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Disclosure – I often work as a senior advisor with Value Capture clients and I have a marketing role with the firm.
Gerald has over 25 years of leadership experience in the delivery of successful large-scale lean transformations across a broad range of industries and companies. His industry experience includes various automotive manufacturing settings and products and, for the past 14 years, healthcare.
While at Tenneco Automotive, a $1.5 billion manufacturer of exhaust and ride control systems, Gerald implemented lean manufacturing and lean enterprise improvement principles throughout the organization.
For the 14 years before joining Value Capture, Gerald served as Executive Director for Simpler North America, where he was instrumental in client launches and Executive Coaching for most of Simpler's largest clients.
Today, we discuss topics and questions including:
- How — when and where — did you first get introduced to Lean?
- Motivations for Lean in those early settings?
- Early activities — what went well? Lessons learned from challenges?
- Pull – “flow if you can, pull if you must, but never push”
- Did people there even think that improvement was possible? Any improvement was possible?
- Short-term vs. longer-term countermeasures, adding inventory to be able to improve — or adding labor?
- “Step change” – response to medication errors? Adding inspection step?
- Interesting that Toyota still has final inspection??
- Systems vs. processes?
- Work, management, improvement systems
- From nursing tasks to the healthcare value stream
- Seeing vs. purposeful observation?
- Value Capture's “guided self-assessment”
- Leaders being too far removed from the work in healthcare
- How did you find the right balance as a plant manager?
- You've gotten more than comfortable with both… Bigger adjustment — becoming a consultant or shifting into healthcare?
- The pitch for Value Capture?
- The Habitual Excellence podcast
- Envisioning the ideal – how do we get to zero?
The podcast is sponsored by Stiles Associates, now in their 30th year of business. They are the go-to Lean recruiting firm serving the manufacturing, private equity, and healthcare industries. Learn more.
This podcast is part of the #LeanCommunicators network.
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Automated Transcript (Not Guaranteed to be Defect Free)
Welcome to the Lean Blog Podcast. Visit our website www.leanblog.org. Now, here's your host, Mark Graban.
Mark Graban (12s):
Well, hi, welcome back to the podcast. I'm Mark Graban. This is episode 459 for October 4th, 2022. Joining us today is Gerald Harris. He is a Vice President of Advisory Services at the firm Value Capture. To learn more, you can go online valuecapturellc.com. Today we are going to tap into Gerald's experience and expertise. He has more than 25 years of leadership experience in different settings like me. He started in the auto industry. Unlike me, he stayed longer and he had significant leadership roles in a number of organizations.
Mark Graban (53s):
He then shifted into consulting where he is been doing a lot of work with healthcare organizations, including recent years with Value Capture. So lots to learn today. I think a lot of great transferable experiences and stories that you're gonna enjoy regardless of what industry you're working in. So, for more detail and links, you can look in the show notes or go to leanblog.org/459. Well, hi everybody. Welcome back to the podcast. My guest today is Gerald Harris. He's a Vice president of advisory Services at the firm, Value Capture. As a quick disclosure, I myself work often as a senior advisor through Value Capture with their clients.
Mark Graban (1m 38s):
I have a marketing role with the firm, and you know, I'm, I'm thrilled that Gerald is one of my colleagues there. So he has more than 25 years of leadership experience in delivering successful large scale lean transformations. And he is done this across many industries and companies. He's worked in automotive, manufacturing, various settings there and for the, the past 14 years in healthcare. So at one of his stops at Tenneco Automotive, a large manufacturer of exhaust and, and other systems, Gerald implemented lean manufacturing and lean enterprise improvement principles throughout the organization. So I'm sure we'll hear some stories about all of that today.
Mark Graban (2m 18s):
And his first step into healthcare, which we'll talk about as well. Gerald was an executive director for Simpler North America, a firm that you've likely heard of, where he was really instrumental in both client launches and executive coaching for some of their largest clients. So, with that, Gerald, we'll learn more about your background as we talk here, but welcome to the podcast. How are you doing?
Gerald Harris (2m 39s):
Well, I'm well, and thank you, Mark. Thank you for the gracious introduction. Much appreciated.
Mark Graban (2m 46s):
Sure. I appreciate you being here. It's a great opportunity to, to pick your brain and, and hear your experiences from, from all of these different settings and what we can take away from that. But, you know, first off is it's become kind of a standard, standard opening question here on the podcast. Gerald, you know, to, to ask about your lean origin story, you know, some of, some of the, the where, when and how, you know, how, how did you first get introduced to all of this?
Gerald Harris (3m 13s):
Yeah, sure. So I'm gonna date myself here a little bit, Mark. But back in the early to mid-eighties, I was working for an organization where we made door panels for Toyota, Toyota Georgetown. And we were in a situation where we couldn't make enough product for them. And not only could we not produce enough product, the product that we produced had grave quality issues associated with them as well.
Gerald Harris (3m 59s):
So I'm gonna give you some crazy numbers here, but from a quality standpoint, we were in the double digits and quality and defective doors that we were shipping to Toyota. And also we were only able to produce about 30% of the requirement.
Mark Graban (4m 23s):
Gerald Harris (4m 25s):
So that's when Toyota graciously came in and instead of firing us and looking for another supplier, they offered to help us with the troubles that we were having. And I'll tell you, it was pretty astounding to me as working with them over about a nine-month period, we were able to reduce our quality issues down to about 3%. And we really improved productivity or, or the amount of product that we were able to ship by 160%.
Gerald Harris (5m 14s):
Wow. So it was a huge turnaround from, I'll give you some numbers. You know, we were producing about 250 sets of doors and in nine months we went from 250 sets of doors to 2,400 sets of doors Wow. In a shift. Wow. So it was pretty phenomenal as we implemented things like pull. So we implemented a pull system and you know, people think about TPS or Toyota Production System and they think, well, you know, single piece flow.
Gerald Harris (5m 60s):
And you know, we had a saying, you know, flow if you can pull, if you must, but never push. And so that was kind of the jingle that we used in producing parts. And so we actually added inventory, believe it or not, to the constraints where we had constraints and then, you know, built the system that was able to support it. And again, went from 250 sets to 2,400 sets of doors in an eight-hour shift, which was pretty phenomenal.
Gerald Harris (6m 44s):
So they kind of had me at hello. And you know, I've been going, you know, full bore ever since
Mark Graban (6m 53s):
That's certainly an eye-opening demonstration of what was possible. Right. I mean, I'm, I'm, I'm curious to hear your reflections, there's a lot we can sort of, you know, unpack from all of that. Like what, what were, do what do you remember about the attitudes of your, your coworkers or others about like whether it was possible to improve at all yet alone to take such leaps?
Gerald Harris (7m 14s):
Yeah. So thanks for that question. So, you know, going into this, as you can imagine, the culture, the attitude around that particular department was way down. I mean, people were working 12-hour days, seven days a week, and seemingly no end in sight. So, you know, and the people didn't really believe that, you know, this area could even be improved at all. I mean, they were doing, I mean, you know, no pushback on the people.
Gerald Harris (7m 57s):
I mean, it wasn't the people's fault, it was the process. Right. And, you know, the people just working hard and not seeing the fruits of their labor. And so, you know, we didn't go in with, you know, back in those days, we didn't go in with an ideal state. And actually what we thought was possible, I'll tell you, was 800 doors a shift. So we thought we could move from, you know, the two 50 to 800. But once we hit that 800 mark, it really opened our eyes to everything else.
Gerald Harris (8m 41s):
I mean, that aperture just opened up for us and we could actually start to see what was possible after we made that first first step.
Mark Graban (8m 53s):
Yeah, it's inevitable here. Your, your stories are gonna trigger some of my own recollections from mid-nineties General Motors times. And, you know, I appreciate the emphasizing Gerald, you know, the problem was not the workers or, you know, people's effort. The, I mean, a lot of times I, I think people think if this problem was solvable, we would've already solved it through
Gerald Harris (9m 18s):
Mark Graban (9m 18s):
Right. Our effort. And that, that, that jumping ahead, that attitude is sometimes they're in healthcare. We, we can talk about that more later. But I remember, you know, the, the, the first plant manager and the first leadership style that I worked under at my two years at General Motors, that first leader did nothing but blame people's efforts. You know, we, we heard every day it became like a, a running galls humor joke on some of us of, you know, the plant superintendent is, which word is he gonna use first? Urgency or intensity. Cause like, those were, to him, the only two root causes and therefore the only countermeasures we needed more urgency, more intensity of like, come on that, that that's not what was lacking.
Gerald Harris (10m 4s):
So Mark, you bring to mind, even in the same department, I remember I had a hesitancy to go into that area because I saw managers being blamed for the, you know, for the process. And so, you know, people were blamed, managers were blamed, and every manager that went into that area was fired. So they only lasted about three months or so. And so that was an area that, I'll just be honest with you, I wasn't looking forward to working in.
Gerald Harris (10m 46s):
Yeah. And, but because of my success in other areas, I was being asked to, Hey, Gerald, come over and help us out. And I'm thinking, well, I need a job. And no one has lasted, you know, 90 days over there. And so I wasn't putting my hand up to be fired as well. But, you know, things worked out and I, I'm just telling you the power of lean and at that time we really focused on cell redesign. So redesigning the process, we looked at it more of a full value stream view.
Gerald Harris (11m 32s):
So looked at it end to end, understood where those constraints or bottlenecks were within the system, did the things we needed to do to elevate those. And, you know, we were off and running and the people really could see, you know, the, what the, the people saw other than numbers was they got their lives back. And so, you know, they went from 12-hour days to 10-hour days to eight-hour days, and from seven days a week to six days a week to five days a week. And, you know, got some really balanced back in their lives as well.
Gerald Harris (12m 16s):
And they really enjoyed, you would think that, you know, you were talking about intensity, but really we were actually able to slow the people down so they could do the work that we were paying them to do and that they were intended to do. And so taking the waste out, they were able to slow down and make more product. Yeah. And I know that doesn't make sense, you know, it's not intuitive when you think about it, but as you slow down and you're able to do more, so the, you know, their work, the people's work became much more satisfying and gratifying to them.
Gerald Harris (13m 4s):
And they weren't working as hard, quite frankly. Right. Yeah. Right. But we were producing much more than we were when they were working hard.
Mark Graban (13m 13s):
Well then, you know, jumping ahead again, before we jump back, I know, I'm sure you and I have, I know you and I have seen situations where improving processes of, you know, how the work is done and improving the support systems mean that nurses or doctors or other healthcare professionals are still working 10 or 12 hour days, but if they can are then spending more time on patient care because they're not running around dealing with waste. Same thing like the, it's probably less net effort, even if it's the, the same amount of time. It's certainly, let's say fewer steps, they're accomplishing more because of the system improvements.
Gerald Harris (13m 55s):
Absolutely. Absolutely. Mark. So when you asked me, you know, you know, how did I get started and when, so back in the early eighties and just going through, you know, that set of circumstances really opened my mind to what continuous improvement could do for not only me, but what it did for my career as well. Yeah. And so it kinda launched me into a different stratosphere where people wanted to see. Right. So it, it created a pull.
Gerald Harris (14m 37s):
It's like, how are you able to do that? You get, Hey, you gotta come and teach us. You gotta show us. Right?
Mark Graban (14m 43s):
Yeah. And so I, I'd love to talk more about, you know, some, the, the progression over time, both kind of generally I think with lean as it was being talked about and, and your own experiences. Like you, you talk about this idea, I think the most counterintuitive idea is sometimes you add inventory to improve flow and delivery, even if it's a Toyota person, you know, coaching on this. Cause I've seen organizations in manufacturing that, that took the idea of one piece flow to an extreme where like the systems, whether it was quality or you know, feeder lines of sub-assemblies, nothing, nothing was capable of one piece flow.
Mark Graban (15m 24s):
But people wanna make that leap. And then you see, you know, a Japanese consultant, some of you know Toyota experience come in and start telling people you, you need more inventory. Like I heard it described as, you know, job one is meet customer delivery, job two is low inventory. Right.
Gerald Harris (15m 45s):
There you go.
Mark Graban (15m 46s):
Yeah. And like at General Motors, I saw like, you know, people would want the pendulum to swing the other direction where, like you were describing like buffering around a constraint can really help improve flow. There was overlap, you know, GM was learning Theory of Constraints. I was, I was kind in this battle against people who wanted to buffer everything everywhere. Buffering, buffering something that was clearly the, the, the constraint. But I'm, I'm, I'm curious if there's anything else you would share about this idea of, you know, first off, supporting the customer and then figuring out how to drain down inventory.
Gerald Harris (16m 27s):
Well, yeah, Mark. So, you know, when you think about adding inventory, sometimes that's necessary because you have to stabilize a process right before you can start to take the inventory away. And oftentimes, you know, people that don't know any better, they would try to go straight to one piece flow without the stabilization, and now all of a sudden you can't support your customer. And like you said, you know, it's customer first. We have to support the customer.
Gerald Harris (17m 7s):
So we do the things we have to do to do that. And then we start to put the tools of continuous improvement at work to then you can start to see where you can reduce some of that inventory that was firstly added on. But, you know, when you, this takes me back to a systems approach. And when you think about it as a system and not just the process, when you stabilize first and put the systems in around that, it allows you to then take the next step.
Gerald Harris (17m 50s):
And that's actually reducing the inventory or those add-ons that you had to do before you became stable. You know, back in the manufacturing days, Mark, I'm sure you remember, you know, a lot of the reasons for our production lines not being stable is that they didn't have the capability. Right. From a, from a quality standpoint or even from a downtime standpoint. You had so much downtime around you that, you know, you couldn't stabilize either. So you had to build that inventory in order to be able to satisfy the customer.
Mark Graban (18m 34s):
And it makes me think of, you know, language, you know, that, that you and I know, and a lot of our audience might know the difference between a short-term countermeasure and a longer-term countermeasure. Like this idea of adding inventory, of buffering around a constraint isn't meant to be a permanent long-term countermeasure. Can, can you, can you tell us a little bit more about that? Or even other instances where a short-term countermeasure might seem to violate some lean principle for what it's worth, but it's a, it's part of your pathway toward longer-term improvement.
Gerald Harris (19m 7s):
So I've got an interesting story to tell you around that. So whenever we came up on, you know, equipment that, you know, it was too much downtime and, and you either had to add labor or another piece of equipment to supplement to, you know, to mitigate that downtime. So those were those short-term things that were going into place. I learned early on as a plant manager, I would walk around and look and those short-term mitigations would end up being long-term solutions.
Gerald Harris (19m 50s):
And so knowing that, I wanted to make sure that whenever I put in this short-term mitigation, I wanted it to cost me so it would cost money because it couldn't stay.
Mark Graban (20m 12s):
Right. There's some pain,
Gerald Harris (20m 13s):
Right? Yeah. So there had to be pain around that. So we couldn't get comfortable with just leaving that add-on in place. And so, you know, I wanted to make it painful for us, so it would force us to go after it until the thinking started to change. That was what I would use to get, get people to move or get my engineers to move around those situations and make sure that we came up with a long-term solution that didn't cost us.
Mark Graban (20m 51s):
Right. Yeah. Well that's a great, that's, that's, yeah. I mean, I think that's, that's said really well of not letting people get comfortable with throwing people at it or throwing inventory at it, or, you know, throwing overtime at it.
Gerald Harris (21m 6s):
Right? Yeah. Cause over time, you know, you'll see that, you know, those things cost you hundreds of thousands of dollars when you let a short-term mitigation go in place of a long-term solution. So I tried to, you know, the short term was necessary until we could engineer or come up with a better way of doing it. But I wanted it to be painful so we could continue to focus on what was necessary to make that solution the right solution. Right.
Mark Graban (21m 45s):
Yeah. You know, and, and there's another word that we would both use back in the auto industry. I think it's interesting to think about how this might apply to healthcare. You know, a different short-term countermeasure when Gerald, you talk about protecting the customer, like comes to quality and defects. Like if, if defects were discovered somewhere along the line, you jump into containment mode, Right. Which might be a temporary increase in labor, an increase in inspection and in, you know, the quote unquote the waste of sorting out the defects so that that waste and that cost wasn't as bad as the waste generated by letting a defect slip through containment
Gerald Harris (22m 27s):
Mark Graban (22m 28s):
Right. To the customer from, from, from a quality standpoint. Can, can you share a little bit more about the idea of containment? Are there, are there times, you know, in healthcare if we're not producing physical products that have defects, is there a time that would be applicable in healthcare?
Gerald Harris (22m 44s):
Absolutely. So you, you'll see from a healthcare standpoint, and I've been working in healthcare mark for over, you know, well over 15 years now from a consulting standpoint. And the one thing that I see that healthcare does, they're pretty good at putting countermeasures in place, short-term countermeasures that end up being in that place for years. Yeah. Right. So they'll put a countermeasure in place and that just becomes the standard of work instead of looking at it from a continuous improvement standpoint and saying, we've got this countermeasure in place, but we're working on a longer-term solution.
Gerald Harris (23m 34s):
And so, sorry for the long explanation, but I have to get into this thing this term that I call step change. So in healthcare, continuous improvement for a lot of healthcare professionals, they just look at it, Hey, we put in a countermeasure, maybe we had a, a med error. And so we put a countermeasure in a short-term countermeasure to make sure that that med error doesn't happen. And that might be another person doing some manual inspection to make sure that that doesn't exist.
Gerald Harris (24m 21s):
But then they don't go back and look at the true system and try to figure out, well really what problem are we trying to solve? Solve it to root? So now you can take away the extra labor that you put in, right. And make it a system so the system takes care of it and you're not relying on an individual. And so when, when they rely on individuals to do that, you know, that problem, it goes away, but then it comes back, it goes away, but then it comes back.
Gerald Harris (25m 3s):
They, you could almost even predict if you did the analysis when those problems are gonna come back and haunt them again. Yeah. So they're not solving to root cause they're only doing the first level of containment.
Mark Graban (25m 21s):
Gerald Harris (25m 22s):
And not taking it deep enough.
Mark Graban (25m 26s):
Yeah. Where you're saying there, I'm trying to remember the source. I read something recently that talked about a healthcare organization that had put some protocols in place to reduce, I think the issue they were specifically looking at was patient falls. And it was, you know, have a matter of, you know, protocol standard work, kind of, you know, extra effort that was meant to contain that problem. And, and they got patient falls down quite significantly probably because of those protocols. And then, you know, the person who wrote this piece was complaining, I think correctly that the organization said, Well, that problem's been solved and they stopped doing the protocol.
Mark Graban (26m 7s):
Right. And it's an illustration of what you were describing of guess what, the problem came back. And my, I don't understand how anyone could predict anything different because to your point, I, I, I think they, they, they, they maybe they thought, they convinced themselves, they had eliminated some of the root causes of falls, but the data kind of showed like, well, clearly like you were saying, they hadn't.
Gerald Harris (26m 32s):
Yeah. And Mark, I think sometimes we jump at symptoms and not the root cause, Right. So we don't follow the process. You know, there are lean tools that help you to, you know, for me, tools are designed to help you see. And if they're not helping you to see or to tell a story, then they're not being used in the correct manner. And so, you know, we just, they have to do a better job of really solving to root and not just looking at symptoms.
Gerald Harris (27m 16s):
Because you can eliminate a symptom. That symptom goes away and it fools you into a false sense of security, thinking that you've solved it. Yeah. But it, oh, it's coming back. It'll be back and you'll be working on it again. I've worked with so many teams and they're looking at me and they're saying, Gerald, we fixed this like 10 times before. Well no, you never fixed it. Right, right. Because had you fixed it, we wouldn't be working on it for the 11th time. Right.
Mark Graban (27m 54s):
I mean, I think there might be a parallel, think back to, let's say automotive assembly or a Toyota production environment like Toyota for many, many decades has talked about the idea of building in quality, quality at the source. And they've worked on that I'm sure very diligently through, you know, error proofing methods and error proofing equipment and different, But I'm sure at some point if defective cars get into the customer at some point, if it wasn't always historically there, they put in a final inspection station at the end of assembly. And if you go to a Toyota plant today, anywhere in the world, I feel, I feel very confident saying this, even though I haven't been to a Toyota factory since late 2019.
Mark Graban (28m 43s):
The last one I saw in Japan was just like the one there in Texas, Guess what? Toyota has this very elaborate final inspection operation. Yeah. And if at some point that was a short-term countermeasure, I think it's interesting to think through the thought process. Like clearly knowing that Toyota's saying, Well let's save money by getting rid of the final inspection operations. You know, it's just interesting to think through how difficult it can be, you know, in a complex environment. And healthcare's a complex environment.
Gerald Harris (29m 17s):
Mark Graban (29m 17s):
Is how difficult it can be to really get to the point where you feel so confident in your process that you wouldn't need inspection steps.
Gerald Harris (29m 25s):
So, you know, it's interesting you bring up the final inspection process at Toyota or at GM or at, or if you think about that, the final inspection is there to protect the end user, the customer. Right. And so, but you can use final inspection in different ways. So final inspection used properly would really understand what issues are we having and then go back upstream and solve and fix those issues. Yeah. So, and it doesn't mean that you'll get to zero, but can you get closer to zero issues Yeah.
Gerald Harris (30m 12s):
As you come into final inspection. So if you use final inspection, look at what final inspection is telling you, and then go back upstream and fix where those issues occurred root cause so they don't happen, It doesn't mean that you might not get new issues. Yeah. But those old issues should start to go away. Yeah.
Mark Graban (30m 38s):
There's a difference. Again, back to your word of fixing, like we fixed the defect. So like to, to your point, the, the goal of final assembly is not to get better at fixing the same defects over time. It's like you said, to have those, those, those feedback loops and you know, I, you know, healthcare is a complex environment. Healthcare people would say, Alright, it's more complex than, than automotive settings. And, and, and what that's based on, you know, who knows, you know, people saying that things have generally only worked in healthcare, but they have their perceptions. But let's grant their assumption that healthcare is more complex and there's more things that could go wrong. Like there, there are a lot of settings in healthcare where it seems like the patient would be protected by maybe having more final inspection, but as a way of not just catching, let's say the medication error and over and over.
Mark Graban (31m 35s):
Like, there's a lot in healthcare that's based on, you know, barcode scanning a wristband or having things that are like meant to get better at fixing the problem, quote unquote fixing, protecting the customer. How, how can we do a better job of making sure that we have those feedback loops within healthcare I'd, I'd love to hear any examples or, or thoughts you have around that.
Gerald Harris (31m 58s):
So I think healthcare, so let me just say this. I think from a healthcare standpoint, they are woefully behind manufacturing when it comes to lean, lean thinking and lean concepts. And I might even agree with healthcare and say that they're more complex, but at some point, they have to realize that working harder is not working smarter. And so let's think of a caregiver, a nurse for instance, and she's probably, you know, know if she's fortunate.
Gerald Harris (32m 42s):
You know, you've got one nurse caring for five to seven patients in a unit. And we keep putting more and more and more on nurses. I'll tell you, I'll give you an example. Nurses are taking care of supplies and stocking supply rooms. And you might think, well, why is a nurse stocking supply cabinets and supply rooms? And that's not patient care. They do so much that has nothing to do with patient care.
Gerald Harris (33m 24s):
And so we keep asking them to do more, but we don't take anything off of them. And so then we wonder, well, why do patients fall? Well, the nurse can't be in the room, you know, a hundred percent of the time. So what else can we do to ensure that patients aren't falling either on their way to the restroom or trying to get out of bed? Why are call lights going off and the nurse can't get to the room and answer 'em? So it is, we continue to ask nurses to do more again, but we're not taking the waste off of them.
Gerald Harris (34m 7s):
We're not allowing them to work to the top of their license. And so it's right back to the, in my mind, what I talked about when I first broke into lean and it was slowing down so they could do more. And so how can we slow nurses down so they can give better patient care?
Mark Graban (34m 37s):
Right. And, and, and how do we, how do we support them? You know, this comes back to core concepts of standardized work, of not just diving into the detail of how we do the work. Like, you know, the procedures, hospitals have endless procedures and, you know, binders or nowadays they're probably online, but like, there are these questions first I, I'd love to hear some other examples from, from your experience of defining who should be doing what and like when, like lots and lots of procedures does not equal the design of a shift.
Gerald Harris (35m 13s):
Mark Graban (35m 13s):
I'd love to hear some other stories or thoughts from you around that.
Gerald Harris (35m 17s):
Yeah. So you know, it's looking at it as a system and I think sometimes we get too caught up in process. And so when I say system, I'm talking about the work system, the management system, and the improvement system. And when we link those together, we can broaden our aperture and look at nursing more as a value stream, not as just what they do. And then you can start to extrapolate who's doing what, and you start to differentiate from actually patient care to other things that's going on.
Gerald Harris (36m 4s):
And as you start to parse that out, I believe we could deliver care cheaper, more efficiently, higher quality by doing that, then just trying to throw everything on one person's shoulders. And I know from a healthcare standpoint, they look at it and say, well, you know, labor is, you know, 85, 90% of what we have, right? I mean, you know, so, you know, and so you keep seeing them either hiring people or laying off huge portions of people because they haven't figured out that if you rightly divide the work, you could do the work more efficiently.
Gerald Harris (36m 52s):
You could do the work with better quality and you could do it cheaper
Mark Graban (36m 58s):
Actually. Yeah, Yeah. Well, and, and, and labor cost is such a huge chunk of a majority and then some of a typical hospital's cost structure. And it's increasingly hard to get nurses, or if we're hiring travelers or you know, agency nurses, they're even more expensive. It seems like that all points back to the need as, as you've brought up to, to maximize the amount of time that nurses are actually doing nurse work.
Gerald Harris (37m 27s):
Mark Graban (37m 27s):
Not, and, and, and there could be some labor efficiency that comes from that, but then there's also gotta be this question of joy and work and satisfaction. Are our nurses less likely to quit if they're better supported and allowed to spend more of their time doing, you know, what they went to school for, what they wanted to be doing, not restocking shelves or dragging bags of dirty linen down a hallway. I mean, it seemed like there, there's a lot of complimentary benefits from that.
Gerald Harris (37m 58s):
Absolutely. And Mark, we've been talking about nursing, but what about the doctors and, and the amount of work that they're facing and that they take home every day. And you know, what I imagine is, you know, a physician that's able to go and say a primary care provider, for instance, going in, seeing a patient after that patient has had his labs so they can discuss 'em and see what problems they're having, solve those problems with the patient, go out, do all the charting and the work that they need to do, and at the end of their shift, they're on their way home with no work.
Gerald Harris (38m 46s):
And, you know, how many providers can you, if you were to pull providers, how many would say they're able to do that, go home and not have homework either before dinner or after dinner Right. And actually spend their evenings or their time with their family and you know, you, you have that good division of, you know, work and personal time. Yeah. Right. Why can't we design the work so they only have to work when they're at work and when they're at home, they're at home.
Mark Graban (39m 27s):
Yeah. I mean, when I first started working in healthcare, people talked about the desire, the important desire to, to go home on time, to get home for dinner. But you raise an important point there. Getting home on time might not mean as much if you're there in the logged into the EMR, catching up on messages or doing other stuff that ideally would've been done, you know, when someone was at work. And again, I'm not blaming individuals for being inefficient. They're, they're doing their best, they're working harder than they need to, and that that, that dissatisfaction and burnout and everything ends up being really, really, really harmful.
Gerald Harris (40m 9s):
Yeah. And so when you think about the pressures that my chart and those types of things put on physicians, and again, division of labor and why do we put everything on the physician to do and why isn't that extrapolated up? Yeah. Again, to allow them to see more patients, Right. It would improve access for patients. And so they're not waiting forever or panels are closed because they can't see doctors or even going in for doctor's appointment, which I had yesterday and I waited an hour before the, you know, I had 1:30 appointment.
Gerald Harris (40m 59s):
I didn't see my doctor until 2:30. Yeah. Well, my time's valuable too. Right. And why am I sitting there waiting and you know, I'm sure, you know, my caregiver was working hard and obviously behind schedule. Yeah. But is that my fault and should I have to pay for that? Right.
Mark Graban (41m 24s):
I mean, I just as a quick aside, I I think back to the time I fired a primary care provider or meaning I took my care, my business elsewhere because every time I would go in, and thankfully it wasn't that often, but it was always, you know, they were always an hour and hour half behind. And what I would ask about it, they would always say, Oh, today's very unusual. Either I'm extremely unlikely or that, or I'm unlucky, or that's unlikely to be true. Like the excuse making.
Mark Graban (42m 4s):
And, you know, talk a little bit about, you know, Value Capture, like, you know, the, the, the origins and the lessons from Paul O'Neill that are embedded in, in, in what we believe what we do. Like one of the, one of the things that stands out to me that, you know, that Paul O'Neill would say in part the job of the leader is to eliminate excuses that are the, the things that, the reasons why people would say, Well we, we, we, we can't ever keep the schedule on time because of this or that, or, you know, we're providing very, you know, customized care and great service and therefore we can't expect can't be expected to be on schedule.
Mark Graban (42m 45s):
Like, well, that, that's an excuse. Right? Yes.
Gerald Harris (42m 49s):
So, you know, I've, I've gotta got something to say around that Mark. So, you know, as we talk about the work we do here at Value Capture and how we, you know, help leaders be better leaders, but really help leaders get closer to the work. Yeah. And so what I see often is leaders don't know what's going on in the workplace because they are too far removed from the actual work. Yeah. And you know, as a leader, you know, they don't believe that they need to be or should even be close to the work.
Gerald Harris (43m 37s):
And because of that separation, they don't have a good feel for what's actually going on either on the shop floor and in hospital and a medical group. They're just not close enough to the work. And so with them being so far removed from, from the work because they believe, well, you know, I've gotta worry about strategy and I've gotta worry about, you know, mergers and acquisitions and growing my business. And yes, all of that is on them, but they also have to understand what conditions their people are working in.
Gerald Harris (44m 22s):
They also have to understand that it is their job to set the condition for people to work and be viable and to do the great things that they're doing that's leadership's responsibility. Right. And you know, without that, they continue to flounder or they have this belief that, well, you know, things look good from my ivory tower because they haven't gone down enough layers into the organization to even understand what's happening. Yeah. So, you know, I, you know, I, I'm a firm believer that even as a leader, you have to come out of the ivory tower and you have to go and observe.
Gerald Harris (45m 10s):
And you notice, I didn't say go see it is go and observe, go and observe what's happening so you have a better understanding of current conditions and what's happening.
Mark Graban (45m 25s):
So that's an interesting distinction in the words is, is observe a lot deeper than c where like we could, is it the difference between like doing a gumbo walk where you're walking through a department versus going to the gemba and really observing?
Gerald Harris (45m 40s):
Yeah. So, you know, in my opinion, when you go see you're walking through and it's not intentional. So you're just being a cheerleader, kind of patting people on the back and you know, you're just letting them see you and you're not observing what work is being done, what issues are, are taking place. You know, here at Value Capture, we have this Guided Self-Assessment that we take leaders through, and remarkably within about three minutes, you could observe actually about 20 different things that act that are going wrong in an area and you don't even have to pre-plant it.
Gerald Harris (46m 33s):
So observing is, I think, a deeper experience than just going and seeing. Yeah. So definitely.
Mark Graban (46m 45s):
Gerald Harris (46m 46s):
No, I was just saying definitely difference there. Yeah.
Mark Graban (46m 50s):
So I think we can connect some dots back. I want to maybe shift back to your time as a plant manager and as, how, how did you find that balance where as a plant manager or as a hospital CEO, you, you, you, you, how do you find the balance? You need to be aware. It doesn't mean you need to be giving all the answers far from it. Right. So how do you find this balance between observing and listening and understanding enough to be supportive without getting into the realm of, let's say, micromanagement or controlling?
Gerald Harris (47m 22s):
Sure, sure. So as a plant manager, part of my standard work was to go and observe. And I had, you know, fairly large plants, large footprints, so you couldn't go and observe the entire building and what was going on. So I had different route that I would take on a daily basis and I really tried to make sure that I was out on the shop floor daily, not every other day or not once a week. I would try to make sure that I was out daily when I had multiple facilities.
Gerald Harris (48m 5s):
Obviously that wasn't possible, but I tried to make it to each facility. You know, I would, you know, target a facility on a day, right? And as I walk through, I might stop talk to a supervisor or a manager. And as I'm asking them how things are going, what problems they're having while we're having a conversation, I had the ability to actually look at the production process and we are having a conversation, I'm watching the lines run, and I'm looking for issues.
Gerald Harris (48m 51s):
I am seeking issues, I wanna understand the problems that we're having. And then I could go back to my office, I would call engineering or whatever support that we needed, and I would be able to describe in detail what I actually observe and what issues they're having. And you know, over time, I was able to establish when I go back and look at that place again, those same issues I shouldn't see. Right. Because we have got on those and taken care of those issues, it doesn't mean that I'm not gonna see new issues.
Gerald Harris (49m 33s):
Yeah. But those same, you know, broken test stands for instance, should have been repaired and back in service or whatever quality issues they're having, they shouldn't still be having those same issues days later. Yeah. Right.
Mark Graban (49m 53s):
So it sounds like there's a parallel between the feedback loop of, let's say, Toyota final inspection of making sure things that are identified come back and get resolved in some way. A complaint I hear about a lot from, from people I work in healthcare or when I first go into an organization is people have become discouraged because even when they speak up about problems that need leadership support to get fixed, those things more often than not, are not getting fixed. And so people stop speaking up, Right? Not because they don't care, but because they think, well, it's just not worth the effort.
Mark Graban (50m 34s):
So I think there's, I think there's a big opportunity for leaders in healthcare to have that similar idea of really just kind of being tenacious in terms of getting the right support from different departments to make sure issues we, what, what good is it if we encourage people to speak up or even create the psychological safety to speak up if speaking up doesn't lead to anything.
Gerald Harris (50m 58s):
That's right. That's right. And so, you know, if I could digress a moment, I, I'll tell you a quick story. So I was consulting in a hospital and we had a project going in SPD, so sterile processing and sterile processing had, you know, at the, it was probably towards the end of that process where we had done many, many improvements and things were going well, The people loved it. The but is, it wasn't supported by leadership.
Gerald Harris (51m 37s):
So over about a six- or eight-month period, leadership had never even come down to see the great work that these people had done. And so when I called on this hospital, I don't know, it had been, you know, 10 months or so, I came back in, I went down to that department to sterile processing just to see, you know, check on their progress and how things are going. And to my dismay, the people were right back to where they had started.
Gerald Harris (52m 17s):
None of the production boards had been kept up. They had stopped doing the new and improved process and went back to the old way. And I looked around and I was thinking, so what happened? So I talked to some of the leaders down there, and even some of the people working in that area, and their response to me, they said, Gerald, our leadership never came down. They never the good work that we had done. I said, But it was working. Why did, why did you let it go back? They said, Well, they don't care, so we don't care.
Gerald Harris (52m 58s):
Yeah. And so in their minds, they were punishing leadership for not supporting them. And so they were working harder actually. I mean, it was, it was the saddest Yeah. Situation I think I've seen in a very long time. But they were, in their minds, they were punishing leadership for not supporting them. Yeah.
Mark Graban (53m 27s):
And that points really powerfully to the need for recognition. I mean, you know, people love using this phrase, rewards and recognition, people are gonna do good things. What's the role of rewards and recognition? Well, we can kind of flip some of that. I mean, recognition, maybe it doesn't cost you anything more than a little bit of time to give recognition. And, and for any leader who, who said, Well, well, people shouldn't need that recognition. Well, hey, guess what? People, we're, we're all human. This, this work is not just in the realm of, of the rational. We people, I mean, to state the obvious, people have feelings.
Mark Graban (54m 8s):
We can't, we can't ignore that or we shouldn't ignore that.
Gerald Harris (54m 12s):
That's right. And even a leader, they've been recognized because they're in the position they're in. So that's recognition to them. So I don't know how you can feel like you don't need to recognize your people. And when I say support, I don't mean that their leadership had to go down and do a rah, but they could gone down and asked, so what's gone, right? And what's in this area? What help do you need? Right? How can we support you? Yeah. That's all.
Mark Graban (54m 47s):
Yeah. How can we support you is such an important question. And that doesn't mean we're, there's this balance again where I know you're not suggesting that how can I support you? Means everything gets escalated to the leader. There's this kind of dual nature of we're empowering you, we're giving you the resources you need to do your job and to improve, but at the same time, we're, we're there to support you if we need to get help if facilities isn't following up, not to pick on them different systemic problem. Right. Or, you know, support you need from different areas. Yeah.
Gerald Harris (55m 23s):
Or you need crossover support, so you need another manager to come in and help, you know, depending on, you know, what you're looking at. So support can take on a lot of different pictures. Right. So you need that.
Mark Graban (55m 41s):
So, and, and so much of what you're touching on goes far beyond the tools. It, it comes down to, to leadership and culture. And you know, as we, as we start wrapping up here, Gerald, there was one question I'm when you made a transition was double transition from being, let's say, you know, internal leader, lean in a company, the transition to becoming a consultant at the same time of switching into healthcare. Like you've clearly gotten comfortable, more than comfortable with both, but which was the bigger adjustment?
Gerald Harris (56m 19s):
I think it was the healthcare. So going from manufacturing to healthcare was the bigger adjustment for me. It wasn't consulting, I think, I'll tell you, as a plant manager, as a lean leader within or other manufacturing organizations, I was acting as an internal consultant even in those roles. So the consultancy part I think was pretty easy for me. It was the going from manufacturing to healthcare and I'll, I'll just tell you this, the expectation in manufacturing, the, the urgency, the, the ability to make change and make change quickly, That's what I was used to in manufacturing.
Gerald Harris (57m 22s):
When I made the flip to healthcare, it became much more political, the sense of urgency. They say everything is STAT, but not really. And so, you know, I was a little disillusioned when I first came into healthcare, I'll tell you, I was thinking, Hey, we're gonna go in here and go and make these revolutionary changes. And even my, you know, CEO at the time told me, Hey Gerald, you gotta slow down because, you know, we, we, you know, we, we take things a little slower here.
Gerald Harris (58m 8s):
So that was the disillusionment for me. And that was, it was just, you know, healthcare moves at a glacial rate. When you think about the comparison between healthcare and manufacturing. Yeah,
Mark Graban (58m 24s):
I think, I think, I think there's a combination, There's a question of speed and there's a question of standards and expectations. So as, as we wrap up here and, and we're gonna explore and talk more about Value Capture, which Gerald at some point in the podcast series that I host for Value Capture, a podcast series called Habitual Excellence. But, you know, I think, you know, thinking back to Paul O'Neill and, and, and the, the clients, the, the great leaders we've worked with in healthcare, I think before you can get speed, there's gotta be higher standards. We're not gonna be satisfied with reducing infections by 5%.
Mark Graban (59m 4s):
We want, we're aiming for zero and we're gonna reduce them by 50, if not 90%, very quickly. There's that, that, that belief that a high standard is something we're really gonna seriously work for. You know, it's more of a statement than a question, but lemme bounce it to you, Gerald, about like, when you see the best of leadership and the best of results, how, how do, how does the, the expectation or the standard play, or how's that inspire speed and effort?
Gerald Harris (59m 36s):
Sure. So healthcare leaders that can envision ideal and so they start with ideal. So Mark, you were talking about zero, right? How do we get to zero defects? How do we change processes? So we see 50 to 75% improvement across all of our numbers, across costs, quality, delivery, growth. Right? How do we see 50 to 75% improvement in those realms? It's the leaders that they can envision it and they can see it, and then they can start to set the conditions within their organization for other people to see it, feel it, and then set a plan to actually go after it.
Gerald Harris (1h 0m 37s):
And, but you know, if you, if you don't believe it, then you know, you're, you're kind of dead in the water there. Yeah. But you, you have to know, and you know, I've been doing this a long time and sometimes when I talk to healthcare leaders and they say, Well, how much improvement should we expect? And I'm like, 50 to 75, and they are really hesitant to, you know, commit, Well, let's commit to 10%. I'm like, no, that's not breakthrough improvement. Breakthrough improvement is 50 to 75%, which means that we have to change the process.
Gerald Harris (1h 1m 21s):
We have to change what we do. We're not gonna make people go faster because you won't get it making people go faster. Right. You have to suck the waste out, slow them down so they can do more. Yeah. Right. And so it's those leaders that can adopt that type of thinking quicker are the ones that are, and we see 'em every day, Mark, they're successful. Yeah. Right.
Mark Graban (1h 1m 54s):
Yeah. And, and we, and we, you know, Value Capture you and others who work with clients and those of us, you know, kind of trying to help share the great examples of what's happening in in different organizations. Here's the challenge that I would lay out to healthcare and I'll hear your reaction to it, is, you know, when, when, if, if people think certain improvements to a certain degree, if they think it's not not possible, we can point you to organizations where it's happened. If there, why not your organization.
Gerald Harris (1h 2m 28s):
Exactly. Exactly. But they first have to get out of that mode that we're different and, and my patients are sicker. And, you know, if we can get rid of those excuses Yeah. And get them to think about really what's possible, we can go and take them and see what's possible. Right. Because they don't have to believe us. They look at us as guys in the shiny pants and we're trying to sell them on something, but we can actually take, take them to go and observe what other people are doing right. In the same space.
Gerald Harris (1h 3m 9s):
And you can see the types of improvements that they're making and that they're, you know, marching towards this habitual excellence. Right. And that's a term you don't hear much. Right? Right. Habitual excellence, and I love that term and it's what drew me to Value Capture in the first place, Right. People that wanna become habitually excellent, they don't wanna just be excellent one time, right? Yeah. They just wanna live excellence and they want to see excellence all around them, and they won't accept anything less than that.
Mark Graban (1h 3m 55s):
So it's, it's another one of those great Paul O'Neill ideals of striving for and achieving habitual excellence. So we can start reaching another phrase, the theoretical limits of performance. And I, I, as I try to emphasize to others, this is not about slogans. If zero harm, it's just a slogan, forget about it, it's about doing the work as, as you, as you've been describing, observing the work, improving the work, leading differently. I mean, it, there's, there's, there's a pathway. And, and I know you and others at Value Capture are happy to people, happy to talk to people about how they can do that.
Mark Graban (1h 4m 35s):
So, you know, people can learn more at the Value Capture website, ValueCaptureLLC.com. Gerald, if, if, if people wanna reach out to you to talk, how, how can they reach you?
Gerald Harris (1h 4m 46s):
They can reach me on LinkedIn. They can reach me here at Value Capture. So, you know, I am open and available for people to, you know, talk to, I would love to have a conversation with leaders that are looking to be habitually excellent. And how do you get started around that idea, right? Yeah.
Mark Graban (1h 5m 11s):
Yeah. And, and there's so many, you know, if people reach out and talk to you, there's so much more. I feel like we scratched the surface on what we, we can learn from you, Gerald. I, I feel like the conversation in a way kind of came full circle from the way you described your first exposure to Toyota people. They had to help you and the team understand what was possible. And like you said, some improvement, dramatic improvement, open people's eyes. I think the same thing happens when it comes to patient harm or employee harm. We can make that first 50% reduction and we know we can then I think that likewise open opens people's eyes to really keep going on the journey toward perfection or ideal care or theoretical limits, whatever you want to call it.
Gerald Harris (1h 5m 57s):
Mark Graban (1h 5m 60s):
So, Gerald, thank you. Thank you for being a guest. I look forward to doing, you know, a, another discussion in the Habitual Excellence podcast series. I'd encourage anyone listening here who wants to get a deeper dive in some of the concepts that we've brought up here today. Search wherever you're listening to this podcast for the Habitual Excellence Podcast. Or you can go to ValueCaptureLLC.com/podcast. I'll, I'll put a link there in the show notes. And Gerald, when we do our episode and our deeper dive into some of these approaches, I'll put a link to that on the webpage for this episode here in our lean discussion. So Gerald, really appreciate it. Thank you. Thank you so much for joining us today.
Gerald Harris (1h 6m 39s):
Sounds good, Mark. And thank you so much.
Announcer (1h 6m 41s):
Thanks for listening. This has been The Lean Blog Podcast. For lean news and commentary updated daily, visit www.leanblog.org. If you have any questions or comments about this podcast, email Mark at firstname.lastname@example.org.
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