Interviewed by Doctors on the “Connecting the Dots” Podcast

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I'd like to thank my friend Skip Steward for inviting me to be a guest on his podcast called “Connecting the Dots.” The podcast is one of their initiatives that's intended to get the word out (internally and publicly) about their Baptist Management System at their health system. I was interviewed by Skip, Dr. H.F. Mason, and Dr. Jake Lancaster.

You can listen using the player below, but I also had a transcript made for those who might want to read instead:



Skip has twice been a guest on my Lean podcast and I'll be interviewing him soon for the “Habitual Excellence” podcast series, as well.

Here is the transcript with my added annotations:

Skip Steward: This is another episode of “Connecting the Dots” podcast. I am Skip Steward, Vice President and Chief Improvement Officer for Baptist Memorial Health Care.

Dr. H.F. Mason: Hi, everybody. I'm H.F. Mason. I'm a general surgeon and Chief Medical Officer at Baptist Hospital, DeSoto.

Dr. Jake Lancaster: Hey, everybody. I'm Jake Lancaster, an internal medicines physician and the Chief Medical Information Officer for the Baptist system.

Skip: Today we're so incredibly honored to have my good friend, Mark Graban. Mark is the author of the Shingo Award-winning book “Lean Hospitals.” He's also a co-author with Joe Schwartz of “Healthcare Kaizen” and “The executive guide to Healthcare Kaizen.”

His most recent book is “Measures of Success. React less. Lead better. Improve more.”

He's also the creator and editor of the anthology book “Practicing Lean.” He serves as a consultant to organizations through his company Constancy, Inc., and also through the firm Value Capture.

He's also a senior advisor to the technology company KaiNexus. He has focused on healthcare improvement since 2005 after starting his career in industry at General Motors, Dell, and Honeywell.

Mark is a host of three podcasts, including “Lean Blog Interviews,” and it's been around since 2006, and then most recently “My Favorite Mistake” and “Habitual Excellence, presented by Value Capture.” I know I listen to all three of these at the gym each night.

Mark has a BS in industrial engineering from Northwestern University and an MS in mechanical engineering and an MBA from the Massachusetts Institute of Technology Leaders for Global Operation program. Welcome, Mark.

Mark Graban: Thank you, Skip. I hope you're not listening to all three at the same time. That would be quite a feat.

Skip: Oh, no, no. I'm not that good.

Dr. Mason: And Skip, that's a long workout you're having, man.

Skip: I'm pretty slow.

Dr. Mason: I hear you. Mark, once again, thank you very much for being here. I'd like to know a little bit about your background — specifically, we're seeing more and more people, more and more industrial engineers who have — I don't want to say crossed over but they've crossed over from manufacturing to healthcare.

Tell us a little bit about your story and how you made that move from manufacturing into the healthcare industry.

Mark: Sure, Dr. Mason. My background is somewhat stereotypical for somebody who's involved with the Lean methodology. I'm an industrial engineer, so I really first learned about Lean or the Toyota Production System as an undergraduate taking an operations management course. What I learned was correct, but it was just a small sliver of really what we would call Lean.

I ended up out in the workplace working in manufacturing operations that were — at General Motors in the mid-'90s, the game plan was clear. It was to try to emulate Toyota so we could catch up to Toyota.

In terms of quality and productivity, one of the things that I think just really got deeply solidified in my brain working at General Motors was the idea that nobody should hate coming to work, simply put. Most everybody there unfortunately did hate coming to work.

We would joke that you'd come in the morning through security, and it's like they would hand out these little dark clouds that would hang over your head, and please turn it back in at the end of the day. We'll do a security check. Try not to take it home with you.

I saw the power of leadership.

After about a year at that plant, which was managed in a very traditional, top-down, command-and-control, yell and scream and blame and shame, maybe with more swearing than you might find in other settings, we got a new plant manager who was an experienced GM leader who had, as he put it, the good fortune to go to California to the famed NUMMI plant that was a joint venture between Toyota and General Motors.

He learned this Toyota leadership style, and then he also had skill in helping turn a culture from what it was to something better. I've been really inspired by that throughout my career. Having the opportunity, the good fortune, to try to contribute into healthcare starting in 2005, I realized that the passion and the methodology were very transferable into healthcare.

It made me deeply sad when I first met people in healthcare who also didn't like coming to work anymore for one reason or another. They were dealing with too much hassle, too much waste. They weren't being engaged by their leadership. There might have been similar patterns of top-down command-and-control leadership.

For me, Lean is certainly — it's not a methodology for building better cars. It's a leadership style. It's a culture. It brings us problem-solving methods so that we can help healthcare organizations be the best version of what they want to be.

That's a little bit of my story and part of the reason why I'm so passionate about continuing to try and help in healthcare.

Dr. Lancaster: That makes a lot of sense. We've had several leaders on the program in continuous improvement, and we've talked about Lean tangentially a few times. I've heard more than one person say, “We do this, but we don't call it Lean,” or, “We do this, but we don't like to say the Lean.”

Can you describe why there might be hesitancy for that, and what is the main difference in the methodology of Lean that sets it apart from maybe other CI methodologies?

Mark: First off, around the world, I don't care what people call it. This creates some challenges. There's a lot of variation of what different organizations in healthcare will call this. You call it the Baptist Management System. Some people use phrases like operational excellence, performance excellence, process improvement, etc., etc.

The word Lean came from some MIT researchers who studied the auto industry.

Part of the challenge… I knew this from being in General Motors in the mid-'90s, you couldn't say the word Toyota at GM. That wasn't going to engage people either.

These researchers had to come up with some… In a way, they were hoping to come up with a less loaded term. Now, we could go back in time if we had a time machine to go back and try to participate in this meeting and try to lobby against calling it Lean. They meant it as a positive.

Describing a company that got better results across all measures was a better environment. They were doing more with less, which sometimes that's also a loaded term. They meant Lean as a positive.

If you look in different dictionaries, the word lean has descriptions, definitions, including implying that we don't have enough of something, and then the word Lean rhymes with mean. That's an unfortunate thing that gets thrown around.

If people feel what is happening to them is mean, whether the words Lean, Kaizen, Continuous Improvement, or whatever. If people feel like what's happening to them is mean, then we should step back and reevaluate what we're doing.

One of my mentors, somebody I've learned a lot from, he's an American who works at Toyota in the US, Jamie Bonini, I've heard him say, “If the employees are really upset about what's going on, then that's not really Lean.” It's not that change is easy or that there's any magic formula.

To the second part of your question, Dr. Lancaster, one of the things that separates, there are a number of things that separate Lean from additional approaches.

Lean is shifting away from mandated, dictated top-down solutions and in instead engaging people at the frontline, or much closer to the frontline, and for one, listening to them.

What are the frustrations? What are the barriers to ideal care? What are the things that frustrate you and keep you late at work instead of getting home to your family?

Listening and hearing what those problems are, and then engaging people and being more of a coach or a facilitator. When I come into an organization, I'm not the guy who comes in and tells anyone what to do.

I try to coach them through understanding their problems, trying to get closer to a root cause — That's one powerful idea that comes from the lean methodology — and then engaging them in developing, testing, and evaluating possible solutions.

You're working on the things that matter, focusing on staff safety, patient safety, quality when we think about focusing on problems that we get in the way of outcomes or patient satisfaction, improving access to care.

If we do all of those things right, we will see part of the Lean philosophy. Final point I'll make here is that doing all those other things well leads to better financial performance, which is 180 degrees different than traditional approaches to “cost-cutting” that often end up alienating or demoralizing people.

Dr. Mason: They might already have these programs. If not, do you think that in the future or near future, there'll be healthcare engineering degrees that you can get, almost an industrial engineering degree, but tailored toward healthcare?

Mark: That's a great question there. I'm a member of the Institute of Industrial and Systems Engineers. The IISE has a professional group subset called the Society for Health Systems. Through that, a lot of undergraduate students learn about opportunities to work in healthcare. I didn't discover this until a decade into my career. I might have pursued that if I'd even known that was a possibility.

I don't know if there's a need for a different degree. We could step back and think of the masters of healthcare administration degree. How much specialized is that compared to an MBA? Probably a little bit. I don't know if it requires a different degree because a lot of the skill sets from industrial engineering turned out to be very transferable.

One, for example, let me get very mathematical and quantitative and think about queueing theory or simulation methods that we could use in conjunction with Lean methods and employee engagement to design a workplace, look at staffing levels, and how many operating room, prep rooms, are there compared to ORs, compared to the number of PACU beds?

Maybe the answer to your question is no, but what we do need more of is opening industrial engineering students' eyes to the possibility to come and play a role in healthcare.

Dr. Mason: When you mentioned queueing theory, I saw Jake's ears perk up. [laughs]

Dr. Lancaster: Because I'm a nerd. It's interesting that you question HF. I got an MHA and we did have an operations management course while I was there, and it tailored all the examples, which was useful to healthcare. It talked about the ED, it talked about queueing theory, and so on and so forth.

That may be one way of doing it, is get an MHA because you're going to learn operations management, but it's not the same as getting a full-fledged degree in it. We were able to sit after taking that course and for the Lean Six Sigma green belt.

One of the questions I have for you, Mark, is, I'm still pretty new at understanding all these different terms and what they all mean. We had another physician on the program who every physician that came into his organization had them all go through a Six Sigma white belt and then some went on to get the black belt.

I was just wondering if you could explain to our audience what all these different things mean, and what does it take to go through that training for those?

Mark: I'm thinking of physical belts that go around your waist, and maybe a white belt you can only wear in the summertime. I don't know. Don't ask me about fashion…

[crosstalk]

Dr. Lancaster: [laughs] After Easter. I did karate growing up. My brother got to the blue belt but I only took a green belt so it's pretty [indecipherable 13:41] myself.

Mark: I think of — and again, this is just one of the jokey comment before getting serious again — the movie, “The Karate Kid.” Mr. Miyagi gets asked by Daniel, “What kind of belt do you have?” and he says, what, “JC Penney's $3.70,” or…?

Dr. Lancaster: Something like that.

Mark: There's a couple things to touch on. One — and I think Dr. Lancaster, you'd maybe alluded to this and I didn't really say in response to your other question — Lean and Six Sigma have a lot of overlap because there's lineage.

There are engineering tools, statistical tools, that have been incorporated into both. Then sometimes organizations as happens in manufacturing also will have Lean and Six Sigma combined in some way.

Dr. Mason: I hear it in the same breath all the time, Lean Six Sigma.

Mark: I tend to think of it honestly, to me, as Lean and Six Sigma. I'll use an example. The last manufacturing company I worked for, Honeywell, had people like me who went through essentially a black belt program that was very focused on the Lean methodology.

Honeywell, at the time, was developing something called the Honeywell Operating System, equivalent maybe to the Baptist Management System, this focus on leadership and culture. They also trained people as Six Sigma green belts, black belts, which was then basically incorporated almost into a full-time job, and then master black belts.

What I'm seeing, Lean methodology and Six Sigma methodology can absolutely coexist in an organization. To me, I would frame it in terms of a Lean culture that also has some Six Sigma specialists in it. Because there's certainly a power in engaging everybody in improvement, teaching everyone to be a problem solver.

Maybe 80 percent of our problems can be addressed that way. Then there are the particularly sticky problems that might require the deeper rigor of Six Sigma.

There's a risk when I've seen organizations jam it all together in terms of training or approach. It turns out to be mostly Six Sigma with a little bit of Lean. That loses the real potential. If we break Lean down into like, “There's a couple of tools that we implement.” That's not as powerful as changing the way we manage. That's not as powerful as changing the culture.

If we're going to go and train people, there's education, there's practice, and then there's certification. We can do education and practice without the formal certificate. I'm not bad-mouthing the certificate, but I think there's a risk, and I saw this back in the last manufacturing company I worked for.

They were proud that they had trained and certified, we'll call it 500 people, to get the Six Sigma green belt, and everybody had to do a project. So it wasn't just education. It was a project that was mentored by black belt. That's good. Only half-jokingly, we'd say, if there were 500 belts, the completed total number of projects that were ever done was about 503.

What happened after people got their certification? The climate, the culture, the environment, didn't allow them to, didn't encourage them, to go and do additional projects.

I'm like, “Well, that's OK. Maybe it was good that they got some projects done.” But there's an even bigger risk of training and certifying people and then what? Again, I'm not opposed to certification, I'm not opposed to belts, but to me, that's not the most important thing.

Dr. Mason: Sure. You mentioned tools that are used with Lean and I see, on your bookshelf, your book, Measures of Success. I want to move into that a little bit. I worked at the same hospital for 22 years and I sat in meeting, after meeting, after meeting, when we were talking about quality scores or HCAHPS scores or whatnot.

One month we'd be in the meeting and the score would be higher and we would pat ourselves on the back. The next month, the scores would be down and we were wringing our hands and wondering the sky is falling. This is the end of the world.

Then I read Doctor Wheeler's book and recently I read your book Measures of Success about process behavior charts or XmR charts and what not. The light bulb went off.

Mark: Good.

Dr. Mason: You start thinking, “We just been looking at all this the wrong way.” Skip and I were talking before we started. Process behavior charts have been around forever. Not forever but for a long, long time.

Mark: Almost a hundred years.

Dr. Mason: Yeah, a hundred years. That's a long time. How much do you think they are underutilized in healthcare, as we look at our processes? For those who are listening who don't know what a process behavior chart is, maybe just in a nutshell, you might could talk a little bit about it.

Mark: There's a lot of great questions there, Dr. Mason. For one, I am pleasantly surprised, if not thrilled, whenever I see a “control chart” or a process behavior chart being used in healthcare. This is true in other industries. This is something that's not taught in MBA programs or MHA programs.

I've taken statistics classes, but I only know of Dr. Wheeler's book, “Understanding Variation,” because thankfully, my father, who is an engineer at General Motors for 40 years, had exposure to Dr. Wheeler and had that book on his shelf. Dr. Lancaster, you call yourself a nerd. I'm a nerd, and then I picked up this random statistics book off of my dad's bookshelf and read it.

That's the most applicable, helpful thing I've come across because Dr. Mason, what you're describing, this dynamic of celebrating every uptick and getting upset about every downturn, every up and down in a metric or when the metric…

You might see, be it in a meeting or see a “dashboard”, which I think that's not the right word to use. A big grid of numbers, showing month by month. You got 20 different metrics in 12 months. There's this dense list of numbers.

They might sometimes be color-coded red and green or red, yellow, green. I've seen some organizations. It goes red, yellow, light green, dark green. It's like the belts. How many colors of belts are there?

A process behavior chart is, for one, if you're in Excel or you think of it as a run chart or a line chart, there's a group. Also, within the NHS, the National Health Service in England, they are teaching this methodology even at the board level of different hospitals and trusts, as they call them there. They shift away from the red, amber, green color-coding.

They have a hashtag they use on social media. It's #PlotTheDots. If anything, just visualize as a chart. The human brain is not good at looking at a long list of numbers. I've concocted different scenarios I use in training classes. Throw the slide up and say, “Quick. Which metric deserves the most attention right now?” If there's 10 metrics, you'll get people voting for 7 of the 10. We're visual by nature, most of the time.

Looking at the chart that visualizes, now maybe we start seeing patterns. What we might optimistically describe as a trend maybe is more of just an up, down, up, down, up, down in the metric or up, up, down, up, down, down, up. It's not just strictly up, down, up, down.

When you're visualizing, you maybe see, “That metric looks like it's just fluctuating around a stable average.” In a process behavior chart, as a version of control chart, what have us calculate and average for a baseline period, throw it on the chart.

I start to see, over time, is it just fluctuating around on the average? You might see a chart where the first six months of the year were below average and the second six months are above average. That tells us something different. Maybe that's not a randomly occurring pattern in the data.

Then we add two other horizontal lines to a process behavior chart that are calculated based off of a base line period of data. We're basically looking at the point to point variation. How much variation is there on the metric from month-to-month or day-to-day?

We're calculating what we call lower and upper limits on that chart. This equips us to, as Don Wheeler teaches, to separate signal from noise.

Noise is that fluctuation around an average. The subtitle of my book, Measures of Success, tries to summarize it — “React Less, Lead Better, Improve More.” When we're reacting to everything and maybe we ask someone to go investigate or explain, or do a root cause analysis, that might just be a waste of time.

Instead of trying to explain each up or down, we need to look at the range of typical performance. If that level of performance is not where we need it to be, we need to be a little more systematic instead of being reactive.

When we have noise in a underperforming system, we need to step back and figure out how to boost performance, how to shift the average. Then when we do see a signal, one example would be a datapoint that suddenly falls outside of those limits, that is worth reacting to. Process behavior serves as a bit of a filter. When should we react? Immediately or not.

It helps us evaluate the cause and effect between things that we've done to try to improve, and the measures. There's risk of, we have some sort of project. We're convinced we've got something that's going to make, let's say, patient satisfaction better. The first two datapoints after this implementation are above average and we declare victory.

Political polling always represents data with plus, minus. If some candidate's got 51 percent and another one's got 49 percent, they say plus or minus four percent. We'd say that's a tie. If a candidate suddenly falls from 51 percent to 49.7, they probably shouldn't fire their campaign manager. I don't know what the parallel would be there.

In organization, we want to use process behavior charts to help us evaluate cause and effect to better understand that, and as we're just tracking metrics that matter over time, understanding when we should react or go investigate within the metric seems to have gotten worse or have gotten better.

Skip: I'll give you a funny story on that, Mark, that you might enjoy, and Dr. Mason, Dr. Lancaster. Seven and a half years ago when I first started, there was a physician that's no longer at Baptist. We became friends. He called me and he said, “Hey, I need you to analyze some data for me if I send it to you.” I said, “What is it?”

I was still new to healthcare. It was blood culture contamination rate. He said, “I want you to let me know whether I'm right or the lab director's right.” I said, “What?” [laughs] I said, “There's another option, you understand, right?” He said, “What's that?” I said, “Neither one of you could be right.” He goes, “Can you just look at the data for me?” I said, “Sure.”

I asked him what it was. It was like 36 months' worth of data. All I had was a pencil and paper, because the calculations are pretty simple. I threw out a process behavior chart. It couldn't have been more predictable. It couldn't have been more consistent. For 36 months, this was what we'd call common variation, up, down, up, down, up, down and within the limits that Mark was referencing.

When I shared it with him, you could tell he was disappointed. He said, “What's this thing telling me?” I said, “It's telling you that the process is doing the very best that it can do. If you don't like it, you're going to have to fundamentally change the process.” It was really funny [laughs] because you could tell that was not the answer he wanted.

Mark: The math for process behavior charts is easy. It is arithmetic. It's not calculus. The politics and the psychology and the human nature is the challenge. When people have spent a lot of money to implement something and they're hell-bent on proving that it's successful, we could get into trouble.

Process behavior charts, as Don Wheeler calls them, it's the voice of the process, the voice of the system. The story that a process behavior chart tells might not line up with the story somebody wants to tell within the organization. That creates…

[crosstalk]

Dr. Lancaster: I had a bit of a similar story. I think I shared this before with patient satisfaction and doing that exact same thing. I've been presenting this multiple times a week at this prior organization. It was up, down, up last week, or week before, or week before that, and they were presenting that. Then as we look over the last three years of this and there was no change at all.

I did get them to start presenting the run chart, as opposed to the old chart. I got them to start presenting the run chart, but they also still insisted on using the old chart too. [laughs] Either we're halfway there, but they didn't throw out the old way. They liked the red, yellow, green.

Mark: Visualizing the data, whether it's #plotthedots or #connectingthedots, going back to the name of your podcast here, breaking the old habits is more difficult than doing the math and drawing the chart.

Dr. Mason: Sure. I know, Mark, you didn't come on this podcast for us to plug your book, but I am going to plug your book, Measures for Success. Anybody who is serious about improvement, especially in healthcare, you need to learn about process behavior charts.

I got the Kindle version, it's very well written, you explain it in just a way that it's very, very easy for us non-nerds, Jake, to understand it. No, I'm kidding, Jake. It's very well written, Mark, and I appreciate it.

Mark: Thank you.

Dr. Lancaster: I'm definitely a nerd. I have once in my life, picked up a book on statistics and started reading it, but I also did these great courses plus lectures where I listened to one on Intro to Linear Programming. So, yeah, I like my nerd level. I do have a question about your book. It says, “React less.”

If you read the book and then I come in the next day, I'm at my office, and I want to, all of a sudden, start being Lean. I want to introduce the Lean methodology, one, to my day-to-day work, and then two, maybe at the organizational level.

It's difficult when you walk back in and I still have the same number of meetings on my calendar, I still have the same number of emails I need to respond to. What's the first step you take to change, whether as an individual or as a company?

Mark: I guess you're asking more broadly if we want to apply Lean methods and maybe we lump process behavior charts under that umbrella?

Dr. Lancaster: No. Just Lean in general, going back to the main theme.

Mark: There's a number of things. There's an underlying requirement of some foundation of trust. How are the relationships between staff and their leaders? Do they know who their leader is?

I've worked in some hospital laboratories where people know their immediate supervisor, but they barely know the lab director's name. There is no relationship. Or if the lab director is out there then they go, “Gosh, something has gone wrong,” somebody is in trouble.

In some settings, I don't know for your situation, Dr. Lancaster, I'm going to assume you have a good relationship with people, but sometimes you have to do a bit of a baseline of, are we building trust, helping people understand that as a leader you're there to be helpful?

There's a big element of servant leadership in the Lean methodology. Of the people saying, “As a leader, I work for the employees,” and to mean that. There's some level of trust and relationship.

I learned that at General Motors. This new plant manager who came in as an outsider would spend… the old plant manager was the imperial type who always stayed in his corner office and rarely came out into the factory. The new plant manager was out there all the time building relationships with the frontline employees.

I was young and impatient, and I remember asking him one day when I saw him out there, I said, “Larry, we have so much improvement we have to do, you got a lot of us who are onboard, when do we start changing things?”

It was one of these sort of Mr. Miyagi, “Oh, Grasshopper” [laughs] kind of moments. He probably took a breath, he was very patient with me, and he said, “I've helped turn around other plants and this plant's…” I'm paraphrasing, but he said, “this plant's not really any different. I think I know what we need to do, but the people who work here don't know that I might know.”

He wasn't out there just selling but he was out there listening. That was a seed change in the leadership approach. There's a level of relationships. Beyond that, I'm a big fan of baby steps, of starting small. This is where the practice of Kaizen, as Joe Swartz has implemented at the Franciscan Health System in Indianapolis, and as I've helped people with and as we've written about.

There's a certain psychology behind it. I've done podcasts or interviews with a psychologist at UCLA who talks about how the fight or flight instinct kicks in.

People get scared, and instead of telling them don't be scared, by relatively large change, even if they're engaged in it, the best way to circumvent the amygdala is to make change small. This idea of baby steps, of asking people, what — you almost make a game of it — what's the smallest problem that we could work on first?

What would make your day a little bit less frustrating? What would make things a little bit better for the patient? Start small and teach to have an iterative systematic approach that people would often refer to as PDCA cycles. Plan, do, check, act, or PDSA. I like to say, plan, do, study, adjust.

Even a very small change of, like, “I think I should move my microphone over to the left.” I'm not just implementing that. I know I have a theory of why that might be better and then I'm going to evaluate.

I'm like, “Well, now it's getting in the way of the screen. Did it make sound quality better?” You might say, “No.” I'm like, “OK, let me put it back to where it was.” Then I need… get coached on what problem…

[crosstalk]

Dr. Mason: By the way, I have a little bit of microphone jealousy. I like yours a lot.

[laughter]

[crosstalk]

Mark: You've got a good mic.

Dr. Lancaster: It's a good mic, but…

Dr. Mason: Yours looks wow.

[laughter]

Mark: You've got a good microphone there. As we're coaching people through this process, we want to ask them… This is not a suggestion box system, by the way. Of like, “Hey, everybody, write down a random idea and put it in a box.” We're trying to coach people to not jump to solutions. That's exactly what a suggestion box did.

Instead, we can teach people and we can ask, what waste do you see? What problem are you trying to solve? What opportunity is there? Because we can then coach people through if they make a suggestion that is impractical, or too expensive, or violate some regulation. We don't just say, “No, your idea is rejected.” We go back and honor the problem or the opportunity.

Instead of just saying, “No, suggestion was rejected, end of conversation,” we step back and ask, “What else could we try to either ‘solve' that problem or even make it 50 percent better?” Then keep iterating and learning. Then people are engaged, saying, “We're working on things that matter to me.” That's very powerful.

Then they start building confidence and building capability that allows them to maybe start tackling bigger, more complex problems.

Skip: Well, Mark, I can't tell you how much I appreciate you and I know I could talk a lot longer. But I do have one question as we kind of bring the episode to a closure.

I think about all the episodes of yours in all sincerity that I've listened to whether I'm at the gym, or whether I'm driving, or whether I'm out walking.

Mark: Or whether you're a guest which you've done twice.

Skip: Or a guest. One question would be, after doing this for 15 years, Mark, are there certain guests that really made you go deeper into an area or maybe helped you connect some dots yourself after you hung up with them? Is there any that come to mind?

Mark: Yeah. I'm going to mention two people real quick. One, the psychologist I mentioned earlier. Robert Maurer. M-A-U-R-E-R. I've interviewed him a couple of times.

He's written two books on kaizen and continuous improvement and the connections between psychology or what some people might even call brain science. Dr. Maurer I think has been incredibly insightful.

Then I have to give credit Norman Bodek who passed — he actually passed away in December in his mid-80s. Norman was a teacher of mine. He was a mentor. I had a good relationship with him over the last 15 years. I have a podcast because of Norman Bodek.

We had done a kind of emailed back and forth, text Q&A that was on my blog. I had done that with others. I thought that was fine. Then Norman gave me the gift of an idea. He said, “You should do a radio interview with me.”

Well, I don't have a radio show or a radio station and I didn't have this cool microphone. But back in early mid-2006, podcasting was starting to take root. I said, “Well, Norman, I can interview you through Skype and we'll record it and we'll publish it as a podcast.”

He was my first guest. He was my second guest. He was a guest a number of times. Learning about continuous improvement from him and like the example that Norman set. I mean, he worked up until — he was working actively and working hard until the day he died because he loved what he did.

He was honest-to-God a lifelong learner. He really epitomized that phrase where he was continuing to travel to Japan and meet new thought leaders who he could bring to a broader audience by publishing their books or translating their books.

That's one thing I admire and I will hope to try to emulate the rest of my career. Whether that rest of my career and rest of my life is one and the same, I don't know. But I want to emulate that example that Norman Bodek set.

Skip: Wow. Well, Mark, thank you so much for time with us today. Thank you so much for the books that you write, for the podcasts that you do, for the impact that you're making in healthcare.

Just want to say on behalf of myself and Dr. Mason and Dr. Lancaster and Baptist, thank you so much for your time, my friend.

Mark: Thank you. I appreciate it. Skip, and Dr. Mason, and Dr. Lancaster, thank you for having me. Maybe someday we can turn the tables and you can come talk about what you're doing on my podcast.

Dr. Mason: Thanks a lot, Mark.

Dr. Lancaster: Thank you.

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Mark Graban is an internationally-recognized consultant, author, and professional speaker who has worked in healthcare, manufacturing, and startups. His latest book is Measures of Success: React Less, Lead Better, Improve More. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. He also published the anthology Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also a Senior Advisor to the technology company KaiNexus.

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