Greg Jacobson and I recently joined Tracy O'Rourke and Elizabeth Swan on the "Just in Time Cafe podcast" to talk about KaiNexus, continuous improvement culture, and the role technology plays -- and doesn't play -- in sustaining improvement. It was a wide-ranging conversation, and I wanted to highlight some of the themes Greg brought up that I think are worth checking out.
You can listen to the full episode here. Or find the video later in the post.
Greg told the origin story, which goes back further than most people realize -- to 2004, when he was transitioning from a third-year emergency medicine resident to an attending at Vanderbilt. His chairman handed him Masaaki Imai's book Kaizen and said, "You think like this."
By page six or seven, Greg said, it had transformed his thinking. His reaction was one a lot of us can relate to: How did I go through four years of college, four years of med school, and three years of residency without anyone mentioning this body of knowledge about improving systems?
As I added, he's not alone. Most people don't learn about these concepts in business school or engineering classes.
Greg started teaching Kaizen concepts to residents and tried managing their improvement projects over email. It was, in his words, "a total cluster." So he thought, how hard could it be to build some software? Three years of banging his head against the wall later, he had his answer: very hard. But the experience convinced him that building a purpose-built platform would add far more value than expecting every organization to cobble together their own system from scratch.
One of the things Greg talked about that I think deserves more attention is how deeply habit science is embedded in the design of KaiNexus. This isn't an afterthought or a marketing angle. Greg has been thinking about the basal ganglia, habit loops, and reward pathways for years -- influenced by Charles Duhigg's The Power of Habit and later by James Clear's Atomic Habits.
As Greg put it,
"Thinking through how do you design technology to change behaviors is critical to what we do at KaiNexus."
That means features like streaks, badges, and recognition aren't gimmicks. They're intentional design choices rooted in how the brain actually forms habits.
He shared a story about a COO of a large electronics company whose very first comment in a meeting was a product enhancement request -- related to losing a streak in KaiNexus. That tells you something about the power of those small feedback loops.
More on habit science: Introducing the Connections Between Habit Science and Continuous Improvement
One of the things Greg and I have always agreed on -- going all the way back to our first conversation over pizza in Austin on Valentine's Day 2011 -- is that software alone is not a silver bullet. You need three things working together:
methodology,
leadership behaviors, and
technology.
If any one of those is missing, you're going to struggle.
Greg made the point that every organization is already using technology for improvement work. Whether it's Excel, a whiteboard, or paper -- those are all forms of technology. The question isn't whether to use technology. It's whether your technology was actually designed for this kind of work.
He also pushed back on the idea that technology replaces critical thinking. "This is not an HVAC system that's just going to work if you turn it on," he said. It's a way to make improvement work visible, support accountability, and enable collaboration at scale.
Greg highlighted UMass Memorial Health as a flagship example of what's possible when you combine culture, leadership, and the right technology. Before KaiNexus, they didn't even know how many idea boards they had across their 25,000-person organization. Turns out it was around 600.
The numbers tell a compelling story. In about nine years before KaiNexus, they completed 100,000 ideas. In the three years after adopting our platform, they completed the next 100,000. That kind of acceleration isn't about the software doing the work -- it's about the software making it possible for leaders and frontline staff to do more of the work that matters.
And UMass Memorial's turnaround goes beyond idea volume. Greg noted that starting in the 2013-2014 era, the organization was hemorrhaging money with poor patient and employee satisfaction scores. CEO Dr. Eric Dickson talked about that starting point and the turnaround on my Lean Blog Interviews podcast.
Through sustained engagement and improvement, they've transformed their financial metrics and satisfaction scores over the past decade-plus.
Greg made a point that I think a lot of CI professionals need to hear -- and he acknowledged it might sound controversial. He believes the tendency to overcomplicate methodology often originates from the process improvement community itself.
"We have such a deep understanding of all these problem solving tools and all these methodologies," he said. "We're facile with being able to talk through 20 or 30 different tools and problem solving techniques, and that is completely overwhelming to the average frontline worker."
His advice: design the improvement work for the average person who doesn't share your technical background. These are creative, intelligent people. They just haven't spent years immersed in CI terminology and frameworks. And he was intentional about keeping jargon out of the KaiNexus platform for exactly this reason.
I've always liked the "move the trash can" example that Greg uses in demos. It's a small improvement that doesn't require root cause analysis. It's barely a PDSA cycle. But getting people started with those kinds of small, obvious improvements -- meeting them where they are and helping them take just the next step -- is how you build momentum. You don't take someone from zero to elite. You take them to their next level.
Greg referenced Seth Godin's framing of culture:
"People like us do things like this."
That's a useful lens for thinking about what it takes to sustain improvement. The "people like us" defines the group -- maybe everyone at your hospital, maybe your senior leadership team. The "things like this" defines the expected behaviors.
And it starts at the top. The most compelling examples I've seen -- whether it's Dr. Eric Dickson at UMass Memorial or Larry Culp at GE Aerospace -- involve CEOs who are leading the work, not just blessing it or launching it. As Dr. John Toussaint used to say about his own transformation at ThedaCare, it requires a different kind of leadership than the old "all-knowing, all-powerful" model.
Senior leaders set the tone through two key behaviors Greg described: recognizing and complementing the improvement work people are doing (which fosters intrinsic motivation, consistent with Daniel Pink's research in Drive, and nudging -- checking in on progress and asking what they can do to help unblock things.
The catch is that leaders need to keep showing up. Greg made the observation that in many organizations, a senior leader will show enthusiasm once, check in one time, and then move on. People in those organizations learn quickly to just wait it out. Sustained behavior change requires sustained attention.
There's a lot more in the conversation, including the hosts' great Q&A segment on what gets in the way of asking for help. Tracy and Elizabeth are fantastic interviewers, and I'd encourage you to check out the full episode.
Listen to the full episode at the Just in Time Cafe
Or watch it here:
What's your experience been with the balance between technology, methodology, and leadership behaviors in your organization? Which of the three tends to get the most attention -- and which gets the least?