Scroll down for how to subscribe, transcript, and more
We've been on hiatus over the summer here, but I did a live-streaming video the other day with my friend Ryan McCormack, who regular readers of this blog will recognize as the creator of the bi-weekly “Operational Excellence Mixtape” emails that he allows me to publish here on the Lean Blog.
He was also my guest for Episode 12 of the “Lean Whiskey” podcast.
In this 30-minute discussion, Ryan and I chat about:
- Why did you start the “mixtapes”?
- What are some favorite books and podcasts that you have highlighted recently?
- What have been the transferable Lean lessons going into healthcare and now back out into other settings?
- Best Thing / Worst Thing — What's the best thing about doing OpEx work? The worst thing?
I hope you enjoy the conversation.
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.
Watch the Video:
Automated Transcript (Not Guaranteed to be Defect Free)
Introduction and Context
Announcer: Welcome to the Lean Blog Podcast. Visit our website www.leanblog.org. Now here's your host, Mark Graban.
Mark Graban: Hi, it's Mark Graban here. I know I had announced a summer hiatus without new episodes, but we'll call today's episode number 421. It is August 4th, 2021. Today I'm bringing you audio that comes from a live stream video broadcast that I did yesterday with my friend, Ryan McCormack. We did that out on LinkedIn Live and the Lean Blog Facebook page and YouTube Live. We talked for about 30 minutes.
If you are a regular reader of Lean Blog, you'll know that Ryan contributes every other Friday what he calls his “Operational Excellence Mixtape.” He includes links to articles and books and podcasts and all kinds of great resources. Again, you can find that at leanblog.org–search for “mixtape.” So we're talking about that: Why did he start that? What are some of his favorite books and podcasts? We'll talk a little bit about his experiences with Lean and operational excellence in healthcare and other settings.
If you are a listener of the occasional Lean Whiskey podcast, Ryan was my guest. We had a conversation in episode 12 of that series. So if you want to find links to all of this, you can go to leanblog.org/421.
Meeting Ryan McCormack
Mark Graban: All right. Hi, welcome to my live stream. I'm Mark Graban, and I am the host of a number of podcasts among other things. I'm the host of a podcast called Lean Blog Interviews. I'm the host of a podcast called My Favorite Mistake. And today I've got a guest here, a friend of mine, Ryan McCormack. We met how long, how many years ago? I should welcome you, but we'll keep this casual. We met maybe 10 years ago.
Ryan McCormack: I'd say 10-ish. Yeah, maybe.
Mark Graban: Maybe a touch more. So we crossed paths when I was involved with the Lean Enterprise Institute and an organization now called Catalysis. I had a chance to come visit Ryan's organization. So Ryan, how about if you want to fill in some of the details here about where you live and where you were working at the time and what you're doing now in terms of some introductions?
Ryan McCormack: Sure. So my name's Ryan, I live in sunny Winnipeg, Manitoba, Canada. Mark and I first met when I worked at St. Boniface Hospital. They were engaged in a fairly significant Lean transformation starting in about 2007. And of course, our paths crossed through all sorts of learning events and Gemba visits across North America. Currently, I work for Canadian Pacific Railway based out of here in Winnipeg. We're undergoing a lot of transformation as well as we learn to be the best operating railroad in North America.
Mark Graban: And so your career has kind of taken the path of, I don't know, like three phases: pre-healthcare, then your time in healthcare, and now you've been doing other things. What was helpful for you or what was that transition like pre-healthcare coming into healthcare with your job at St. Boniface?
Ryan McCormack: Wow. Yeah. Pre-healthcare, the idea of using industrial engineering techniques or continuous improvement techniques in healthcare was still fairly unheard of at the time. So the challenge early on was just convincing people that these methods have merit and can actually be helpful in reducing harm for patients and also improving flow and financials. So the early part of that was really just on that demonstration and convincing. Of course, now it's fairly well established that it can be part of an approach to transform healthcare and improve value.
Post-healthcare, it's been a bit of an adjustment to get back to a private industry with a little more results focus than public healthcare in Canada had. So I've enjoyed that transition back as well. And I've been able to apply a lot of what I learned in healthcare, which is probably the most complex system you can work in, into my roles post-healthcare.
Comparing Healthcare Across Borders
Mark Graban: And you know, there are opportunities that we've both had to help bring ideas from one industry to another. Then there's the question of bringing ideas across borders. I've been part of groups to come up to Winnipeg there to St. Boniface years ago; you were part of groups to come down to the U.S. You know, the Canadian healthcare system in the different provinces is of course very different in a lot of ways from the high-level structure of the U.S. health system. But what comes to mind when you think in terms of things that can actually be learned when it comes to healthcare delivery–commonalities or lessons that can be shared?
Ryan McCormack: Yeah. I mean, that was a common question I would get as well: “That works well in public healthcare, but what about private?” And truth be told, having visited so many different locations throughout Canada and the U.S., the problems that the healthcare providers and patients and facilities encountered were all the same. The “who pays” side rarely figured in the main causes of what was preventing the delivery of the highest quality care. Your usual suspects applied absolutely everywhere.
That bore out really quickly. I personally thought it would be a bigger difference from the first time we went to Appleton. And I was like, “Ah, well, yeah, that's the U.S. so it won't be the same.” But once we talked to the first nurse and first doctor about what was frustrating them, I realized the problems are absolutely the same.
Mark Graban: Those day-to-day challenges when it really gets into the nitty-gritty of how care is organized and how care is delivered tends to be very similar. You know, there may be slightly different systemic root causes to an issue like emergency room waiting times. In the U.S. it might be people who don't have insurance and don't have access to care, so they go to the emergency room. In Canada, there might be other drivers leading people to come to the ER when it's questionable, “Should this be emergency care or not?”
Ryan McCormack: Yeah. And of course, probably the biggest contributor to systemic emergency backlog in Canada is downstream, which is the lack of capacity in acute medical wards primarily, which isn't always the case in the U.S.
The Operational Excellence Mixtape
Mark Graban: So speaking of different places–and please do add into the chat where you're from. I see people who've been doing that already. We've got people here from South Africa, Chile, Ghana, Iran. So, wow. Really cool to have a global audience to say hello to and share a cup of coffee with.
One thing I wanted to talk about today, and one thing I've been really appreciative of Ryan for, is something he puts out every other Friday. He calls it the “Operational Excellence Mixtape.” If you are ever short on something to read, or you're looking for a new podcast to listen to, Ryan does such a good job of curating things that would be interesting on topics of operational excellence or even things that might be kind of on the periphery of operational excellence when it comes to leadership and psychology and change management.
Ryan puts that out as an email, which you can sign up for, or Ryan's been kind enough to allow me to post all of the mixtapes going back a couple of years on my blog. So if you do a search for “Lean Blog Mixtape,” you'll find Ryan's most recent one. I wanted to ask you, Ryan: what was the origin for putting together the mixtape?
Ryan McCormack: Yeah. So when I started in healthcare, part of that whole convincing process that some of these ideas are worth experimenting with included the predisposition of healthcare professionals to look for the literature first. So quite often I'd be like, “Hey, why don't we try this approach? Or why don't we run an experiment on this particular process?” And one of the defensiveness, or even the questions I would get from providers is, “What does the literature say?” So that was starting to frustrate me a bit. And I thought, well, okay, what does the literature say?
So what I started to do was procure different articles–at the time, mostly from like New England Journal of Medicine–that related to improvement. And then I started sending those out to a mailing list at the hospital every couple of weeks. I was like, “Well, here's what the literature says,” as a way for us to discuss what it could mean for us at St. Boniface Hospital, but also as a way to kind of convince people, “Hey, why don't we try this? This is a legitimate approach. Look at what other places are learning.”
And then from there, I had more people from hospitals start asking me, “Hey, I heard you send out these links. Could I be included as well?” It just kind of spiraled from there. And it became something I started offering up publicly maybe six years ago. It started off just as healthcare-related links, and now I tend to include anything that I think is interesting relative to creating value, driving improvement, and coaching and developing self or others.
Book Recommendations and Systemic Thinking
Mark Graban: It seems like if you were given the choice of spending an hour sitting in a conference room arguing about “Should we include an eighth type of waste?” you'd be a lot better off spending that hour actually out on the floor, actually looking at your process and working on the elimination of waste. But back to the mixtapes. Is there a recent favorite book or one that you've read that you might want to share a little bit about?
Ryan McCormack: Sure. I'd say some of my more recent favorites. There was one book by Roger Martin called When More is Not Better.
Mark Graban: Cause he writes a lot about corporate strategy. Is that correct?
Ryan McCormack: Yeah. So he's a professor at the University of Toronto here in Canada. I found this book particularly interesting. It's a bit of a modern take on some principles that we're all familiar with from Deming.
I would say he walks through some fairly well-publicized examples of where seeking efficiency for its own sake can create a host of problems rather than solve them. It can lead to monopolistic situations, sub-optimization, and short-termism, whereas of course, students of improvement know that long-term thinking is an essential principle.
He walks through, for example, the Wells Fargo example that many of us are familiar with, where sub-optimizing created immense systemic damage to the customers and to the brand of Wells Fargo that continues to endure today. He offers up some different ways of thinking from a business executive point of view, from an academic point of view, and even into political point of views.
Mark Graban: Just a quick comment on the Wells Fargo case. The CEO decided “Eight is Great” and that every customer should have eight accounts. But that led to a very systemic problem where frontline bank employees and managers were under pressure to either pressure customers into signing up for accounts they didn't need or even doing so on behalf of the customer when it wasn't authorized. I would die on this hill that this was a systemic problem.
Ryan McCormack: Yeah. And the basic thesis of When More is Not Better is: if we've gotten pretty good over a hundred years at treating business as a mechanical machine that we can optimize by pulling levers, that doesn't always lend itself to sustainable improvement in the more complex environments we have today.
There was a second book I liked called How Innovation Works by Matt Ridley. Innovation is the flavor these days. There are some great historical walkthroughs of innovation over history, whether it's the steam engine to the computer. And Matt Ridley does a great job of sharing what the underlying principles are that are common with innovations throughout human history.
There are things again very familiar to Lean thinkers–things like collaboration. Most innovation over history was actually done by what he refers to in the book as “unlettered people.” This is another reason to engage widely in your organizations to drive improvement. People need to be free to experiment and learn from trial and error. That's an essential ingredient to innovation throughout human history, as well as gradual incrementalism.
That's part of the challenge. Big organizations engaging in innovation strategies may struggle with that short-termism. You want that big step change. You want to go all-in on that one change, but history shows us that sustainable innovation and breakthrough innovations come from long-term, gradual incrementalism.
Mark Graban: Does the book touch on the idea: can you turn innovation into a process?
Ryan McCormack: Yeah, it does, but the spoiler alert is: the process is the scientific method.
Variation, Noise, and Podcast Favorites
Mark Graban: There was a comment in the chat here from Tom Bouthillet, and he says there isn't much evidence for many of our medical treatments either. I know a couple of years ago I heard Dr. Brent James, who was pretty legendary in healthcare quality improvement circles, say that maybe one-third of medicine is driven by really well-known evidence-based best practices.
Ryan McCormack: Yeah. And that's another book I've been reading too, is Noise by Daniel Kahneman. It's a good reminder of this topic about variation, which is obviously near and dear to Lean thinkers as well. But it just reinforces the point you just made: variation is way more rampant than we think. Humans are lousy at judgment. And the bad news is machines that we're building now are only slightly better.
For those of you who've read Daniel Kahneman's Thinking, Fast and Slow, which was one of the better books I've ever read, I had high expectations. I found Noise to be good, but ironically, I found it to be a bit noisy as well.
Mark Graban: Ryan loves sharing books, and then he's also a podcast listener. Is there a podcast episode or a podcast series that comes to mind recently for you?
Ryan McCormack: Sure. I'm a big fan of The Knowledge Project by Shane Parrish, who has a website called Farnam Street. He brings on a lot of heavy-hitting thinkers. Recently, the last one I recall listening to had Danny Meyer, the founder of Shake Shack. The lessons he shared on customer service are universal and were just inspiring.
I'm also a big fan of Coaching for Leaders with Dave Stachowiak. They're good too because they're shorter, like 20 to 30 minutes. He brings on great coaches. Of course, Lean Blog Podcast is a classic that I continue to listen to. Mark, I just noticed the other day that you published just a brief list of those who've been guests on your podcasts that are no longer with us. And of course, one of my personal mentors, Dr. Michel Tétreault, you mentioned and reshared his audio clips. So I want to thank you for that.
Mark Graban: Yeah. I probably had four or five different encounters with him visiting St. Boniface Hospital. I will never forget how he was part of a group that went and visited an airbag manufacturer in Utah called Autoliv. So here he was crossing borders, crossing industries, looking for lessons about improving safety and Lean management. We all miss him a lot.
Ryan McCormack: Absolutely. Another podcast I'd like to recommend is WorkLife with Adam Grant. He recently had a podcast centered on speaking up at work. It's, I think, a great job of dissecting the very prevalent and popular concept around psychological safety. He shared some interviews with folks from Boeing regarding what contributed to the 737 Max tragedies. He brings on some military guests as well to talk about how to cultivate psychological safety and remind us that it's not about being nice to everybody.
That's a common thing I get when I bring up this subject: psychological safety is not just being nice and placating people at all. I think Admiral McRaven on this particular podcast does a great job of reminding us how to achieve psychological safety without it becoming an exercise in softness.
Mark Graban: And in that episode, Amy Edmondson from Harvard was, I think, one of the experts.
Ryan McCormack: Yeah. Amy Edmondson was on it. Again, another great book, The Fearless Organization, I recommend without reservation. It is about psychological safety and what are the factors that contribute to creating a culture where people aren't afraid to speak up at work.
Best Thing / Worst Thing
Mark Graban: Maybe the last thing before we wrap up: in interviews recently I have come up with this question. What's the best thing and the worst thing about doing operational excellence work like you do, regardless of the industry?
Ryan McCormack: For me personally, the best thing is teaching and developing others with these principles. I was fortunate to have strong mentors throughout my career, and whenever I'm able to give back, if I look back on my proudest accomplishments, it's those I was able to help along their journey.
I'd say the worst thing is… well, one of the better things is that you get to work on all sorts of interesting problems, so you're never bored. But I gotta tell you, once in a while, it'd be nice to be bored. I had a director that I used to work for who would say, “You know what? Sometimes you just need to dig a ditch.” I think what he meant was sometimes you need to get into a routine in order to liberate some of your thinking to come up with your most novel ideas.
Mark Graban: Best thing, worst thing about living in Winnipeg? I'm throwing this out.
Ryan McCormack: Best thing about living in Winnipeg: the sense of community. Winnipeg is well known for its small-town feel in a big city. And if you're in Winnipeg, you're halfway to everywhere, right in the middle of the country.
But that's also the worst thing: you're halfway to everywhere. So to get anywhere, you have to travel. I know people hate the winters here. That's a big sticking point–“Winter-peg.” Everyone thinks that's hilarious. But I've lived in Canada my whole life. I love the winter; that doesn't bother me. But being isolated, sometimes Winnipeg's a bit behind the trends as well.
Mark Graban: Final thing here. Best thing about putting together the Operational Excellence Mixtapes to you?
Ryan McCormack: It forces me to stay current. It keeps me motivated to keep learning and reading and listening and learning from others and to be able to share that as well.
Mark Graban: Is there a worst thing?
Ryan McCormack: Well, since I've been publishing the mixtape–it's been about nine years total–the amount of paywalls has increased year over year. So the amount of free and shareable material has gone down a lot.
Mark Graban: All right. Well, there we go. Ryan, thank you a lot for doing the discussion here today. Thank you to everybody for joining us. If you want to find links to his mixtapes and everything he shares, again, you can find links to this by going to leanblog.org/421.
Announcer: 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@leanpodcast@gmail.com.
Thanks for listening or watching!
This podcast is part of the Lean Communicators network — check it out!
Please scroll down (or click) to post a comment. Connect with me on LinkedIn.
If you’re working to build a culture where people feel safe to speak up, solve problems, and improve every day, I’d be glad to help. Let’s talk about how to strengthen Psychological Safety and Continuous Improvement in your organization.
![Pinterest](https://pinterest.com/pin/create/button/?url=https://www.leanblog.org/2021/08/innovation-noise-strategy-mccormack/&media=https://www.leanblog.org/wp-content/uploads/2021/08/Lean-Blog-Cover-Image-30.jpg&description=Ryan McCormack joins Mark Graban to discuss his "Operational Excellence Mixtape." They explore key insights on strategy from Roger Martin, decision-making from Daniel Kahneman’s Noise, and the roots of innovation by Matt Ridley.){kind=link}