Disruption Proof: Brant Cooper on Uncertainty

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My guest for Episode #422 of the Lean Blog Interviews Podcast is Brant Cooper, appearing for the third time and the first time solo. Brant previously appeared, alongside Patrick Vlaskovits, in Episodes 99 and 162.

Brant is the author of the upcoming book, Disruption Proof: Empower People, Create Value, Drive Change, due out in late October, but is available for pre-order now.

Brant is the New York Times bestselling author of the book The Lean Entrepreneur (now in a 2nd Edition), and he's CEO and founder of the firm Moves the Needle.

He is also organizing a virtual summit — the Endless Disruption Summit — on Sept 30.

Topics and questions:

“One thing in life is certain: Disruption is the new norm.” — Why is that increasingly so?
How can a company become disruption proof?
What's a good example of an Industrial Age company that has transformed to thrive in the Digital Age?
Lessons from the pandemic?
- Working from home and now what?
Empathy and restaurant signs
- The entire world is understaffed?
- The hospital sign about your energy and the workplace
The 5Es: Empathy, Exploration, Evidence, Equillibrium, and Ethics
His experiences in healthcare — cancer
- The people are amazing
- Ransomware attack affected his radiation care

I hope you enjoy the conversation.

Sadly, Brant passed away in 2024.

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 Episode:

Announcer: Welcome to the Lean Blog Podcast. Visit our website, www.leanblog.org. Now here's your host, Mark Graban.

Mark Graban: It's Mark Graban. Welcome to the podcast. It's episode 422 for September 8th, 2021. Our guest today is Brant Cooper. He is the author of a new book due out in late October called Disruption Proof: Empower People, Create Value, and Drive Change. You can learn more about Brant and his book by going to BrantCooper.com. He's also organizing a virtual summit called the Endless Disruption Summit. It's being held on September 30th. I'll be taking part in a panel discussion there. You can learn more at endlessdisruption.com. For show notes, links, and more, you can go to markgraban.com/422. Thanks for listening.

Reconnecting With Brant Cooper After Eight Years

Mark Graban: Hi everybody, welcome to the podcast. We're joined today by a returning guest. Brant Cooper's here. He was previously a guest going back to episode 99 in 2010 and episode 162 in 2013. So Brant, it's good to reconnect with you. Thank you for coming back.

Brant Cooper: Thanks for having me, Mark. I didn't realize it had been eight years. That's a while.

Mark Graban: Yeah, I had to look it up. Eleven years from that first one. So we take advantage of opportunities to talk about books that Brant has written, and sure enough, he's got a new book coming out. It's going to be available October 26th. It's called Disruption Proof: Empower People, Create Value, Drive Change. He's previously the New York Times bestselling author of The Lean Entrepreneur, and he's also the CEO and founder of the firm Moves the Needle. I don't have this right in front of me — what was the other book that you and Patrick Vlaskovits wrote? That was the first episode we did together.

Brant Cooper: That was the first book that talked about customer development and lean startup and product-market fit and all those fun things. It was a self-published book called The Entrepreneur's Guide to Customer Development. I've actually got a second version of that book in the works as well, though I'm calling it the Startup Blue Book. That one was focused primarily on startups and entrepreneurs.

Mark Graban: And then as a bit of a recap — people can go back and check out episode 162 — what's the elevator pitch summary of The Lean Entrepreneur?

Brant Cooper: That's the deep dive into how you develop empathy for customers or other stakeholders, what we mean by running disciplined experiments and how to run those, and then what data you should be focused on. These are the learning impacts, or impact metrics as I call them — progress toward desired outcomes, as opposed to really task-oriented KPIs or OKRs.

Why Lean Startup Techniques Transfer to Healthcare

Mark Graban: I looked at the book for a while, and I would invite — I know there are a lot of people in the audience here who are involved in different entrepreneurial ventures, but even people doing lean work in healthcare, I think, would learn from how you frame it. Looking at measures and experiments, connecting dots, having empathy for your customer. That's going to be a topic today, because your new book touches on that. But I think we'd find there's probably more that's transferable, or more commonality, across sectors.

Brant Cooper: Right. Moves the Needle, my company, has worked with companies in absolutely every sector — 60 to 70 companies — and hardcore healthcare and life sciences companies are included. I'm always interested in healthcare because the ecosystem is so complicated. So I purposely use “stakeholders,” since yes, we have to pay attention to patients, but there are also patients' families, and there are payers and insurers and government regulations and all of these other players in that ecosystem that make it very complex. And of course, what that means is a lot of people sort of throw up their hands and go, “You can't do lean startup,” or “You can't do lean innovation in healthcare.” And of course you can. The books have been focused on how you apply it to different sectors. Where's your uncertainty? If you have a bunch of assumptions to bust or biases to cut through, then these lean entrepreneur techniques apply pretty darn well.

Empower People, Create Value, Drive Change

Mark Graban: We'll talk more about healthcare and some of Brant's experiences later on, but we talk about uncertainty — healthcare is nothing but uncertainty here on August 30th as we're recording this and coming into early September. I'm sure that will still be the case when this episode is released, and it will certainly still be the case at the end of October when Brant's new book comes out. Again, I'm going to give it another plug: Disruption Proof: Empower People, Create Value, and Drive Change. The six words of that subtitle — before we get into the book deeper — that connects with me. I think those are important ideas for people who might describe what they're doing as lean in healthcare.

Brant Cooper: Right. There are two industries, two sectors, that have been at the tip of the spear when it comes to changes brought on by massive technological innovation, the digital age, the increased complexity of the world — and that would be the military and healthcare. I'm a big fan of McChrystal's Team of Teams, which describes pretty much on point the changes that needed to happen in the military facing this new world that we're in.

I think the changes have been a little bit slower in business and in healthcare. But this idea of decentralizing decision-making is paramount to this new world. That's the empowering part — pushing the decision down toward the edge where issues are arising. And then “create value,” of course, is a long-held lean tenet, that we need to be focused on the efficiency of creating value and not efficiency for efficiency's sake. And then driving change. I just think that change is inevitable, and change is every day, and change is going to continue to happen. So we just need to make that part of our daily life, the ability to deal with change and to make things better.

I think that's the promise of capitalism. It's why I love capitalism — that we can solve big, wicked problems. And rather than using some command-and-control hierarchical system, we simply need to empower the smart people that we hire to go solve these wicked problems, and we can do it.

How Capitalist Companies End Up With Central Planning

Mark Graban: And there's still, in healthcare in 2021, a lot of top-down command-and-control management styles. Now, people, especially hospital CEOs who have embraced lean, are working really hard to change that culture within their organization. First off, just to acknowledge that that is real and that it's not ideal, and let's work on shifting that.

But I'm reminded — and I use this as a discussion point teaching lean in healthcare — going back to General Eisenhower, President Eisenhower. I think this is a quote from when he was a general, but anyway, he was criticizing the Soviet system, and the quote is something to the effect of, farming looks very easy when your plow is a pencil and you're sitting 500 miles away from the field. Something to that effect. When people are making far-off decisions, they make all kinds of, I'm sure, bad assumptions about what you should or shouldn't be able to do. And he was clearly saying that a capitalist system avoids some of those traps. But then it's funny — there's a philosophical question I'm going to throw back at you. How do very capitalist companies in a capitalist system end up back in that command-and-control model? The central planning, the central committees.

Brant Cooper: It is. It's funny, because I even sort of say that in the book, as I'm mapping out my history with economics back in college. I think it's based upon uncertainty and complexity. There was a rapid period of growth post-World War II in the United States where our industrialized society was innovating, creating new technology, just doing amazing things and creating products that — pretty much, if these products came to market, you knew there was a market for them. Microwave ovens and washers and dryers and refrigerators. We were raising the standard of living. We were changing how people could live their daily lives and free up time. And it was generally a positive experience.

In the throes of that, there's relatively little uncertainty. There's relatively little complexity. We know how to create the widget. We need to create the widget as efficiently as possible. We want to keep the cost of the widget low because we want everybody to buy it. That was the momentum of the industrial age. So managing by execution and by efficiency — input versus output — kind of makes sense in that model. And the hierarchical decision-making sort of makes sense, because the consumer has fewer choices. If it's close enough to what they need and what they desire, they're going to buy it. There's just not a lot of uncertainty or complexity in the model.

But of course, if you fast-forward to today, and if you look at healthcare and the ecosystem that we were just talking about, and the technology and the complication of care — doctors now are all specialists, and yet curing one individual might require several different specialists in several different avenues of care. The complexity is immense, both from an economic point of view and from a care point of view.

That complexity means there's all of this uncertainty. And all of this uncertainty means that if you're still making decisions in the middle, in the core, top down, then you're filled with all of these things you mentioned Eisenhower talking about. It's easy with a pencil to figure it out, but it's not the reality that the doctors and the nurses and the patients and the families are enduring on the ground, on the edge of the system.

Staffing, Listening, and the Dialogue That Is Failing

Mark Graban: One of those decisions that might be made with a pencil in a hospital context instead of a farming context is, well, here's how many staff you have. That might make sense to somebody distanced from the frontline of care with a pencil, and staff might be screaming, “We're understaffed. We're not able to provide safe care.” And that, I think, quite often falls on deaf ears. They're told to toughen up, deal with it, do your best.

Brant Cooper: And to be honest, just to paint that scenario, it could be that the staff is wrong. They aren't understaffed. It could be that the processes are wrong, or the scheduling is wrong, or the way they're orienting how those individuals work together is wrong.

Like all great entrepreneurs, you have to listen to the market — but listening to the market doesn't mean that you're doing what they say. It means that you're understanding what the needs are, and the issues, and all of those types of things. So it's the dialogue that's failing there, almost more than anything. And I think that's actually what the frontline people feel like. It's not that management isn't doing what they say. It's that management's not really even listening.

And again, it gets back to what I said earlier. The idea is to allow smart people to solve problems, and yet organizations tend to look outside of themselves. They're looking at their customers and saying, “Okay, what are their customer problems?” But all of those principles can be applied internally. What are our internal needs? And how do we listen better to our colleagues and employees and leaders and management and all of these different stakeholders in order to test and design systems that work better?

Frame the Problem Before You Jump to the Solution

Mark Graban: And I think there's a disconnect, and maybe there are some parallels to think about with entrepreneurship. Somebody wants to develop software, they want to develop a solution — but how have we properly framed the problem first? That's where, to me, lean startup and customer development is lean, because it starts with this problem solving, or what we call A3 problem solving, or what have you. Don't jump to solutions. Let's define the problem well.

Because when nurses or nurse leaders start unions and they start lobbying, they want solutions like mandated staffing levels. And I try to be empathetic to the pain and the burnout and the frustration that frontline staff are going through. I would get slapped, maybe, if I said, “Well, you haven't framed the problem correctly.” They might say, “Well, you're not listening, Mark.” But when someone says, “We need more staff,” that gets shut down, right? The solution is “we need more staff,” and management says, “No, you don't.”

But if you can start getting more granular and saying, well, what's the pain point — a patient got dropped on the floor because we didn't have somebody available to help with the transfer. Now that's very specific. And then we could trace back to different things related to the process. Maybe it's division of labor, maybe it's communication, different things, to go solve important problems that matter.

So back to you from the entrepreneurship side. Would you agree that's what all entrepreneurs should be doing — not focusing on developing your solution, but helping frame and solve problems?

Brant Cooper: Yes. I mean, it's sort of what you wish, but it's just still not reality. I think entrepreneurs will often build product first, because they're likely solving a problem that they've experienced themselves. I'm kind of okay with that, but it means that step two is going back to the source and understanding the problem or the need.

There are frameworks — human-centered design, design thinking — which I think go back to the problem first, which is great. Entrepreneurs, at least a certain class of entrepreneurs, are always going to start with product first, and I'm like, okay, I'm not going to break you of that one. So it means that their next question is always, “But how do I find customers?” And it's like, well, there's your gap. You actually haven't figured out what the real problem is and who has it. So that's your step two. And hopefully you didn't waste a whole heck of a lot of money building the product, because it's going to change.

Why Disruption Is the New Normal

Mark Graban: We'll come back to the title of the book and talk about disruption. People might be developing a product that was correct, that would have been good in the world as it was at a point, but then things change — disruption, uncertainty, world events, technology changes something in their market. So I want to bring it back to the book. Again, the title is Disruption Proof. In the notes about the book it says, on your behalf, Brant: one thing in life is certain, that disruption is the new norm. Why is that increasingly so? Why is life becoming more uncertain and more disrupted?

Brant Cooper: I want people to understand, I'm not really talking about technology startup disruption. That's part of it, but I want people to think about things like the pandemic. Arguably 10 years ago, 15 years ago, 20 years ago, the pandemic wouldn't have had the impact it did today. And why is that? It's really the interconnectedness of the world. We're flying all over the place, and the opening of trade and borders and all of these types of things. To me it's really the digital age. It's the digital revolution that makes us interconnected — the stream of information and misinformation, even the decision-making that we're able to do with computers in our pockets, the knowledge that we have. All of these things make us closer together than we ever have been before, and it makes things move so fast, and decisions need to be made so fast to keep up. That's the landscape that we're in.

So a ship getting stuck in a canal disrupts global supply chains. An energy grid collapse affects millions of people and commerce. Ransomware attacks are happening in gas pipelines and in hospital systems, and these things can shut down services in metropolitan areas. It's really pretty extraordinary, the impact of events that arguably decades ago would have been page four or page five in the newspaper. Not great events, but their impact wouldn't have been felt this way. We're sort of living in this era where the butterfly wings causing chaos on the other side of the world is observable.

That is just the world that we're living in. And I think those organizations that see it that way, and then take preemptive steps toward making their organizations more resilient to that phenomenon, are the ones that are going to survive and thrive.

Disruption Proof Versus Future Proof

Brant Cooper: That's really what Disruption Proof is. It's positioned in many ways opposite of the popular term “future proof,” which is really about investing all of this energy into long-term innovation. That's great, I'm all for it, but that doesn't actually solve the pandemics and the supply chain issues and all of these things that can hit us any day.

And boy, even this pandemic — you've brought it up a couple of times. Here we are, August, September 2021, and we thought we were going to be done with this, and we really still can't see the end. So all of those companies that in the spring of 2020 were saying, “Listen, we need to just kind of buckle down and we can ride through this,” now, 16, 17, 18 months later, are saying, “Okay, maybe some of these things now need permanent change. And how are we going to protect ourselves from the next event?”

ING: Restructuring So the Behavior Comes Naturally

Mark Graban: So there are these grand waves, different industrial revolutions, key technologies that are pointed to. In your book, you talk about the shift from the industrial age — grouping all the industrial revolutions together — into a digital age. There's been so much turnover over time in the Fortune 500 list. The fact that you were a big, hugely successful company in one decade doesn't guarantee that you'll still be there a couple of decades out. But is there a company that's a good example that comes to mind to you, Brant, of a company that has successfully navigated going from the quote-unquote industrial age to the digital age?

Brant Cooper: That's a great question. In terms of the change, the transformation, the company that I know of that's moved the furthest is ING, the global bank headquartered in the Netherlands. Long term, they had had an innovation practice that was, “What is banking going to look like in 10 years?” and that sort of thing. But they didn't stop there. They applied their quote-unquote innovation mindset to those things that maybe are two or three years out, and to those things that are immediate. So, where's the uncertainty in the core business that we can apply the mindset to?

They have a program called PACE Everyday, which is really supposed to be teams that are dealing with everyday uncertainty in a way that is quote-unquote agile, or agility-like, and that tests assumptions and runs experiments and uses data to inform decisions. So it's a way of thinking, a way of working in the everyday, instead of “here's my manager gave me these 10 things to do.”

ING did that throughout the company, and then reorganized the company such that that behavior was more natural. They adopted techniques that they observed at Spotify and Amazon and Google and some of these other tech companies that are — I'm not sure how much more innovative they are, quote-unquote, but they're fast-moving and they're definitely agile, and they're always coming up with new things, and they're very aggressive. That's a mindset that these other companies, these legacy companies, want to adopt.

So ING restructured their company. No more departments in silos, but restructured in a way more similar to the tech companies in order to get that team agile lean behavior to be the normal outcome of the structure. Because the normal outcome of a traditional structure, with the silos and the hierarchies, is going to be slow and not customer-focused and not able to incorporate new information and change plans. It's actually built into the structure of the company. So the fact that ING went to the point of reorganizing tens of thousands of employees is pretty extraordinary.

Return to Office, Remote Work, and the Missed Opportunity

Mark Graban: Thinking of the disruption of the pandemic, coming back to that again — what are your thoughts on particular lessons from the pandemic, of companies figuring out working from home? What comes next? Is it continued work at home? Is it a hybrid model? What are you seeing?

Brant Cooper: COVID, as devastating as it was and continues to be, did offer an opportunity for companies to exercise whatever resiliency they had already built in. And there are some really good examples of that. The easiest is probably the number of restaurants that were able to change their business model to delivery or to curbside delivery. That seems obvious now, but it did not in March of 2020, and a lot of restaurants went out of business. So maybe they weren't able to adapt.

Work from home, I think, is another really great example of an opportunity that the pandemic presents. And it's really hard to see how companies are going to choose one way or the other. It's absolutely extraordinary to me that a company like Apple would sit there and go, “Nope, everybody's got to come into the office.” And Tim Cook, the CEO, seems completely out of touch to suggest, “Well, I really enjoy coming into the office and seeing my colleagues, and the serendipity of the collisions.” And I'm thinking, there's probably not a lot of software engineers who are sitting in their cube with their headphones on who benefit from that in the same way that Mr. Cook does. It just seemed incredibly out of touch to even say that. And of course the engineers are pushing back and going, “No, I'll just go work somewhere else.” So you have companies on both sides of the fence around that.

But to me, the glaring thing that is missing is this opportunity to understand your colleagues. There's this comfortable summary that young people want to work from home and remote, and management wants to work from the office. But it turns out that's not really true. A lot of young people really want the office environment. They want the social part of it. They want the mentorship. They want to be seen and heard. Whereas a lot of leaders actually have a very comfortable home office. They're tired of the commute, they've paid their dues, and they're really sort of directing people and attending meetings, which Zoom is fine for. So they would actually prefer to work at home. It runs counter to the narrative.

What it really brings home to me is that the organizations, the companies, aren't taking the time to actually go and develop empathy for the people that work there. And again, it's not that we're going to build policies that do what the employees say, but you should at least understand what the implications of your policies are on your employees. And maybe there are ways to build flexibility into the model, such that if you're working on a quote-unquote agile team, the team itself can choose where they're working from. Maybe sometimes it's home, maybe it's the office. Maybe sometimes it's at a local coworking facility that they're all closer to — and that would be life-changing, to be able to drive to the coworking space instead of downtown, which is a 60-minute commute.

So again, the opportunity being missed, in my opinion, is the opportunity to use some of these entrepreneurial mindset techniques to develop empathy, run experiments to figure out what works, and use what works to develop the policies. And yeah, it means that you can't make a decision overnight, but you're teaching all of these people how to deal with complexity and uncertainty. So it's a great application of these principles.

Constraints that are brought by things like the pandemic create opportunities, but we have to be willing to tackle those opportunities in new ways. And it just seems like the knee-jerk reaction is, “If we have one policy, we need it for everybody,” or “We've never done it that way,” or “Tradition says.” And that's just not going to work in the digital age, if you ask me.

The Five E's Start With Empathy

Mark Graban: Well, you beat me to the punch to bring it back to the word empathy again. Within Brant's book, he's got a framework — and maybe we'll explore it a little bit here — the five E's, and it starts with empathy. We can talk about developing an understanding of customers. We can also apply that to other stakeholders, developing an understanding of our employees and their perspectives.

I went back just real quick — one dictionary definition of the word empathy is the ability to understand and share the feelings of another. And from my memory, I'm thinking of at one point this definition that was more focused on understanding the feelings of another who was not like you. That's maybe a deeper level of empathy.

Brant Cooper: Yep.

Mark Graban: And we can think of applying that in the workplace. My wife and I are childless, and I've done a ton of Zoom meetings. I learned very quickly, don't get upset at somebody because their kid interrupts the meeting or their dog interrupts the meeting. They're probably not, from their reaction, happy about it either. So it happens, and we move on, right? There are a lot of things in life these days where I've tried to focus on, is this worth getting upset about? And if you can practice, if you can stretch your empathy a bit, the answer is, well, no, probably not. Let's understand their situation a little bit better, even if it's not the same as ours.

Brant Cooper: Right. Most people that are trying to solve problems enjoy that, because they bring to the table certain skills and expertise, and they want to exercise their own creativity in solving problems. Taking the time to go and develop empathy, to understand the needs of those that you're hoping to create the product for, doesn't stop you from exercising your creativity. In other words, you're the one who gets to solve the problem, but you need to understand the problem in order to solve it the best way possible.

I think that's a skill set that can be developed in everyone. There are going to be people that do it better than others, but it's not something that's held only by design thinkers or human-centered design people or [inaudible]. It's really just taking the time to pause and listen and consider. And then when you go back into your own space, you still get to decide what you're going to do with that information.

One of the things that I've talked about over the last couple of years, talking to a lot of innovation groups — a lot of innovators complain that their leaders are not bought in and they can't get funding. And I ask them, have you ever gone and developed empathy for your leadership? I'm sure you want the leaders to develop empathy for you. Have you ever done it in reverse? I actually even have a tool that helps people do that.

I always kind of feel like I need to throw a caveat in here, that you could actually use empathy for selfish reasons. I know that's not what we're trying to get at here, but if you're somebody that needs your leaders to buy into something that you're doing, then the more you understand what your leadership is facing — the things that keep them up at night, what are the criteria that they're using to evaluate decisions, what's their background that led them to that decision-making process — the more you understand all of that, the more you're going to be prepared when you're there pitching your idea for funding. And it's likely not going to be just idea-based. You're going to bring evidence. You're going to have done some groundwork in order to make the case that this is a good thing to do. So “selfish” is kind of a strong word there, but it allows you to address the needs of others if you understand those other people. And so you can use that to your own benefit.

Good Empathy, Bad Empathy, and a Corporate Buzzword

Mark Graban: But to the benefit of you or your startup or your organization of any age. That, to me, is not necessarily selfish. That's how companies are structured, and all kinds of other things.

So it's interesting, you're talking about getting better at empathy. Do you want to start an empathy boot camp for a weekend? No, I'm kidding. I'm jumping to a solution there. But it's an interesting idea. Maybe just ask you to elaborate on that. Some people could learn to be more empathetic. Some people maybe are hopeless. I'm not a psychologist. This is where sometimes executives get labeled as psychopaths, because they are completely unable to empathize with others. But most people, not being psychopaths, can learn and get better at practicing and demonstrating empathy.

Brant Cooper: Right. Back when I was a product manager, I don't think I was actually out developing empathy. I think we just really went out and gathered feature requirements. So that's like bad empathy development. But it's something. It does allow you to actually take information from another person, and you're recording it, and you're perhaps going to put it into your product.

I joke that empathy is now a corporate buzzword, and in some ways it makes me cringe. But even if people inside that company are doing bad empathy, it's a start. It is actually getting them out of their own mindset for a short period of time and listening to others. So I'm guessing even those people that are completely narcissistic can, for small periods of time, actually listen to what others have to say.

Bad empathy doesn't take you that far, and you're not going to put the bad empathy individuals on your innovation team or on your product design team. There are other roles for those people. But I think the point is that there are a bunch of core business functions, back office functions, that we don't consider might be able to benefit from this entrepreneurial mindset, from this innovation mindset.

So if you have an HR group that is trying to implement new policies — maybe it's “we need to fix our hiring,” or maybe it's “we need to fix the way we're doing our employee reviews or performance reviews” — they can actually go and practice empathy and run experiments and do all of that entrepreneurial spirit thing, and it's obviously going to be beneficial to whatever program it is that they put together. Whereas people would not necessarily — and I don't mean to diss HR people or IT people — they're not going to be considered the most empathetic people in the world, at least as part of their job functions. But they can be taught how to go and do that sort of thing, to the benefit of their groups and their departments and ultimately the company.

So yeah, a boot camp on how to do that sort of thing — it's one of the things that Moves the Needle does, but there are a ton of people out there that teach this stuff. And as a matter of fact, when we're talking to large organizations, and I would even bet healthcare, you already have people inside your organization that know how to do this, are willing to teach it and coach it. That's really one of the things that I tried to emphasize in the book. You don't have to go in and hire all of these different big five or big four, however many consulting firms. You don't have to hire all the agencies. They're great, and you could benefit from some of them, but you actually already have people that are doing this. And so that's what you need to double down on.

“The Whole World Is Short-Staffed”: A Sign That Misses

Mark Graban: You're talking about empathy, good empathy, bad empathy. I'm going to throw an example out there and see if you agree. There's a very common sign, we see it in social media and memes and different ways, and the sign says, “The whole world is short-staffed. Be kind to those who showed up.” A restaurant or a retail establishment will post that sign. And I think they're asking us to be empathetic to the people who are there, which I'm all on board with.

I think the sign is bad empathy. For one, it's making a false generalization that the whole world is short-staffed. And I think it's showing bad empathy, or a lack of empathy, to those who are unable to come to work for one reason or another. I think the sign is telling the customer, don't blame us, the owner or management, for any of this. Please be kind. And asking people to be kind is okay.

But there's a version of the sign that I think is even worse. I was able to find one in a Google search: “We are short-staffed” — now, that's different than saying the whole world is short-staffed, so point for that — “please be patient with the staff that did show up. No one wants to work anymore.” I think that's an even bigger lack of empathy there.

Brant Cooper: It's funny, I agree with you that it's missing on several different layers, if you ask me. Any time that you're going to put up a sign, you actually should be understanding the people for whom you're putting the sign up. In other words, you're actually supposed to be developing empathy for your customers. It's great that you have your employees' backs, and you're maybe demonstrating empathy by having your employees' backs. I really wonder if it's more about what you said — the owner feeling a particular way.

To me, there's not a lot of benefit for people who are “just showing up.” Both of those signs kind of use that phraseology, and I'm like, listen, if you're going to show up and be crabby and not empathetic back to the customers, that maybe doesn't show up. So that one's a little bit odd.

I think they're trying to gear it toward those customers that are impatient, or that won't wear masks, or something like that. So I can understand the frustration, but it's really not great empathy or good practice to lump all your employees into the worst employee bucket. So yeah, kind of missing out on a lot of fronts, if you ask me. I understand the sentiment, but with some human-centered design somebody could have helped with that sign. That would have been a winner for all, and maybe injected a little humor into it that would ease things right from the get-go, as opposed to this little tone in there that's a little bit aggressive, a little bit off.

Mark Graban: It's fair to ask people, please treat our employees respectfully. But part of the tone is sort of like, well, you shouldn't get upset, dear customer.

Brant Cooper: Right. Well, not only that, but why not just lead with, we should be respectful of each other? And then that just starts us off in the same place, right? And maybe not even construct the two sides from the get-go.

“Take Responsibility for the Energy You Bring”: A Sign Aimed at Staff

Mark Graban: So there's one other sign, and maybe this will be a segue to talking a little bit about healthcare. There's another sign that has been making its rounds through hospitals, and I've seen a number of social media posts of different versions of the sign. It's a sign directed at staff, let's say if you're entering a workspace or leaving a break room. One version of the sign — they're all very close — says, “Dear employees” — so it's addressed to you — “please take responsibility for the energy you bring into this space.” And then basically it says, take a slow, deep breath and make sure your energy is in check before entering.

I'm going to blog about this. I find this to be a deeply insulting sign. Easy for me to say, it's not directed at me. But I think this is deflecting. If the employees are all miserable and burned out, sending them to resiliency training or telling them with a sign to check your attitude — I don't see that helping.

Brant Cooper: Yeah. So the contrast I'm going to throw out there is this bank in Turkey, which ING took over, a bank that was dedicated to the military in Turkey. And they put this young woman in charge. She had managed no more than five people, and she was suddenly CEO of this bank. The building and the infrastructure of the bank reminded you of the military. It was dark brown walls, very office, siloed. And she just threw all of that out, and recolored. And the banners that she put up for the employees, when they walked in the door, said, “Bring your true self. You are welcome to be your true self here.”

To me, that was just brilliant, and the start of a long course of change inside that organization. Things like, I'm trusting my people with huge budgets, and now I'm supposed to approve their $15 expenses? And she says, I'm done with it. I'm not approving expenses anymore. Everybody else, just submit your expenses. There were a bunch of different steps to have respect for the employees and invite them to show up as they are.

And that means, actually, if you don't have a great day, you don't have a great day. Obviously, in a healthcare situation, those people are interacting with patients, and not having a great day is not an excuse for bad behavior. But on the other hand, you have to find that right balance. You want, when somebody walks into the room, that they felt heard and felt respected.

And I guess the other thing I'll add is, it's not woo-woo, right? This is not like, oh, why can't we all just get along, and peace and love and all that. It's about driving impact. It's about serving the mission of that business. So it's maintaining the context of the reason why that organization exists. People need to be held accountable to metrics and to behaviors and to all of these other types of things. But on the other hand, you actually have to empower these people to do the right thing.

The Sign as a Symptom of a Disconnect

Mark Graban: You have to help them do the right thing, and you have to listen. You made a really good point earlier about disconnects. To me, this sign is a symptom of a disconnect. Somebody at some point wrote these words and said, well, there's this problem, patients are complaining, or staff are being mean to each other, I'm going to post a sign. That sign doesn't invite a conversation. It says, basically, stifle yourself. A different sign might ask or invite: if you're struggling today, let's talk about it — whether that's with their manager, or somebody higher up, or an EAP program. But this sign says, take a breath and be quiet.

A lot of behaviors and people's reactions to situations, I think, are very systemic in nature. You said it better earlier — you said there's balance. Yes, we have free will over our actions. Stephen Covey used to talk about creating a little gap between stimulus and response, and some of us are better at that than others. I have my moments where I'm not good at it. But there's just something off. I think the sign is well-intended, because the middle part that I glossed over said things that I think are true — your words matter, your behaviors matter, our patients and teams matter. I just disagreed that they've jumped to a solution, that taking a slow, deep breath fixes everything.

Brant Cooper: Again, I think you start off with the welcome. Start off with — it almost feels like that restaurant example again, where management is purposefully creating separate teams, and those teams are opposing each other in certain situations. It seems to me that what you would want to do is first say, we're all on the same team. So, welcome, and again, sort of, show up as your true self. And then if you have this separate sign that says, hey, if you're struggling today, let's talk, or something like that, then it feels like you're being supported rather than being confronted by somebody you're not even sure who it is. It's sort of not trusting your ability to regulate yourself.

Brant's Cancer Diagnosis and What He Saw as a Patient

Mark Graban: So we had a chance to talk privately, Brant, and you had shared — and you said it was okay to talk about it here — some experiences that you've had recently of seeing, like a lot of us say, there are great people sometimes in bad systems, and they're doing their best with what they're given. To your comfort level, do you want to share a little bit about what you've been going through?

Brant Cooper: So back in March, I was diagnosed with esophagus cancer, stage three I believe. I think we caught it in time. And so I spent most of April and May in radiation and chemotherapy.

When confronted by something like this, my way is to become pretty introspective and sort of look at things from a philosophical perspective. But also, I'm right in the middle of finishing up the production of the book, which is talking about efficiencies and creating value and empowering people. So to me it was just an interesting period where I wanted to publicly document some of my thoughts about the care that I was going through — and especially from the perspective of being really a privileged white male with great health insurance, and realizing that a huge percentage of people that would be undergoing the same thing would actually have fewer advantages than I have. So, wanting to be transparent about that.

And then, of course, what's crazy is that on top of that, the hospital that I was primarily going to was struck by a ransomware attack. It was really just kind of a crazy time. My care was disrupted. The radiation equipment was shut down because of ransomware. The hospital system was being pretty cagey about it, and the media, to me, was not really reporting on it adequately, because they were just talking about the inconvenience of appointment scheduling, that type of thing. But my chemotherapy continued, and due to the heroic efforts of the doctor, my radiation, after being skipped for a week, was re-upped.

So I don't know if I have any grand conclusions around it, except that the people were awesome. The nurses, the doctors, the technicians, the front office people were really just uniformly amazing. Wrestling with the insurance company was problematic, both as a business owner as well as the patient. That still, I think, is the biggest hurdle toward long-term improvement of the whole healthcare system.

I found some interesting observations in terms of the technology that the hospitals deploy being extraordinary. We haven't really taken into consideration human-centered design in the patient interaction with that equipment, which I think is kind of an interesting avenue.

The Patient Navigator, and Why the Role Should Not Be Necessary

Brant Cooper: There are all sorts of things that I could identify as being positively agile, like in Disruption Proof. Scripps hospital had a nurse who was in charge of — I can't remember the title they gave her — but she was in charge of helping me navigate the system, the several different doctors, the several different specialists that had to be on the team. And that was absolutely extraordinary. Otherwise it's me that has to hop around, and all of the support staff of the doctors don't know what the others are up to. So it's very siloed, like a big business. But the fact that they had appointed this role to manage that was extraordinary and very positive, and worked very well.

Mark Graban: They may have called that role a patient navigator.

Brant Cooper: Exactly. Right. Patient navigator.

Mark Graban: And there's this fine line. Yes, it's good in the short term to help people navigate the system. But then what are we doing to help reduce the need for that? It would be like a parallel, if you went out for a drive and you had a road navigator, and they're driving along and you're like, oh yeah, that sign there, that sign is totally wrong, so don't turn left there, you're actually going to turn two streets down. Who closes the loop to fix that?

Brant Cooper: No doubt about it. I guess it's a step. And if one can see that that step works, then maybe there's something that somebody does to break down those silos. The doctors do meet on a board to go over the cancer treatment. So the fact that they're bringing them together, and that the navigator is there, is another step. It's almost like a Team of Teams approach there.

I think that ultimately the structure needs to change so that you don't have to purposely put these mechanisms on top of the existing structure. That's really sort of what the problem is. So eventually one hopes that there would be a more rational way of organizing the systems, such that you don't have to put these mechanisms on top. But the fact that they did put those mechanisms in is more advanced than the other hospital systems that I had been looking at or involved with.

And then they also, to me, prematurely stopped the navigator. They might as well go through the whole process, even post-treatment. I'm really kind of back to navigating my way through all of the different departments again. I'm also taking some services from a different system, and so the inter-system stuff is, as you can imagine, even worse than the intra-system.

But again, to me — you're steeped way more deeply in this than I am — this was my first interaction with it, and I could compare one to the other, and I was pretty amazed by it.

And then even the treatment itself, the chemotherapy itself and the radiation, the way they have those systems set up — this was a new building that the chemotherapy was in, and it was very open, such that the staff could see all of the different patients while the patients had privacy amongst themselves. It was a very team culture in terms of how the medicine was administered and how people were observed. Again, I thought all of that was very positive, and recognizing really the complexity of these types of treatments, and that everything needs to be verified, and you need people on the same page and feeling like they are part of the same team, and that we're going to make each other perform better, is really spot on for what I think should be in all company cultures. And we're not there yet, obviously.

EMRs, Scribes, and the New Risks Technology Creates

Mark Graban: So one of the biggest technological changes in recent decades is the electronic medical record, or sometimes called the electronic health record. There have been a lot of advantages to that. There are, like you said, opportunities for human-centered design when it comes to the users of the system, meaning the doctors and the nurses and the other providers.

There are some jobs that got completely disrupted out of existence in what used to be the medical records department. Maybe there was an increase of staffing in information systems. But then there's been this new function — I don't know if you saw this in any of your observations — the scribe. Somebody who basically, and I think in a lot of cases this is a very good division of labor, a medical student or somebody who's in training gets the benefit of shadowing the physician, and basically being there as the scribe with the keyboard and the mouse. So you could say that's better, more efficient use of the physician's mental cycles and their brain and education and everything. But I did not see that. It seems like a great idea.

Sometimes disruption takes away, sometimes disruption adds. But with the good, I think EHRs haven't been the cure-all that some would have pitched them as. And then, to your point, it creates new risk of disruption, meaning ransomware. That's something that would not have been an issue 25 years ago.

Brant Cooper: Right. And the thing is, in this particular situation, that's not a collapse of IT. That's IT getting attacked. I'm an old IT guy, and maybe I'm completely wrong, but it seems to me that you could develop an internal IT system that is not dependent upon public exposure. And it would seem to me that at the very least you have to have some sort of redundancy for the EMR, such that people's treatments can continue. So there are all sorts of things that I would bet haven't been done because of the old industrial-age managing toward financial efficiency only, versus efficiency of accomplishing the mission.

I'm wondering now, with all of these disruptions that have happened just in the last year and a half, two years, whether we'll start seeing companies realize — and really more than companies, governments — in industrial policy for computer chips, or supply chains. It may require bigger action by the federal government to mandate some of this stuff. As much as we all don't want a bunch of regulation, if the companies aren't going to do things that protect the infrastructure and the data and the functioning of these organizations, then that really is a role of government.

But I'm really wondering whether we'll see a change. If we can get people back to measuring efficiency of the mission achieved versus just simply financial efficiency, we'll start seeing things like redundancy of supply chains, and redundancies of IT systems, and these other ways to keep the very mission, the very function, of these organizations up, even during disruptions.

Faxes, Interoperability, and What Digital Transformation Really Means

Mark Graban: The final thing I'd add — you mentioned interoperability. One example I had: I had some test results from primary care, and I went to a specialist, and this specialist was, I thought, part of that same integrated health system. They were in a building with that name. And they wanted the test results, and I thought, well, just look in the EHR. And they're like, oh, we don't have access to that. You're a part of the same system, right? And, no, we just leased space in their building.

And so then this involved faxes. I could pull it up on my phone as the patient, and they could not pull it up, and I couldn't just text them a screenshot. So all the time and cost and effort on both offices' sides to have this really clunky handshake and exchange of information — I think that's still more common, and some of that's got to just go away.

Brant Cooper: It's one of the things that I raise in the book, that digital transformation to people means, how do I build a mobile app for my refrigerator? And really what digital transformation needs to be is that all of the back office functions are brought up to the standards of today. It's incredible, the faxing and the paper that's still here. And at the same time, the lack of backups and redundancies. It's really pretty extraordinary. We're so forward, pushing this technology out into the new world, but you're really only as resilient or agile as all of these weaker links that go very deep into the organization. And you really just sort of get the feeling that there aren't people that are paying attention to that, because it's just not the sexy work that needs to be done. It's really super hardcore fixing of age-old technical debt, even.

Mark Graban: And if it's viewed as a cost, instead of something that provides more value, then it probably doesn't get done.

Brant Cooper: Right. Yep.

The Book, the Virtual Book Tour, and the Endless Disruption Summit

Mark Graban: So before we wrap up here, I want to talk again about the book, and then an event. The book, again — Brant Cooper has been our guest — is titled Disruption Proof: Empower People, Create Value, Drive Change. It's due out October 26th, and you are encouraging people to help support independent bookstores. Do you want to say a little bit more about that?

Brant Cooper: We're doing a virtual book tour, and there's event information on the website, BrantCooper.com, as well as some book bundles there, if people are interested in having me maybe as a speaker, or do a lunch and learn or a workshop or something, in addition to buying the books. But we're doing a virtual book tour, and I'm reaching out to the bookstores to help host events around the country. We've got one coming up in Los Angeles on September 8th through Chevalier's Books. Basically we'll talk about the book, and hopefully if you want to buy a book, you can buy it right then and there through the independent bookstore that we're partnered with. So we've got one coming up here for Los Angeles, but the event page is on BrantCooper.com or MovesTheNeedle.com, and you can see where we'll be next, and hopefully coming to a city near you.

Mark Graban: Virtually.

Brant Cooper: Yeah, virtually.

Mark Graban: I hope people will check that out. And there's going to be a virtual summit event that Brant is organizing called the Endless Disruption Summit on September 30th, if you want to tell us a little bit about that.

Brant Cooper: Yeah, thanks. And happy to have Mark participating with us on that, by the way. The idea there is that I want to help demonstrate that the big change is this change to this interconnected, complex, digital world. And so the changes that Mark and I have been talking about in healthcare and in business are going to happen everywhere. I fundamentally believe that the very structure and management of all of the institutions that we depend on are going to fundamentally change — in education, government, healthcare, business, nonprofits, startups.

So the Endless Disruption Summit is bringing together some people that demonstrate their leadership in some of these different areas and the changes that they are making. I sort of call it disrupting conformity, because you have to step outside what everybody else is doing and what was working before in order to figure out new ways to manage and structure these organizations. And a ticket gets you a copy of the book. So that's at endlessdisruption.com, or endlessdisruptionsummit.com. And you can join us for what I really think are going to be some fascinating discussions on these changes that are already underway in all of these different organizations.

Closing

Mark Graban: Well, I hope people will check that out. And thank you for having previously asked me to participate in that. I didn't want to put you on the spot, in case you or your team had changed your mind. So thank you for mentioning that, and I hope people will go check it out. I'll put links to all of that in the show notes.

So Brant, thank you. I'm glad that after eight years we could do this again. It doesn't have to be related to a book launch. We can do another episode sooner than that.

Brant Cooper: Well, I know you're a busy man tackling some big issues, Mark. So I really appreciate you fitting me into the schedule. I hope people check out some of this. I'm Brant Cooper on all the social media, so people can feel free to reach out. I'll respond to all messages. And yeah, look forward to the events coming up.

Mark Graban: Yeah, we'll see you on September 30th. And in advance, congratulations on getting the book out there.

Brant Cooper: Thank you so much, Mark. Appreciate it.

Mark Graban: Thank you, Brant.

Well, thanks again to Brant for being our guest today. For links, show notes, and more — for links to pre-order his book, to learn more, and to register for the Endless Disruption event — you can find all of that at leanblog.org/422.

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 at leanpodcast@gmail.com.

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