One thing I like about Facebook is the way it reminds you about things that happened on this date in previous years. Facebook is reminding me these days about different milestones related to the publication of the book Healthcare Kaizen that I co-authored with my friend Joe Swartz.
In this post, I'd like to share a few reflections about the book and the impact it has (or hasn't) had.
As you can see on the Amazon listing, the publication date is listed as 6/23/17 (so the anniversary was actually yesterday). I had a few early “print-on-demand” copies to have on hand at the Lean Healthcare Transformation Summit earlier in June 2012.
After writing Lean Hospitals, I wanted to write something else. A number of people warned me against co-authoring a book with anybody, because it's probably more effort than writing a book on your own and there's a risk that you might end up fighting and losing a friendship. A book is like a startup, so there's basically the same risk in starting a company with a friend or a family member.
But, I'm glad I took the risk and it's been such a pleasure working with Joe over the years. I was highly confident that we'd work well together and that's been the case.
We first chatted about the book in early 2010 at the Society for Health Systems conference where we've often crossed paths. We were both presenting about Kaizen and we talked about the idea of collaborating on a book. Joe had an incredible depth of experience leading the Kaizen culture change at a single health system (Franciscan St. Francis in Indiana). I had experience helping many organizations get started with Kaizen. So, it was a combination of depth and breadth of experience… and a shared connection and mentor in the legendary Norman Bodek. Norman was kind enough to write the introduction for the book.
When people ask me if they should write a book, I usually say this:
If you want to write a book, then you'll probably start writing.
If you feel like you NEED to write a book, then you'll probably finish it.
Joe and I didn't write this book because we did market research or because we detected some trend where Kaizen and daily continuous improvement were about to get really hot and popular. We wrote the book because we wanted to. We finished it because we felt like we NEEDED to write the book. We were certainly PUSHING the idea on healthcare, the idea that it's important, if not necessary, to engage EVERYBODY in continuous improvement.
We hoped people would listen.
By the way, Lean Hospitals came to be because my publisher HAD identified a gap in their product offerings. There were competing books already on the market about Lean or TPS in healthcare, but my publisher didn't have one. Long story short, it was a unique situation where they approached me about writing a book (and then giving me the leeway to write that I felt the need to write).
After our SHS meeting, it took a full year (both of us being busy and all) to really get the wheels turning, getting the book proposal submitted and approved through the publisher and then getting to work with the writing. The book was submitted in the fall of 2011 and came off the presses in June 2012.
Originally, the publisher was going to have the books printed in India. That would have been lower cost (especially for a full-color book), but it would have meant longer shipping lead times and a higher risk of books being stocked out. I lobbied the publisher to have printing done and they relented… books are printed in my home state of Michigan, as it turns out.
As the book was coming out, I had the honor to finally meet, in person, another legend, Masaaki Imai, who had graciously agreed to write the foreword for the book:
As the book was being released, I did this analysis of the Kaizen improvement examples that were in the book after somebody asked me how many were about safety and other goals other than cost.
The Kindle version of the book was released in July. It was the first time I had seen what they call a “print replica” edition, which recreates the entirety of each physical page. The format still allows you to search, take notes, and other helpful Kindle-ish things:
As an experiment, I had engaged a public relations firm for a few months to get the word out about the book and about Kaizen.
I was interviewed on a few radio shows, including this news broadcast from Seattle's KOMO:
You can listen to more radio and podcast appearances here.
Free Chapters in English and Spanish
Before long, somebody volunteered to translate the freely available chapter 1 PDF into Spanish:
That chapter is still available when you request chapter 1 in English through our website.
In 2013, we were honored to receive what's sometimes referred to, for books, as “The Shingo Prize,” but the formal name is the “Shingo Research and Professional Publication Award.”
This nice video was made to highlight the role of Joe and the Franciscan leaders and team… a shorter version was played at the award ceremony.
The Executive Guide
Joe and I got a lot of nice feedback about the book. We heard one piece of constructive criticism quite often, basically:
“We love the book, but it's too heavy for an executive to carry on a plane. Can you do a condensed version for them?”
So, thanks to that actual voice of the customer, Joe and I worked to produce the shorter, less-expensive Executive Guide to Healthcare Kaizen edition. It's meant to be a complement to the original book, which is over 400 pages, has a lot of how-to detail, and well over 100 examples.
The Executive Guide focuses more on the “why” — why Kaizen? The first book sort of assumes you've already decided to try building a culture of continuous improvement.The Executive Guide focuses more on the leadership behaviors, at all levels, that are necessary to create this culture. We've ended up recommending that an organization buy many copies of The Executive Guide for leaders and then a small number of the larger book for the Process Improvement team or other internal specialists.
Impact of the Books?
It's hard to gauge the impact of the book. Again, we felt like we were pushing the idea of Kaizen as opposed to reacting to pull for a book on this topic.
In recent years, there is FAR more talk about daily continuous improvement and I see more evidence of daily Kaizen in healthcare organizations. It's been great to have the opportunity to speak about Kaizen, host workshops and site visits, and do consulting related to Kaizen in healthcare.
When we wrote the book, it seemed most people thought Kaizen was an event – as in Rapid Improvement Event. As we discuss in the book, RIEs are great… but not every improvement needs to be a project or an event.
We don't know how much of that shift is due to our book and how much is due to other great discussion of broader “Daily Lean Management” approaches. Kaizen is a core part of that approach as Kaizen is a core part of Lean, in general.
Joe and the folks at Franciscan St. Francis have extended their approach from “just Kaizen” (which has been wildly helpful for them) to a more complete “Managing for Daily Improvement” approach. We'll talk about that soon in a new podcast, following up on this first podcast we did together:
We figured the book would be a harder sell than Lean Hospitals. For one, there are probably far more people searching for a broader term like “Lean” than they are looking for “Kaizen” or continuous improvement.
We can confirm this by looking at public Google Trends data.
For one, there's “not enough data” for the phrase “Healthcare Kaizen.” People aren't searching for it.
But what about a broader search like “healthcare continuous improvement?” Same thing.
There are more searches for “Lean Hospitals” and “Lean Healthcare.”
Maybe I should have called the book Lean Healthcare instead of Lean Hospitals? Oh well.
The data also begs the question of whether we hit “peak Lean healthcare” in 2012 since the red line goes down since then?
I can see the sales data that's provided to me each week through Amazon… and you see that Lean Hospitals has been a far bigger seller. The red and yellow lines are the 2nd and 3rd editions of Lean Hospitals. The blue and purple lines are the Healthcare Kaizen books. You can see those books barely register with the scale of the graph being set by Lean Hospitals.
There are many weeks when ZERO copies of the Healthcare Kaizen books are sold. That's disappointing.
One thing that's interesting is that the Healthcare Kaizen books website gets about six times MORE traffic than the Lean Hospitals book website (by recent numbers). Over the longer term, it's about a 4X difference, as you can see in the two charts below:
I don't know the reason for the 2016 spike in Lean Hospitals book website traffic.
Some popular pages and features on the Healthcare Kaizen books website include pages that share examples of Kaizens, the Kaizen definition page, downloads of free Kaizen templates, examples of Kaizen boards, and the free chapter downloads.
Why Are Healthcare Kaizen Sales Low?
Why don't the Healthcare Kaizen books sell more? This isn't about author royalties to me… it's about spreading ideas that I think are good and helpful.
I think price is a part of it. People complain to me sometimes about how expensive the books are. The prices are set by the publisher. They have to consider the printing cost and their needed profit margin. The book is 400 pages and color printing is expensive… Joe and I asked for the color printing.
We didn't get voice of the customer feedback to tell us if color images are more helpful than black and white for the Kaizen examples and their embedded photos.
I feel bad that the price goes up a few dollars each year and I argue with the publisher over that one, to no avail. It's harder for people (or their organization) to justify a book that's almost $70, I realize.
What are your thoughts on any of this, whether you've read the book or not?
If you have read the book, has it helped you and your organization? We'd love to hear from you.
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Check out my latest book, The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation: