Podcast #226 – Steve Hoeft and Dr. Bob Pryor, “The Power of Ideas to Transform Healthcare”


My guests for episode #226 are Steve Hoeft and Dr. Robert (Bob) Pryor from Baylor Scott & White Health in Texas.

Bob serves as President, Chief Operating Officer and Chief Medical Officer for the system and was formerly CEO of Scott & White Health before their merger with Baylor Health Care System. Steve is the Chief of Operations Excellence for the system.

They are co-authors of a recently released book that I think is outstanding: The Power of Ideas to Transform Healthcare: Engaging Staff by Building Daily Lean Management Systems.

Steve is also previously author of another book I really like, Stories from My Sensei: Two Decades of Lessons Learned Implementing Toyota-Style Systems.

I'm sure you'll enjoy the podcast, as they combine the perspectives of an industrial engineer and Toyota-influenced automotive guy (Steve) and a pediatrician and physician executive (Bob). They share a passion for healthcare improvement AND a belief that we need to respect and engage everybody who works in healthcare as a way to better serve patients.

Streaming Player (Run Time 46:47)

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In the podcast, we discuss topics including:

  • Can you tell us about how legacy Scott & White got started with Lean? What was Bob's role as CEO of the system?
  • Can you give an overview of the daily huddle system and how that cascades through the organization?
  • What are some of your greatest success stories, in terms of results?
  • How did you know when the culture was really changing? That you're shifting from a culture of blame to a culture of safety?
  • Wow has it helped to bring in other Toyota or Toyota-trained people?
  • Now that Scott & White merged with Baylor to become Baylor Scott & White, what have been some of the strengths and opportunities as you combine organizations and cultures? Can you speak to any differences in the Lean approach in both organizations?

For a link to this episode, refer people to www.leanblog.org/226.

For earlier episodes of my podcast, visit the main Podcast page, which includes information on how to subscribe via RSS, through Android appsor via Apple Podcasts.  You can also subscribe and listen via Stitcher.

Partial Transcript:

**Mark:** I was impressed when I got to see those huddles that were taking place at different levels. It was impressive that there was a pretty standardized approach to the huddles, but I think the most important thing was the sense of alignment in terms of what priorities were about what to bring up, what to discuss, and how information was flowing up from the front line, focused huddles, all the way up to the executive team and that the executive team was huddling and that information could then cascade back down. That was really good to see.

Steve, maybe a question for you just more generally about huddles and how you've coached people on this. Huddles is one of those practices where people say, “That seems simple.” They try to copy what another organization did in a rote way. Then, unfortunately, what develops is people, just checking the box.

If you ask, “Why are you huddling?” They might say, “Well, because they told us to huddle,” and there's not the same spirit involved in the huddle. Do you have any thoughts on that, of how to make sure those huddles are not just the check the box activity that they're useful to the organization and everyone involved?

**Steve:** Boy, if I had a nickel for every time in healthcare I've heard people say, “We already huddle,” and maybe that's been the power of why it's been so quick. Bob has talked about it in some cases. We've turned this ship, a big ship, in two weeks. We could be heading off in taking new ground in a different direction, whether it's access to population health.

The key and the reason why that it's different, and maybe, Mark, what you saw when you first came down here about the linkage and all, we're using hoshin kanri just to use that concept to link every single person so that they can see how they fit into the vision, mission, value of Baylor Scott & White Health.

People really do feel like they're not just huddling over quality work life issues. They are huddling over meaningful stuff. That was very important that we did different. Maybe the biggest key is leadership. A top leader is trained first. We won't do this unless the top leader's trained first. That leader doesn't tell her staff, “You go huddle.” She says, “Come to see my huddle, and then I want you to make yours better.”

They lead by example in this case, so we did not stop at that, start at the bottom too. I think Veda Care and others did do that. We started at the top. Of course, we met in the middle here, but each leader has to start their own huddle and they have to sponsor a tier one direct performer huddle, and that's where everything…Remember, there's no training class.

They come the next day. After the end of their class, they're expected to huddle. They're going to be bringing their staff members to this on huddle.

Flipping it around and saying, “Leaders, you have a job. It is management's job to build the systems by which workers can check whether or not ideas are working.” Our huddle process, because everybody huddles, we've actually had to start calling them idea huddles, because the whole purpose of this is to bring forward a based idea and while people are working, try it out.

Bob started this. We had to accelerate a point. How many projects can you do in a year of health system? How many can they stomach? 10. 10 or 12 people are on each project. There's 144. What did the other 12,000 employees do? How are we going to get them involved?

Every one of them has ideas, so we've actually…Bob and I realized this at one point. It was a Toyota tour. Every one of those Toyota workers, the one that we saw, we happened to go to Kentucky to San Antonio which, you know Mark, is better and more powerful for this picture.

Every employee, every week, every month, they're coming up and implementing ideas. Bob's like, “We're just as smart as them.” We realized where we weren't event asking. We didn't ask staff for their ideas. We had these things. All healthcare people huddle.

During the huddle, why not we pick one metric point with a finger, make sure that their daily or weekly manager has a key to this thing, too, and meaningful. Here's where we're at. Here's where we need to go. Have the leaders ask, “What could we try today? While we're working, what could we try today together to try to close that gap?”

The answer to that astounds Bob every day, is that daily invasion that healthcare workers are great at this. If I could just say one thing, Mark, the passion part, Bob and I watch people physically visibly change. Something is inside of a person when their boss says, “I don't know what else to try.” Maybe it's false.

This could be our mother. This could be our grandmother, our neighbor. I don't know what else to try. We've tried A, B, and C so far this month, and they look at the team and say, “I don't know what to try, but I believe you do. What could we try together, as a team, while we're working today, to budge this number?”

People brainstorm, and somebody comes up with a great idea. They always do. When the team tries it works, and it works. It has to be quick. Within two or three days' cycle, you got to be able to check these based ideas. If it's longer than three days, four days, you need to be doing a project. Write a formal, slower PDC cycle.

Those people, when it works and the boss says thank you, they go home at night and they tell their kids, “Kids, if I wasn't at Baylor Scott & White, they'd be going to heck in a handbasket.” They're beating their chest. I'm single-handedly meeting all my department goals. I don't care if you call it Lean or daily Lean.

It doesn't matter what you call it. You can't take it away from them. They're going to tell kids, “You know what? I'm going to give them another idea next week. I really like what I do.” We've watched that click. Bob just the second ever huddle up at our new site in Irving. They were so excited with the second ever.

An idea came right there while we were filming with Bob. Bob was watching that engagement, that excitement in their eyes again. We're not going to do it any other way.

Feedback & Comments:

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.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Thanks, Dan!

    Here is the context of the quote from Dr. Pryor:

    Bob: First of all, healthcare is like what I learned in surgery. The ABC is a surgery, assess, blame, and criticize. Moving from assess, blame, and criticize to “Here is an issue,” and we have very, very good people working, but they’re working with bad processes. Let’s design our processes so that it gives everyone a chance to succeed loudly. When we succeed, our patients of course succeed.

    When you really know that the culture is changing, it’s by stories. Stories tell the culture of an organization. When a story starts shifting from…Let me tell what’s wrong in this organization. As a matter of fact, I was in an organization the other day that was outside of healthcare. I just happened to hear some of the employees talking.

    They were saying, “What do you think about those people? Don’t those new people have it all wrong?” They spent 15 minutes while they weren’t working complaining about their organization. When the people start coming together, the front end of care, and start telling stories about, let me tell you what we’ve done, let me tell you about how we’ve changed the way that we work. Let me tell you how we came together.

    Once you start hearing those stories, then you know that culture has changed from, one, “I’m really afraid to step out of my box and speak up,” two, “Let me tell you how I spoke up, and let me tell you how that changed our whole organization.”


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