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KaiNexus Blog

Everything Continuous Improvement


Mark Jaben

Mark is a residency trained, board certified Emergency Physician with over 25 years of clinical experience. After 20 years in a single hospital group, he has been doing independent emergency medicine practice for the past 7 years in the community setting in emergency departments ranging from 5000- 75,000 annual visits and has experience in hospitals, Indian Health Service facilities, office practices, and EMS services. His initial immersion into Lean came in 2008 while living and working in Taupo, New Zealand, where he had the opportunity to test Lean methodology while leading implementation efforts at the hospital there. After returning to the US, he continued to apply these concepts in emergency departments, hospitals, clinics, and regional collaborations, with a particular focus on how this can inform individual work. Observing the successes, as well as the trials and tribulations, led Mark to delve further into why this stuff works. His soon to be released book, Free the Brain: Overcoming the Struggle People and Organizations Have With Change, takes a look at what neuroscience research says about how the brain operates and provides some real insight into why organizations do, or don’t, function so well. In addition to supporting hospitals in their efforts to improve their delivery of quality patient care, his particular interests include the application of Lean principles to medical decision making and to individual work. He was included in A Factory of One, by Dan Markovitz, the 2012 Shingo prize winning book on this topic. Mark has written extensively about what it really takes to engage people in change efforts and has presented internationally on these topics. His experience includes EMR development and implementation, facility design, regional health delivery, and the interface between different hospital departments as well as between different organizations.
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Recent Posts

Vet the Plan: A Guide To The Dilemma Of Planning in PDSA

Posted by Mark Jaben

Mar 16, 2017 8:19:00 AM

In my last post, we reflected on PDSA/PDCA and how different it becomes when thought of as a true cycle, rather than if considered in a linear fashion as it is written.

When we write the improvement cycle as linear, we start at P, which places the emphasis on the plan (noun) you intend to implement. But if P is understood to mean ‘planning’ (verb), the emphasis is on first constructing a plan. Thinking of the P in this way, it becomes clear that you must first understand the current circumstances and make an honest appraisal of what can be done, given the way your organization works.

In other words, when the cycle starts at Study, your Planning is much more likely to result in an ideal change - one that works and is workable to both address the issue at hand and be feasible given the way work is done.

However, this leads to the question how much Planning should you do?

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Highly visible current events, described in the last post, nicely demonstrated that jumping into a change without enough Planning derails the effort before it ever gets off the ground, and of even greater significance, causes a big hit to credibility.

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How PDSA Could Have Prevented the "Muslim Ban" Fiasco

Posted by Mark Jaben

Feb 13, 2017 3:21:59 PM

Wow! The daily lessons served up by the current political climate in the United States just keep coming. I’m quite certain nobody intended to help us gain these insights, but why bypass the opportunity! So here we go.

Some people call their improvement cycle PDCA, as outlined by Walter Shewhart, while others refer to it as PDSA, as evolved by W. Edwards Deming. Whatever the terminology, we often forget that this IS a cycle.

We write it in a linear fashion because that is the way our language operates. P stands for plan, right? But stop and think about it. Is “plan” a noun or a verb? Is it A plan, or TO plan? Understanding this nuanced difference makes all the difference in understanding the cycle.

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If PDSA is a cycle, where does it start?

According to the article Re-translating Lean From Its Origin by Jun Nakamuro, the actual Japanese figures used for what we call ‘standard work’ make it clear that the intent is not to start the improvement cycle at Plan, but rather, to start with Study. This makes a lot of sense if you stop to consider that nobody concocts a plan out of nothing; any plan starts from some issue, problem, dilemma, or conflict.

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The Election And Organizational Improvement: What We Can Learn

Posted by Mark Jaben

Dec 28, 2016 7:23:00 AM

This is Part II of a two-part blog post. You can read the first part here.

In such a deeply divided race as the 2016 Presidential election, the slogans said it all.

“Make America Great Again”

On this side of the political debate was a group of people who believed that something valuable had been lost and needed to be restored. The loss was not their fault; others had taken advantage of them. They were victims of change - scared and voiceless, in survival mode, focused on all that was wrong.

Their resistance was rooted in adrenaline, the neurotransmitter used by the brain in stressful circumstances.

Adrenaline produces the fight or flight response, causing one’s heart to race and palms to sweat. It diverts blood flow to muscles to be ready to act. Vision narrows down. Attention is focused on the immediate threat.

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Topics: Spread Continuous Improvement

The Election And Organizational Improvement: The Lesson We Can Learn

Posted by Mark Jaben

Dec 1, 2016 8:22:00 AM

The pundits, pollsters, and people around the world are confused about the US Presidential election, but maybe we shouldn't be; how the brain operates explains a lot.

Our brain draws a conclusion to make sense of its world. That story is based on an interpretation of its observations filtered through the lens of what I call its sorting criteria - the parameters for success and consequences of failure unique to that circumstance.

The brain hones in on what matters most at the time. What you look for depends on your brain's sorting criteria, so what you ‘see’ is what you look for. This explains why two people might see the same thing so differently.

The brain operates in two contiguous, non-overlapping yet interactive spheres. One contains processing you are aware of - deliberating, analyzing, and what we think of as decision making. Here you compile a spreadsheet of pros and cons. If the decision rests upon ‘running the numbers,’ so to speak, if something costs more or less, or if the number is higher or lower, then the decision can be made here.

But decisions that involve a value judgment between worthwhile but competing options occur outside awareness in the Hidden Brain. Here the sorting criteria are prioritized and applied to craft the story.

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Topics: Leadership

Why Your Political Beliefs are Confusing, and How that Applies to Work

Posted by Mark Jaben

Oct 7, 2016 7:58:00 AM

First off, while this blog post may be about the extraordinary election going on in the United States, this is not a partisan plea. Sorry if you were hoping for a suggestion.  Only your brain can make that choice. I’ve talked with a lot of people who are, quite frankly, disgusted with this whole political cycle. For me, though, this has been a fascinating nightly expose of how brains operate.

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Topics: Leadership

Making a Better Pitch for Your Improvement Initiatives

Posted by Mark Jaben

Sep 15, 2016 7:38:00 AM

In my last post, we learned that while our brain has the capacity to honor the experiences of others and incorporate that data into its decision making, the fact is that the more power and controlone has, the less likely we are to do so. The Hogleven study that came to this conclusion found that “People in positions of power tend to act in a self-interested manner and display reduced interpersonal sensitivity to their powerless counterparts.”

This matters to leaders because, in order for your employees to perceive you as credible, they must see you as a worthwhile partner who is also concerned with what matters to them. If credibility is the foundation for any improvement effort to get off the ground, then Hogleven has unearthed a pivotal dilemma: the success of your well-intended change initiatives rests upon the decisions of the people who need to implement those changes. And the choice they are making is whether they believe in you or not.

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Think You Are Credible? Think Again.

Posted by Mark Jaben

Aug 11, 2016 7:30:00 AM

When it comes to gaining traction for a change in an organization, credibility trumps reason. Establishing such credibility demands we are neither deceptive with the language, data, and metrics we choose, nor coercive with the standards being implemented.

When leading any change effort, no matter if you are a senior executive, a middle manager, or front line staff, the key to establishing yourself as credible is this: those being asked to change have to see that, even while dealing with your own concerns, you have a sincere interest in dealing with theirs as well. Most people believe they act with the best of intentions and motives, even if others may not be doing the same. In reality, (most) people don't intend to be deceptive or coercive, but may inadvertently or unintentionally do so given the way they deal with language, data, metrics, and standards. Because they were well intentioned, this person then may not understand why their change efforts are unsuccessful.

But recall, you don’t determine how credible you are on a given topic: others decide that based on how you act in that circumstance. A history of acting credibly in previous situations helps to establish trust in your motives, but it does not automatically confer credibility in the current circumstances. Of course, previous experience when you have not been credible puts you behind the eight ball starting off. Unless you are aware of this reality, it is incredibly easy to be inadvertently deceptive or unintentionally coercive despite your  best intentions. The effect is the same whether or not you were deceptive and coercive on purpose.

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Topics: Leadership

Is Accidental Deception and Coercion Slowing Your Improvement Culture?

Posted by Mark Jaben

Jun 15, 2016 8:30:00 AM

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Topics: Leadership, Spread Continuous Improvement

Credibility Trumps Reason: Why Improvement Fails to Spread

Posted by Mark Jaben

May 19, 2016 2:44:08 PM

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When It Comes to Empathy, We Have It Backward.

Posted by Mark Jaben

Mar 8, 2016 6:56:00 AM

I recently attended a mandatory staff training session at one of the health systems in which I work. Billed as a communication class, it addressed why we ought to show empathy for our patients. The reason given for such empathy training was that it translates to better satisfied patients and families, but it also happens to result in better satisfaction scores and improved hospital revenue.

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