Insights from Leading a Lean Healthcare Revolution
Dr. John Toussaint is the executive chairman of Catalysis Inc. and is one of the foremost figures in the adoption of lean principles in healthcare. John has written three books, all of which have received the prestigious Shingo Research and Publication Award. His books include On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry,1 Potent Medicine: The Collaborative Cure for Healthcare,2 and Management on the Mend: The Healthcare Executive Guide to System Transformation.3
I was introduced to John by Norman Bodek, owner of PCS Press and a pioneer in introducing lean techniques and thinking to the western world. Although John’s experience and work are focused in the healthcare industry, what he brings to the conversation is very much applicable to any workplace.
Bill Fox: How can we create workplaces where every voice matters, everyone thrives and finds meaning, and change and innovation happen naturally?
John Toussaint: I think it’s a combination of things. I always go back to John Shook’s, CEO of the Lean Enterprise Institute, description of how we truly get to excellence, which is it’s about processes, and it’s about people. We have to equally recognize that we need to have an environment in which people are allowed to do work that gives their life meaning, so that’s the people part.
The leader’s role is to make sure that the people that work in the organization are allowed to do work that gives their life meaning.
But then we also have to have systems or processes. I like to call them systems in which people can thrive. If there aren’t any systems (or processes) that are standardized and reproducible every day, then people end up doing a lot of non-value added work. If they’re doing non-value added work, this then gets back to this point of they’re not necessarily doing work that gives their life meaning.
I think it’s a combination of these concepts of building systems that allow people to do work that gives their life meaning, and the leader’s role is to make sure that there’s a balance between these two activities.
Bill: How do we get an employee’s full attention and best performance?
John: I think there has to be a recognition of why people come to work every day. We’ve been doing a lot of work in our company with something called Strengthsfinder , which focuses on what your strengths are rather than your weaknesses. In the classic performance review that you get once a year, you have all these things you’re supposed to get better at, but nobody really talks about what you’re really good at doing. This concept flips the equation to let us focus on what you’re good at and how can we take what you’re good at and make you even better at it?
Focusing on your strengths is one way to try to help figure out how you as an employee can best help your organization.
From the standpoint of understanding the human dynamics of why and how people work, focusing on your strengths is one way to try to help figure out how you as an employee can best help your organization. We’ve found that to be very helpful because first of all, everybody has different strengths. From a team perspective, you can leverage each team member’s strength if you understand what it is. Then when we put each team member’s strengths together, we can really do some pretty amazing things that we wouldn’t be able to do if it was just one person at a time who has a certain role.
I think it’s very important to tease out where people’s strengths are and how their personality traits can reinforce effective teams by understanding the diversity of who they are and what their strengths are. If we start there, then we can look at what is the work to be done and really try to understand what is the value that’s being created and what every person in the team’s role is to help create that value. That’s how I think we begin to get these high functioning teams.
Now at the same time, we also need to be focusing on the processes of that value creation. We need to understand how to most efficiently and effectively with the highest quality produce that value. We need to understand what the value stream is. We need to understand where the non-value added activity is and try to remove that every day. Then we need to build a system of rapid learning so that as we identify new customer needs, we can “skate to where the puck’s going to be” with either a new value stream or a refurbished value stream to deliver that value that the customer is seeking.
I think it gets back to this balance of let’s make sure we leverage the strengths of the people we have in our organization, which can then make them excited to come to work. But let’s also build the systems to understand how we create the maximum value for the customer that we serve.
Bill: What do people really lack and long for at work?
John: I think the most important thing is respect. You read every day about some multinational corporation laying off thousands of workers. To me, that is just the ultimate lack of respect for people.
One of my mentors in the leadership work that I do is Paul O’Neill, past CEO and Chairman at Alcoa. He made Alcoa the safest company to work for in the world back when it wasn’t cool to do that. He did it based on a fundamental respect for people. His point was the ultimate respect for people is to not have them get injured at work. In a manufacturing environment back in the 1980s, a lot of people were being injured. If we fast forward today, safety is job #1 in most manufacturing companies. I think today it’s respecting the work that people do and celebrating that work, which is another way of showing respect.
What people fundamentally are looking for is respect for my opinion, my ideas, and some kind of celebratory function saying “you’re doing a great job, thanks for being here.”
But I think what people fundamentally are looking for is respect for my opinion, my ideas, and some kind of celebratory function saying “you’re doing a great job, thanks for being here.” You get to the bottom line by building these fundamental human systems in which you create an employee that’s willing to go to the mat for you.
Bill: What is the most important question leaders should ask employees?
John: Have I made sure that our employees have the tools, training, and environment to do work that gives their life meaning? I think that’s the fundamental question.
We often throw people into situations where they don’t have any knowledge, and we expect them to figure it out themselves. That’s unfair. I do most of my work in hospitals and clinics. The work environment in most of those places is caustic. They’re full of fear, and the autocracy of the traditional healthcare management systems makes people not want to take any risks or try anything new or improve anything. That environment is just extremely negative.
I think it’s the leader’s role to ensure we are trained at what we need to do, that we have tools at our disposal to do it the best we can, and that we have an environment that’s conducive to doing good work and improving that work.
Bill: What is the most important question employees should ask leaders?
John: If the environment’s been created to flourish, the employees then need to ask, “What is it I can do that’s going to contribute to the success of the organization? How can I contribute? What do you need from me in order to be successful and effective?”
But the first condition is leaders have to create that environment. Then once that’s created, the employees have a responsibility to respond to that environment with their best work.
My experience has been after being CEO for three different companies that if the leaders do create the environment, most of the time the employees will respond because, frankly, people do want to get up and go to work and do a good job. I fundamentally believe that people given the right environments are going to make good choices. The reason they don’t make good choices is that the environment stinks, and so they have to go into survival mode. But if you have an organization that’s really trying to achieve the top of Maslow’s triangle, and if the leader has been able to create that environment, then that brings out the best in people.
Occasionally that’s not true. Occasionally you have an employee who is not willing to or able to do what’s necessary. But by far and away the lion’s share of people that I’ve worked with over the years—if you give them what they need to do their work—will do great work for you.
Bill: What is the most important question we should ask ourselves?
John: I think it’s a question of self-reflection. I work with a lot of CEOs around the world, and one of the things we find is they take very little time for self-reflection.
I think the question is: “Do you have a process to reflect on how effective you’ve been as a leader and is that happening on a regular basis?”
Some leaders that I work with schedule 15 minutes once a week on their calendar. It’s a specific time where they reflect on questions such as, “What did I do this week that unleashed the creativity of the people that work for me?” Or, “What did I do that shut people down?”
We published an article with the CEO of the San Francisco General Hospital and in The New England Journal of Medicine online journal where we identified five core behavioral traits that are really important to build this culture of continuous improvement.4
We created a radar chart around those five traits, and we asked people to rate themselves on a scale of one to five. One being not practicing it to five being proficient. Then you end up with this radar chart that shows several places where you really need to improve. We’ve asked them to use this process as a way of self-reflection, so they can use those questions of what did I do this week that really worked well, and what did I do that didn’t work well and then work on those key behavioral traits to begin to change some of those actions.
I think the biggest thing for leaders is this making time for self-reflection.
Bill: How did you make the leap from the medical profession to being the CEO of an organization that brings lean thinking to the healthcare industry?
John: I worked as a medical doctor for about 20 years. I stopped practicing when I became the CEO of an integrated healthcare delivery system in Wisconsin, which is where we experimented with the principles of lean. I spent a lot of time in manufacturing companies trying to understand quality processes, and that’s where we stumbled across lean thinking.
We were one of the first places to apply it in healthcare, which is why I do what I do now because we found that it was so powerful. We wanted to bring it to the rest of the industry, so I started a not-for-profit education institute in 2008 after I stepped down as CEO to work with the many different hospitals around the world.
We facilitate a peer-to-peer learning network of many organizations around North America, and we do a summit every year called the Lean Healthcare Transformation Summit. I’ve written three books, published multiple articles, and peer-reviewed journals including the Harvard Business Review. We also do executive coaching from the perspective of the CEO and senior executive team to try to help guide them on the content knowledge and behavioral change that’s required to build lean principles into their organizations.
It’s been an interesting journey to try to transform the healthcare industry. We have some really great examples now of organizations that have been doing unbelievably better work than when they started this learning journey. We know it works. It’s a challenge because it’s not anchored in the DNA. What’s anchored in the DNA of healthcare people is fear and trembling from the massive autocracy that exists within the industry including starting with the medical education system. But some of that is starting to crumble in certain places, and we’re part of the wrecking ball that’s trying to change it.
Key Takeaways
It’s about processes, and it’s about people.
Without systems, people end up doing non-value added work.
Focus on what you’re good at and get better at it.
Leverage people’s strengths and build systems that create value.
Respect people’s opinions and ideas and celebrate them.
Have I made sure our employees have what they need?
It’s unfair to expect people to figure it out themselves.
Leaders must create an environment where people can respond.
People make good choices when given the right environment.
Do you have a process to self-reflect regularly?
What did I do this week to unleash creativity?
Recognize that fear is anchored in the DNA of many organizations.