Today I have two guests joining me for Episode #314 of the podcast. They are Skip Steward, the Chief Improvement Officer at Baptist Memorial Health Care in Tennessee and Brandon Brown, the owner and “Master Kata Coach” of his firm, Continuous Coaching Commitment, LLC.
Together, they share how Training Within Industry (TWI) and Toyota Kata have become powerful practices inside the Baptist Management System.
Skip describes the origins of the Baptist Management System, shaped by Deming's influence and Toyota's example, and explains why the organization intentionally emphasizes people development over tools. He highlights the importance of humility, interpersonal skills, and leadership behaviors that create psychological safety. Brandon reflects on his own journey from event-driven Kaizen to scientific thinking through Kata, and why coaching–not just “telling”–is essential for sustaining improvement.
The discussion explores the dynamic between coach and learner, with both Skip and Brandon stressing that leaders must first be learners themselves. They share stories of Baptist leaders rotating through learner, coach, and second-coach roles, and how this structure built capability and trust. They also explain why pairing Kata with TWI is a “marriage made in heaven,” enabling leaders to reduce variation, strengthen relationships, and create standard behaviors that improve care quality.
Listeners will hear candid reflections on what works (and what doesn't) when translating Lean practices from factories to hospitals. Skip and Brandon's stories illustrate how Kata and TWI, applied together, can create systems that truly respect people while improving processes.
Streaming Player:
For a link to this episode, refer people to www.leanblog.org/314.
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Transcript:
Announcer:
Welcome to the Lean Blog Podcast. Visit our website at www.leanblog.org. Now, here's your host, Mark Graban.
Mark Graban:
Hi, this is Mark Graban. Welcome to episode 314 of the podcast. It's August 15th, 2018. Today I have two guests joining me. They are Skip Steward, the Chief Improvement Officer at Baptist Memorial Healthcare in Tennessee, and Brandon Brown, the owner and master Kata coach at his firm, Continuous Coaching Commitment, LLC.
In this episode, we discuss their use of methods such as Training Within Industry and Toyota Kata in the important work of healthcare improvement. Skip and Brandon both have backgrounds in manufacturing, but they've been able to translate Lean skills and mindsets into healthcare. We'll also talk about their dynamic as consultant and client and how the roles of coach and learner are often very situational. So if you'd like to get links to more information and videos–I've linked to the Baptist Management System YouTube channel in the blog post for this episode–and if you want to find their LinkedIn profiles and more, you can go to leanblog.org/314. Thanks for listening.
Well, Skip, hi. Thank you for being a guest on the podcast today. How are you doing?
Skip Steward:
Great, Mark. Thank you for having me.
Mark Graban:
And Brandon, thanks also for being here. How are you?
Brandon Brown:
I'm doing great, Mark. Thanks for asking us to be on and being able to talk about some of the things we've been doing at Baptist. I appreciate that.
Introductions and Early Influences
Mark Graban:
I'm looking forward to hearing about this journey. Both of you share a lot of great stuff on LinkedIn and YouTube, and we'll make sure people know how to find you online. Why don't you start off with introductions and tell us a little bit about your backgrounds? Skip, if you can start first, I'd be curious to hear about your career path and background with Lean.
Skip Steward:
Sure. My career started about 26 years ago, the vast majority of it in manufacturing with one company, Emerson Electric, and a subsidiary of theirs known as Copeland, which eventually became Scroll Technologies. My career got heavily influenced by the work of Dr. W. Edwards Deming. When I started my career, a mentor was our mutual friend, Mark, Dr. Don Wheeler out of Knoxville. He influenced the way I think. I've been giving out Dr. Wheeler's book, Understanding Variation: The Key to Managing Chaos, for years. And so I'm so excited, Mark, that you're bringing out Measures of Success, your new book. I think it's going to be a huge contribution to healthcare.
I started off in quality engineering and industrial engineering, then ultimately got into running operations. I was introduced to Lean probably the way that many folks were, with the book Lean Thinking by Dan Jones and Jim Womack. Back in 2008, I left Emerson and went into the private equity world and got introduced to healthcare, working with some of the nation's largest healthcare organizations. Then I left that world and came to Baptist starting in the summer of 2013 when they first created my position. That's when we started putting together what we call the Baptist Management System. We don't necessarily use the word “Lean,” not that there's anything wrong with that word. We just refer to it as the Baptist Management System.
Mark Graban:
How would you describe the connection between Deming and Lean? Why should Deming be relevant today?
Skip Steward:
I think that Deming taught a meta-routine, a way of thinking that is as prevalent today as it ever has been. Many folks give Dr. Deming credit for taking his mentor Dr. Shewhart's PDCA (Plan-Do-Check-Act) and translating it into PDSA (Plan-Do-Study-Act). Even if you do nothing short of going through his 14 points, that thinking is just as consistent as it is today. We even see some of his thinking all through the Shingo principles. As a Shingo examiner, when I think of things like “think systemically” and “have a constancy of purpose,” well, I first learned those principles through Dr. Deming. So I actually think that it would serve us well for a lot of folks to go back and to read some of Dr. Deming's original works.
Mark Graban:
I agree. Brandon, can you tell us a little bit about your career path and your introductions to Lean?
Brandon Brown:
Sure. About 25 years ago, I took my first job. I'm a mechanical and industrial engineer by degree. I went to work for Lincoln Automotive, a Pentair company, designing automotive service equipment. Shortly after that, I got an opportunity to take a deeper role in manufacturing as an engineering manager for Waterloo Industries. They produce Sears Craftsman toolboxes. At that point, we were really moving into Lean, thinking about The Machine That Changed the World and Value Stream Mapping by Rother and Shook. We started working in the traditional way, through event-based Kaizen. I led several dozen of those and had some traditional difficulty sustaining.
I moved on to be a plant manager and open up a couple of plants for Central States Manufacturing. Then I had an opportunity to do some state-supported MEP work with various other manufacturers. Then I went to a three-day W3 Group-sponsored workshop where Mike Rother came to speak and talk about Toyota Kata. As he started talking about what he sometimes refers to as “five days and a pizza party,” and how the traditional Kaizen way is not a good way of implementing the entire Lean system… as he began to tell that story, I was like, “This guy's followed me around for the last three or four years.” It really inspired us.
So I did some work with W3 Group for a while, and now we've formed our own company, Continuous Coaching Commitment. We're not consultants; we call ourselves coaches because we coach for leadership development through scientific thinking about problem-solving. We service manufacturing, healthcare, financial institutions, and a whole variety of industries.
Translating Manufacturing Principles to Healthcare
Mark Graban:
Skip, or maybe it's a question for the both of you, since you have experience in manufacturing originally, as I do. When someone says, “All right, but Skip, patients aren't cars,” what's your general response to that?
Skip Steward:
I've actually had that before. My first response typically is, “You're right, they're not,” and just to kind of let that rest for a second and then try to engage them in a dialogue about their real work. My first six months when I joined Baptist, I intentionally went all throughout our system doing nothing but what I called a “listening tour,” trying to understand the frustrations and where people really were in their work. That seemed to serve me a lot better than arguing and trying to convince them.
Mark Graban:
And I think your point's a good one about having that conversation and finding out their perspective. Brandon, the corollary question, “Brandon, a hospital is not a factory.”
Brandon Brown:
Yeah, exactly. And I will say it's not. But I'll start to talk to them about, as Skip said, meeting them in their world. I'll ask questions like, “Well, tell me about your hospital. Do you have different processes that take the patient step-by-step through care?” And they'll immediately say, “Well, yes.” “Tell me about some of the goals that you have.” And they'll start to usually talk about time-related goals or quality-of-care-related goals. I'll just try and talk to them about that and say, “Well, I know that manufacturing and healthcare aren't the same, but those same things you're telling me go on under a manufacturing roof.” So maybe some of these thinking patterns and processes that we're trying to coach people with might be applicable to helping you meet your goals.
The Origin of the Baptist Management System
Mark Graban:
Skip, I'd be curious to hear some of the origin story of the Baptist Management System.
Skip Steward:
Sure. My boss, Dr. Paul DePriest, came out of the University of Kentucky's healthcare system and was heavily influenced by a little factory near him called Toyota, Georgetown, Kentucky. He had the vision for this. He went to the board and created this position. He asked if I would be interested in stepping out of an operations role and coming into Baptist to introduce this into healthcare and create the Baptist Management System.
Like I said, I spent the first six months really trying to meet people and understand. What became very clear to me was how important the interpersonal skills were. So as we first started introducing the Baptist Management System, I started off with putting together a little workshop around Managing to Learn, John Shook's book. I took the Improvement Kata model and I “baptized” it. Mike Rother always likes to tease me that he's never had anything baptized before. I made that model look very Baptist. I started introducing the language of current condition, countermeasures, target condition, PDSA. And what I found was that people were very much willing to embrace that language.
What didn't go well was, even though I had communicated that if we're going to do this A3 thing the correct way, we need to have a learner and a coach, not everyone heard that. A lot of people took the form and somehow unconsciously thought if they filled out the form, magic would occur. I could see that the whole learner-coach concept was not going well, so we introduced Toyota Kata in one of our hospitals, and really, it caught on like wildfire.
Mark Graban:
What were some of the factors that led to it catching on that way?
Skip Steward:
Well, I think one reason was that Toyota Kata gave them something they could jump in and do. We laid out the roles of learner, coach, and second coach. They also started seeing some success in certain areas, both clinical and non-clinical, in the ED and in the billing department. They saw that if they changed the way they were playing the game, they would get different results. And like many companies, healthcare systems tend to be pretty competitive with each other. As other administrators started hearing about the great success coming out of these experiments at our NEA hospital, my phone started ringing off the hook. And that's when I started bringing Brandon in.
The Role of Coaching in TWI and Kata
Mark Graban:
Brandon, can you talk about being brought in as a coach for these Toyota Kata efforts?
Brandon Brown:
About late 2015, Skip called me up and said, “Hey, wondered if you would come over to one of our hospitals and just take a look at our Toyota Kata work that we're doing.” I just came in with hat in hand and said, “I'm going to learn from you all as much as, hopefully, you're going to learn from me.” From that hospital, Skip asked for a few more days here and a few more days there, and pretty soon I was working with several different groups.
Mainly what we taught was the style, the format, and the good interpersonal interactions between coach and learner. And the storyboard was just a mechanism for telling the story. So we started meshing Toyota Kata with TWI, the programs that Skip had already started deploying. I remember a phone call, he called me up and said, “What do you think about using Kata as the mechanism for us deploying TWI?” And it really challenged my thinking. We wrestled back and forth and said, “Well, let's give it a try.” So we created a storyboard on how one of the entities was going to deploy Job Instruction. After a couple of months, it started to get more comfortable. I don't think I would approach any organization to roll out TWI without that Kata thinking and the storyboard and the frequency of getting, every day, just a little bit more of a step up.
Mark Graban:
Brandon, how would you describe TWI in a nutshell?
Brandon Brown:
Well, Skip would probably echo this. I've heard him say that TWI and Kata are a “marriage made in heaven.” The countermeasures to obstacles and eliminating variation… what we've learned is that nurses have learned on the job from different nurses, and we find some variability there. So in our Kata work, we've integrated, as a countermeasure, the Job Instruction for specific jobs and tried to eliminate that variation. As far as Job Relations, there's no better method that I know of to develop a good relation between second coach, coach, and learner than the four-step methods of Job Relations. And we've also found, with Job Methods, I don't know of a better way of understanding your current condition and breaking down a job than using Job Methods.
Mark Graban:
Skip, I'm curious to hear your thoughts on why people development is a priority.
Skip Steward:
Sure. Kata is a people development process because what we're doing there is we're creating a meta-routine, just like we all have meta-routines that we don't think about. With Kata, we're trying to create this meta-routine where we can experiment our way forward to multiple target conditions on our way to a challenge. What we've seen is that people really get developed in their thinking, and what I didn't expect to happen is that it overflowed out of their work into their personal life. I've had multiple people come up to me and share private stories of either how they lost 75 pounds or cut their blood pressure in half or started a business, and they all used this meta-routine that we happen to call Kata.
We work a lot with Patrick Graupp and the TWI Institute. What we discovered is people that are practicing Job Relations are significantly better coaches than those that are not. Job Instruction fits naturally because what we discover quite often is that everyone is doing a task completely different–drawing blood, starting an IV–and that variation creates errors and mistakes. So Job Instruction helps us create a standard behavior. Job Methods also fits inside that Kata approach. By using those three legs of the TWI stool–Job Instruction, Job Relations, and Job Methods–it fits inside that Kata.
The Dynamic of Coach and Learner
Mark Graban:
Brandon, one question I had for you. I've had people question, “Are we just improving a fundamentally bad process?” I'm curious to hear your thoughts on that.
Brandon Brown:
Well, I think any of the methods you've talked about–A3 problem-solving, DMAIC, Kaizen events, value stream mapping–all of them are great methods. But taking a class and transferring knowledge from the teacher's head to my head and then me going out trying to portray myself as an expert, that's not a good model. Each one of those tools has to be coached and practiced. An A3 without coaching is a tool that many times is ineffectively used. And I don't think you'll see any successful company such as Toyota that would say without a coach, without someone who's been there, been that learner, who's experienced that experiment, failed and then learned from it… without that coach, they're all simply just tools.
Mark Graban:
As we wrap things up, Skip, why does a good coach need to be a good learner?
Skip Steward:
First, I think it's hard to be a good coach if you haven't been a player. One of the things we've encouraged is for folks to lead with humility and, regardless of your titles, to start off as a learner. We've had directors that have 500 people reporting to them start off as a learner. And Brandon's coached a lot of them. What they've told us, inevitably, every single time, is that once we rotate them into a coach's role, they'll always say something to the effect of, “Well, this coaching is really tough.” When I ask them to explain, they'll say something like, “I never thought about me being a person that just likes to give orders, but I'm realizing it's easier to give directives than it is to coach.” But because I was a learner for a good period of time, it has helped me with that temptation. Even myself, I get coached every week. It makes me willing to be more vulnerable, and by being willing to be more vulnerable, it helps me be a better coach also.
Mark Graban:
And Brandon, what are your thoughts on that question?
Brandon Brown:
Very similarly, I was told one time by a mentor that said, “Take water skiing, for example. You can read a book on water skiing… but if you haven't put the skis on, gotten in the water, and had that rush of water almost drown you as it goes up your nostrils, you don't really have an appreciation for the skill.” And I think in any of these methods, if you've not experienced it, you can't just use your title and say, “Okay, I'm a coach.” We've had a Director of Med/Surg that, due to turnover, had to move from a second coach to a first coach and then down to a learner again, probably two or three times over a year's period. And she would teach how to be a learner in the learner position, when she's actually kind of being a coach. And then when she moved to the first coach position, it made more sense to the learner. Those individuals are some of the best coaches within Baptist that we've had because they were humble, they were avid learners, they wanted to learn from the process.
Mark Graban:
Well, again, lots of great insights and perspectives from the both of you. So I want to thank again, Skip Steward, thank you for joining us here on the podcast today.
Skip Steward:
Absolutely. Thank you for having me.
Mark Graban:
And Brandon Brown, thank you also for being part of a really good discussion. I appreciate it.
Brandon Brown:
Thank you, Mark. I appreciate the opportunity.
- Thanks to Skip for mentioning my book, Measures of Success, available now.
Videos:
Check out their Baptist Management System channel on YouTube:
Here is a video demonstrating TWI training methods:
Thanks for listening!
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