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My guest for Episode #532 of the Lean Blog Interviews Podcast is Anne Frewin, a seasoned Lean leader with over 12 years of improvement experience in healthcare, laboratories, and manufacturing.
Anne's background in finance and healthcare administration provided her with a unique entry point into Lean — first supporting improvement efforts through data, and then stepping fully into the role of change agent. She shares the story of how a persistent mentor who always asked “why” helped her shift from just reporting metrics to developing problem-solving thinking and leading transformation efforts herself.
In this conversation, Anne and I explore how Lean principles, such as respect for people, effective idea systems, and a problem-solving culture, manifest in real-world settings. She explains why she prioritizes coaching people to become relentless problem solvers and how systems like visual management and simple idea boards, when supported with good questions, can lead to safer, more efficient work. We also discuss how Lean applies differently (but effectively) across industries, the balance between improvement and documentation, and how to avoid siloed thinking when solving cross-functional challenges–especially in healthcare.
“A strong idea system is the first real show of respect for people–it tells the frontline we value their insight and want them to own the solution.”
Anne also shares her perspective on Lean, Six Sigma, and Lean Six Sigma, offering a practical framework for how these approaches can coexist while serving different purposes. Throughout the episode, we reflect on systems thinking, psychological safety, and the importance of learning through experimentation. Whether you're in healthcare, manufacturing, or any people-centric industry, Anne's passion for leadership development and continuous improvement offers valuable insights.
Questions, Notes, and Highlights:
- How did you first get exposed to Lean, and why did it resonate with you?
- Looking back, did your mentor's persistent “why” questions help develop your thinking more than if he had been directive?
- How would you explain the concept of a Lean operating system to an executive unfamiliar with it?
- What's the difference between “respecting people” and “respect for people” in your view?
- Can you share an example of an effective idea system that truly engages frontline staff?
- How do you balance employee-generated ideas with the need for leadership support and coaching?
- What's your approach to helping people decide whether to use a rapid improvement event, an A3, or a PDSA cycle?
- What are the three questions you use to evaluate whether an idea is safe to try?
- How do you coach teams to iterate and learn from problems when working across functional silos?
- Can you share a healthcare example where process mapping revealed hidden breakdowns or assumptions?
- How do you handle improvement suggestions that require significant changes, like IT systems or facility layout?
- How do you view the relationship between safety, quality, delivery, and financial performance?
- What's your perspective on Lean vs. Six Sigma vs. Lean Six Sigma, based on your experience?
- How do you see variation reduction as part of Lean, not just Six Sigma?
- What was it like moving from healthcare into manufacturing? What was surprisingly transferable?
- Did you encounter documentation or quality systems in manufacturing that got in the way of improvement?
- How do you deal with the extremes–either lack of standardization or over-control through documentation?
- What reflections do you have about the human side of improvement–what helps people succeed in these systems?
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Automated Transcript (Not Guaranteed to be Defect Free)
Mark Graban: Hi, welcome to Lean Blog Interviews. I'm your host, Mark Graban. Our guest today is Anne Frewin. She describes herself as a seasoned Lean leader with over 12 years of experience applying Lean in settings including healthcare, laboratories, and manufacturing. Her primary goal is to help organizations close gaps in safety, quality, delivery, financials, and people by coaching leadership and frontline employees to be relentless problem-solvers.
Mark Graban: She does this by developing people in Lean thinking and motivating them through hands-on coaching. So, Anne, welcome to the podcast. How are you?
Anne Frewin: Thank you, Mark. I'm great today. Thank you.
Mark Graban: It's great to have you here. I'm always happy when SQDC or, in this case, SQFP… I'm happy when, or SQDFP by mistake… I'm glad when safety and quality are at the forefront of the approach and the conversation.
Mark Graban: So, thank you for that.
Anne Frewin: Absolutely.
Mark Graban: Even though I got some letters wrong, this is not… this is not my favorite mistake, but I'm just demonstrating yet again, we're all mistake-makers. But thank you.
Anne Frewin: Yeah, no, absolutely. Isn't that… isn't that the Shingo? Easier, better, faster, cheaper. Did I get that one right?
Mark Graban: Easier, better, faster, cheaper, cheaper.
Anne Frewin: Yeah. Safety, quality, delivery, cost.
Mark Graban: And I shared that online the other day, and somebody pushed back, rightfully so. Well, like, why isn't safety at the front of that list? And like, I'm all for it. I mean, I think if an organization, honest to goodness, makes safety really the first priority, maybe they don't have to state it, but why take that risk?
Mark Graban: I figure.
Anne Frewin: Right, right. I agree. I agree. Safety should be forefront, should be in everything that we do. Right.
Anne Frewin: That's… we're getting, I'm jumping forward, but that's motion waste right there. Right? Motion waste is to protect their…
Anne Frewin: Make things safer. Easier. Safer, yeah, for sure.
Mark Graban: So maybe we'll… we'll… we will come back, and we can talk more about that. But you know, I like to start off, you know, with, if I have a standard question, I'm always curious about people's origin story, you know, where, where and how and why and when. And you know what, why'd you, how'd you get exposed to this, Anne? And you know, why did it resonate with you?
Anne Frewin: Yeah, that's a great… I have a great story. I think I have a great story. I actually have a background in finance, so I spent most of my first part of my career in financial planning and analysis at a bank, which I don't do banking anymore, but that's where I was. Most of my training was at. And so I really kind of slipped into the process improvement world.
Anne Frewin: And while I was in healthcare, so I had actually gotten a Master's in Healthcare Administration right out of college. I was going to go change the world of nursing homes, and that didn't last very long. I had a rude awakening of how nursing homes really work and decided that I'd go work with numbers instead of people to get some better experience. And so after a while, I was in financial planning analysis for, I don't know, 10, 15 years, and then moved… I've moved out to Maine from Minnesota.
Anne Frewin: I moved from Maine to get warmer because Minnesota's so doggone cold. And so I was working at a hospital system as a Senior Financial Analyst. And when I was hired on, they were… they hired on the same day as me. Sat next to me in the orientation, and he…
Anne Frewin: …a guy who was running, going to be the process improvement specialist. I don't remember what his title was exactly, and I had no idea what that was like. Tell me about that. So he was telling me about it, and I ended up being the metrics person for all of their improvement work. They were rolling out A3s, doing a lot of very great stuff initially.
Anne Frewin: And so I provided them with data, with the metrics. I was in some of the projects with them. And then after a year, the company hired on a Director of Process Improvement. This guy was great. He had 30 years of experience.
Anne Frewin: He was an industrial engineer, Master Black Belt. I always joke, he had all the bells and whistles. Fantastic guy. Became one of my best friends.
Anne Frewin: And he really introduced the hospital to what an operating system, a Lean operating system, is. And he… he created a training program called Central Maine Operating System. We called it CMOS affectionately. I was in the first cohort of that. I helped them develop it.
Anne Frewin: So I was really learning everything from him. And, and I joke because he, he was one of those senseis that kept asking me why, why, and why? And I would find… I remember sitting outside a coffee shop one day with him and I was like, “Would you stop asking me why? Just tell me what you want me to do.”
Anne Frewin: But he didn't. He kept asking me why, and eventually I caught on. But so I was working with him for a couple of years and really starting to understand what process improvement was. At the same time, I was… we were rolling out a benchmarking program called ActionOI.
Anne Frewin: And so I was working with the ActionOI group from Truven Health as far as like learning about process improvement and tying in the metrics that way as well. So I was kind of getting it on both sides. It was, you know, I've read Katie Anderson's book, right, with I think it's ‘Woven' and ‘Unwoven,' right? And I'm like, that's, that's exactly my life. Like, I look back and see how these things kind of came together.
Anne Frewin: And, and so after a couple of years, I was really getting tired of finance. I wanted to change. I've been talking with the CEO about what else could I do? About that time, the Director of Process Improvement decided to leave the organization. His wife had never moved from Pennsylvania, so he was going to go back to her.
Anne Frewin: And so I walked up to my CEO and I said, “I think I can do his job now.” He had all that experience, and I had two years of him asking me why all the time. So to the CEO's credit, he said, “Yeah, let's try it.” And I really never looked back. And the president of the hospital said to me one day, he goes, “I've never seen you happier.”
Anne Frewin: And I said, “Yeah, I finally think I found what I should be doing.” So we, I took on that department there, which was at the time one person. I grew it to three, and I haven't ever looked back. And it's, I love it. I really enjoy…
Anne Frewin: I get to use my finance, my metrics background, I get to work with people. It's, it's best of both worlds.
Mark Graban: Yeah. Yeah. So sometimes delving by questions can be a bit much, you know, I get pushback on that, and you know, I mean, I think, you know, asking a lot of questions, in particular why, is… is useful.
Mark Graban: You know, sometimes a statement is appropriate instead of a question. But I mean, would you say looking back at it, did, did the “whys” develop you more in those two years than if he had been more directive?
Anne Frewin: For me, it, it, it did. It really forced me to think, right? That's what he was, he was doing, right? He was forcing me to think differently, not just to take things at face value. And you know, it wasn't easy.
Anne Frewin: And I'm sure there were days where he finally just told me what to do. But, and I find that too, there's many times that I keep just asking questions. Sometimes it drives people crazy. But the end game is the thinking, right? It's the critical thinking skills we're trying to develop in people.
Anne Frewin: And the more that you're told what to do, the less you're going to be able to sustain things and understand the why behind it. Right. All of that. But yeah, it did drive me crazy, but it did force me to think differently. And I think that's why when I took the role over, I was better in the role because I had been challenged to think, to understand what he was trying to do.
Anne Frewin: Not just the end game, but the process of getting there.
Mark Graban: Yeah, and you mentioned one thing I wanted to follow up on. You mentioned the idea of a Lean operating system. I mean, how would you describe to an executive who said, “Well, I've heard of Lean, and maybe people do projects or we certify people, but I don't know what's an operating system?” What did that mean in that setting? Or what do you think it should mean?
Anne Frewin: Yeah, that's a great question because I think sometimes we just take it for granted what it is. But I was trying to explain this to somebody earlier today actually, that it's not just about going out and doing projects. It's not just about trying to get the results through problem-solving. It's about setting up the systems and structures in place in the organization so that it's sustainable and so that it's driving the culture that we need, which for me is a culture of relentless problem-solvers, as you said in the introduction. Right.
Anne Frewin: Continuously improving culture that drives respect for people. So it's really about what are the systems we have in place to ensure that people are learning, developing, driving that continuous improvement culture. And it's not just, we're not just going to go out and do a project and fix what was broken because we can fix what's broken. It's going to break again, or another part of it's going to break.
Anne Frewin: But if we have the underlying systems and structures, which to me looks like an idea system, a recognition system, it looks like some sort of problem-solving methodology. I lean towards A3 thinking, maybe doing some rapid improvement events or Kaizens or whatever the word is, you wanted to develop that continuous improvement. So teaching them fundamentals culture and then setting up the systems to carry it.
Mark Graban: And you mentioned respect for people, and we're talking about establishing systems. That makes me think of a mutual friend of ours who was a guest recently, Scott Gauvin, who talked about the difference between respecting people and respect for people and encouraged people to find that recent episode with Scott, because, you know, he, he… I think there's a difference between how we behave and establishing systems. I mean there, there's, there, there's a. Would you say, I mean, there's kind of a deeper level of leadership activity to help put systems like that in place that, that, you know, kind of help ensure… I don't know if “ensure” is the right word, but make it more likely that people are being respected.
Anne Frewin: Yeah, I think that the systems have to be in place in order to be able to have the respect for people. Right. And I love that distinction between respecting. Respecting is kind of a… I forget how he described it, but for me, it's a passive. It's…
Anne Frewin: I can respect people, but if I have respect for people, then I have to be actively following that up with my actions. Right. And so to me, one of the… one of the things I love is a really solid, good idea system. And to me, an idea system embodies what respect for people is.
Anne Frewin: It's telling your frontline, “Hey, we respect your thoughts. We respect, you know, the work best and how you can make it better.” And so if you… if we can put a really strong idea system in place that grabs those ideas and not only implements them, but the people who had the idea get to implement it. So it's not going up to management.
Anne Frewin: It's not an electronic system that falls into a black hole. Right. It's. It's an active. That to me is…
Anne Frewin: …is your first show of respect for people is by asking them what bugs you and what, what would you do to fix that?
Mark Graban: Yeah.
Anne Frewin: And, and just those questions start to open that up. And, and people start to feel that respect because they're actually getting to own the idea that they had. And so I feel like this, that's one perfect example of the systems that have to be in place if you want to show that respect for people.
Mark Graban: Yeah, yeah. And I think I'm going to paraphrase maybe a little differently, looking at Scott's differentiation between those words, that I could treat you respectfully. So we could say, “I respect people, I want your ideas.” Someone could present an idea and I could react in a respectful way. Like, for example, you know, the worst case scenario would be a leader saying something like, “Well, that's a dumb idea.”
Mark Graban: Okay, well, you're not respecting the person. You're not acting respectfully. But I love how I think you threw the word “effective idea system” in there, or “strong idea system,” like one that's actually a system and not a suggestion box black hole. Because we could… we could act respectfully.
Mark Graban: But then ultimately, if people's ideas lead to nothing, that's not a respect for people. That's not. There's not a system there to ensure or at least make much more likely that ideas are followed up on.
Anne Frewin: Right, right. Yeah. The worst I've come across is when you have… some I've had. I know one organization. I won't name them, but I know one organization where an electronic idea system is actually working, but it's got a…
Anne Frewin: …they've got a really strong culture there. But most of the times, if there's an electronic system, it's going up to a management team that has to decide if something was a good idea or not. Right. And at the end of the day, it's. I…
Anne Frewin: …one of my favorite… I have a couple of good examples are small, but one of my favorite recently was there was a woman who needed to step up, reach up, to cut something. I forget what it was, something up here, part of the process. She was stretching, and she said, “I just need a step stool.”
Anne Frewin: And she wanted a step stool so she could reach and not stretch. And she'd asked for it, but nothing had ever been done until we put the idea system in place. And suddenly the team was like, “Yeah, that. We need that. That's a great idea.
Anne Frewin: Let's get that.” And suddenly it was there. Right. So it's not big. It's not these big engineering changes or management changes.
Anne Frewin: It's just the small, “I need scissors at stations” or “I need a step stool” or, you know, what's important to them.
Mark Graban: Yeah.
Anne Frewin: So I don't know if that answered the question you asked.
Mark Graban: No, that is. No, I think that's a good example. And, you know, it's not like somebody's having to reach up too high. That sounds like an ergonomic issue. And, you know, I think, you know, part of respect for people comes back to starting with safety.
Mark Graban: If we really… to demonstrate respect for people, we want a process that has safety designed in. Right. So you think about the reach. Right.
Mark Graban: I mean, to jump in and micromanage here. But I think, I think the situation, well, does the step stool create a different safety risk? Is there, is there, like, you know, is the ultimate, you know, the… the goal?
Anne Frewin: And…
Mark Graban: And I think this is where, like, collaborative coaching comes into effect. I don't think it's disrespectful if somebody would say, “I need a step stool.” I don't think it's disrespectful to say, “Well, thank you for bringing that up. And boy, we sure we… we need to eliminate the ergonomic risk, like maybe try to restate the problem where we find a solution.
Mark Graban: How can we design the work so it works for taller people and shorter people at the same time?” Right.
Anne Frewin: And that goes back to the concept of it being a system. Right. And being an effective system because it's again, it's not like we're going to go put an idea board up and here's a card and go fill it out and good luck. It's as a continuous improvement practitioner, I am there or somebody on my team is there with the people leading the board, with the team, coaching them on not even, you know, how to use the board, but what are some of the coaching questions for the leader to ask or even the team members when they finally take over and run the idea board?
Anne Frewin: What are those coaching questions to your point? “Hey, that's a, that's a great idea. You're right. That is an ergonomic issue.” I'm a little, you know, let's get a step stool in the short term.
Anne Frewin: But what else could we do to help that, to fix that problem? What are some other ideas? Or, you know, we rolled it out and they, the boards were too high, but they couldn't come down. But somebody put on the board, “Lower the board.”
Mark Graban: Yeah, okay.
Anne Frewin: Yeah, it needs to be lowered. But are there other ideas? And you know, it was fascinating because I, as I asked that question, like, “Are there other ideas or is there something else we could do?” And one of the operators said, “Hey, it's a square board because it was on a whiteboard. Could you get something that's long?”
Mark Graban: Yeah.
Anne Frewin: “Could we have a long board?”
Mark Graban: Yeah.
Anne Frewin: “And then we could all reach it.” And I was like, that's exactly the thinking we're looking for. Right. It's, it was so even first day to start having them think of outside the box different ways. And that's, that's what makes that system work is when you start to coach them to, you know, it's not that the idea is the end point.
Anne Frewin: The idea is maybe a stepping-off place to somewhere else, but continuing to develop them and coach them to think that way. And what could we try? One of the organizations I worked with taught me three questions for idea system, like, “Is it safe?” So that's the first question that you have to ask. “Is it safe to the employee and to the customer?”
Anne Frewin: “Does everybody who needs to know know?” And, “Can it be undone?” And so if you can answer yes to those three questions, then that falls into the… then let's try it. Right. So if that step stool wasn't safe, then okay, what, what could we do differently?
Anne Frewin: Right. That's how that tends to follow. So, but that's, that's what makes up the system. All of it.
Mark Graban: Yeah. And I'm sure you've navigated, you know, especially I think when you're getting started with Kaizen or, you know, improvement and employee engagement, you know, I agree with what you said about, you know, an ideal state. If you have an idea, you're able to work on it, you're able to explain, experiment, you're able to try things and, and iterate. But sometimes that, that freaks people out where like, “Oh, if I, if I raise an idea, I'm going to have more to do.” And “Oh, yeah.” So I'm curious, like, you know, some of your experiences in navigating this balance between…
Mark Graban: …well, sure, we want to keep decision-making at the work, you know, to as close to the front lines as we can, but then there's times when leaders do need to jump in and help or coach or be a servant leader. I'm curious, you know, your thoughts or story about, you know, finding that balance.
Anne Frewin: Yeah, the balance. It's definitely a balance. And there are definitely times where we don't. Somebody doesn't have. There isn't time.
Anne Frewin: We need engineering's help. We need… maybe it's help. Sometimes I'll just say, “Those are, those are going to take longer. Is there, is there a solution without them that we could try first?”
Anne Frewin: But it goes back to the alignment with strategy or doesn't go back to because we haven't talked about. But that's, to me where it goes to is what's the alignment, the strategy, what's. What is the ultimate why as to why we're doing this? Right. One is employee engagement.
Anne Frewin: But how is that going to help relieve some of the time and the energy that the managers are doing for other things? Right. And how can we show that connection to, “Hey, if you help them with this, you're actually not going to need to run that major project that you want to run,” or “if you're going to run it, but maybe it's going to go faster because you're giving frontline some opportunity.” Or it's just learning to prioritize. Right.
Anne Frewin: We. I've used the, the two by two a lot. The benefit-effort matrix. Everybody calls it something different. Right.
Anne Frewin: The benefit-effort.
Mark Graban: I prefer to call it the PICK chart or different things.
Anne Frewin: Yeah, right, right. And so then it's, you know, “Okay, that. What's the, what's the benefit of it?” Right. “What's the, what's the impact we're trying to have?”
Anne Frewin: So, and where does it fall on that, that scale? And that, that helps people also realize the quick wins. Those are the ones we can just go do. Right. Versus the ones that are going to take longer.
Anne Frewin: So if we get to a point where we're starting to feel like things are taking too long or the ideas are too big, then I go to that two by two and we put it up there and let that dictate how we're going to, what we're going to work on. But the, the whole key of that is that keeping the communication and the feedback loop back to the operators or the frontline. Right. Because if they have an idea, but it's got to go, it's a bigger project or bigger, it's going to take longer. We can't just say, “Thank you for your idea,” take the card off the board and walk away.
Anne Frewin: So there's a long-term section on the board. We put it in there, and you know, you name what's going on, where it's at, so people still know it's being worked on. It hasn't been forgotten, but it's being worked by somebody else. And there's a line to make sure that there's a carry-through. Right.
Anne Frewin: There's that accountability and the follow-through and then the feedback loop back to the frontline to say this is still important, it hasn't been forgotten.
Mark Graban: Yeah, yeah. And I think in that category of finding the balance, I think another thing that's challenging, especially at first, is helping people think through like what type of problem or situation is big enough to merit a rapid improvement event, slash Kaizen event, whatever we call it, versus like when, when, when do we need that, that week or however many days it is, or when, when can we just… I don't like to say “just do it.” I like to say “just PDSA it,” you know, as you were describing, try something, evaluate it, see how it works. You know, it's not always obvious.
Mark Graban: Sometimes, in my experience, in a way of like, sometimes something really big maybe actually has a small countermeasure we could just go test. And sometimes something that seems relatively trivial has a deeper root cause that we don't understand. How do you help people navigate? Kind of like which style of PDSA… I'll throw A3s in there as well.
Mark Graban: Because you brought that.
Anne Frewin: Yep. Yeah, there you go. There's another system, right? It's the problem-solving system. When do you take what toolbox tool out of your toolbox?
Anne Frewin: And, and I find that you, you know, PDSA… I say PDSA, PDCA. I've done PDSA. I like that better too.
Anne Frewin: To me, that's foundation to everything, right? Everything we do, whether it's putting an idea board, a Gemba board up, running a big project, you have to follow PDSA. And then I've done a lot with A3s where I've had people in my organization go, “But what if it, what if it's smaller than an A3?” I'm like, “Why does it have to be smaller than an A3?” Right.
Anne Frewin: It's just the complexity is different, but the thinking is still the same to some degree. So to answer your question, for me, it's first and foremost, if it's just within some… the own, the area itself, it's not cross-functional. I say let's just… I call it, “Let's try it,” right?
Anne Frewin: If it meets my three questions, let's try it. Usually there's not a big metric we're trying to affect. It's just a safety issue or makes it easier. People are happier as we start to branch out and things become more cross-functional. Now we're talking about Kaizen or, you know, an event or an A3.
Anne Frewin: And then that then becomes the priority and how quickly do we need to change? Right? So I find a good solid A3. If you really give it the dedication and it needs and the coaching it needs, it's going to take three to three to five months. I like to use an A3 when I'm really coaching somebody through the thinking process, teaching them how to think through a problem, structured problem-solving methodology.
Anne Frewin: I want to have the A3. I want to have weekly coaching sessions with the learner. I want the sponsor to be involved. Right. To me, it's more of a development and training thing.
Anne Frewin: The short-term event is when we've got a project, we need to fix it, and we need to fix it now. We know it's. It's a short. You know, there's. It's cross-functional.
Anne Frewin: But we believe if we get everybody in a room for three days, we'll come out of there with really solid action plans that tie back to root cause. Not just the wish list and pet project of people, but really has its foundation in the process and things that are happening. Right. So that's. The event comes when you need it done.
Anne Frewin: You A need it done quickly, or B it, it can be done quickly and there doesn't need to be this leaning, this learning development piece. Piece to it.
Mark Graban: Yeah, yeah. And, and those, those three questions again. “Is it safe?” Remind me the second one. I'm sorry. Restate this for people.
Anne Frewin: “Is it safe?” “Does everybody who needs to know know?” And, “Can it be undone?”
Mark Graban: Okay, so I have. Yeah. Have we engaged all the right people?
Anne Frewin: Correct. Yeah, that's if it's multi-shifts, do all the three shifts know if people downstream? I, I like to say make sure people downstream. No. Right.
Anne Frewin: Because you could make a change, and if people downstream don't know what happened, it could affect them. So do they know that this change is happening or upstream? You make a change and suddenly you need different information from the people upstream of you. But they better know you need that information.
Mark Graban: Yeah.
Anne Frewin: Don't make any assumptions.
Mark Graban: Yeah, yeah. And I think sometimes that's the iterative, iterative nature. It's probably best to err on the side of checking upstream, checking downstream. Sometimes that's a mistake that we learn from and work through.
Anne Frewin: Correct.
Mark Graban: And hopefully in the future, you know, people learn by doing that, “Oh, okay. Well, this problem-solving was slower, and we actually created a new problem because we didn't check downstream.” That'll reinforce the need to do that going forward because I mean, you know, healthcare, be curious to hear, you know, if you've got thoughts or stories about, you know, breaking down the silos. I think that's just such a challenge in healthcare.
Mark Graban: Even if you look at like the flow of a tube of blood going from the doctor's order to the blood draw in the emergency department to the lab, like there are multiple professions and departments involved in that. And you know, I've seen just these, you know, just these, these disconnects that are pretty easily solvable when you get people walking the whole process. I'm curious what examples come to mind, you know, for you?
Anne Frewin: Yeah, so one of my favorite examples was I was working with… oh gosh, I can't remember even the department. It was, it wasn't cardiology, anyway, they were. So this was, this was back in, when I was working in healthcare. Right.
Anne Frewin: And the problem was, it was one of those things where patients show up at 6 o'clock in the morning. The surgery is at 9, but the doctor, the surgeries weren't starting on time. I think they had like a 40% on-time rate. And so the nurses wanted to point fingers at a certain provider that he was a problem, and the doctors wanted to point fingers back at the staff that was getting the patients ready, that they were the problem. Right.
Anne Frewin: And so it was more of we brought people in the room, and there definitely was, there definitely was some outlying issues going on. But it was one of my favorite times where we did do more of a Kaizen. We brought everybody in the room. There was, I believe, one provider in the room. One provider didn't show up.
Anne Frewin: But we worked together and we started to map the process backwards. We started with, “What time does the surgery need to start?” And then, “What do we need to do?” We did a backwards process map. Yeah.
Anne Frewin: And how much time does it take today? And how much time do you need to have? And I. And. And so there was a lot of aha moments in that.
Anne Frewin: And I remember, looking back, I believe it was, you know, we had the schedulers, we had the nurses, we had the techs, and we had at least one provider, and they went through the three days, and they came out with a plan that would work for everybody. And here. And looking back, and this was, gosh, 10 years ago. So I don't remember all of the details, but I do remember that there were many times where they'd be like, “Oh, I didn't know you needed that.” “Oh, I didn't know that happened.”
Anne Frewin: But my favorite part was when the provider, who hadn't been there, showed up on day three, and we were walking him through the process, and he actually said, “Oh, I didn't know you guys were waiting for me.”
Mark Graban: Yeah, yeah, right. Miscommunications and assumptions and silos.
Anne Frewin: Exactly. Complete siloed, and assumptions were made, and he. He ended up turning around. I do not take full credit for that. I know there were conversations happening in the background, but that comment of his in front of the nursing team and the techs was what was most important, because they heard it so they could realize that it wasn't just this, you know, OpEx person coming in saying, you know, “Doctor, so and so is is on board.”
Anne Frewin: They heard him recognize it, and they were able to then meet him halfway as well. And. And it was great to see it in the progressions. As we went through the changes and talk about iterations, I remember we iterated a number of times. We came out of there with our plan, but as we put it into practice, “Oh, that wouldn't work.”
Anne Frewin: Or “this has to change,” or “what happened here? Nobody got notified.” “We missed that.” Right. So it was making sure that all parties were talking.
Anne Frewin: And. And I like to always build into my implementation plans that SA part. Right. Like, how are we going to check and adjust? If you have a board up, if you have your Gemba board or whatever you want to call it, board up, what are the metrics that you're going to measure so that we can all, again, see if it's working and we can all together make those changes?
Anne Frewin: And so I find those events one of the best ways of breaking down those silos, because you got everybody in the room and inevitably somebody says, “I didn't know you did that.” I've never been in one where that conversation hasn't happened. I know, I love that it happens.
Mark Graban: Yeah. I mean, you're making me think of, I think, you know, a similar situation where, you know, procedures were starting on average, roughly 40, the first procedure of the day was starting roughly 45 minutes late on average. And there was the, the blame game and the finger-pointing and, “Well, you know, surgeon's not there,” and the surgeon says, “Well, the instruments in anesthesia are never ready, so why should I show up on time? It's never.” And there was a lot of that happening.
Mark Graban: And we got that cross-functional team into a room, mapped out the timing and the swim lanes of the process, and when they drew the conclusion of the light bulb going off and saying quite… it sounds like a Demingism. Right. “This process is perfectly designed to start 45 minutes late.”
Anne Frewin: Yep, exactly.
Mark Graban: Then they could go through that same process you described of what would we have to do to start on time. And you know, to be fair to all the people in healthcare, they were never given the opportunity to step back. And when I say it was probably not accurate to say this process was perfectly designed to start 45 minutes late. This process was only capable of starting 45 minutes late. And then you find, you know, the leverage points of you change a couple of things here and there and then, oh, you know, the, the punchline to the story is the team was really excited about running the process the first time, the first day, and they ran it and they're ready to go.
Mark Graban: Who wasn't there? The surgeon. But I'll tell you, you know, no, it, once they demonstrated to the surgeon that all the other pieces are going to be in place, guess who started showing up on time? The surgeons. Right.
Mark Graban: So these weren't bad people or lazy people or selfish people. They, they, they were happy to be part of a system that started on time.
Anne Frewin: Correct. Exactly. And if they don't think it's going to start on time, again, it's not like they're just la-la-gagging. They're probably, you know, at their desk answering emails or whatever. Right.
Anne Frewin: So why aren't they there? Because they don't expect it to start on time. So once, once they see the process, they understand it. I mean, everybody's… I've crossed that bridge many times.
Anne Frewin: You just have to see it, and you have to trust. And where you build the trust is by having the conversations and breaking down those silos.
Mark Graban: Yeah. The other thing that really resonates with me, I love all three of those questions. But the risk assessment of like, “Can it be undone?” You know, and I think of an example, there was a hospital, a nurse's station, where like one example might be like, “We need.” This is an…
Mark Graban: It's going to date the story. “We need to move the paper cutter from here to there.” Like, that's such a low-effort, low-risk move. Like, what's the worst that could happen? We move it someplace else, we move it back, you know, thing.
Mark Graban: But then there were. There were other issues around visibility and communication. And one of the proposals was like knocking down one of the walls.
Anne Frewin: Right.
Mark Graban: So that sounds like a situation where harder to undo. I mean, you could, but you don't want to go back to leadership and say, “Well, I know we just spent money to knock it down, but we're going to iterate and study and adjust and please put the wall back up.” You don't want to find yourself…
Anne Frewin: Yeah. And especially in a hospital setting with all the contagions. Right. All the dust. No, it's exactly it.
Anne Frewin: And so the question then becomes, okay, if we knock down the wall. Right. Layouts are perfect ones, you know, especially as hospitals have. Have changed over the years. Right.
Anne Frewin: We used to have very stark places when they've changed, they've opened things up. There's more circular. Right. Things have. We have to change layout sometimes.
Anne Frewin: That is the right answer. It's going to make a difference on quality, on communication, on delivery. Right. But before we do that, can we prove, can we try something that helps us show that that's the answer. Right.
Anne Frewin: Is there something we can do in the meantime? Now that might be a little harder because it's hard to change a layout of a hospital or a clinic or something without making a lot of significant changes. But what can you do? What can you do in the short term? Right.
Anne Frewin: And so that's the other question I always like to ask is that's great. We know that's going to help. But that's also going to take six months or my other one's favorite is IT. Right. IT systems.
Anne Frewin: We have to upgrade. Yes. We have to change something in Epic. Yep. That's going to take time.
Anne Frewin: Is there anything we can do in the short term? Can we do something to the process or visually? Like I'm all about the visual management. Right. I will talk that all the time.
Anne Frewin: Like what can we do in front of somebody to help them remember? Like one of my favorites, you've probably experienced this back in the day was with the nurses, right, delivering the meds and I… And it's changing off from the long term, but, like, how do we protect the nurses from making med errors? Right.
Anne Frewin: Well, we can give them. We can. We can make sure they have it on their computer. They check everything off. They can't make a mistake.
Anne Frewin: That's true. We can do that. But what can we do in the short term? What can we do that's more visual right now? And we, you know, I think a lot of people went to the lanyards or went to a sign on the cart or something.
Anne Frewin: They stood in a box. When they're in that box, you don't talk to them. When they have that hat on or that vest on, you don't talk to them. Right. Some very simple mechanism.
Anne Frewin: Can it be undone if it doesn't work? Yeah, you can try. Maybe the vest and maybe this lanyard wasn't enough. Maybe you need a vest. Maybe you need to put them in a box.
Anne Frewin: Right, but what are the different iterations to help you? And that's where I love that. Can it be undone because, you know, it makes people, again, think differently about, well, what could we do visually or short-term? It's not. It's not healthcare, but I just have to share the story.
Anne Frewin: So. Yeah, on the, on the manufacturing floor, we had pallets, and some of the pallets were broken. So they had a pile of broken pallets next to the pile of good pallets. And I was on my Gemba walk, and I was like, what. What problem could happen here?
Anne Frewin: And I asked, I said, “Can you somehow make it more visual that these are bad?” I know they look bad, but people come to work and them. Back to our nurses, right? People come to work to do a good job. Right.
Anne Frewin: Nobody wants to harm a patient. Nobody wants to harm an employee with a bad pallet. “Oh, no, we can't. We can't put a controlled document on that.” I'm like, “It doesn't have to be a controlled document.”
Anne Frewin: “Can you put a… can you put a red cone on the bad pallet?” Like just. “Well, they. They should know.”
Mark Graban: So dangerous.
Anne Frewin: “They. They know that they're supposed to check before they take it.”
Mark Graban: Fantastic.
Anne Frewin: Fantastic. How many things are going on in their personal lives right now and in the world today that is causing them not to think about the pallets at this very moment. Does that make them a bad person? No.
Anne Frewin: For the nurse that gives the wrong med, does that make them? No, they just. Something distracted them. So how do you build those again, the systems visually, what visuals can you use to slow somebody down just enough to pause before. Right.
Mark Graban: Yeah.
Anne Frewin: Set that system up so they can't make that mistake. Right. I'm sure you've said that many times in your career. Right. And to me it's so it doesn't have.
Anne Frewin: That's why that “Can it be undone?” question's so important. It's like it doesn't have to. You don't have to knock down a wall, you don't have to change the IT system. There's a lot of things we can do to people again and that shows respect. Right.
Anne Frewin: It goes back to that respect when we build the system in them to help them slow down and help them not make the mistake. Stake it tells us we know there's other things going on in your life besides this job or, and you are human, we want to help you be successful.
Mark Graban: I think that's part of the core of respect for people and respect. There's, there's some who prefer the translation, as you know, from Japanese into respect for humanity. And all those things you described are part of being human. We get tired, we get distracted, we sometimes aren't feeling well or have a bad day or we have stresses. And you know, I think that's where mistake-proofing checklists, things like that are systems that like, you know, that you said protect the worker from being involved in an incident and then God forbid, being blamed for that incident.
Mark Graban: I mean, I always think, remember pretty vividly some words the surgeon Dr. Atul Gawande used around in his book, The Checklist Manifesto, of saying the checklists are there to protect a surgeon with a perfect career, long track record from having a bad day and performing a wrong-site surgery. It's there to protect the patient, but it's in alignment to protect the surgeon. Because now you've got a connection between safety and the quality of outcomes and cost or financial impact of having a lawsuit, a settlement or, you know, any of that.
Anne Frewin: It's all connected, 100% connected. That's why those five metrics or four metrics, some people put people in with safety. Yeah, they're, they're, those can be so easily siloed as well. “We have to just focus on quality.” Yeah, right.
Anne Frewin: And, and you know, in back when I was doing process improvement, my job was to reduce costs, and our quality improvement team improved quality. We all use the same tools and we tried to work together, but you can't silo the metrics either because not everything that we needed to do was going to reduce costs. But by improving quality, it actually did reduce your costs. Right. By, by improving the delivery, it reduces your cost.
Anne Frewin: And, and so you can't silo those metrics either because they are completely interrelated. And, and so that's, that's one of the hardest things for me is when you, and especially in this day and age where all companies are so focused on cutting, and they always have been cutting costs, cutting costs. At the end of the day, you know, by treating your people with respect, setting up your systems so they can't make mistakes, guess what? You're actually going to save yourselves money. Maybe not tomorrow, but yeah.
Mark Graban: And you know, with those, with those letters, you know, it doesn't spell anything. It's not a good mnemonic. I've learned it 30 years ago in the auto industry as SQDC, Safety, Quality, Delivery, Cost. That's why I got tripped up earlier. But for you to say financials is actually I think more all-encompassing because I've been involved in healthcare projects that interconnectedly were improving the quality of care, the delivery and flow.
Mark Graban: Right. So preventing delays is leading to better outcomes and being able to increase capacity to be able to do, for example, more MRI scans per day, you're losing fewer referrals because the waiting times used to be really long and now they're short. And that, that, that financial impact of being able to take care of more patients is I think perfectly aligned with, you know, employees want to provide care. I think they'd rather be doing value-added work in a well-designed system that's not stressful than it is just sitting there with nothing to do. I think in a, in a dysfunctional environment, people are happy to sit there and do nothing.
Mark Graban: But look, I'd say that's a, that's not a criticism of them, that's a reflection of the system. But when you've got aligned teams and strong mission and purpose and you have that in healthcare and some other settings, the day goes by more quickly when you're doing the work you were trained to do and want to do. And so it's hard to disconnect a lot of that. This is interconnected benefit. And I agree.
Mark Graban: I've seen organizations that have the process improvement team and the patient safety team and they might report up to the same person, but they're, they're siloed and they each have kind of their own flavor of root cause analysis. And I tend to look at it like, “Well, a problem is a problem. We could be using the same language, we could be a little bit more cross-functional and getting people, you know, and not silo people off,” because I think, you know, even if you're an engineer, I'm okay, I have my biases. Being an engineer with a non-clinical background, I think we have a role to play in kind of more clinical safety and quality-related problem-solving. Doesn't mean we're going to solve it for them or have the answers.
Mark Graban: But I wouldn't say we're ineligible to work on that.
Anne Frewin: No, not. I'm kind of hesitant because I don't have a clinical background either. I went into healthcare administration coming out of an economics-math double major in college. So, yeah, you know, it is. I remember thinking back that I, we actually trained our quality improvement team. They did use our same tools, they did use the same root cause analysis.
Anne Frewin: So we were able to align with them on trying to work together. But it was kind of, I think I was set up to fail on that one on some degrees. But we did train. We ended up training the entire leadership team in our operating system thinking. And I still have people reach out to me today and say, “Hey, thanks for helping us.”
Anne Frewin: And we're still using those. Now you had mentioned going back to the financial piece. So I was working with a primary care clinic recently, and one of the things I was helping them with was trying to just establish some sort of a model line using a primary care. And we were, we looked at, I was watching their work, and I was talking to them about eliminating waste and simple things of searching for material or walking back and forth. Right.
Anne Frewin: Going back to that, and what's, what are the roles and responsibilities of everybody? Is, is everybody doing what they're, you know, unutilized talent? Are they working to the, to the level of their license and their skill? And we had one provider who was at, I think it was a 70% slot utilization, and by just changing what people were doing and getting more moving around who was doing what. The nurse took on some more responsibilities off the MAs, the front desk took on some things.
Anne Frewin: We were actually able then to fill up those slots because there was less of that of him having to spend time doing all of the reports that he was doing all this stuff because we just were able to look at what was he doing, what were other people doing. And that's where some of that waste comes down to too is right, that underutilized talent, are we working to our licensure or are we doing things that we shouldn't be doing because somebody else can do it? And so, yeah, so by changing that, that actually increased their revenue significantly too. So I, I just wanted to go back to that because I feel like it's so important to think about how are we using our quality and our delivery to drive our, our financials or our costs. I always like to think about it's maybe not budget, doesn't mean you're not going to see it in your budget.
Anne Frewin: You're going to see it in that revenue side. You're going to be able to do more with the same amount of people, and that's what we're all working for anyway. Again, keeping people's jobs, respect for people.
Mark Graban: Yeah. I want to ask you to, you know, compare and contrast a little bit. And I'm not setting this up and framing it as, you know, one of these, you know, arguments across methodologies or which is best or. But you know, my roots and my bias, I always state them, is around Lean. You know, I started auto industry, very Toyota-based methodologies.
Mark Graban: I used to think statistics and we can fold that in and then we know there is Six Sigma, which we don't talk about a lot on this podcast because again that's not where I come from. I'm not anti-Six Sigma. And then we have Lean Six Sigma. And you've been around all of these. How would you compare those experiences or see things fitting together in your experiences or the way you would want to see it?
Anne Frewin: Yeah. So I'm, I'm with you. I'm Toyota Production System Lean. That's what I was taught when, when I started learning about process improvement. In fact, I think I changed the, the name of the titles of everybody from Process Improvement to Lean because I wanted people to be thinking about, about that.
Anne Frewin: So. But when I was, there was one place I worked. I had a director who made it help me see the difference because I always, I was struggling with what, what's Lean? What's Six Sigma? What's Lean Six Sigma?
Anne Frewin: What's. And the way she had set up the structure was the Six Sigma team. There was a Six Sigma team. They were green and black belts. They were focused on improving the actual quality of the product.
Anne Frewin: So reducing that variation, the variation, reducing the variation and any defects in the product. She would talk about it as being value, the value-added part of the process. Like what's the science behind it? Right. That's where Six Sigma works best.
Anne Frewin: Right. With your statistical process controls. All of that focusing in, on moving to. Yeah, that, whatever.
Mark Graban: Yeah. I mean reducing variation, reducing defects. I mean there are rigorous methodologies that can be helpful.
Anne Frewin: Right. And then, and then Lean is, was more the people process, right. It's eliminating variation in the process, but for the work that the people are doing and looking at simplifying it by saying just elimination of waste. But that's not what Lean is all about. Right.
Anne Frewin: To me, Lean is the whole picture. Right. The continuous improvement. One of my favorite books is Toyota Way and Jeffrey Liker's 14 principles. Right.
Anne Frewin: There's more to it than elimination of waste. But in her, the way she trained, and the way we were set up was as a Lean team. We were out there doing the rapid improvement events and helping to drive. Going back to our previous conversation, focus on quality, and we're going to get delivery and we're going to get cost savings. Focus on making sure we have one-piece flow and the product is safe and we're going to get better capacity, more capacity.
Anne Frewin: And that was such an aha moment for me to learn that. And I've carried that with me for on from there. Like really we are talking about one-piece flow, deliver without defects. Right. Reduce variation, but in a process mentality.
Anne Frewin: And that Six Sigma can focus on the value-added science part of, of the product. And it makes sense to me, and that's how, that's how I live my life. So, you know, Lean Six Sigma to me is, is. I still struggle with what that means. It's almost like we're trying to take two things that have really powerful, and we're trying to do it the same, the same way.
Anne Frewin: I, you know, it's, it's, it's like having, you know, a general contractor. To me, Lean Six Sigma is almost the general contractor, but. Or you could have a specialized plumber and a specialized construction person focusing on their own things.
Mark Graban: Yeah.
Anne Frewin: Stronger. You get more from it.
Mark Graban: Yeah, yeah. I mean, I, I mean I, I think the best example I worked at was a manufacturing company where Lean and Six Sigma coexisted. You know, and you know, I, you know, I forget where I heard this from originally. I wish I could give credit where credit's due, but you know, a. I haven't said this in a long time, but it just jumped back to me now when I, you can put a cat and a poodle in a room together and they might very well coexist, but it doesn't mean they become this animal called a cudle.
Anne Frewin: Yeah.
Mark Graban: Yep, yep.
Anne Frewin: Exactly. Exactly. And you know, even in healthcare, to me, I think Lean is so powerful in healthcare because it's all about people processes. Right. You're never going to have somebody use Lean and tell a surgeon how they should cut or an anesthesiologist and how much medicine you should be giving during anesthesia.
Anne Frewin: Right. That's a Six Sigma level thing. Right. But everything else in the healthcare system is all about people process. And Lean is exactly the right tool for methodology.
Anne Frewin: I don't want to use the word “tool.” Can you edit that out? Lean is not a tool.
Mark Graban: Capital. Right.
Anne Frewin: One of my pet peeves. Yeah, exactly. Analogy. But Lean, Lean thinking is what we need in healthcare. Because the Six Sigma, where does variation, that level of complexity needed is it.
Anne Frewin: Can you use it? Yes, but for most of the stuff in healthcare to help us reduce the cost of healthcare, there's a lot of waste, as we all know there is.
Mark Graban: And I agree with you. And you know, waste reduction is important, but that's not the only thing. And thank you for saying and putting together Lean and variation reduction because my pet peeve is when people, you know, sort of suggest or get, imply or state directly that, you know, variations of like, “Well, Lean is about speed and Six Sigma is about reducing variation.” I'm like, “Well, we could both, both methodologies can contribute to them because they're interconnected.”
Anne Frewin: Absolutely.
Mark Graban: I mean like standardized work and other Lean method, other Lean methods. I mean, certainly we are trying to drive out variation. And you know, my view is that there are some really sticky, complicated problems that are worth that more rigorous approach. But you know, at that one company where the two coexisted, I saw the one version of the mistake of sometimes the Six Sigma approach seemed like overkill, you know, to, to certain problems.
Anne Frewin: Yeah, I've seen that as well. I've seen that as well. But you know, it's, I just lost my train of thought.
Mark Graban: That's also part of being human.
Anne Frewin: Thank you. Thank you. Anyway. Oh, variation. Going back to the variation.
Anne Frewin: Right. You know, I see it more from a Lean perspective going to the standards. Right. When we have standard work, if we're not following the standards, that's going to create variation in how long things need to get done, the quality of things. Right.
Anne Frewin: So you can't say that's a Six Sigma problem because it's a, it's actually a standard work problem or it's, it's how. Why have we not set the process up? So everybody's following it the same way. Right. So it does coexist.
Anne Frewin: I mean, variation has to be part of reducing variation has to be part of Lean.
Mark Graban: Yeah. So Anne, maybe one, one last question here. And I think, you know, it's a meaty question, I think perhaps, but you know, what are some of your reflections of working in different industries and you know, common principles or things that you've learned in one that are transferable back into the other or others, you know.
Anne Frewin: Wow. I think it's all transferable. I mean, for me you were talking about. Were we talking when you asked that question, you're talking about like clean work, right?
Mark Graban: Yeah. Lean work. And maybe frame it a little bit differently for you. You started in healthcare and then have also done work in manufacturing, right?
Anne Frewin: Yes.
Mark Graban: So that I think that's unusual because it's more likely the manufacturing routes. People end up in healthcare and then maybe back in manufacturing. But so let me frame the question a different way of like what were some of the challenges or the things that you noticed then going to work in manufacturing where you're like, “Oh, well, these things are transferable, but you're kind of going in an unusual direction?” Direction.
Anne Frewin: Yeah, I, I think to me the biggest, the biggest difference. I found it and this is going to sound. I don't know if it's going to come across like there is. I talked about my quality improvement team in healthcare. Right.
Anne Frewin: So I, maybe it's because I wasn't ingrained in the quality side of the healthcare. I know there's a lot of standards and control documents and all of that around in, in healthcare.
Mark Graban: The traditional clinical quality.
Anne Frewin: Correct. Clinical quality. I wasn't. Right. I didn't work with that.
Anne Frewin: So, so part of this might just be my exposure. So I don't want anybody listening to this to think there's not quality. Yes, there's 100% quality in healthcare. But what I found in, in maybe it was the site I was at recently is that there's so much control document and I guess I found this other place too because one of the. I did.
Anne Frewin: Anyway, I could go off a couple rabbit holes on this one. The, the documentation required at the manufacturing sites that I've worked at which felt like it hindered improvement. So going back to, going back to my, you know, Lean and Six Sigma, how much information are you putting in your standard work in your controlled documents? If you have, if your work instructions or your standard work is com. Like every single little step is in there and somebody can't look to the right because the standard work said to look to the left and they're going to get written up for that or dinged on that.
Anne Frewin: That's how, that's the constraints I have felt in the manufacturing setting. I didn't get that in healthcare. And maybe it's also how things are documented and written up. But in manufacturing it feels like because of the environments I've been in, very regulated environments in the manufacturing sites I've been in that things have to have been. Eyes have had to be dotted and T's have to be crossed.
Anne Frewin: But I think in some cases they went too far and they put too much into those documents because they wanted to make sure they didn't. Everybody did it the same way. Again, going back to our systems, if your systems start in place are strong enough, you don't need to have all of the I's dotted and T's crossed. In one of the projects I did in one of the manufacturing sites I was in, we were, we actually looked at work instruction. We pulled it.
Anne Frewin: There was like 140 blanks that had to be filled out. 26 pages. We worked to reduce that by half. But I brought in regulatory and quality into the. And I said, “Do they need to have this?”
Mark Graban: Yeah.
Anne Frewin: And some of these, “Do they need these?” They said no, those were put in place because somebody made a mistake 20 years ago and they put it into the work instruction.
Mark Graban: Yeah.
Anne Frewin: And as long as the system's in place so it doesn't happen, it doesn't have to be there. And I don't know. And to me that was the biggest difference for me is afraid of making a mistake or causing a problem because it's not on paper. That's what I found when I've gone into manufacturing. From when I left healthcare and maybe healthcare where I was at 12 years ago, we didn't have a lot documented.
Mark Graban: But there's my perspective. I think what you're describing, there could be two different extremes. So one is, I've heard people use the word like there's enabling bureaucracy and then there's stifling bureaucracy. So we could take the documentation too far and it becomes an unnecessary barrier where people hold it up as an excuse. “We can't change because of this quality system or this documentation or ISO or whatever.”
Mark Graban: I've heard some of that in healthcare where people say, “Well, we, we can't change.” “Why?” “Because while we're working in the blood bank and the, what's the acronym, AABB or, you know, like some professional organization or regulation says we can't do it that way.” Which is sometimes true and sometimes not.
Anne Frewin: Yeah, that's, that's true. I did hear, I did hear that when I was in the healthcare in the. From our laboratory manager. Yeah, there was a lot of “we can't do it because of the lab or organizations,” know.
Mark Graban: And so you have to gently. And I found, like, working, you know, usually it's somebody who is one of those professionals that can push back on the professional question where I would feel like it was risky to do so as an engineer. But then there also is in healthcare, shocking to me, like very much in a lot of settings, a tradition of, “Well, I do it the way I want, I do it the way I was taught, I do it the way that works for me.” Lack of standard work to an extreme, that either leads to problems in any of those categories, it could lead to safety, quality, delivery, cost problems. So finding back to, like, finding the right balance.
Anne Frewin: And I've seen that in manufacturing, too. I mean, even despite all of those work instructions, there's still areas that didn't have it.
Mark Graban: Yeah.
Anne Frewin: And people were doing it their own way, or “I was trained by Joe and you were trained by Mary, and Joe and Mary did it different.” Right. And “I'm going to do it my way. I'm going to do it Anne's way.”
Mark Graban: Yeah. But these are the things where, you know, the principles, whether it's, you know, Jeffrey Liker's Toyota Way 14 principles or Dr. Deming's different 14 points, or the five principles of, you know, the book Lean Thinking, like, those principles are often straightforward, but now working with them in the real world, that's where we earn our paycheck. Because otherwise you could just mimeograph the 14 or the 5 and it would be easy.
Anne Frewin: But wouldn't that be great?
Mark Graban: Well, we, you know, talk about protecting people's jobs. You know, we want to be able to. I mean, look, I wish things were perfect and you didn't need improvement professionals. But again, part of the human condition, the organizational condition, is things are never perfect. Look, even at Toyota, Toyota's perfect.
Mark Graban: They still have problems, they still have waste, they still have people working on Kaizen and improvement.
Anne Frewin: So they're still learning.
Mark Graban: Hopefully, we all are. So I think with that, we'll wrap up again. We're joined by Anne Frewin. I will link you in the show notes to your LinkedIn profile if people want to connect with you or. Or reach out.
Mark Graban: And an hour went by very quickly here, so thank you for having a great conversation. Thank you for sharing some of your experiences and passions here today.
Anne Frewin: My pleasure. Thank you for having me.
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