What Did People Want to Talk About? Open Space & #Lean Coffee at #SHS2017


Today's Post in <50 Words: Yesterday, Isaac Mitchell and I asked a group of Society for Health Systems Conference attendees what they wanted to talk about with peers and colleagues in the room. Here's that list and how the discussion was structured…

Yesterday, Isaac Mitchell and I facilitated an hour-long session at the Society for Health Systems Conference (hear my recent podcast with Isaac). Things continue today, so follow along today using hashtag #SHS2017.

Thanks to Jordan for taking this photo of us afterward:

Instead of the usual presentation format, we used the “Open Space Technology” approach for facilitating open, but structured, discussion. It was sort of a hybrid approach of that and the “Lean Coffee” format that I love.

We had about 30 people in the room, I think.

We asked people to brainstorm somewhat topics that they'd want to discuss in groups.

We got these generated in a few minutes (click for a larger view):

Topics included:

  • ROI / making the business case to improve
  • What to do after increasing capacity?
  • How to have success without leadership buy in?
  • Starting Lean “from the middle,” the PI department, instead of a directive from senior / executive leadership
  • How to effectively use the “Two Feet Rule” at work
  • Working with hospitalists vs. other physicians
  • Lean vs. Six Sigma
  • Connecting improvement across the integrated health systems (hospitals & insurance)
  • Organizational structure for industrial engineers in your org
  • How to stay on course with uncertain CMS direction
  • Adopting Lean as an improvement methodology
  • Personal development
  • Benchmarking
  • Setting process improvement financial goals
  • How consultants can add the most value locally between engagements
  • Management engineering consulting rates / marketing consulting to healthcare
  • Introducing systems engineering to clinicians
  • Selecting process improvement team metrics
  • When to ask for more resources
  • Making implementation last
  • Can we stop huddling without purpose

Everybody in the room got two votes to put toward topics they wanted to discuss. You could choose two topics or put two votes on the same topic if you really wanted to.

These got the most votes:

  • Lean vs. Six Sigma
  • Benchmarking
  • When to ask for more resources
  • Management engineering consulting rates / marketing consulting to healthcare

So, we had four sheets of paper around the room. The rule of two feet said people could choose where to go participate. And, if they weren't learning or contributing or interested, they could move.

Each group brainstormed more specific topics and talked for 30 minutes in a Lean Coffee format, as pictured below.

Panoramic of the whole room
A group talking Lean and Six Sigma
The “Lean vs. Six Sigma” team's board. The “Done” post it notes got discussed. The ones still under “To Do” didn't discussed.

Isaac live streamed some of it:

After 30 minutes, we asked each team to summarize some “epiphanies” and key points to report out to the whole room. Each team had 3 minutes and none of the spokespeople from the groups ran long. Such good engineers :-)

Thanks to everybody who participated!

I'm going to share that list of brainstormed topics with the SHS leadership team. It's interesting to see what the responses were to a very open-ended question of “what do you want to talk about with peers?”

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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. I love the format and approach of asking what would you like to talk about. This is the premise for real coaching that triggers engagement and pulling others to new levels of awareness through the discussions. Excellent!

    • Thanks, Rick. I was happy to also learn that many SHS members are hosting Lean Coffee discussions around the country.

      Let’s do this in the DFW area sometime with our Lean group!

  2. I would like to know about Connecting improvement across the integrated health systems (hospitals & insurance). As i worked for a health care insurance company as a business analyst, there was no lean methods implemented and they were many errors in the process with regards to the staff. what would be a better way of implementing lean in a company like that for the first time? what are the appropriate methods specific to Health insurance companies? How does lean differ for a corporate company and a health care system?

    • I think a great starting point is asking the question, “What problem are we trying to solve?” A health insurer has different problems than a car factory or a hospital. The key is to use the same mindsets, including the idea of engaging everybody in improvement.

      See this post and video.

      Thanks for the comments.

      I’d also encourage hospitals and insurers to work together on improving across the “extended value stream” that they are both a part of. Work together for the benefit of the customers (the patients and those paying for care).


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