Lean Blog Interviews: Real-World Lean Leadership Conversations in Healthcare and Beyond

Episode #145 is a conversation with Natalie J. Sayer, co-author of the recently updated 2nd edition of the book Lean For Dummies. I was able to meet Natalie at the recent ASQ Lean and Six Sigma Conference, where she was also a presenter. While I was a bit resistant at first to the “for Dummies” being associated with Lean (given that “dummy” is a sort of disrespectful word), I came around when I read the first edition and found it to be a fun, solid overview of Lean concepts and a great first read for people who are new to Lean. In the podcast, Natalie shares what's new in the second edition and shares some of her history and experience with Lean, including some time learning at the famed NUMMI plant while working for GM. For a link to this episode, refer people to  www.leanblog.org/145. ADVERTISEMENT: This podcast episode is brought to you by Creative Safety Supply, leaders in Visual Safety, floor marking, label printing and more visit their website at  www.creativesafetysupply.com/leanpodcast  for a discount. For earlier episodes, visit the main Podcast page, which includes information on how to subscribe via RSS or via Apple Podcasts.

Episode #144 is a discussion with Dean Gruner, MD, the president & CEO of ThedaCare, talking about Accountable Care Organizations  (ACOs) and how ThedaCare is using this approach, along with Lean methods, to improve the coordination of care for patients. Dean was  previously a guest in episode 119, talking about the “strategy deployment” methodology. Dean will be presenting at the upcoming Lean Healthcare Transformation Summit, June 6-7, 2012 in Minneapolis. I hope to see you there! I'll be attending and moderating the CEO panel again this year. For a link to this episode, refer people to  www.leanblog.org/144. For earlier episodes, visit the main Podcast page, which includes information on how to subscribe via RSS or via Apple Podcasts. Transcript: Mark Graban: Hi, this is Mark Graban. Welcome to the podcast, episode 144 for April 16th, 2012. My guest today is Dr. Dean Gruner. He is the CEO of ThedaCare. He was previously a guest on episode 119 talking about “strategy deployment” as part of their management system at ThedaCare. Today, we're going to be talking about ACOs or Accountable Care Organizations and how that fits in with a Lean perspective at ThedaCare, related to healthcare reform happening here in the United States. Dr. Gruner is going to be presenting at the “Lean Healthcare Transformation Summit,” June 6th and 7th in Minneapolis. This is an event that's co-sponsored by the Lean Enterprise Institute and the ThedaCare Center for healthcare Improvement. I'll be there. I'll be attending. I'm going to be moderating the CEO panel again this year. I certainly hope to see you there. It's a great event, wonderful speakers from the healthcare value network organizations, just a lot of great attendees, networking, learning and sharing. You can visit leanblog.org/healthcaresummit and that will forward you to the official conference website to learn more and to register. For other episodes, you can go to leanpodcast.org and for Dr. Gruner's previous episode, go to leanblog.org/119. Thanks for listening. [music] Mark Graban: Dean, it's a pleasure to talk to you again. Thanks for joining us here on the podcast. Dr. Dean Gruner: Thanks, Mark, for inviting me. Mark: I think a lot of our listeners, especially those outside of healthcare and maybe even some within healthcare might not know a lot about ACOs or “Accountable Care Organizations.” Would you mind giving us a little bit of an intro about what an ACO is? Dr. Gruner: I'll try. I think the short version is that, there are multiple definitions out there. Everybody has a little different description of what an ACO is. I think of it as a mechanism for a group of providers, whether it's a group of physicians, physicians at hospitals, hospitals or healthcare systems, to be accountable for both the quality and the cost of the care that they are providing to a group of patients. An example today that people might be familiar with is Kaiser. Kaiser provides the premium in their case, but they only provide premium for their health insurance, but then they become accountable for providing all the services that that person would need under the Kaiser umbrella. All ACOs aren't just models like Kaiser, which is what we would call a staff model HMO. There may be groups of physicians in hospitals and other care providers that come together, again, for the purpose of providing the services to patients and assuming some degree of accountability for both the quality of the care that's provided and the cost of the care that's provided. Mark: Part of the idea, if we look at this from a Lean perspective, when you talk about improving quality and cost which, people familiar or experienced with Lean would realize it's possible to do both. Where do these improvements come from? Is it a matter of better coordination between hospital care or primary care.? How do people in different organizations collaborate in an ACO? What are the types of benefits that we're expecting to see?

Like podcast #133, this episode is a Q&A that follows up a webinar I did for my good friends at Gemba Academy recently, on the topic “Using Statistical Process Control (SPC) to Make Better Management Decisions.”   You can view a recording of the webinar here or on the Gemba Academy website. You can get the slides here. This might seem like an esoteric topic, but it's one I've found to be VERY practical and helpful in my career and with my clients. Some feedback I got included, “That wasn't nearly as boring as one might have expected.” :-) Update: This topic is something I later explored in my 2018 book Measures of Success: React Less, Lead Better, Improve More. For a link to this episode, refer people to www.leanblog.org/143. For earlier episodes, visit the main Podcast page, which includes information on how to subscribe via RSS or via Apple Podcasts.  

Episode page Episode #142 brings us a returning guest (#115), Eric Ries, author of the best-selling book The Lean Startup: How Today's Entrepreneurs Use Continuous Innovation to Create Radically Successful Businesses. In the book, Eric cites the work of Taiichi Ohno, including the “5 Whys” problem-solving approach. In this podcast, Eric shares his story about finding Ohno's work (including the Lean classic Toyota Production System: Beyond Large-Scale Production) and how it has influenced his work with startups. For a link to this episode, refer people to www.leanblog.org/142. For earlier episodes, visit the main Podcast page, which includes information on how to subscribe via RSS or via Apple Podcasts. Eric: It's been incredibly influential. I think I would go so far as to say it has changed my life. It's actually just a coincidence. It's a funny thing how these things work. To set the stage a little bit, I had founded a company called IMVU in 2004. I was really into a lot of the ideas that are called Agile software development, which have their origins in Lean, but a lot of the works I had read about them, Toyota was not specifically mentioned. Lean principles were not mentioned. I didn't know the theory of Lean or anything like that. I knew nothing about manufacturing. I've actually, to be totally honest, never set foot in a manufacturing plant in my whole life. I have no idea any of that would be relevant to me. I had this intuition that we should be going a lot faster in a startup and doing practices that even in the Agile world were considered a little bit extreme. We've had the chance to talk about them on other occasions, things like continuous deployment or putting software in customers' hands much faster than was previously considered possible. I had this problem which was I had no way to explain to anybody why that was going to work. People would look at me like I was completely crazy. I could see that it was working, so I was very stubborn. I had this intuition. I said, “We're going to do it no matter what.” It was working, but we're always hiring new employees. The company's growing. We're bringing on investors. We had investors that when they were doing their due diligence for the company, pulled out because they didn't like the answers I was giving them about how we built the technology. They would bring their experts in, experts trained in more traditional software development methodologies, and they'd be like, “This kid is crazy. Doesn't know what he's talking about. This is not the way it's done.” This is a continuous point of stress for me and my co-founder. [laughs] You got to remember, at the time, I was by far the youngest person on the team. I was often younger than the employees I was hiring and training them in this method. It's not like it was an easy situation to be in, but I really believed it was right. I was reading everything I could get my hands on for ideas about, first of all, was I actually right or was it a fluke? If it was right, how could I possibly explain it? I read some cases about Toyota, the business school cases, so I was a little bit familiar with it. There was this thing called Toyota Production System. That's all I knew. I figured I should be educated about it.

Show notes: https://www.leanblog.org/141 Remastered audio June 2021 Episode #141 is a chat with Norman Bodek, as he shares his recollections of working with Taiichi Ohno, one of the creators of the Toyota Production System. Norman met and worked with Ohno in Japan and then published the translation of Ohno's classic book Toyota Production System: Beyond Large-Scale Production in 1988. For a link to this episode, refer people to www.leanblog.org/141. For earlier episodes, visit the main Podcast page, which includes information on how to subscribe via RSS or via Apple Podcasts.

Episode #140 is a discussion with Scott Patten and Peter Armstrong from LeanPub.com  – they want to be THE website for publishing “in-progress books”. We'll be talking about lean publishing and how that's different than self publishing and about how leanpub.com works. In the upcoming part 2 of the podcast, we'll talk more about how they are applying the concepts of the Lean Startup methodology to their service and their business. Conflict of interest disclosure:  I have published a number of books through Leanpub. I'm a huge raving fan of their service and the way Scott and Peter have worked with me as I learned and used Leanpub.com.   For a link to this episode, refer people to www.leanblog.org/140. For earlier episodes, visit the main Podcast page, which includes information on how to subscribe via RSS or via Apple Podcasts.

Episode #139 is a conversation with Dave Munch, MD, the Senior Vice President and Chief Clinical Officer for Healthcare Performance Partners (HPP). Before joining the consulting firm, Dave was a senior C-level clinical leader at Exempla Lutheran Health System where he led their Lean Production applications for more than five years, resulting in substantial improvements in both clinical and non-clinical processes. Today, we are talking about important Lean mindsets and systems principles, including making it safe for people to surface problems in the workplace and aligning management behaviors and methods at all levels so we can use Lean to achieve our most important objectives in healthcare. Dave is also a speaker at the upcoming Lean Healthcare PowerDay event, produced by HPP. Hope to see you there! Conflict of interest disclosure: I will be a paid speaker at the Lean PowerDay event. For a link to this episode, refer people to www.leanblog.org/139. For earlier episodes, visit the main Podcast page, which includes information on how to subscribe via RSS or via Apple Podcasts.

Episode #138 is a discussion with Al Norval from Lean Pathways, talking about his new publication titled: “The Lean Manifesto: Back to basics – how a Lean business system creates value by engaging everyone in improvement.” It's a free six-page document and you can download it here. The manifesto is a fun, upbeat guide to the basics of the Lean methodology and management system, including a brief history of Lean, as well as its foundational concepts, and a discussion of why “just in time” is not the right place to start. Conflict of interest disclosure: I have a business relationship with Lean Pathways where I sometimes work with their healthcare clients. For a link to this episode, refer people to www.leanblog.org/138. For earlier episodes, visit the main Podcast page, which includes information on how to subscribe via RSS or via Apple Podcasts. If you have feedback on the podcast, or any questions for me or my guests, you can email me at leanpodcast@gmail.com or you can call and leave a voicemail by calling the “Lean Line” at (817) 993-0630 or contact me via Skype id “mgraban”. Please give your location and your first name. Any comments (email or voicemail) might be used in follow ups to the podcast. About Al Norval (from the Lean Pathways website): Alistair Norval is a professional engineer who developed his skills at Eastman Kodak Company, where he helped design and implement the Kodak Operating System, based on the principles of the Toyota Production System. In this capacity, he received in-depth personal training with leading international senseis. Following that, Alistair helped guide Celestica International, a provider of Electronic Manufacturing Services, with their lean journey at multiple site value streams in Asia. More recently, Alistair has been guiding clients on their lean transformation while achieving significant business results. His clients include the Medical, Consumer, and Professional Services business sectors. Alistair has been a manager of manufacturing, product and process engineering, and has helped launch several plants. His experience covers both continuous chemical processes as well as discrete manufacturing. He has applied lean methods in new product development and the supply chain. His passion is to apply lean thinking across the enterprise so as to achieve consistently superior results.

Episode #137 is a chat with Jerry Bussell, founder of the Jacksonville Lean Consortium. I've met and talked with Jerry many times through LEI, so I'm thrilled to finally get him on the podcast. Jerry is a retired Medtronic executive (leading Lean efforts in a unit that won the Shingo Prize); he's now doing work with healthcare quality improvement, he's writing a new book, and he's speaking at the Lean Transformation Summit next month in Jacksonville. Jerry is also friends with Sami Bahri, DDS – and he's also a patient of the “World's First Lean Dentist” (click here for my podcasts with Sami, episodes 29, 69, and 82). For a link to this episode, refer people to  www.leanblog.org/137. For earlier episodes, visit the main Podcast page, which includes information on how to subscribe via RSS or via Apple Podcasts.   If you have feedback on the podcast, or any questions for me or my guests, you can email me at leanpodcast@gmail.com or you can call and leave a voicemail by calling the “Lean Line” at (817) 993-0630 or contact me via Skype id “mgraban”. Please give your location and your first name. Any comments (email or voicemail) might be used in follow ups to the podcast. About Jerry Bussell (from the Lean Transformation Summit site): Sporting a license plate reading “Leanjax,” Jerry Bussell is the past chairman and founder of the Jacksonville Lean Consortium, a group of companies and government agencies improving business performance by sharing knowledge about implementing lean principles. Recently retired as vice president, Global Operations, at Medtronic Surgical  Technologies, Bussell is president of Bussell Lean Associates, a lean management advisory service for CEOs and their executive teams. He is also an executive advisor to Underwriters Laboratories' Center of  Continuous Improvement and Innovation. Bussell received the prestigious Medtronic Wallin Leadership award for transforming Medtronic ENT's traditional manufacturing operation into a nationally recognized model of lean manufacturing. Under his leadership, Medtronic ENT/NT received an IndustryWeek Best Plants award for North America in 2002, a Shingo Prize in 2003, and a Shingo  Silver Medallion recipient in 2009. In 2005 Bussell was inducted into the Shingo Academy for his contributions to operational excellence. He is a past chairman of the Board of Governors for the Shingo Prize and is a member of the Champions Club with the Association for Manufacturing Excellence. Bussell holds a bachelor's degree from St.  John Fisher College and a master's degree from Baylor University. He is currently writing a book on lean leadership lessons from Abraham  Lincoln that will be available in 2012.

Our guest for episode #136 is Paul Akers, President of FastCap and author of the book 2 Second Lean. Remastered August 2021 Here, we are talking about the new book and how small improvements that save two seconds in your daily work can contribute to an engaging and fun “Lean Culture.” You can also view a video recording of the discussion here on YouTube. Paul was previously a guest on episode #122, talking about LeanAmerica.org, so please check that out too. For a link to this episode, refer people to  www.leanblog.org/136.