Dr. Mark Jaben on Lean, Change, and How Our Brains Respond to Resistance

My guest for episode #193 is Mark Jaben, MD, talking about our brains, Lean, and change. Mark has been a guest blogger for me before and it's great to talk to him today about his research and experiences.

In our conversation, Mark talks about “the troublesome features of our brain's operating system” (such as our “hidden brain”), how the A3 problem solving process fits with the way our brains work, and how to deal with “resistance” to change. Mark has also helped talk to some healthcare organizations about KaiNexus and we both presented at a conference last year.

For a link to this episode, refer people to  www.leanblog.org/193. Also check out this “video remix” by Mark Poole (also embedded below in this post).

Below are some links and material that Mark wrote to share with the listeners (and he'll have a guest post soon that expands on the thoughts in the podcast).

BOOKS:

How We Decide by Jonah Lehrer

The Hidden Brain by Shankar Vedantam

Drive: The Surprising Truth About What Motivates Us by Dan Pink (listen to Mark Graban's podcast with him)

To Sell Is Human by Dan Pink

Start Up Selling: How To Sell If You Really, Really Have To And Don't Know How by Scott Sambucci (Mark's podcast with him)

LECTURE:

“A Matter of Trust,” Onora O'Neill, 2002 BBC Reith lecture

STUDIES:

1)  Our brain is into plausability, not reality-

‘The Split Brain: A Tale of Two Halves,' Nature, vol 483, issue 7389, mar 2012

Spit brain surgery was used to treat intractable seizures in the 1950's and involved cutting the corpus callosum, the connecting pathways between the left and right hemispheres. It did not work well for seizures, but it did create an opportunity to better understand the function of each half of the brain. This is how we learned about the differing functions, including that vision is split by visual field, not by eye. In a classic study, participants were shown a picture of a chicken claw in the right visual field. This is processed in the left brain, which is where we assign a word to an object. A series of pictures were placed In the other visual field, and the participant was asked to pick the most appropriate one. They would pick  the image of a shovel. When asked why, their response would be that they needed the shovel to clean the the dung from the chicken coop. There were no images of this, indicating that their brain concocted a story that fit the data they were given. When challenged with this reality, the participant would hold to their story and defend it as accurately depicting what they had seen.

2) Memories are selected–

Permanent Present Tense: The Unforgettable Life of the Amnesic Patient, HM; Suzanne Corkin

HM had surgery to treat his intractable seizures by removing the tips of his temporal lobes. When he awoke, he was unable to remember anything said to him. He could recall remote events from his childhood, but otherwise he was totally amnestic for current information. He eventually was able to learn and retain information about very  mundane tasks. Eventually he could remember how to get from one part of his house to another, demonstrating that recall occurs in different parts of the brain depending on the emotional context of that event. The more immediately impactful memories store in the hippocampus, close to the amygdala, and may explain why these are the first memories that come to mind when we feel challenged, ie, those that would have the biggest affect on making decisions about survival. In a subsequent study, it has been demonstrated that we are better at remembering things we think about more often, presumably because we think about things that are most important to us and select those to remember.

3) Memories can change—-

Elizabeth Loftis has had a career of demonstrating that however a memory is imprinted in the brain, it can change over time. She has been involved as an expert in many trials that hinged on someone's memory of a crime that had occurred in the distant past.  In an interesting twist, she recently had just such an example from her own family background.

4) Where do we process——-

‘The Price of Your Soul: neural evidence for the non utilitarian representation of sacred values“
G. Berns et al, Philosophical Transactions of The Royal Society, Mar 2012, vol. 367, no. 1589, pg 754-762

They took people who had a very strongly held belief and put them in a fMRI to find out that their amygdala lit up when talking about that belief. They then  offered each person a sum of money if they would vote on a survey differently from that belief. Some would; some would not. Those that would were then put back into the fMRI, and now they were processing in an area of their prefrontal cortex, suggesting that options and alternatives are processed in different parts of the brain from closely held beliefs.

 5) The effect of power on mirror neurons——-

‘Power Changes How the Brain Responds to Others‘, Hogeven, Inzlicht, Obhi, Journal of Experimental  Psychology, June, 2013

Each participant was given a series of scenarios while in an tMRI. As the scenarios unfolded giving the participant a greater degree of control and power over the outcome, the researchers observed that there was less and less activity in their mirror neurons

6) Creativity requires getting past the prefrontal cortex—–

‘Neural Substrates of Spontaneous Musical Performance: A Study of Jazz Improvisation,' Limb and Braun, PLOS One, 2008

Researchers took professional jazz musicians and placed them in an fMRI with a keyboard. They were asked to play a written piece of music, and a certain area of their prefrontal cortex lit up. Then ,they were asked to improvise anything they wanted. Now that prefrontal area was quiet and a different area of the brain was lit up, suggesting that the ‘rules' area of the brain must be turned off in order to get creativity which occurred in a different area.

Here is a video remix of the podcast that was created by Mark Poole:

For earlier episodes of my podcast, 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 episode 193 of the podcast for February 5th, 2014. My guest today is Dr. Mark Jaben and he's going to be talking about our brains and Lean and change based on some research he's been doing from his own personal experiences. In fact there's a lot of different things he's citing in the podcast. If you go to leanblog.org/193 you can find links to books and articles and the things that Mark is going to talk about here today. He's going to be talking about ideas including our so-called hidden brain, what Mark describes as some of the most troublesome features of our brain's operating system, how the A3 problem-solving process fits well with the way our brains work or should work and how to deal with so-called resistance to change.

So there's a lot to think about, a lot of really interesting ideas here. Hope you enjoyed the podcast. As always you can go to leanpodcast.org or leancast.org. That's one Kaizen that I've done recently. Either URL works if you want to find past episodes and thanks for taking time to listen. Well Mark, hi, thanks for being a guest on the podcast and joining us today.

Dr. Mark Jaben: Well thanks Mark and thanks for the opportunity to share.

Mark Graban: Yeah, well sure. So we're going to talk about some really interesting things today, some research you've done on brain science and connections to Lean and Change. But before we get into that, can you start off by telling the listeners about your professional background, your medical background, and how you first got introduced to Lean?

Dr. Mark Jaben: Sure, Mark. So I'm trained as an emergency physician. I've practiced. I completed a residency in the early 80s, and since that time I've worked as an emergency physician mostly in small and medium-sized hospitals, mostly rural areas. For 20 years, I was part of a single group in a pretty high-functioning organization that was really getting better and better over time. But somewhere along the late '90s, things sort of began to change. There were a lot of changes occurring in medicine at that time, and the relationships in the hospital really sort of started to fragment. By the mid-2000s, the institution was spiraling down and in 2006, we sort of became collateral damage to that and lost our jobs. We were left to wonder, how could we devote 20 years of a career to a place and have it come to this?

So because we needed to eat, I started filling in at a few other emergency departments. And what I found out there was that they were struggling with many of the same issues and I wasn't seeing any of those places doing a particularly effective job at managing those changes. In fact, a year later, the hospital that I had been at lost its Medicare and Medicaid funding and that was devastating for the community and something I'm not sure they recovered from yet. And so, and again, that had been a place that was really delivering quite good care at one time. So I thought, there's got to be a better way to do this. And it started me on a journey to find how to better manage change. In 2008, I had the opportunity to go to New Zealand and work there and was fortunate enough to land in Taupo Hospital on the North Island. In Taupo, shout out to the folks there, especially Julie Eilers, who's the administrator, and Kingsley Logan, who was the medical director there, and they essentially gave me their institution as a little Lean learning lab. I didn't know much about Lean at the time, but they were interested in trying this. And I guess I was the outside American and that seemed to fit.

And what I discovered in Lean was the first sort of change methodology that to me addressed the elephant in the room. I concluded that there was great value there and opportunity for the US healthcare system. I think it was during that time, Mark, that you and I first began sharing some emails. And also during that time, I befriended John Shook, who's the CEO of the Lean Enterprise Institute, who kindly took under his wing a floundering doc trying to figure all this lean stuff out, as I'm sure John's done for a lot of people.

Mark Graban: Yeah, I've learned a lot from John as well.

Dr. Mark Jaben: And at one point, John had asked me what I thought the problem was in healthcare. And my answer was, a lack of dialogue. And his response was, “Well, lack of dialogue is not a problem.”

Mark Graban: You say you were jumping to a solution. We need more dialogue.

Dr. Mark Jaben: Yeah, it took me a while to understand what he meant, which was that dialogue is a countermeasure. But to what problem? So I kept searching. Recently I was able to email John, and I think the subject line of the email read something like, “At last, the root cause.” And the root cause, Mark, lies in the way our brain operates. If you've seen the cartoon which says, “I've seen the enemy and it is us,” well, I've seen the problem and it's me, or more accurately, it's my brain.

Mark Graban: So tell us. That's kind of an interesting insight. Okay, so even though we talk about not blaming in Lean, okay, we're going to blame our brains. That sounds like a fairly systemic root cause. So tell us about the research or how you started looking into this. Why is this important for the listeners to understand some of these insights about the brain?

Dr. Mark Jaben: I think it's, you know, we're all after creativity and innovation, but the fact of the matter is that creativity and innovation are really hard work and hard to achieve. And the biggest impediment that I see to that is really resistance. You know, we all observe that people resist change, or at least people don't like being changed. And frankly, we dread dealing with it. And what I've learned in my career in medicine is that when I dread dealing with something, it's generally because I either don't understand it or I don't have an effective approach to it. So when it comes to resistance, the insight to me was that it lies in our brain and its operating system and specifically three troublesome features in our brain's operating system. And I think that once we understand this, then we can use resistance as the tool that it can be and devise countermeasures that are more effective, making our improvement efforts more effective.

Mark Graban: Yeah. So, when we talk about resistance to change, I mean, I think sometimes that's a loaded term. Managers will complain that, “people are resistant to change,” and sometimes that means they won't do what I'm telling them to do. And we don't delve into the reasons why that resistance is there, but tell us a little bit about the brain's response to new ideas and what some of the sources are of responses that get interpreted as being resistant to change, as if it's a choice. Some of this is just happening, right?

Dr. Mark Jaben: Yeah. So, first, I always give a disclaimer when I talk about this stuff because, you know, if you're a neuroscientist or you're married to one, you'll find much to quibble with what I'm going to say. But my goal in describing it isn't really to be scientifically pure as much as it is to give us a framework we can use. So the first thing is that whether we're talking about creativity, innovation, improvement, learning, decision making, all of that is really the same from your brain's perspective. So we'll need to spend a little bit of time covering some basics on that to understand all this about resistance. So first thing I want to do, Mark, is just give people a mental image that I want you to keep in your mind as we're talking about this. It's sort of a structure to how this all works. Put “hidden brain” on the left side of your page of your brain, then arrow over to the middle to “prefrontal cortex,” and then arrow over to the right for “creativity.” The path to creativity is pretty well specified, and it can't be short-circuited and you can't skip steps and expect to get there.

So the hidden brain is where the existing neural connections reside. The prefrontal cortex is where these connections are analyzed. In creativity, the definition I like is the connection of previously unconnected thoughts. The brain doesn't jump straight to making these new connections because it takes a lot of energy to do that. And our brain is very much geared to not knowing if the next meal is coming. So it has devised a system that requires the least caloric intake possible. The good news is that we are rational creatures. We are capable of gathering data, analyzing, and acting upon it. It's just that's not the way we make most of our decisions most of the time. This occurs in what some researchers call the hidden brain. The hidden brain does this based on these existing neural connections, patterns of recognition and response, which have been developed over millions of years in experience, standards, if you will, that are constantly being monitored and upgraded. And it takes in the data from our senses, and if it recognizes a pattern, it can respond. It doesn't take much energy to do that. The thing about the hidden brain is we don't know what goes on in there. We aren't aware of it, we have no direct link to it. So the only way we know about these decisions is through our feelings and emotions. It's a very rapid communication system and this works really well, except when we face a new or novel situation where there's no pre-existing pattern. That then becomes the role of the prefrontal cortex, which is to fact-check the hidden brain and to be vigilant for these outlier circumstances.

Your prefrontal cortex can focus very intensely on an issue and bring vast powers of analysis to it. But the problem with the prefrontal cortex is that it's easily overwhelmed. And researchers believe it can only handle four to nine variables at a time, which is why multitasking is a myth. Our brain really can only do one thing at a time. So if the prefrontal cortex evaluates the existing connections and doesn't get a satisfactory response, then and only then is the brain willing to expend the energy necessary to make these new connections. And that's the “aha” moment we get when we put things together in a new or different way that works. And when things work, it feels good and right. And it feels that way because we get a release of the chemical dopamine whenever we do something that our brain approves of, namely something it believes will enhance our chance for survival. So, Mark, this leads actually to the first troublesome feature of your brain, which is this: The brain is not into reality, it's into plausibility. What I mean by that is it's into making a plausible explanation of the data it receives. And why is that? Because our brain is geared to action, which is to fend off the immediate threat in front of it. And if you think about it, that kind of makes sense because if we spend too much time analyzing the speed of the saber-toothed tiger, what direction it's coming from, how big its jaws are, do I fight, which way do I run, we spend all that time, it doesn't really matter anymore. So our brain, and even more importantly, the brain, will take this plausible explanation and treat it like a fact, even to the point of discounting clearly conflicting data so that it can maintain that story.

Mark Graban: So this is kind of evolutionary, this is the fight or flight response that gets in the way of that higher order thinking. Right?

Dr. Mark Jaben: Right.

Mark Graban: I mean, back in podcast 153, I talked with Robert Maurer from UCLA, who's a psychologist and has looked at Kaizen, and that's one of the things he really focuses on is the idea of what our brains are doing to us. And instead of telling people, “don't be scared of change,” to recognize that, well, it's a very natural human behavior to be scared by change and to be aware of that and then try to figure out how to get through that. His strategy is classic Kaizen, make the change small. Instead of a saber-tooth tiger coming at you, it's just a leaf blowing at you. It doesn't scare you. And then you can think creatively. But that's the same idea. What you're talking about is that our hidden brain, the amygdala, will take over or get in the way.

Dr. Mark Jaben: Right. That's right, Mark. And it actually becomes a little scarier than that because we also can't really depend on our memories. All our memories are not really imprinted, or there's some recent data to suggest that memory is imprinted. We just can't retrieve them all. So what we do is we remember the stuff that most impacts our chance for survival. So we have memories that are selected. And then it's been shown that no matter how well memory is imprinted, it can change over time. So the really scary part of this, as you say, is that you can't depend on your brain for an accurate appraisal of the current condition. So when you get feelings that are really certain about something, you should be really afraid because you're likely missing something. And if you feel uncertain about something, well, you need more data. So the question is, where will that come from?

So that leads us to the second troublesome feature of your brain, which is the hidden brain is actually made up of many separate functions, and each one of those functions has a particular area of interest, and it focuses on that area of interest to the exclusion of the others, and will eagerly tell you what you should do from its perspective. So when you get a feeling, it's not an arbitrated, mediated, negotiated settlement, it's the loudest voice that wins. Because remember, your brain is geared to act quickly in the face of danger. So those other perspectives are in there. They're just being drowned out. And as you said, Mark, talking about the amygdala, that's your flight or fight stress response area. And your amygdala is one of these very prominent hidden brain voices, and it's focused solely on your individual survival. So there have been very nice functional MRI studies that show that when somebody's expressing a closely-held belief, what lights up is their amygdala. But when the same person is considering options and alternatives at other perspectives, now they're processing their prefrontal cortex. So, so what this means is forget having a fruitful discussion with someone who's in their amygdala. They're just not capable of it. And the same is true for you. So the second troublesome feature is this: Our default response to anything is from our amygdala. So when we begin to interpret the world, we always start there in the amygdala, which is our personal survival. So our personal survival trumps everything else.

Mark Graban: So on these two points, how would you tie it back to the workplace, an emergency department or a hospital? I mean, I think some of the things people are fearful of, like people are fearful of losing their jobs. Can you think of some scenarios where you might recognize when people's amygdalas, their hidden brain is taking over? How do you recognize that? What can you do about that?

Dr. Mark Jaben: Yeah, it can be really hard because people who are, on the face of things, resisting something, who are saying no to whatever you're suggesting, they're not necessarily in their amygdala. You can have people saying no to something who are analyzing very carefully and have very important dissenting views, and they're in their prefrontal cortex, they're considering options and alternatives, and they're seeing it a certain way. On the other hand, you can have people that are saying, “Yes, I'll do it, I'll do it,” then don't follow through. And they appear to be in their prefrontal cortex, but actually they're in their amygdala and they've just figured out that the best way to protect themselves is to play along as far as they're willing to play along. So it's not easy at all.

And this leads actually, Mark, to what the third troublesome feature is in terms of how we deal with that. Because somewhere along the line in evolution, people discovered that at times, being part of a community would improve their likelihood of personal survival. So, for instance, “I'm not big and strong enough to kill the bison myself, so I might starve. But together we can kill the bison so we all can eat.” So the brain actually evolved an adaptation for this. Because if you're going to live and work with others, it requires that you be able to acknowledge and accommodate the needs of others. So this is your mirror neurons. And mirror neurons enable us to, for instance, see a picture of a person in pain and be able to feel that pain without having to directly feel it ourselves. So that's really great. That's helping us entertain some of these other perspectives that our plausible explanations want to ignore. Because if you remember from a little bit earlier, your brain will ignore clearly conflicting data in order to keep its story intact. But there's a problem here, because researchers have demonstrated that the more power and control a person has in a given circumstance, the less active are their mirror neurons.

So what do we do when we put people in leadership positions and we expect them to be aware of all that's going on? They're less capable, less inclined, less able even to do that. And from an evolutionary sense, that makes some sense to me, because a leader might be called on to make really sensitive decisions, time-sensitive decisions that favor the survival of the group, but maybe at the expense of certain individuals. If they're so concerned with those individuals, they may not be able to act on the benefit of the group. So this effect on mirror neurons makes some sense to me. But when it comes to a complex world that we live in, where we have many people involved in anything and many options to respond and conflicting priorities, the best decision in any circumstance involves challenging that plausible explanation and accommodating needs of others. So this effect of mirror neurons doesn't serve us well in that environment. And in our world, we have more power and control in our lives than at any other time in the history of man. So it's not a matter of who we are. Any of us would be equally subject to that effect, right?

Mark Graban: Yeah. And that's, like I said, that's what our brains are doing to us. I mean, I think back to workplace scenarios. People move up the ranks through an organization, and maybe they get disconnected from the workplace, they lose, for maybe for a lot of different reasons, the ability to be empathetic to what employees are facing. Some of that could be, as we would say in Lean, “Well, they're not going to the Gemba. They're not seeing firsthand.” But it sounds like you're saying, maybe can elaborate on this. Some of this is what's happening to their brains because they are in a position of increased formal authority and power.

Dr. Mark Jaben: Sure. I think I've seen it in my physician colleagues who went from the bedside to the boardroom. Well-intentioned, good-meaning people who understand what the practice of medicine is. But again, the farther away you get from the bedside, the harder it is to recall exactly what goes on there. So, yeah, and I think empathy is interesting, Mark. You know, that gets a lot of talk these days. But I think what I'm talking about is even beyond. It's more than just empathy, because empathy sort of carries the connotation that's kind of optional. I can be empathetic or not. I can look at this other situation or not. What I'm really saying is that this effect of the mirror neurons is not optional. If you want to be able to get to creativity, if you want to be able to get to innovation, it follows the path through the prefrontal cortex. And if you never get to processing the prefrontal cortex, you'll never get to creativity.

So you did a recent podcast with Karen Martin and she mentioned at the end of that sort of her interest in exploring the role of hope when it comes to improvement. So if you go back to that diagram that I posited early on, the hidden brain, arrow to prefrontal cortex, arrow to creativity. What is hope? Hope is seeing a path, having a plan to move forward. Your brain really likes the idea that presents a better chance for survival and will respond with a dopamine squirt. That's why hope is so important, I think. In a subsequent podcast with Rich Sheridan from Menlo Innovation, he spoke about creating a joyful workplace. That was the whole intent of their effort. Joy comes when you're able to act on that plan and, you know, your brain really, really applauds that.

So you talked before about what are some of the other scenarios where it happens. So what do we do in our workplaces? We apply Lean tools and PDCA, Kaizen and Kaizen events and Hoshin Kanri, and these are all structures that help us clarify a path forward but this is prefrontal cortex processing. And remember what happens if the other person is in their amygdala? They're not capable of having that sort of participation that prefrontal cortex thinking requires. And so what do we do? Just as you said, we want to hold somebody accountable. Which, as you said, usually means, “Why don't you do it the way I want you to do it?” Or we want buy-in. “Well, somebody's buying something valuable. Do you really have to convince them that they need to buy that?” So, and what do these do? Well, these are perceived as threats. And what do threats do? They just force the person deeper into the amygdala. So if you never get past the amygdala, you can't get to prefrontal cortex thinking, and you'll never get to creativity and innovation. So that's why recognizing, responding, and reconciling resistance is so crucial. What I call the three R's of resistance. So the root cause of resistance is not rational. It lies in the hidden brain, and it doesn't respond well to a rational approach.

Mark Graban: So you talked about the three troublesome features, the hidden brain, the separate functions. Are there any others that you've seen?

Dr. Mark Jaben: No, those are really the main three. And you had mentioned in the past, you've always talked about Dr. Deming speaking of the need to stamp out fear. And I think that's what he's really talking about in this regard. You have to stamp out the fear to be able to get to the prefrontal cortex. And I think also this is why the respect for people principle is so integral. Bob Emiliani has talked a lot about that. Bob's been really helpful to me in sort of working out these concepts. But I kind of believe the ultimate form of respect really lies in how I deal with resistance. Do you remember some years ago, you and I were at a conference with Dan Florizone? I think you've had Dan as a podcast guest.

Mark Graban: He was a very recent guest.

Dr. Mark Jaben: Yes. And he said something to us that really, really took me a long time to come to grips with. What he said was if he wasn't getting pushback or resistance as a leader, he wasn't doing his job. So, I thought a long time about that. What I think I understand now is, you know, remember, we don't have a direct connection to what's going on in our hidden brain. But I think I would restate this for Dan and say now that resistance is the one tool we have where we can gain some insight into the hidden brain. The hidden brain, I think, is where the point of cause is, if you will, for what gets in the way of our improvement efforts. So if we want to move forward, we better embrace it. So that requires a tool, I think. So the tool, I think, is this: there's a scale. That scale has resistance at one end and satisfaction at the other end. And what you need to know is where the person lies on that scale. So that speaks actually to another problem we have, which is what satisfaction is. And I think we've horribly misinterpreted what satisfaction means. So we believe, I think, conventionally that it's about what the other person wants. But what I want is really amygdala thinking. Satisfaction is really about what people need. And that's a prefrontal cortex process. And when that person is satisfied, we know they're in their prefrontal cortex.

So what's an example of this? So you take a patient who's newly diagnosed with cancer, right? That's a devastating bit of information to get. The person's depressed. What are they going to do? They're already putting nails in the coffin. What happens the next week? They go to see their oncologist, they get staged, they get a treatment plan, and now what? They're going to fight it. They have a path forward. They have hope. If you ask a person, is satisfaction dependent on what somebody wanted, then they would never be happy with their oncologist, because nobody wants to have cancer. But if you ask them, once they have this path forward, are they satisfied? They'll say they are, because again, they're getting what they need in that situation. So to me, what Dan was talking about is this. And again, unless we take on this resistance, actively seek it out, embrace it, work on it, we can't ever get where we want to go in terms of satisfactory responses to our situation. Mark, that talks also about why the A3 process works. If you think about it, the A3 process, you got to complete the left side before you go to the right. So the left side is all about getting from your amygdala to your prefrontal cortex, to getting what I think is wrong, gathering other perspectives, validating the current condition onto analysis and root cause identification. That's prefrontal cortex thinking. The right side is, of course, all PDCA and reflection, in which we either decide that the countermeasure works and we're going to stay with it, or if nothing works, we're opening up the possibility that maybe we need a new and novel response, which is creativity. So if we go there prematurely to the right side, people just aren't ready for it.

Mark Graban: I think it's interesting you talk about that shift of what we want, that survival instinct. I want food, I want safety, as opposed to saying what I need, requiring more creative thinking. I think it's an interesting thought. I just want to mention first for listeners, past episodes, if they haven't heard them. You mentioned Dan Florizone. He was episode 180. So you can go to leanblog.org/180. And then you mentioned earlier the myth of multitasking. I actually got to interview Dave Crenshaw, who's the author of a book called The Myth of Multitasking, episode 100. So that's leanblog.org/100. So thank you for kind of tying together some of those themes from past episodes that are all out there on the website. So I'm curious a little bit more to summarize what you're saying is that the A3 process helps us because of the structure. It helps us get from kind of reactive short-term hidden brain and into the deeper thinking parts of the brain.

Dr. Mark Jaben: Well, I think that if you think about Lean as something that has evolved over many years by many people, keenly observing the way people work and interact and how they work together and then through millions of PDCA loops, essentially revealed a system that actually reflects the way our brain works. They didn't have access to all this research and functional MRIs and stuff. So there was no way for them to know that this was going on. But it's interesting to me that the product of what came out of Lean really is that direct reflection to our brain. And I think that's why Lean works so well. To me, Mark, the benefit of Lean is that it is a system to deal with resistance. Yes, we want to elucidate problems, we want to solve problems. But in order to do that, we've got to get past this resistance and Lean. What attracted me to Lean in the beginning was that here built into the methodology is a mechanism to do that. It wasn't an add-on, it wasn't an extra, it wasn't optional. It was part of what you do to do Lean effectively. So the countermeasure that I propose is even a greater focus on this left side of the A3. I'm calling it the Engagement Kata because it's a routine that sometimes we're going to need to gain the participation that we need to do the testing and trialing phase, the right side of the A3.

Mark Graban: Yeah, let's not tease people with that. First off, for people who might not know, they might know Mike Rother and Toyota Kata. But what do you mean by first off by kata and then what an engagement kata is?

Dr. Mark Jaben: So kata is a routine. So, you know, my experience in medicine is when I struggle with something, it's because I don't understand it or I don't have an approach to it. So if we have an approach, what we've created with an approach is a structure to help guide us forward. That's what hope is, the path forward. So a kata is a routine. It really comes out of the martial arts regimen. And when you start to do… I've never done martial arts, but what I understand is when you start to do martial arts, the first step is you follow the form and you learn the form exactly as instructed. So a kata is just a routine to help you recognize that resistance in this case is there. And then how am I going to respond? What am I going to do? What are the steps I'm going to take that will work me through that, get me from amygdala to prefrontal cortex?

Mark Graban: So, Mark, as you continue researching this, I'm going to put you on the spot and push you to maybe write about this. If people want to discuss this with you. I guess for one they can come to the blog page for this episode. Are there other ways you can imagine, do you want people collaborating with you on this or if they want to discuss this, what are some different ways they might be able to do that?

Dr. Mark Jaben: Yeah, no, I love talking about this stuff with folks. I guess the best way, Mark, is through my email, which is jabenmm@aol.com. And I think also, Mark, we can post attached to the podcast a list of the references that I've used, the resources that have been helpful to me. And I guess I can also include some brief summaries of some of the particular studies that have been so impactful to help me understand this.

Mark Graban: Well, good. Yeah, so you sent me those. I will post them on the page of this episode and people can check that out, they can post comments. If there's some good discussion in the comments thread, we can maybe get together and do this at some point down the road. We've got some new insights or some other examples or other questions to share. So really appreciate you talking about this, Mark. I think it's a really interesting topic. We talk about root causes. I mean, I guess going into the depths of our human nature is important. You mentioned earlier the respect for people principle. I think it's interesting that Toyota's original term for this was the respect for humanity system. And I think part of that doesn't mean just treat people respectfully, but respect what makes us human in terms of, you know, don't expect people to never forget things, don't expect people to be superhuman. And it seems like this is a big part of it, respecting the way our brains work. And that is what it is. I guess we can cope and better understand that leads us to hopefully better lean implementation. So on that, I'm curious if you have any final thoughts you'd want to wrap up on?

Dr. Mark Jaben: Yeah, I think again, to me the ultimate form of respect is how I deal with your resistance because it acknowledges that you have a valid view and it requires me to rethink my view. And I think that's the most important thing about resistance. You know, I reflect back to Dan Florizone's comments. If we aren't actively embracing resistance, then we're missing the best opportunity we have for the kind of creativity and innovation we need. Healthcare is really complex and there are a lot of stakeholders. Each has their own plausible worldview and they each speak really different languages. When John Shook asked me what the problem was in healthcare, I answered a lack of dialogue, a countermeasure. But to what problem? And I believe that problem really is a lack of credibility among those stakeholders. And the root cause of that really lies in this suppressed mirror neuron activity. So if we want to be more successful at shepherding change in our organizations, I think we'd be well served by focusing there.

Mark Graban: Well, great. Well again, our guest has been Dr. Mark Jaben, not to be confused with the non-Dr. Mark Graban. You know, we have such similar sounding names. There's a fun story there that we'll maybe have to save for another time, but thank you so much for sharing some of your thoughts and insights and research and for being a guest here today.

Dr. Mark Jaben: Well, Mark, thanks. I can't express how valuable you've been to my career, or at least our names. I'm really honored to now be part of the long list of distinguished guests you've had on the podcast and hope that the list is valuable.

Mark Graban: Yeah, well, thank you. I'm sure they do. I hope they do. So well. Thanks. Thanks again. We'll talk soon, I hope.

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