GA 273 | Lean as a Management System with Skip Steward

The devil's in the details. That's why that cliche is out there, is we're discovering things that we didn't really realize that's how we were playing the game or that's what was going on.

Today. I'm excited to welcome Skip Steward back to the show. Now, if you're a frequent listener, Skip's name will sound familiar. Skip was just on in episode 269. In fact, if you have not listened to episode 269 with Skip, I would encourage you to pause this particular podcast, go back into your feed there and find 269 and listen to that one first. Skip and I were having a fantastic conversation in episode 269, and frankly, we ran out of time. And there was a lot of things that I wanted to get to that we didn't. We weren't able to get to. And so I asked Skip if he would come back on, and he was grateful enough to do that. And so today what we do is we really just kind of continue the journey that we were on and we take a deeper dive into Baptist Memorial's management system. In fact, we talk quite a bit about what is a management system and how does that relate to other types of systems that we're all familiar with. And Skip, as normal, does an awesome job sharing all kinds of stories. We also talk about the shepherding groups, which is a integral part of the Baptist Memorial system that they have over there. And another topic that was really interesting, we explore how they are applying scientific thinking, Toyota Kata and the traditional Kaiser event, and kind of marrying the two and coming up with something pretty special. So I think you're really going to enjoy this show. As always, you can get the links and everything that Skip and I are talking about over@gembapodcast.com youm'll just look for episode 273, and you can also check out Gemba Academy's Lean Learning system over@gembacademy.com with a full access trial. Okay, enough from me. Let's get to the show. All right, Skip, welcome back to the show. How's it going, my friend?

Going great, Ron. Thank you so much for having me back.

Yeah, yeah, yeah. So I just mentioned in the intro that you were on a few weeks ago. 269. Episode 269. And so as I mentioned in that intro, I think if you haven't listened to that episode, this one's not going anywhere. It'll be there in your podcast app, whatever you're using. Go back and listen to episode 269. Because I think we might even think of this episode here today as part two. I think we would have gotten to a lot of this stuff, but gosh, we were rolling so good there, Skip, that we just ran out of time.

It was a wonderful time. Wonderful, yeah.

So since we're going to encourage people to go Back to episode 269, we'll keep you from having to repeat your bio and all that. You can just maybe just a quick 30 second shout out of what you're up to these days. But let's open up with a quote. I know you're a big quote guy, Skip, so do you have another one that you want to open with?

I do. So I have a quote. It's actually the quote we use at the beginning of our book that we have coming out this summer and it's from Dr. Russell acoff, which I was a big fan of his work. And the quote says, managers fail to diagnose the failures of the fads they adopt. They do not understand them. Most panaceas fail because they're applied anti systemically. They need not be. But to do otherwise requires an understanding of systems and the ability to think systemically.

So this is, I think the root of the, of the episode here is, is really this topic of, of a management system, you know, within a lean world. There's just lots of, lots of ways to describe this movement, you know, of lean. And I think the most accurate way is when we describe it as a management system. The problem with that and the problem I've had for many years is I'm like, yeah, well what is that? You know? Oh yeah, there's two pillars, people, continuously. Okay, that's cool. Yeah, I got it. That's a nice diagram on your PowerPoint slide. But what's that mean, you know, so, right, let's, let's start there. Skip, like what is a system?

Right, so in the basic definition, you know, it's a whole with the word W is the word whole that cannot be divided into independent parts. Now that's a basic definition and we could go into more academics and I would recommend that whether it be the fifth discipline or whether it be Dr. Russell Acoff's work or so on. But I think one of the great ways is since most of us live in stories and live in pictures, let me just provide a picture. Most of us listening to this podcast are very familiar with a car. And Dr. Russell Acoff would always use an example of a car. He would say that the purpose of a car was to get you from point A to point B. And then he would go on to say, but no part of a car by itself can get you from point A to point B. The engine can't, the brakes can't, the axle can't. It's only when the parts interact do they have the ability to bring about that property. He would then go on to even say that he would give an example about that. The property of each individual part loses its property when disconnected. So, for example, the property of an engine is to create movement, but if you take an engine out and lay it on the floor, it can't even move itself. And then he would kind of end his speech with this little analogy. And I was always surprised at how many people kind of fell into the trap. He would use the analogy of a thought experiment where he would say, we're going to have the greatest automotive engineers in the world and we're going to pick the best parts of every. And he would go through and he would say, maybe the Mercedes has the best braking system and maybe the Rolls Royce has the best engine. And he would go on to every and he would make a joke about maybe the Volkswagen has the best horn. And he said, so now we have all these parts laying in this room. What do we have? And I was surprised when some people would jump the gun and say, well, we have the best car. And he would say, no, we don't even have a car at all. And the reason we don't have a car is because the parts don't fit. And so it's not about having the greatest finance department, the greatest marketing department, the greatest production department. If the parts don't fit, then we've got a problem because they're not interacting as a system. And so he would make that argument quite often. And so when I think about that, I then go into the thought about what is a management system. And that really deals with all the different parts of not only the physical company that we might be managing, you know, the different departments, but also the approaches. So when I, you know, we've talked a lot, Ron, about KATA and TWI job instructions, job relations, job methods. We've talked about strategic deployment, and there's many more avenues that we could talk about. I love talking about variation with process behavior charts and things of that nature. But at the end of the day, we've got to connect those. And we've got to not only connect them physically, we've got to connect the dots in the learner's mind, right? We have A responsibility to do that. And so that's how I think about a management system. When I think about Toyota's house. A house is actually a great example, Dr. Acoff would argue for what a system is. And so I think that. But that meant a lot to them, that analogy, Toyota. And so whatever analogy you might use, whether it be a car or whether it even be the human body, the human body is a great example of a system. We've got to make sure that the individual parts as well as subsystems are connected together to bring about a purpose.

So we. I remember the first time, I think, I, I don't know when I heard Mike Rather speaking about Toyota Kata many years ago. He used a, a phrase that, it was always stuck in my, in my brain. And it started with the word meta. And I thought meta. That's a very powerful word. Right, Meta. I mean all encompassing. Meta, Meta routine is what he is, I think how he described scientific thinking or Toyota Kata.

Right.

Talk a little bit about what is meta even mean? Just that word alone. Meta.

Sure. I think Beth Carrington did a great job. A friend of ours, both, Beth, she says, you know, she says that meta routine stays the same regardless of the circumstances. She refers to it as a routine way of acting and thinking. And I think we all have physical routines that we do many times that we don't even think about. We drive the car to work every day and we drive it home and it never enters our mind because we have these neuro pathways that are built into our brain. Many of your listeners have probably seen the movie Karate Kid and they remember the famous wax on, wax off. Well, I can relate to that because I went to college on a wrestling scholarship and we had a very similar wrestling move that looked like wax on, wax off. And so one of the scouting reports on me when I was in college was, hey, don't reach out and touch him because he's going to bait you. In other words, I was going to do that wax on, wax on, off you. Well, at the age of 51 now I still have that worthless routine in my brain so that when someone reaches out, grabs my shoulder, I automatically think about wax on, wax off. That doesn't, that doesn't serve me anymore. But what is a much better routine that can serve me for a lot longer to come is this meta routine that you and I refer to as Toyota Kata. And because one of the things that drives me crazy, and it may you, is when I hear people refer to Toyota Kata, the improvement kata, coaching Katana, as a Tool. I don't view it as a tool. The storyboard that we might play out the routine on is a tool. Some of the forms might be tools, some of the little cards and techniques or starter katas, like Mike likes to call them, might be tools. But the meta routine is how we have a conversation scientifically. And it sounds a little bit like, what step am I going to take? What do I expect is going to happen? What do I expect to learn from taking that step? Ooh, what actually happened? And oh, what did I learn from that? And then what's my next step? So I think about that meta routine a lot and I think about that being embedded in every element of our management system. Whether people are at a storyboard doing the physical kata or not. Do we hear that meta routine infused at every level within the organization? And the answer is no right now. But that's where we're driving towards now.

So let me play contrarian for a second. So, yeah, I've actually had conversation with some really old school lean guys, you know, and gals who have been around for a long, long time. They've seen all the, you know, fads come and go, all of the new books that get written and new terms get written, you know, for tools that we've had for 50 years and just repackaged as X, Y and Z. Right. So someone can write a book and sell, sell some speeches or whatever. So I've even heard people be critical of kata initially. And most of these people end up coming around. I think almost all of them have, in fact. But in the beginning they were like, this is pdca, you know, or pdsa. This is nothing new. And in a way, I can't dispute them that it is pdca. It is pdsa. But I guess what I dispute is when we talk about. Because PDCA could be looked at as a meta routine, right? Sure, you know, it could. We could use those same words to describe that. But what I think we've learned with this, what we called in the beginning at least, the starter kata, is that we have a recipe. Whereas maybe when we're learning PDCA or the scientific method even, you know, it's like we don't necessarily have this routine we can wrap our arms around and practice. And that to me is what's made Toyota Kata and scientific thinking so powerful for me personally is that it allowed me to practice this technique or this, this idea of PDCA that I've known for the better part of 20 years. But I just, we all struggle. I don't know if you did skip. But I did, you know, over the years and I knew Damaic, I knew lots of roadmaps. Okay. I would almost argue a traditional Six Sigma guy practicing DMAIC is actually closer to Toyota Kata than I would say the traditional old school lean guy running around trying to do PDCA because it was, it is more. The Domic roadmap is a bit more structured. Right. So you can practice it a little bit more. So what do you think about all that?

Yeah, that's a great question. Because it's funny that I've went down that same path. I've had actually friends that have worked at Toyota and I've had them on both sides of the spectrum. I've had some that said the very first time that they read Toyota Kata, they said that explained the way that we thought and I didn't even realize it. And then I've had others, you know, old, you know, kind of style, lean people push back similar to you. What, you know, my argument to that is if you've ever been around Mike Rother, he's one of the most humble, oh yeah, giving individuals I've ever met. He's not a salesman and he's a true scientist. And when and when I got into kata and it has never stopped. It's not like we've arrived. That's why I love katacon, because I'm so excited to see what people are going to learn next year. But what it did for me is it brought clarity to the thoughts. In other words, sometimes people that grew up in a long term, maybe Toyota, or maybe they're old school, have been around lean for a long, long time. I refer to them sometimes as the fish inside the water. It doesn't know that the water even exists. It's just swimming. Right? And the thinking is just so natural to them. And I was a Six Sigma Black Bell, I went through all of those similar paths. But what Toyota Kata did and is still doing for me is it's bringing clarity to thought. As you know, there's a phrase in TWI job instructions that says if the worker hasn't learned, the instructor hadn't taught. And the improvement kata coaching kata has brought clarity to my thought process about moving forward in a scientific way. And a lot of times the things that I see people argue about, they have a misunderstanding of what they even think that we're trying to say in the kata community. I've had some people, you know, start off with a presupposition, they lay out their full argument and I let Them finish. Because I want to be a good listener. And. And then I'll say, in all due respect, that's not what Mike is trying to say. I actually, you know, a lot of times I'll tell them, I agree with what you just said, but let's make it clear we're not trying to, you know, say what it sounds like you, you know, you're. You're thinking. We're trying to say if that makes sense.

Yeah, no, exactly. Exactly. So I'm curious there at Baptist Memorial, you guys are doing a lot of creative and innovative approaches to just continuous improvement, I would just call it in general. And one of the things that I know you guys have been experimenting with at least over the last last year or so, I think, is this Get Better jump start, sort of your version of a Kaizen event done in more scientific thinking style. Talk a little bit about Get Better. Jumpstart. What is that?

Yeah, yeah. So Get Better is part of our branding. So if you go anywhere in Tennessee, Arkansas or Mississippi, or even in the Memphis metropolitan area, you'll see Get Better quite often on billboards and different. It's part of the branding. Now, it initially implied towards patients getting better, but I love the phrase because think about the world we're in. We want to get better. Right? We want to make our lives better. We want to make our processes better. We want to make everything around us better. So my boss, Dr. Paul Dupriest, challenged me. He said, you know, I know you're not really big into episodic events, Skip, but from time to time, there are times when we need to drop and roll, that we need an intense focus on some, like a Kaizen event. And I said, okay. And so then I started working with Brandon Brown and others, and I said, well, let's do this. Let's create a Kaizen event done kata style. And what I meant by that and what we've created so far is traditionally, and I don't want to offend anyone the way I'm saying this, but traditionally, a lot of times people will have this Kaizen event and it'll be. They may have even accomplished great work, and it'll be a kind of a big emotional event. But what happens many times is that when it's over, when those three or four days are over, it ends up being a bunch of homework that maybe never gets done. And even though they may have moved the ball per se. So what we did was we said, well, since we fundamentally believe in this meta routine that we. We call the improvement Kata Coaching kata. Let's make sure we embed that. So what we've done so far, and we've been experimenting with it for the last several years, is we have created a guide and we say as long as you're a competent coach and we define what competent coach is, it's basically off what they call the Dreyfus model. And as long as you're a competent coach, you should be able to follow this guide. And, and this guide has you work with leadership to articulate what is the challenge. Write that challenge many times. It's going to be very multifaceted. It's going to be cross functional. So instead of point Kaizen, it's going to be more process kaizen over several areas. So we're going to articulate what that challenge is, make sure leadership buys off on that. This is what we're trying to accomplish by this date. And then we're going to assemble the team six to eight people, and they're going to spend six to eight weeks, about an hour to two hours a week, truly understanding the current condition in light of that challenge. Wow. And then when it comes time for the event, they're going to spend three days, basically three to four days locked up in a room. Not literally locked up, you know, but anyway.

Really, what are you guys doing over there again?

Yeah, exactly right. Shove the food under the door, you know, but. And that these folks, many of them will have experience in kata and twi, they're just going to be rapidly experiment. So they're going to be leaving the room and going to the front lines and they're going to be doing rapid experiments on their way towards multiple target conditions, towards the challenge. And we have seen great success as we've experimented with this multiple times. And what has happened so far is we've had several chief nursing officers and others come back and say, skip, we got more done in three days than we would have gotten done in five, six months. Now what we're doing there is we're doing the same experimentation, improvement, kata process, but instead of 20 minutes a day and then we come back the next day, we are running rapid experiments. And we might even be working on multiple processes that are feeding that challenge because many times that challenge is multifaceted. And so that's what a get better jump start is. And we're continuing to, as my friend Patrick Grop likes to use the word, we're continuing to road test it in different scenarios because what we'd like to be able to do is hand that document, that recipe list we'll call it to any competent coach and they should be able to assemble the right team and put that process together. So we've been seeing great success with Get Better Jump Start and a tremendous amount of enthusiasm. And so what the deliverable is at the end of the three days is a very mature storyboard. And so now there isn't homework the next day when the event is over, there's just your next experiment and you just keep moving forward.

So what's interesting about this approach, if I'm hearing it correctly, is you spend quite a lot of time deeply understanding the current condition. I think you said you spend many weeks, was that right?

Yeah, six to eight. Six to eight weeks, that's right.

So talk a little bit about why you would spend so much time, two months understanding the current condition versus four.

Days.

Taking action, if you will.

Yeah, no problem. Basically because it's a multifaceted challenge and many times there's many processes. In other words, this is a real booger, a real ugly thing that leadership has brought about. What becomes very, very clear is that we don't really understand the current condition. We have all these myths and misunderstandings in our brain and what you'll hear different levels of leadership say, I was shocked at how much I didn't understand the current condition. And we're using really, you know, how passionate I am about TWI job methods. We're using TWI job methods to really help us dissect the details of some of those processes. And the devil's in the details. That's why that, you know, cliche is out there, is we're discovering things that we didn't really realize that's how we were playing the game or that's what was going on. And so it's, it's having us. And it's not just looking at data. Data is a piece of it, but it's. It's talking to the real people that do the real work on different shifts. It's maybe, like I said, using JM to dissect something. We might discover that everyone's doing a task completely different. But as you're crossing boundaries in that value stream, as you're. I'm going back to systemic thinking. When you're going from one department, we'll say, to another department, as work's flowing through there, there's assumptions of what's going on, but we discover that many times what we thought was true and what is actually true are two different things.

Yeah. You know, the reason I asked that question is because I've seen it firsthand with people that we coach, getting people to calm down almost a little bit and say, listen, I know it's exciting to think about how we're going to go fix this.

Right?

I know you have a. You feel you have a problem, and I'm sure you do have a problem. But we can ask clarifying questions about how bad is the problem and how do you know it's a problem? And I mean, just an incredible percentage of the time our folks, the folks that we're trying to help, to your point, they just don't deeply understand the current state. But it's so. I mean, it's so hard to get people to focus on that because it's not exciting, it's not sexy, it's not fun. You know, fun is the Kaizen event. Let's go move stuff and, you know, make things better. But.

Well, and what I've. What I've also learned about him so far, you know, I was kind of, you heard me, kind of walking on eggshells when I kept on saying, if you're a competent coach, you can lead this. What was behind that? The way I was saying that is that I continue to come back to what really makes the leadership of those Get Better Jump Start successful is if that leader is also skilled in TWI job relations. I saw a leader lead two different groups, one from a clinic, one from a hospital, multiple different departments that all had opinions of each other, of how each other hands off of. Hands off a baton or hands off the work. And this leader, she was absolutely amazing. How she showed respect to everyone and how she. I called, maneuvered through the buoys. You know, she was really practicing her jr and I can't say enough about that at how well she did as a result of that.

Yeah, no, exactly, Skip. I know. You know, in episode 269, we talked quite a bit about. About your. Your journey there at Baptist Memorial with Jijr jm. I don't want to repeat any of that so folks can go back and listen to that one if they haven't already. But I want to.

I want.

I want you to talk a little bit about another area where I know you're using KATA to deploy a subsystem of this, of this management system, and that is idea generation. Many terms for that, ideation or whatever it might be, talk about idea generation and how scientific thinking can help foster that.

Sure, sure. So we worked with a good friend of ours, Dr. Allen Robinson, and I know you're probably familiar with his work and so basically, we're trying to find ways in our management system so that every single human being has the opportunity to share their thoughts, their creativity, their ideas. And so we have a basic entry level way that we first start idea generation in different departments where they can offer ideas on, as Paul Akers would say, things that are bugging them, right? Things to just improve their world. And one of the things that we wanted to do after we initially got started was we said, wait a second, before we get too far down this road, let's not, let's not just go implement, let's use that meta routine of KATA to ask ourselves, where do we want to be at in a year? Where are we at today? Current condition in light of where we want to be at? You know, what are we trying to accomplish in a year? And then where could we be at in a month? And how do we experiment our way there? And what that has developed as a result of that is it's developed, you know, how those ideas get escalated when they can't, when they're not quick ideas that are easy to make a decision on. Maybe they need some capital, maybe they need money, maybe they need permission. How do they get escalated? How do they get reviewed? How do they get shared within just a entity? So forget about all of Baptist. If you just take one hospital, let's say the one in northeast Arkansas, you have around 1800 folks there. It's easy for folks on one side of the building not to know what's going on on the other side of the building. And so how do those ideas get shared? And they're, and they're discovering things of that nature as they move forward. Some of the things that came out of some of those experiments was they had a annual ideas fair where they had over 500 people within that hospital during their own time. Lunchtime came to the ideas fair and there was, you know, there was a photo booth and there was just a lot of fun, right? But what was funny when you heard people walking around, I didn't know you were doing that. Ooh, I didn't know that was happening. And so. But because they used KATA to experiment their way forward versus implementing their way forward, idea generation is in much farther. It's much more broader and much more depth in that particular organization. The other thing that they're doing, just to add to that, this goes back to the systems definition and connecting the dots, is that I remember talking to Dr. Robinson. He said, oh, you know, this one hospital, NEA in Jonesboro, Arkansas, they're doing Great work, Skip. He goes, the next thing you need to do is start introducing idea activators. And I said, okay, so what do you mean? He goes, do you know what TWI job methods is? I said, yes, I sure do. And he said, well, I call that an idea activator. And so basically what he was saying was how do we take it to another level? How do we deepen these ideas? And so when we talk about idea generation, we're not talking about the traditional suggestion box with a. Yeah, exactly. I always get tickled when they put a lot a lock on who in the world wants to steal any of that stuff, you know, so. But that's what, that's how we think about that. We think about using that meta routine to deploy this thing we call idea generation that allows multiple people to fix what's bugging them. To quote Mr. Akers.

Love it. Shepherding groups. One of my favorite things about the work that you guys are doing. What is that? And, and how can we learn from it?

Very, very, very passionate about shepherding groups. Mike in his Toyota Kata work refers to it as advanced groups. And for our culture, we felt like shepherding groups was a, a better term. We're a faith based organization and shepherding groups to simple way of saying it is. It's a. Let's start off with kata. So we have shepherding groups for both KATA and JR and JI and JM and for idea generation. But for it's basically how do you kata your kata? So at a particular location there's a. You'll have. Well, actually at every one of our hospitals we'll have a shepherding group for kata. So in other words, where is Katana? Where do we want it to be at in a year from now? Where is it at today in our current condition? Where could it be at in a month? What obstacles are in our way and how do we experiment our way forward? Now, what makes up a shepherding group is normally a combination of both executive leadership as well as people that have gotten really good at catta. So a lot of times you'll see people at shepherding groups that are CEOs and administrators of that local hospital, in addition to directors and managers, because those managers and directors have gotten really good at the coaching kata and the improvement kata. What we've seen, Ron, and this has made me really think deeply about the science of habits, is we've seen if the shepherding group is weak, if it's not intentional, if it staggers, then the boards, the storyboards where KATA is being Done. Many of them will go dormant regardless of their success. And that was somewhat. That was a surprise to me. One of many come to my mind. We saw a billing department using improvement kata reduce their denials by a million dollars in 10 months. Doing it every single day, Monday through Friday, they reduced it a million dollars. But then all of a sudden I saw that the shepherding group had kind of gotten inconsistent. And I happened to go by that board and I noticed that the board was wiped clean. And I asked the director, I said, hey, what's going on? They said, well, we're all done. I said, what do you mean all done? We finished the project. They said. I said, no, no, no, it's not a project. What that was a reminder to me about Ron was how incredibly hard habits are for the long term. Yeah, right. And I think about even my daughter. My daughter, I taught her how to drive the last couple years. But if it was up to her, she does not enjoy driving. Right. And so if I took, if I didn't know, if I didn't kind of make her go out and drive with me on a regular basis, she would be more than comfortable. Let her friends pick her up, you know, drive her around, but then she's going to start to lose that skill.

Yeah.

And so the shepherding groups are also, in that term, shepherd. It's a group that we want to help celebrate when people have hit significant target conditions. So we have one shepherding group. I know that when they hit target conditions and when groups are kind of Moving forward, the CEOs and the administration go around with cookies and Cokes and all kinds of stuff just to celebrate and give credit where credit is due, as JR would tell us to do. So the shepherding group is incredibly. I've never seen such a strong correlation as, as I've seen between the shepherding groups and the actual work. Regardless of how successful someone is, if that shepherding group is not engaged, the work can dry up pretty quickly.

So I know, I've met many of your senior leaders and I know the answer to this question for some of them that many of your even CEO level folks are very passionate about, lean about Toyota, kata about all of these things. And they're very, very wise and have studied it and practiced it themselves. Now, is that the case? I don't put you on the spot here, but is that the. I have a feeling that's very important for the success of the shepherding group is that not only do you have senior leadership buy in and support which we have to have that. But they also. They know what's up, right? They know what's going on here. It's not that they're just rolling in with their CEO hat on and they have no idea what you're talking about.

No, no, no, that's exactly right. So we've had. We've had some CEOs that have actually. That I've had the privilege of coaching them. And they've gotten coached by other people, too, people like Beth Carrington and others. And so they've really gotten their. I call it their hands dirty with kata others. You know what the shepherding group does? We have, like, a radar chart that's connected to it. It lets them know real quickly when someone's struggling. So, for example, with one look at the board, you can tell, let's say that it's. Let's say it's been two weeks since we checked in. And we know that if you go Monday through Friday, that's, you know, that's 10 PDSAs. And we see that there's only one one marked up on the board. Well, that tells you what's going on if someone's struggling, right?

Yeah.

We're also making sure the shepherding group is also making sure that those challenges from those improvement katas are directly connected to the strategic initiatives of the organization. The last thing you want to happen is to have good people working on things that don't matter. So one of the things that I ask every time when I'm coaching someone or when I'm walking around throughout the system, even though the first question, as you know, is what is your target condition? I always ask, tell me about your challenge. Always. Because the challenge informs everything else. But I'm also. Ron. I'm watching their body language. I'm trying to see if the people doing the role work, if their heart and mind is connected to that challenge. Do they know why it's important? I'll give you one little story, just to be transparent. I was at a hospital not too long ago, and someone said that in a particular area, their manager wasn't real engaged and they were in the role of a coach. And I asked him, I said, well, do me a favor. Let's just stop on talking about the board for a second. Let's just have a conversation now. I was going to have a KATA conversation, though. I said, tell you. Tell me about that challenge. And they told me about it. And I said, if you'll let me be the devil's advocate for a second. Who cares, is what I said. In other words, why should that manager even care about that challenge? Like, what's the big deal? And the person responded and they said, well, I care. I said, no, no, I get that. That's quite evident. I understand that you care, but why should that manager care? And they couldn't tell me. I said, you know, I promise you, that manager could tell me if patients were in harm's way, why that challenge was important, if it was a challenge that dealt with taking care of patients. Because, you know, healthcare people are some of the most passionate people you'll ever meet. But if the challenge doesn't mean anything to the real people doing the real work work, it's going to be very hard to coach them forward. Right? And so that's another thing the shepherding group can really do is not only make sure they're connected to the strategic initiatives, but they have a responsibility to make sure we're communicating to the coaches and the learners why these challenges are important. So, for example, if I came to work for you at Gemba Academy and I had a challenge challenge, I could, I'm a good little soldier, I could salute and say, I'll work on it. But if I don't really understand why that's important, what's the big deal about it? You're not really getting my creativity, you're not getting my mind, you're not getting my passion, you're not getting my heart, and you want all of that because that's what's going to move us forward. So the shepherding group is very, very important. Very important.

It's all like a spider web here. All these things are together, like, you know, reasons for the key points. Right? You know, like, reason.

It's.

Everything's interrelated here, right, within this.

Well, I think about that spider wave being a system, right? Yeah, yeah. All the dots are connected and it's not just one dot, so it's how do those parts interact? You know, Another example I love talking about systems is I was asked Jim Hunsinger, our friend Jim, this not too long ago, I said, if you remember the old joke in the 90s about, I don't mean to step on anyone's toe, but the Jaguar. There was an old joke in the 90s about, Jaguar was the ultimate driving experience, but make sure you buy two, one for spare parts. And that was the running joke. And so you have to ask yourself the question, what was the difference between the Jaguar of the 9 90s and the Lexus of the 90s? Both of them were cars. Both of them all had the Same parts. One was. One the parts were fitting and one was executing better than the other.

Yeah.

Right. And so the parts have got to connect. They've got to fit.

Yeah.

And so the shepherding group. I. I hate that. No, actually, I don't hate it. I'm going to keep plugging, Junior. The JR also makes a shepherding group move forward because you have so many different personalities in a shepherding group. You're going to have nurses, you're going to have non nursing, you're going to have administration, you're going to have all different personalities. And a shepherding group of where we show respect to each other is so important. I'm just very passionate that the shepherding group has got to be strong to move the work forward.

Yeah, yeah. Last topic. I can't let you off the podcast without you talking about the Baptist Management System Review, or bms, I believe you call it.

Yeah.

What is that?

Yeah, yeah. Very passionate. So, basically, I am a Shingo examiner. And as a Shingo examiner, when we go into organizations, we are attempting to look at that organization through the lenses of the 10 principles that make up the Shingo model. Things like respect for every individual, lead with humility, quality at the source, systemic thinking, and so on. And we're asking the question, does this organization's. Their behaviors, their activities, their work, does it support these principles or does it go against these principles? And so one of the things that we have done, me and Paul Terry, which is on the board of examiners for Shingo and retired from O.C. tanner, we have been over the last year creating our own internal review process. But we don't have awards and trophies like Shingo. But what we've done is we've picked 45 individuals. Three of them are CEOs, five of them are chief nursing officers, a couple of them are chief financial officers. But we've picked 45 individuals that will go out and review another Baptist entity that's not their own. And at the end of that week, they will give that CEO a report. And that report will say, here are some great strengths connected to these principles. Here are some great opportunities connected to these principles. Think about this, Ron, being just like when you go to your primary care physician once a year, you go in and the first thing your doctor more than likely says is, ron, how's it going? Now, he's not saying that to have chummy talk. He's saying that because he's wanting to see what's going on with your human body system. And you might tell him you're back. Exactly. He's wanting to know the current condition of your system. And so. And then he's going to start poking around, he may take some blood. At the end of it he's going to say, ron, you're really good in these areas, but your cholesterol is a little high. Now what you do with that is your choice. Same thing with this. The Baptist management system review is we're reviewing different Baptist entities in light of our 11 principles, which look very close to like the Shingo principles. And we have pretty intensely trained these 45 individuals and we're actually never going to stop training, training them. And we're going to get, we're going to review that entity, that Baptist entity. We're going to give them a report and what they do with that to improve their management system is their choice. What has come out of this that I didn't expect out of this experiment is it's ended up being a tremendous leadership development process to where I've had people saying, I finally get how the principles are connected to the work. And to give this one story I think helps really bring attention to it. I had a manager on one of our reviews come up to me and said, skip. She pulled me aside before we started and said, a nurse manager from another hospital. And she said, skip, you know how you said that some of us on our interview track are going to have to look at the strategic initiatives and try to walk them all the way to the front level work? I said, yeah, yeah, I remember that. She goes, let me pull you. She goes, come here for a second. What exactly do you mean by that? And I said, oh. And so I was really kind of shocked and I gave her an example. I said, let me walk you through an example of a major infection issue that you have at your hospital. And so I walked her all the way to the front level work in this made up story of how people were ultimately using TWI job instructions on how to put in a Foley catheter that had an impact on a certain infection, which ultimately had an impact on a strategic gap they were trying to shut. And she goes, oh, okay, I get it, Skip. I said, now let me ask you a question. I said, I walk into your department and my stomach is hurting, my back is hurting and I've got blood coming out of my nose. What do you do? And she instantly, Ron started connecting the dots and she started laughing and she stopped. She goes, I see what you're doing. She goes, skip, I went to school to be a nurse and one day I woke up. Now I'm a manager. She goes, this whole process is helping me learn how to connect the dots in our management system. And I said, wow, that's insightful. So that's what the Baptist management system is.

Got it.

Review process. Yeah.

So folks want to come and visit a Baptist facility. Is that possible?

Yeah, it is. I mean, obviously, we have to manage that, but it happens to be that yesterday we had wonderful folks from Northeast Georgia Healthcare System visit. We've had folks from Kaiser Permanente. We've had folks from ThetaCare and several healthcare systems visit us. But I always like to go on the record to say I don't want to imply or get anyone to think that we've arrived or we've got it all figured out. But, yeah, we love for folks to come visit. We're always willing to share what we're learning. I have multiple conversations a month with healthcare Systems that maybe don't want to visit, but they have some questions. We have great friends out at Intermountain Healthcare that we have kind of an informal partnership with. They've come multiple times, and we've went out there to help kick off their TWI program. And so we're just one learner trying to share with another learner what we're learning. And. And, you know, we haven't arrived. And I'm always. Always get. I always learn a lot by the questions that people ask. But that's a long answer to saying yes.

Yeah. Okay. Well, if folks want to connect with you, Skip, what's the. What's the best way?

Probably the best way is by way of LinkedIn. I'm on LinkedIn, and you can find me at Skip Steward. Steward with a D. And so, yeah, so free. I've contacted many of your people. As you know, I watch every single Gemba Academy. I promote it pretty heavily, I think, y'. All. I'm not saying this because I'm on a podcast. I'm saying this because I believe it. I believe passionately about the work that y' all are doing, and y' all produce tremendous quality work.

Well, thank you, Skip. It's because of people like you that help, you know, make our job a little bit easier. And let's have Skip on.

Thank you. Thank you, my friend. Thank you.

All right, well, hey, Skip, thanks again for everything. I know we'll see each other at Katacon and the Ames and all the other things of the world, so it's always a pleasure. And I know you'll be back on the podcast sometime down. Down the road. As well, so keep up the good work. Give my best to everybody there at Baptist. And keep that. That guy Brandon out of trouble, would you?

I sure will. I sure will. Thank you so much, Ryan.

All right. You take care, Skip.

All right. Bye. Bye.

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