In this edition of 5 Questions we meet Mark Graban, a good friend of ours that has become focused on the opportunities lean creates in the healthcare industry.
1) Who are you, what organization are you with, and what are your current lean-related activities?
These days, I often get asked “so what *do* you do, anyway?” It’s an understandable question, because I wear many proverbial hats. In no particular order: 1) chief improvement officer at KaiNexus, a technology company that “makes improvement easier” for healthcare organizations; 2) Lean healthcare consultant and speaker, both under my own personal banner of Constancy, Inc., and as part of the team of Lean Pathways, Inc. (led by Pascal Dennis); 3) an author, of Lean Hospitals and Healthcare Kaizen, as well as LeanBlog.org. I haven’t been a traditional full-time employee of an organization since mid 2010 after being an employee the first 15 years of my career. I love the variety and the challenges and all of that work is very synergistic (I think the MBA buzzword actually applies here).
2) How, when, and why did you get introduced to lean and what fueled and fuels the passion?
I was initially exposed to Lean as an undergraduate at Northwestern, but it was basically taught as a production planning and materials management method (pull production, kanban, etc.). I was fortunate that my dad attended one of Dr. Deming’s famous four-day seminars at GM/Cadillac in the late 1980’s when I was in high school. I was a total nerd and read Deming’s “Out of the Crisis” while in college, even though it wasn’t assigned for a class. It wasn’t so much the statistics that interested me, but the “psychology” that Deming wrote about. It all made so much sense, even with my limited part-time job experience.
When I graduated, my first job was at a struggling GM engine plant… the furthest thing from a Lean environment. They supposedly lived by a copy of the “Deming Philosophy” with their union contract, etc. but that philosophy was, ironically, just a bunch of posters on the wall and empty slogans (Deming would have hated that). I saw how miserable people could be working under the traditional top-down, “make the production numbers” GM management style. But, I was lucky that GM Powertrain had hired some people from the Toyota supply base to come help the plant. But, as in many cases when somebody from headquarters is here to help, the local management didn’t want anything to do with them. So, they had plenty of time on their hands and me as an eager student… so I got a lot of mentoring. We’d see waste and the resident Lean thinkers would tell me how things would be at their old plant and what we’d have to do to fix it there. Our next good fortune was getting a plant manager who was one of the first GM people sent to NUMMI. He was an amazing leader and, again, a mentor to me.
So, my passion has always been people – create an environment where people can do the high quality work they want to do. Everybody deserves that. So, when I got into healthcare in 2007, it was really sad to hear nurses and other highly educated front-line staff describe what sounded exactly like the old GM environment and management approach. As at NUMMI, the thing that turns around hospitals isn’t the application of Lean tools in the old culture… it’s the changing and the transformation of the culture that matters. In healthcare, it really matters for the sake of the patients, not just the employees. My passion for people is amplified working in healthcare.
3) What is the most powerful aspect of lean?
I think it all comes back to Deming, the PDSA cycle, and scientific problem solving. As with so many other Lean methods, there really needs to be alignment across the organization about mindsets and culture. We can teach PDSA in a classroom (and people in healthcare have generally heard of Deming and PDSA), but that doesn’t necessarily mean the culture exists for effective improvement work – whether we call it kaizen or PDSA. Do we have an environment where people can freely point out problems, errors, or near misses in a fact-based, blame free environment? One reason the preventable patient harm incidents still occur so much in healthcare is that healthcare professionals are afraid to speak up because they might be blamed. Dr. Deming had it right when he said we have to eliminate fear. Does the culture encourage people to take the time for effective root cause problem solving or do we just jump to solutions? Can we insist on countermeasures that go beyond saying “be more careful next time” or that we need more training or more inspection? Anybody can copy 5S, for example. I’m convinced that people would, given enough time and the right leadership, invent 5S if they had never been exposed to it. So, teaching people how to problem solve (and giving them the right environment) will ensure that people adopt and adapt the right methods to solve the problems that really matter.
4) What is the most misunderstood or unrecognized aspect of lean?
One major misunderstanding is that Lean or Kaizen equals weeklong events. There’s a time and a place for events (aka “Rapid Improvement Workshops” in healthcare), but my book Healthcare Kaizen is primarily about daily continuous improvement as taught by Norm Bodek and Masaaki Imai. KaiNexus was founded by an emergency room doctor who was given Imai’s book Kaizen. The reason I got involved with KaiNexus was that the software really helps support everybody getting involved in improvement every day. Many of our customers practice daily Kaizen and weeklong events… so based on that customer input, our system now helps people manage both. Kaizen isn’t a choice of weeklong events OR daily Kaizen or PDSA… we need both modes of improvement. It all fits together and, well, it’s all based on PDSA.
5) What is the biggest opportunity for lean in today's world? How can that be accomplished?
Healthcare. We can, using Lean effectively, probably reduce our national healthcare spending by 25% without resorting to rationing (or use that money to provide more care). Improving patient safety and quality leads to huge cost savings. For example, when a hospital does great work to reduce central line associated blood stream infections (a nearly preventable infection that can kill >25% of those infected), they are not only saving lives, but they are saving the health system money, and they are reducing the patient’s length of stay by two weeks. This creates free capacity (free beds) that can be used to reduce waiting times for other patients. Flying commercially used to be very dangerous for passengers. I hope we will, in my lifetime, look back at the time when healthcare was very dangerous for patients. I think the next frontier (already being worked on at organizations like ThedaCare) is improving the health system so it keeps us healthy rather than just treating our sickness. The payment system needs to change to enable this – Lean alone can’t do it all.