beam, right. I mean, it ends eventually. And the only way to know is to walk forward. So what's interesting in this story is that you're at this threshold of knowledge, right? And not just you, your doctors, right. And so the challenge, I guess, really not to use the same word, but the dilemma, if you will, is, you know, which, which story, you know, do you, do you go with, Right. You know, which recommendation, you know, because even the folks in Boston, they don't know, you know, I mean, they don't know for sure what's going to happen, right. I mean, no one does. So it's, but, you know, here, experiment and see what you learned could have life and death, you know, consequences. Right?

Yeah, well, and so, and I think that's, this is another nice psychological benefit of success with the KATA practice is that you realize that nobody knows and the best that you can do is your best. So, you know, the sort of, you know, the defining moment for this episode was when we had this recommendation from the center in California that we felt was wrong. And we had two other highly regarded surgical centers saying, no, go do this. And then suddenly our original surgeon had surfaced in Texas and I had gotten him on the Phone. And he had very clearly said, no, you'd want to stick with the guy in California. He's got. He's actually said, what I would do is just treat it heavily with medication and hope things work out. But at the plans that you're getting, go with the one in California. And so we were sitting here with four competing, four different opinions. The only two people who had actually seen this kid's heart were saying, do this one thing. And we were thinking that that was the wrong answer and were making the decision to go through a more dangerous path. The surgeon in Boston had estimated a 30% chance of him dying in the surgery, whereas this other one was a, a one foot putt in California. That was a tough call of, is this really what we want to do? But at the end of the day, we had kind of built the confidence that if we trust our gut, go with the facts and data that we have in front of us, but do our best, that things will work out, and we've been lucky. But at the end of the day, you're just rolling the dice.

Yeah, well, that's what's hard here is, you know, in a, in a company or whatever where, you know, we got too many defects, you know, or whatever, okay, go run an experiment. And. Oh, whoop, that didn't quite work, but we can contain it. But here again, you know, you're experimenting with your son's life, you know, and so it's. Golly, it's got to be tough.

Well, I'll tell you what, I'm a lot less worried about problems at work.

Yeah. Oh, yeah, yeah.

So, but, yeah, you know, in our case, we've been really, really lucky that, that, you know, our, our work has paid off, and whenever we roll the dice, they come up good enough.

So. Okay, so obviously, I guess you went to Boston, right?

Yeah, we, we had to fight, fight our way out there. So, you know, the, the health plan that we were with in California only had surgical relationships with these two centers or, you know, business relationships with these two surgical centers that we'd been at and, and, and just basically flatly refused to send us to Boston. And we use their appeals process, but in denying the appeals, they never even addressed the technical concerns that we had raised. I had this huge technical rationale at this point for why this was an important treatment to go get, but the responses never even dealt with the technical details. And it was really frustrating for me. It was almost like the system didn't know how to, how to handle a family that was able to engage at that level of technical detail. And so it just didn't. The denial. The basis for the denial was basically just that you're at a very highly ranked surgical center with a nationally regarded surgeon, you're all set. And the facts, the technical details underneath the argument were not considered. But this was early August of 2014, and the surgeon in Boston had made room on his calendar. He was booked four months out, but had made room on his calendar to give us a date in the middle of September. We had six weeks to figure out, okay, how are we going to get there with insurance saying no. So this was maybe the highlight of my first couple years of this CADA application in my son's care. I basically took a week off of work at one point in August and just spent the whole week exploring potential paths that I thought might be out there. Could I continue with the appeals up through appealing to the state? Could we look into changing insurance? Because my employer had another plan that actually had this hospital in Boston in network, but I couldn't get a qualifying event to change plans. I explored the potential path of filing for separation with my wife to trigger a change so I could go into the system and change plans. And that didn't pan out. We explored Massachusetts has. If you are a Massachusetts resident, you can get coverage through the state that we would cover the surgery, but we had to be residents, and we weren't planning to stay out there. So I investigated. I consulted a lawyer on, could we go out there, get this coverage, and then fly home? And she's like, no, buddy, that's called fraud. And so that was a dead end. So all these different. I was exploring all these different potential paths that all mostly turned out to be dead ends. But I was just seeing how far could we get and what would pan out in the meanwhile. We ended up getting tickets, plane tickets, and making arrangements. And a couple of days before the flight, we didn't have a solution other than flying out to Boston and not coming home, because we wanted to be able to get covered through this insurance, which meant we wouldn't come back to California. But. But at that point, we had convinced ourselves that this was important enough that we were willing to do it. But I was still continuing to work the obstacles and experiment. At that point, the hospital in Boston had been pestering me because here we were a few weeks away, a couple weeks away from the surgery, and I had no way to. I had no coverage for it. And they were getting ready to move the date to push out the date, and I had some hair Brained scheme to keep all these balls in the air. And I had a phone called the benefits manager, my employer, to ask if this kind of harebrained next step would work to keep everybody happy. I think at that point, I had worn her down. And she came, came up with an idea for how I could legally trigger a change that would shift me into another. The plan that I needed. So suddenly, here, a day before our flight, this path opened up and I was able to change health plans to this plan that was covered. And we flew out to Boston, landed, I did, did all the pre authorization stuff, and things went smoothly. We were able to come home and spend the holidays, spend the holidays back in California after things went well with that risky surgery in Boston. But it turns out that he just kept throwing his curve balls. And we found out that December that he would need to come back out to Boston. But, you know, my wife and I had really liked it and looked at each other and said, why don't we just move? So, you know, then the next thing was okay with the surgical date at the beginning of February. And here we are in the middle of December. How do we figure out how to pick up and move in six weeks? But, you know, before, at that point, I had the confidence, confidence that we can figure this kind of stuff out. It's fine. You know, we just need to know what we're working on today, basically. Yeah. Your next step, right? What. What are we trying to be and where are we trying to be in two weeks? And where are we trying to be in, you know, in six weeks? And what are we working on today? And, and, and so we, we made that work. And so we, you know, we were out. We come early February, you know, dragged my family to the airport with, you know, know, eight boxes or four of us, you know, and you can have two carry ons with Southwest, right? Or not two carry ons, two check packet, two check bags per, per person. And so we each had two boxes, cardboard boxes that were the maximum possible dimensions that you could have. So I looked like I had this, you know, this rack that looked like the Grinches stole Christmas. Just loaded up with all. With eight huge boxes. That was our. That was, that was us moving. And so we got out and did that next surgery and things went okay and recovered. And March. I went back to California and packed up the house and shipped it all back east.

That was March of what year?

That was March of 15.

Okay.

But again, it's a set of decisions about what's possible and what can we Achieve that I would have never ever thought of before if not for the kata work originally in my professional life and then the successes that we had had along the way with the personal stuff. So that success breeds more confidence and ambition, that you can make a difference and that you can take on challenges where you don't have the answers. And so I've really come to believe that this is sort of a really important path. Not just in a work situation with managers and their reports having this sort of management by means method, but I've really come to believe that there's a promising frontier here in healthcare for patients to learn to manage their career.

So, I mean, I'm sure there was a whole lot more to cover since 2015. But if you don't mind me asking, how are things today?

Today he's great. So, I mean, we had maybe three years of just constant crisis and then things fell into place. He's had a total of six surgeries, six open heart surgeries at this point. The last one was right after his third birthday, but now he's six and thriving in kindergarten. He, he's skinny and he's still complex. He terrifies his school nurse, but to look at him, he's just a sweet, little, energetic, awesome kid. He's amazing. He's doing great these days.

Now, what about, we haven't talked about your other child. How old is your other child?

Yeah, the other one's eight.

So what was that like? Just going through this whole process. Obviously you have another, another kid in the picture, right?

Yeah. And I think this is, we've kind of come to see how many families there are that deal with stuff like we're dealing with. And this is one of the sort of unaddressed themes is these siblings and what they go through. So he's 20 months older than his little brother and so has basically just been dragged around through all this as long as he could remember. You know, so that winter that we moved to Boston and you know, the beginning of 2015, that was the legendary winner in Boston with the record snowfall and all that. We moved right at the beginning of it. So, you know, here we are in western, you know, on the western edge of Boston next to the hospital with no car and, you know, so every time I needed to go, you know, so I was hoofing it to get groceries and, you know, pots and pans and clothes, clothes and stuff through all that snow and dragging this three year old along with me. But he was amazing in his own right because he was a great sport about that, and I think all the time in the hospital has really made him into a very empathetic and just amazing kid in his own right. But my wife and I are very cognizant of the fact that. That the first three years were about his brother. And so we're trying to make it a little bit more about him these days. So these days he's our hockey star, and so he takes all the hockey he can get. It's funny, I never even knew anybody who played hockey growing up in California, but out here, it's life, right?

Yeah.

Right. And we exposed him to all these different sports and hockey, he just loves hockey. So that's kind of his thing. Now all the extracurricular time right now is going into satisfying that urge for him to get all the ice time he can. So that's his thing. But he's amazing in his own right.

That's awesome. That's awesome. So, gosh, we've talked, had an amazing conversation here. I'm just curious if we could maybe wrap things up, Tyson, with maybe some, I don't know, some suggestions or, I don't know, insight that you can share, maybe for healthcare professionals, but then also for any of us, because we're all potentially patients of this system. What do you think?

Well, so I think in general, putting the healthcare stuff aside, my experience has really made me convinced of and compelled by the idea that management by means, where a manager is a teacher of the scientific method or of whatever the necessary skills and mindset are. A manager's role is to teach that to their reports in a sort of wholesome and mutually beneficial way. That's a better approach than traditional management by objectives, or I've seen it called management by results, where your annual review is where you find out how you're doing, but the less supervision, the better. I think that conventional management can have such destructive personal dynamics where ultimately it affects the business in a negative way and it affects people's lives in a negative way. I've come to see the model that Toyota Kata is pursuing as just being a huge win for everybody in terms of a better way to operate, where people enjoy better relationships and the business enjoys. Enjoys better results. I'm a huge proponent of management by means at this point based on how impactful it's been for me personally. Not only am I a better, more capable employee as a leading practitioner and teacher, so my manager achieved that result, but he deflected my personal life in this incredibly positive way. I think that's what Mike Rother is really after which, with all this work.

Yeah, no, I guarantee he is. Yeah.

So that's the sort of general takeaway that I have. But on the healthcare side, it struck me somewhere along the line that the basic model of clinical care, where if I have a problem, I can go to a doctor and the doctor's gonna make a plan and tell me what's going on, tell me what to do. It's the same improvement model model that Lean has had and has struggled with, where the expert parachutes into a process and holds an event and fleshes out an implementation plan that the process owners are going to go follow when the expert moves on. In Lean, it's been seen that that's really a bad model because it means that most of the time, most processes are being governed by business as usual, and the improvement events produce nice gains, but then they erode from entropy when the expert moves on. It means that for the organization, improvement is constrained to how many experts you have and how good they are because you're not improving when there's no expert around. I think healthcare is actually using the same exact model. You go to a doctor when something's wrong and improving your health is their job. I think as a society, we've overburdened the medical professionals to do improvement for us. And just the way. Same way Lean has been functionalized or compartmentalized in a Kaizen promotion office or something like that. And so I think that the transition that Lean is having towards equipping process owners with the skills and the habits. Habits to drive improvement themselves. I think there's an analogous frontier in healthcare that needs to be explored where if you're looking at a value stream map in healthcare, like a clinical system, to me, in each of those process steps, the patients and their families are actually operators and somehow the process owners at the same time. Because most of care planning and execution is done outside of a clinical setting. When we're at home, our health is either getting better or not. I think equipping patients to drive that when there's no expert around is really a promising frontier.

Yeah. Have you run cross paths with. With Skip Steward?

Yeah, yeah, I know Skip.

Yeah, you know, I know. He's listening. He listens to every podcast. He's probably like, if you're on a treadmill, Skip, you need to pick it up a little bit, my man. Keep going. I know it's been almost an hour, but keep going. Don't stop. You can do it. No, but. But I have a lot of hope, you know, with people like Skip And Brandon Brown and, and some of these folks doing some amazing work, you know and largely driven with, with, with, with scientific thinking and Toyota Katana at Baptist Memorial Healthcare. And just, you know, not just them, you know, there's many, many other healthcare organizations that are trying, you know, so I have a lot of hope.

Yeah. And you know, going back to Katakan real quick, you know Michael Lombard there, he's at Kaiser now, he had that presentation that included a clinician. I think she is an obgyn who is using the KATA pattern as the framework for a clinical encounter with her patient. You know, what's your goal? What's your question goal? Where are you now? And you know, heart condition. And I, to me that's just incredibly promising, you know.

Well, just seen that video that he showed of the doctor, you know, or the clinician, you know, she had this like glow in her eyes, you know, and like this hope in her voice. It was almost like she discovered a new way. Right. And it was beautiful. Right.

Well and think about it, you know, there's all this stuff now that you hear about clinician physicians burnout, right. And this horrible stuff about the rate of physician suicide. And I've got to wonder how much of that boils down to the root cause of they're overburdened with 100% responsibility for improved health on behalf of other people. And we're seeing in our profession it's not possible. And as a lean practitioner I've found, I mean historically I'm the sort of technical introvert guy who's happy to do to sit at my desk and plug away on the computer. But through my lean work and my KATA practice I've become much more interested in working with somebody and seeing them grow and seeing them gain the ability to drive this themselves. So it's so much more rewarding as an improvement expert to watch somebody else and help and have the feeling of helping them gain self efficacy. As fun as doing improvement is on its own, it's so much more rewarding to see somebody gain that ability. I think there's probably an analogy there for physicians, how much more rewarding would it be for them to watch somebody else, their patient gain the self efficacy to manage their own care? Because at that point the physicians patients role boils down to being a technical expert and a sort of resource which is where their strengths are. They have this deep technical understanding that no patient ever could and they have access to goods and services that patients don't have. And that's really their strength. When they have to also remember the patient's history and look at the details of the patient's patterns and nuance and facts and data. And they have to put in the effort on behalf of the patient. I think that's when. That's when, you know, problems start.

Yeah. Wow. What an episode. Tyson, thank you for coming on and sharing such a personal story with the world. Hopefully it shows that the stuff that we practice goes way beyond, you know, the 40 hours that we work, you know, professionally. And it really can, and it should, you know, impact all areas of our lives. Life.

Yeah. Yeah. This has been a lot of fun for me, Ron. I really appreciate the ability or the chance to come on and. And. And. And invent like this. Yeah, it's been a lot of fun.

So what's the best way for folks to. To connect with you, Tyson? No, maybe they want to bring you out to consult or something like that. How can they reach you?

Yeah, so just. I'm on LinkedIn. You know, if you just Google Tyson Ortiz or. Or, you know, go to LinkedIn, I'm. I'm right there.

Okay. Yeah. And we'll link to it in the show notes. So this will be gembapodcast.com go to. This will be 263 episode 263. So, yeah, we'll. We'll link to you, Tyson, there. So thanks again, man, for coming on. You know, hopefully our paths will cross again. We can go have dinner next Katakan.

Or whatever it is, and.

And keep up the great work and all my best for your. For your. For your. For your family and for you and for all the work that you're doing.

Okay? Thanks, Ron. I've had a blast.

All right, take care.

You too.

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