GA 523 | The Cleveland Clinic Improvement Model with Tim Pettry

So recognizing that, you know, behaviors are important, tools are not the most important thing, but how do you get people to do the right thing using the right systems and behaviors? So my Shingo background helped out a lot, but it was challenging at first.

Today, I'm excited to welcome Tim Petry to the show. Now, Tim currently works for the Cleveland Health Clinic. And so Tim and I actually met up at the most recent, recent AME conference, and we had a great chat. And so I asked him if he'd be open to coming on to the. Onto the podcast, and he was. And so we got to talk quite a bit about his background. So Tim used to work at Ford, and so that's where he sort of first learned about continuous improvement and lean and so forth, and then got involved in Cleveland Clinic. And now he's also very involved with the Shingo. Shingo Institute. In particular, he's done, you know, does the audits and so forth, but he's actually running a workshop at the upcoming Shingo conference. And so he describes this workshop towards the end of the. Of the episode. So you gotta listen to the end, because I'm gonna tell you what, you've not heard of a Lean workshop or discontinuous improvement workshop quite like what Tim's gonna put on. And so this conference is going to be May 9th and 10th. We'll have a link to it in the show notes. So listen and see if that sounds interesting to you, and if so, you still got time to go register for the conference and be sure to tell Tim that you heard about him on the Gemba Academy podcast. But great guy, I think you're going to enjoy this one. I know I had a lot of fun recording it. Show notes can be found over@gembapodcast.com look for episode 523. Also, again, all the links are below. So go follow him on LinkedIn and all those other social media channels, and then also go check out that Shingo conference. Okay, enough from me. Let's get to the show. Tim, welcome to the show.

How are you? I'm doing well, Ron. Thanks for having me.

Yeah, man, it was fun meeting up with you at ame. Gosh, that was a little while ago now.

I mean, it's been a while. Yeah, yeah.

Already talking about the next one. So.

Our whole snow season.

Yeah, yeah, for sure, for sure. All right, well, Tim, you know the drill. We like to begin with our guest sharing a quote. So what do you got?

Yeah, so this is something that my wife gave when we first started dating, a long Long time ago, when we were in college, she gave me a poster. You can see it in behind me there, a van driving off into the distance. And the quote behind it is how long the road is. But for all the time the journey has already taken, how you have needed every second of it to learn what the road passes by. It's by Dag Hammersgold, who was a former General secretary of the United nations in the late 50s and early 60s. But that quote to me is. It was interesting because it was the beginning of our relationship. But this lean journey that we're all on and everything like that, you do need to learn every second of it to learn what the road passes by and nothing comes easy and you got to work for it. So. No, I really like that quote.

Oh, that's a good one, man. That's good. All right, well, hey, tell us a little bit about, about your background, Tim. Tell us about how you first got involved in continuous improvement and then for sure we're going to dive all into Cleveland Clinic. But tell us a little bit about what you guys got going on there as well.

Yeah, yeah, no, so. So it's interesting. I first started my lean journey at Ford. I worked at the Ford Cleveland engine plants and got my job there. Kind of. It was a str. I had no background in finance and no background in manufacturing. I had been working with Ernst and Winnie, that was. Had turned into Ernst and Young at the time. And at that merger they moved my. I was in the national marketing department and they moved all of that to New York except for the people. And so my father in law was the superintendent of maintenance at Ford. He was looking after his daughter, wanted to make sure she was provided for. So he asked me if I wanted to send in my resume and I did. So I got. Got a call from one of the controllers saying, hey, we're hiring for a cost analyst. And I said, well, you know, I don't have a background in finance, I don't have a background in manufacturing, but I was just finishing up my mba and I said, we're looking for a good business person. So I said, all right. So I went into interview thinking that, you know, Ford is always viewed as a family organization. If they mention family, I may consider it. It wasn't my dream job, but it was going to be something. And they did mention that being at Ford is like being part of a family. And they offered me the position. I took it thinking I'd be there for a year, fill in a couple holes in my resume, and then go after my dream job and ended up being there for 18 years. So it was a long thing. But my exposure to Lean happened when we were opening up a new engine plant and Gifford Brown, who is the plant manager, had been hanging around with Shigeo Shingo and actually was one of the people who helped get the Shingo Institute started. He served as one of the first, if not the first chairman of the board of governors for Shingo, and got a lot of funding from Ford to help Shingo in the beginning. And he wanted to create what we ended up calling the Cleveland production system. He hired a couple of ex Toyota Georgetown managers to come and help us. Russ Gafferty was one of those who did that. And we started putting together this production system. My boss at the time was responsible for writing a lot of the material. And based upon my previous role at Ernst and Young, I said I'd love to proofread all of that, if you don't mind. And that's how I started to learn. And then I was finishing up my MBA project, final project, and decided to do that on the implementation of team based approach to manufacturing at Ford. So I got to study a lot about what was going on at nummi, what was happening at Toyota, and that was my exposure to it. I eventually moved into a role in the training department, got involved in organizational development, became a Ford production system coordinator, and kind of went on from there. We applied for the Shingo Prize. I was responsible for helping write our achievement report and then responsible for hosting the site visit. And we won the prize in 1996. And as a result of that, I became a Shingo examiner. And so I've been an examiner now for a long time. And it's been the best thing that's happened to me. Just being able to be a part of that, part of that role is I got to be. I was nominated to be the Shingo representative on the Lean Certification program with ame, SME and Shingo. And so I was on the Oversight and Appeals committee for about six years, served as chairman of that committee for a year and just was a great group of people to work with putting that whole certification process together, working with the body of knowledge and writing exam questions, which is a lot harder than you originally think.

Right.

But so, yeah, so that's, that's kind of been my journey. I. In 2008, was that 2008, when the auto industry hit the big downturn, my job at Ford was eliminated, which was probably the best thing that could have happened. I ended up interviewing at the Cleveland Clinic, which was right down the road. Didn't have to relocate, didn't have to do any traveling at the time. They were just starting their continuous improvement program. I think I was number four or five as my job was being eliminated at Ford. I was also interviewing at the clinic. They were getting their improved continuous improvement group started. And I was one of number four or five hired into the department and we went from there. So we started out, we were more project based organization. We were going in and we used to call it parachuting in fixing a process and then help. Yeah. And then wondering why they're not following our process three months later. Right. And so a lot of the work that I had done at Ford also involved a lot of organizational development. And so recognizing that, you know, behaviors are important, tools are not the most important thing, but how do you get people to do the right thing using the right systems and behaviors? And so my Shingle background helped out a lot. But it was challenging at first. Yeah.

One question I have, I'm curious to hear. I mean, I'm sure it's different now because been many years past, but when you were back in your Ford days, when you guys were getting going, you hired some Toyota folks and all the rest of it, like what was the perception of Toyota as a Ford employee?

Yeah, no, so I actually it was good when I was working at plant one. So after we won the Shingo prize at Plant two, I got rewarded by getting a chance to go to Plant one and implement the same stuff over there. A little bit different situation. They had just lost one engine line, their second engine line. Production volumes were cut in half. They had just signed a new modern operating agreement with the uaw going to a team based approach. Most of the people who were in Plant one chose not to go to Plant two to be a part of their team based approach. So they weren't really enamored with this whole team thing. And the Cleveland production system had morphed into the Ford production system. And so every plant was now required to implement this. And so we were starting to do that. And oh, by the way, the plant was scheduled to close in two years and everybody knew it. However, we were able to get people engaged and get people going. We ended up saving the plant closed down for a couple years and then reopened. And as we reopened, we started to do this training program called Changing role of the Leader. Where part of that is being able to create a vision for people and understand the current reality, understand the need for change, come up with a Transition plan that will get you to your vision and that will help you overcome any resistance. And one of the visions I love to talk about, there's two of them. One was at that site at the Cleveland production site. There used to be about 16,000 people working there. Father in law used to tell me that one of the biggest problems they had was finding a parking spot at change of shift. So I said, wouldn't that be a good problem for us to have one day? And I said, the second vision that I had is we need to put a sign out in front of the building that says reserved for visiting Toyota Executive, because we would have something worth them coming to see. We had been, we had visited Georgetown, visited New me, had had talks with a lot of the people there. You know, we learned a lot from them. And so it was, there was a lot of respect for what they were doing.

Yeah, that's really cool. I mean, I, I've heard, you know, similar thing, just a lot of humility all around, really, you know, on both sides, on Toyota side, you know, Ford side and, and so forth. So that's, that's really encouraging, really, you know, because competitors at the end of the day, but, you know, you can still still learn from each other.

So. Yeah, yeah, good.

Well, let's jump in a little bit on, on Cleveland Clinic then. And in particular the Cleveland Clinic improvement model. I know you've been involved with that. So first of all, just tell us about that model and then, and I am curious, like, what role you played in it.

Sure. So my role was really when I first started trying to bring in Shingo principles and the Shingo model, and it was difficult at first. It's a complicated thing to try and explain to people what it is. We had actually started to do some Shingo type assessments in some of our institutes. And in Shingo assessment, we look at a lot of the different systems that organizations have in place. And as we were doing these assessments, we found out that we weren't very good yet. We were getting zeros and ones and, you know, kind of the scoring and using the rubric that's used. And we said, you know, we can't really focus on all of these systems. What are the, what are the most important systems to focus on? And we came up with four. So the first is organizational alignment. And somebody said in our group, you know, well, what does that mean? And we said, well, it's what matters most. So that became our tagline that we use. So organizational alignment was what matters most. The second pillar of it is visual management. So how do we manage what matters most? So it's being able to look and see where our goals are, how are we performing to those goals? Where are the gaps? Once we see that there are gaps, we then use problem solving, which is the third pillar of it. Problem solving says, how do we improve what matters most? And then the last pillar is standardization. How do we sustain what matters most? And so what we did then is within each of those subsystems, we identified certain behaviors for different levels of the organization. So when we do a Shingo assessment, we look at leaders, we look at managers, and we look at frontline employees to understand the behaviors that are going on. And how do those computers compare to ideal behaviors? So we created behaviors that we would see at each of the levels. The upper level of our leadership, we used to use leaders, managers, and frontline. We've changed that now, changed the wording of that to be leading leaders, leading teams, and then as part of a team. And so those are the three levels that we look at. And the idea behind that is that anybody now can pick up this one piece of paper and understand what we're trying to do. When we created it, we purposely called it the Cleveland Clinic improvement model. We didn't ask for permission to do that. We didn't call it the continuous improvement improvement model. It was the Cleveland Clinic improvement model. And what we did then was we went out to different constituencies and asked them, what do they think about it? And is the language that we're using similar to what's being used in the rest of the organization? Does it resonate with all of the different areas? So we talked to nursing, we talked to the institutes, we talked to human resources, we talked to our quality department to make sure that we had wording that people could understand. So it did become the Cleveland Clinic improvement model. And then down below, we would list tools, certain tools within each of those subsystems that people could go and find information on how to use those. So in our organizational alignment, we use OKRs as our objectives and key results as our. The metric system that we use in our goal setting. And so we have references to those types of tools and where people can get more information about it. So it's evolved. It's about 10 years old now. And again, my involvement was really helping to write the initial draft and using a lot of the things from the shingle model to influence it. And so we're now in the process of looking to how do we now expand that into a more of an overall operating system? So we're in the process now of really looking to say, okay, it's an improvement model. It was originally meant to be a management model, but there's more that we can start to add to it. So we're in the process now of looking at that and seeing how we can improve it.

So do you envision, like, wouldn't necessarily be the production system, but like the, you know, Ford production system or Toyota production system? Do you envision a Cleveland Clitic operating system? Is that what you envision?

Yeah, something like that. So, yeah, giving people the tools on, you know, how to do this. So we're looking at operating reviews now. So how do we actually go through reviewing the work that's being done? How do we focus on the right things, make sure that we're, we're doing it and then how do we approach, you know, everything when we're doing it? So. Yeah, yeah, yeah.

It's interesting. Like words matter. Like even today, just internally here again by Academy, where we're starting to create some new content that's just more we would just generic general leadership. Like not necessarily lean, not necessarily Six Sigma. It's just like facilitation or leading team. So like we're known as continuous improvement training kind of thing. But it's like, ah, maybe that's too focused, you know, like it's, yeah, you know, you need to, not everybody's into Lean or Six Sigma or something like that.

But yeah, no, I, I, I've started just using the term. It's management 101, right? Yeah, yeah, yeah. I don't, I don't, I, I, When I started, it started here I was, it was kind of labeled as the Lean guy. Yeah. And at the time it was like, okay, I'll wear that badge with a badge of honor. But yet in our original improvement model, Lean was just listed as a tool under problem solving. And it's like, well, no, Lean is much bigger. I always viewed Lean as kind of the overarching umbrella of everything. And so it took some time to recalibrate myself with our leaders at the time.

Well, then you could get all kinds of people fighting on LinkedIn. Is lean the same as Toyota production system? And you just step back and get the popcorn and start eating.

You know, and Lean in healthcare has a different connotation than what we're used to. And you know, when people talk about a lean organization, they, they typically think of cutting people and. Yeah, so, yeah, so I tried not to use the word lean much. Yeah, I got you Management.

Yeah. So in a healthcare Organization. Obviously physicians are very important, as many people are important, but definitely need physicians. So I'm curious to hear how you have involved physicians there at the Cleveland Clinic as you've rolled out and your improvement efforts and continuous improvement. How have they been playing?

Yeah, no. So for a long time it was just kind of hit, hit or miss. We worked a lot with administrators and we worked a lot with managers, but we didn't get in. And we worked a lot with nursing, but didn't really get touch physicians much. And part of that is just their time commitment and everything. They didn't always have time to get involved in the projects. And so just recently, about two years ago, there was a position that was. So Cleveland Clinic is a physician led organization. So all of our top leaders for the hospital, for the institutes, for all the different departments have a physician lead that is responsible for all of the decisions, but they have an administrator that works with them as a dyad. So it's important to have a physician lead. And so we do have a physician lead within the continuous improvement department. And that was a big step in our development. But what we've done recently is we created. There was a position created called the Institute Continuous Improvement Officer. So a lot of places have quality officers or quality improvement people and everything. This was the first time we had a continuous improvement position. It was one where it was a part time position for people, their time. You know, one of the interesting things about our physician leaders is that they still practice medicine. They still practice and see patients in addition to their different roles. So these people were given 25% of their time dedicated to continuous improvement activities. The challenge was, is that some of them had a background in continuous improvement or some exposure to it, but some of them didn't. And so we created a program where we meet with them once every two weeks for an hour on Friday mornings. And we reviewed the Cleveland Clinic improvement model with them and walked them through what the expectations were about that we had them develop a culture of improvement. A3 strategic A3 for their area. And so one of the goals or the vision of our Cleveland Clinic improvement model is every caregiver every day is capable, empowered and expected to make improvements. So we had to talk to them about what does that mean and what do we mean by that. So we had them do some assessments. How are you doing with organizational alignment, how are you doing around visual management, around problem solving and standardization, and identify where the gaps are. And then we started introducing some of the more the tools of lean and continuous improvement that can help them to understand that. The interesting thing was, is a group of them were interested in going for their Lean Certification. And I said, well, you're doctors. I don't know that a Lean certification is going to do much to help you in your career, but I appreciate the interest. And so we're actually working with. We gave them the body of knowledge for the Lean Certification program, said, go through this, see what you know, what you don't know, what you don't know. We can certainly provide some training on that, but we also told them we can supplement any of the training that we have with Gemba Academy. We are a subscriber, and so we know that we didn't have the time to develop all the materials. It's helpful to see something from the outside in terms of. And to validate what we're saying. When we see others who are saying the same thing, then it kind of validates that we know what we're talking about a little bit.

Yeah.

So they've been able to. We give them assignments each between every two weeks to go out and look at different GIM Academy videos up front. And now it's really on their own to go in and fill in whatever gaps they see in their knowledge. So it's been really good. It's been going on for about a year and a half. We're getting ready to hopefully start a second cohort this fall, and it's been really good.

Have they watched any of the Franciscan Health videos that we've got in the library?

Yeah, no, we haven't assigned those yet.

I didn't know how that would go over, you know, like, see it in a Ford Toyota. I don't know. I mean.

It'S interesting.

You know, those are old too, man.

Yeah, but they're good. We. Yeah. You know, one thing about the Cleveland Clinic, we. We are working hard to practice leading with humility. We are one of the top healthcare organizations in the world. And so, yeah, it. It's sometimes hard to get our physician leaders to say, hey, go look and see what, you know, this whole hospital.

Maybe in the grand scheme of things, compared to you guys. Yeah, yeah, yeah, yeah.

But, you know, again, if you focus on the principles of what they're doing and the systems that they have in place, those are the things that we're really trying to do.

Right, right, right, right. So. So I know you're. You're really involved. You've mentioned it already with. With various single conferences and whatnot. So you've got a workshop coming up. So what's that One all about.

Yeah, so this is. This was kind of fun. So I was sitting around trying to figure out, you know, how can I get into the Shingle Conference this year? Because it's been a while since I've been able to attend. And I was actually, it was on Groundhog Day. And I thought, oh, I've got this program that I developed many years ago at Ford. And when I first was exposed to lean, when we went to our first lean class and I was there with two of my engineering reliability and maintainability engineers that were working at Ford. And we went to our first class and we found out that our jobs were considered non value added. I was a cost analyst. They were. They were engineers. We didn't add any value to from the customer's point of view. So we said, we have to figure out a way to celebrate our newfound roles within the organization. So we said, what's the most non value added activity that we can think of? We thought about going out to a bar and having a few drinks, but there's a chance that you might have some good deep conversations where you might learn something. So there's some value there. We said, you can't really do softball or anything like that because there's some physical activity and some value there. Yeah. So we came up with bowling. Bowling, you don't have to keep score. You don't have time in between frames to really get into deep conversation. So not a lot of value in bowling. It's just a good, fun activity. Right. So then we said, well, let's. We got to come up with a. The most non value added day of the year. So we threw it. Somebody threw out Sweetest Day. And we said, no, we don't want to touch that. That's. That's okay. And, and so we came up with Groundhog Day. Groundhog Day. If you look at the calendar, whether he sees a shadow or not, you still got six weeks of winter left. So then we had to come up with some rules. We couldn't go for the highest score because that would imply value. So we came up with an average score. And we said, the person that comes up with the closest average, closest to an average of 110 over two games will be the most average individual. And we have prizes for these people. And then we had to do a team based thing. So we said, all right, it's the team of four or five that comes up with a 110 average over one of the two games. And so we just started doing this. And what was really interesting was the behaviors that came out as we did this. So the first thing was I had a production manager on my team first time we did this, and he started bowling strike after strike after strike. And I finally said, hey, it's not about highest score. He goes. I know he goes, as soon as I get to 110, you know, or 220 total, I'm going to throw gutterballs. Typical production manager, right? Overproduced. And so. So I said, you know, we got to come up with a tiebreaker. And I said, okay, the tiebreaker is going to be the person with the fewest gutters. You can't change the rules in the middle of the game. I said, dennis, it happens every day. The rules are always changing. We need to adjust. And so ended up that there was a tie. One of our. One of the other women got a tie. So we had some people there as spectators. I said, all right, you guys are the. You guys are the tiebreakers. The tiebreaking committee come up with a rule. I said, I don't care what it is, but he can't win because we don't want to reward that behavior. So they said, okay, most consistent between two games. And so he didn't. He was not happy. But the interesting thing that came out of it is that I started to see. We took pictures, you know, so we gave everybody disposable cameras at the time to take pictures. And then I took all the pictures, and I started to put together a presentation that focused on what are the lean tools and principles that were being applied. So techtime is certainly one of them. You can see, see frame by frame. How are you doing to your goals? And then as we started doing this several more times, right, Each year, we would try and do it. We would add different things. So error proofing, right? You can put the gutter guards up, Prevent you from throwing a gutter may not be the most effective thing, though, because sometimes you may need a gutter. If you go over the score, you know, there's nothing you can do to stop you from getting pins knocked down. So we, you know, error proofing, We. We talked about. We tried to introduce visual management. The last thing that we tried to do was we said, okay, what if the whole. Everybody who's involved came up with a 110 average? Let's. We pay for the plant manager or our managers will pay for the whole thing. You know, nobody has. And of course, nobody got that. And what happened was that as we introduce. Try to introduce tools, changing people's behavior so people are used to going out to bowl and have a good time. They don't want to be bothered with introducing new things like that. And that's kind of what it's like when we try to introduce continuous improvement to teams. If we go in focused on the tools as something extra to what they're doing, they're not going to be as receptive to it as if we just kind of say, okay, let's. And this is kind of getting into some of the kata stuff. Right. So what's the current situation? What's, you know, what's the. Where are you trying to get to? And then what's the next step? So that's something that we're trying to introduce now also is how do we engage in the kata concepts into this bowling thing. So what we're going to do is we're going to. I called Mary, talked to Mary Price at the Shingo Prize, sent the thing to her. She goes, I love it. Let's do it. So we're going to do it.

So are you like literally going to go bowling?

Yes.

Oh, wow.

So I looked at the website and the hotel is one block away from the nearest bowling alley. And so she, she contacted them and she got. We got the place reserved and that.

Might be the best lean workshop of all time. You know, you're gonna have the highest score. So, yeah, so we're hoping.

We need to make. We gotta make sure we get enough participants to join us and everything. But yeah, I'm looking forward to it. It should be a lot of fun. And it is different. Is something different from your typical workshop at a conference.

Yeah, for sure, for sure.

But yeah, so the idea is that we. We'd introduce it. We go and we bowl, we try and introduce some tools and then we come back and debrief at the end about what did people see. And then if we do get enough pictures and everything, we'll put together some type of a presentation that. Nice.

You need to come back on the podcast now and update everybody on like how it went to what you learned. Because that sounds. I mean, not only that for. You're going to do it in your workshop, but gosh, like it's games like that, like experiential learning, I would call it, you know, to where you can actually do something. I mean, everybody's done Legos and whatnot.

Fine.

But you know, this type of thing is. I feel like neural pathways are going to be formed. Yeah, yeah.

And we've we've also in the. While we've Done it here at the clinic. We've added some, some charity work to it too. So we asked everybody to donate a dime for every pin that they knock down to Harvest for hunger or something. And so, yeah, so we've been able to. And we'll set up a lane, a separate lane where people can bowl. And if they get a strike, they get two raffle tickets. If they get a spare, they get one. And then we do a 50, 50 drawing to see who wins that. And then half of the money goes to the charity. So it's a really neat event that organizations can use. It's a great team building event, man.

I love it. I love it. Very cool. All right, well, hey, man, this has been a lot of fun, Tim. I appreciate you carving time to come out and talk to us, maybe tell how everybody can connect with you. Is it LinkedIn or what's the best way?

Yeah, no, LinkedIn is probably the best way to do it. I am on X. My handle on X will be hard to figure out. It's values Stream ldr. So long time ago I had this concept of the continuous improvement work that we do. It's really where values align, value multiplies. And so it's kind of instead of value stream management or, you know, value stream mapping, it's more about values stream alignment.

Got it.

How do you align your values so that.

We'Ll have it all linked up on the show? Notes. Everybody just scroll down and go. Reach out to Tim, LinkedIn and X and everywhere else. And yeah, I appreciate you coming on, man.

Yeah, no, thanks for having me. It's been a pleasure.

Okay, take care.

All right, thanks.

Thanks for listening. Whether you've been on the continuous improvement journey for many years or perhaps you're just getting started, Gemba Academy is here to support you. And while we're best known for our more than 1500 lean and 6 Sigma T and virtual tour videos, we also have a team of experienced Lean and Six Sigma practitioners available for one on one coaching, as well as a variety of Lean and Six Sigma certification options. To learn more and to schedule a demo, head on over to gembaacademy.com.