• Tell us about the label of “process excellence” and what that means to the system?

• Shifting from being doers to helpers and coaches.

• What's the role of a Continuous Improvement (C.I.) specialist?

• Why is starting with observation so important?

• How and why did you shift your team’s focus from facilitating projects to coaching others on their improvement work?

• What’s your belt training and certification process like, including the levels? Are there goals for who to train and certify?

• What's next for you and the system?
  
  

Watch the video:

Stay tuned for two more Customer Month podcasts coming to you soon!

Transcript:

Mark Graban: Hi, everybody. Welcome to the "KaiNexus Continuous Improvement Podcast. I'm Mark Graban, the Senior Advisor with KaiNexus.

We're joined today. We have two guests from one of our customers, Memorial Health System in Marietta, Ohio and in that Marietta, Ohio area they are Lynn Howell and Mary Huck. They'll introduce themselves a little bit more.

Let me first off say thank you for being here. Thanks for joining us.

Lynn Howell: Thank you for having us.

Mary Beth Huck: We're glad to be here.

Mark: Mary, can you start off first and tell us a little bit about Memorial Health System?

Mary: Like you had mentioned, Mark, we are in Marietta, Ohio. That is on the southeastern border. We are along the Ohio River. We have multiple sites and locations within about an hour's driving distance from the main, Marietta. We have inpatient and outpatient services. We stay around 3,000 employees.

Mark: To hear a little bit about your backgrounds because I know you have different professional backgrounds, but you've both ended up working in process improvement. Lynn, can you introduce yourself first?

Lynn: My name is Lynn Howell. I have been with the organization for about 10 years. I started here right after I did my undergrad, which was in respiratory science. I have a Bachelor's of Science in Respiratory. I worked on the floors, worked in sleep lab, and that's where I got introduced to Lynn.

I did a bunch of Kaizens. That's when our organization had just started that and became very interested in the department. From there I managed some clinics and completed my master's at Ohio University.

Then I joined the team about four years ago. It'll be four years in August, I believe. I completed my Black Belt with MoreSteam. I have a Black Belt in Lean Six Sigma. I have one kid, one dog, and I'm married. That's my big story, I guess. [laughs]

Mark: That's a good rundown, and this is to put you on the spot. Do you remember what your first Kaizen was or one of the first?

Lynn: Yeah. It was world hunger. They were trying to do inpatient throughput. Basically, when they had brought in frontline staff, and I was a frontline staff member in respiratory at that time, they had this big map up on one of the board room walls. We were working through patient admission to discharge.

Basically how those big Kaizens went guided how our team worked from that point forward, because it was really hard to pull frontline staff out for weeks at a time. It was my first introduction. We got to present our ideas to admin on how to fix our pieces of the puzzle, which was really great. I'm like, "I like this." Something I wanted to learn more about.

Mark: You were hooked a good first experience. That's great. Mary, can you tell us a little bit about yourself and your background?

Mary: My clinical background is my associate's is radiologic technology. I started in the system a little over five years ago as a X-ray tech. I then went to educational services. I worked in the educational department teaching hospital orientation and supporting the ancillary departments.

I transitioned to this role about three years ago as a continuous improvement specialist, and been loving it ever since. I think we are still working on throughput, Lynn. [laughs] Like you say, it's never-ending.

Lynn: I have a little bit of flashbacks when we had started this in the last year or so. Everything comes back.

Mark: You're right. That is a big, sticky problem. A puzzle is a good way to describe it. I guess with each improvement, you chip away at the problem. Is that fair to say?

Lynn: Yeah.

Mary: You calling it a puzzle is true, because that's one of the things I love about this job. We get to see all of the different pieces and how they connect together. That is a huge part of throughput, of understanding each different department's role together.

Mark: The departments and the fields that you both come from are part of many different patient flows. I don't know if that helps give you a better appreciation for getting outside of your silo, if you will, and being able to look more broadly.

Lynn: I've worked respiratory and in the clinics, so I think it's always interesting to see when we talk about throughput, because we are an inpatient/outpatient health system, how those two interchange each other.

One of our big projects I'm going to bring up was our...We're working on improving outpatient access. Now they want to flip back to inpatient. We brought up that improving outpatient access may hinder our inpatient blow because they utilize the same resources. Our team a lot of times is the person or team that bridges those gaps, because we are familiar with many different areas of the health system.

Mark: Yeah, that's great. Mary, I'll ask you the same question, I asked Lynn. Do you remember what your first Kaizen or one of your first improvements that you formerly worked on once?

Mary: My first improvement, I went out to the revenue integrity department. I went there of the backside of healthcare. I was able to bridge the gap between understanding what the frontline staff is doing and how their documenting can affect what the backend is seeing for the billing department. I thought that was a great first opportunity to start learning all the different areas of the system.

Mark: Maybe, Lynn, we have an opportunity now to take a little bit of a deeper dive into some of the terminology and methodology that's used there at Memorial Health System. I know you use the term process excellence. Can you tell us what that means and a little bit about your structure there?

Lynn: That is our department's technical name, it's the Process Excellence Department. It came about our director went for operational excellence for his master's. They crafted the title off of that, because it was a new department. They set him for that master's program to lead our team now.

A lot of people still call us the Continuous Improvement team or CI team. If you would ask what that means in our health system, it depends on who you're asking. If you would ask admin, admin would see us as save that means we're facilitators of change or initiatives.

Basically, if they come up with an idea of something new that they want to try with their leaders, or with the health system, or a big problem, they present it to us. We come back to them and say, "This is what this would look like. If we want to work on this, this is how we think we should approach it." Give them that guidance on...They're big thinkers and we're the doers, sometimes how that works.

If you would ask the frontline staff that we work with, they would see us as helpers. A lot of times when we do go into areas we are just there to improve their flow whether it's helping them figure out how to work Excel, which seems silly, but it literally can change a frontline staff members day and we're there to listen.

If you talk to people we've worked with, frontline staff, they just see us as blending in and they see us with the help. They know that we mean change. Sometimes they're hesitant when we first show up. That's people that haven't worked with us at all. They usually see us as someone admin sent sometimes and don't know why we're there until we start working with them.

Then leaders or people we're coaching through the different health systems, they just see us as a guide. I think they sometimes aren't sure why they need a coach until they meet with us for a while. Then they keep coming back even when they don't have to anymore. [laughs]

Mark: It's funny, you talk about those different names and is it fair to say they can call you whatever they want, as long as they call you in to help and coach? [laughs]

Lynn: Yeah, exactly. We always say, "We're available if you need us." I don't care. Sometimes I even call us the CI team, so people know that to reference. It doesn't matter to me [laughs] what they call our department.

Mark: You talk about the need, the time, and the place for helping, sometimes you have to step in and do. I mean in healthcare, it can be a challenge to get people's time dedicated, because patients are still coming in.

Sometimes people use the analogy of trying to replace an engine on an airplane as it's flying through the air. You don't have the luxury of calling timeout, shutting things down. What are some of the ways that you help navigate some of that?

Lynn: I would say, as we're going into projects, we don't start having work sessions until they're needed. Since we follow DMAIC process, we spend a lot of times just doing observations and then those observations is where we start to build those relationships and talk to them why we're going through the project.

If we are recruited to do a project in area, we will tell the leader we need to have some time with the staff and you need to give them that time. It's setting that expectation up front that we will need the staff help to do this.

We're not going to come in and just give you the answers because we don't know them. Recently I was in the wound center, we had weekly work sessions one day a week for an hour. They had their lunch and we had great feedback. As we don't need them any more, we can taper them off as we move into improving control.

I think that's pretty consistent across the board as far as projects and getting that time. Now, leaders, they have a harder time even with that, just stopping to do coaching. A lot of times for us it's just telling them, "You are already doing the work. You're doing this stuff." We utilize KaiNexus to track that work.

Right now you're doing all this work and no one even knows you're doing it. You're butting up against people. Sometimes once we can get them to see that and really know that that's not an extra step, it's to help them and to be able to celebrate all the hard things that they're working on, it really starts to sink in with them.

Mark: Mary, I'd like to come back to you in a second to talk about your title and role of CI Specialist. Lynn, what's your title in this?

Lynn: I'm a CI specialist as well, so we're the same.

Mark: You're both CI specialists. I was going to bounce it back over to Mary, if you could maybe elaborate on...there's the formality of what the job [laughs] description says...

Mary: [laughs]

Mark: You don't have to read the job description, but there's the formal role and then what do you try to make of that role being a CI Specialist?

Mary: The formal role is leading improvement projects. Really, we start observation somewhere and we set our KPI from the beginning, this is what we're going to track, but when you get in there, there are all these other little things that you become that person for the staff. They come to you with little questions.

If you're able to do that that we can get their buy-in that way. They start to trust us and they see that we are here to help them. We become a middle man for them. We try and be their voice when we can to represent them and how we can help them in their daily work, and what they see and hear and what our patients hear, and see how is for our patients.

With coaching, we sometimes become just someone to bounce ideas off of. A couple years ago, we started...We have a program initiative called value enhancement. Every leader in the organization was required to do some sort of project or just do it and to track it in KaiNexus. Our team divided up different leaders and who we coached.

I was lucky enough to get a couple who, even though when we took a break on value enhancement, still continued wanting to meet and doing that coaching to double-check, getting that second input, we're their internal consultant. Getting that second feel, idea, hearing about what other departments are doing with this issue, we're able to bridge that gap for the leader.

Probably not in our job description but definitely a bonus. As all other duties as necessary.

Mark: [laughs]

Lynn: Yes, that is definitely in there [laughs] I think.

Mark: As assigned or as necessary. [laughs]

Lynn: Yeah. [laughs]

Mark: I'm glad to hear you both mention...You talk about starting with observation and whether you're using DMAIC as a structured framework or let's say if someone's using the A3 methodology from Lynn terminology or method standpoint, I think the one common theme is trying to avoid jumping to solutions.

I was wondering if you could elaborate on that a little bit. Hopefully you're not being bought in, say, "Hey, go implement this." You're following a methodology.

Lynn: We may be bought in and told that. "This is our goal, we want to add staff or we want to get rid of staff." We always say that's not what we're going to do. We will go in and say, "You guys really thought the problem was X and then when we dove into it, we seen all these other things."

One of the best things for our project is that we basically guide the project. We are the ones that are saying, "This is what's actually happening." We'll go into projects and the leaders perception of what's actually going on is a lot different than what is actually going on.

Once we start doing observations and we're able to bring that back to the leader, they're like, "Oh, I didn't know that." Or, "I didn't ask that." Or along any of those lines, we're able to shift that leader. A lot of times, the leader thinks that they need to do the work or they know the answer.

I coached a supervisor, he was sitting through a Yellow Belt class and he's like, "They just need to work harder. That's all they need to do, and if this other department would fix their problem then we wouldn't have a problem."

When I was coaching him through his Yellow Belt project, the solution that they implemented was something that didn't have to do with that other department and helped them reach their goal. He's like, "Lynn really had to beat me up to get me there but I understand."

Mary: He ended up eating his words.

[laughter]

Lynn: Yeah, he did. I'm like, "You can't go outside and tell other people what to change before you can say you've optimized yourself." I think that's something that we bring, again, just knowing the health system, the ins and outs of a lot of places, being able to talk to frontline staff.

They'll question why something happens. "Well, actually, this is the process for that." They're like, "I had no idea," because they're stuck in their silos. They don't have time, or get that time, to go and see the customers on the other end or those that are feeding them their work.

Mary: I think when we go into areas, we get to ask the dumb questions. The leaders, they're supposed to be the ones who know it all. We get to ask, we call it the dumb questions, but there's no dumb question. We get to ask the, "Why do you do it this way?"

That helps a lot understand the process and the history and the background to it. "Well, it helped this other department change what they were doing. To help...We had to change this way." We're able to be like, "Well, I don't think they're actually doing that any more." That's nice when we are able to do that.

Mark: There's a real advantage and a benefit to coming in. Fresh eyes maybe is a more positive way of framing it, because you're right. They're not dumb questions. Some people use language around humble inquiry. You're asking questions that you don't know the answer to. "Help me understand. Let's figure this out."

Mary: Oh yeah, and we don't understand their process. That's why we have to get to that. I think when we start asking why, it starts maybe making the staff ask why as well. Because when they're in it every day it's just their life. They don't really always understand that there's another way.

Mark: Lynn, back to your point about coaching. I love the way you describe...Sometimes a coach has to disagree, or push back, or challenge things. Like you said, you might be brought in...I've been in situations like this.

We think the problem is this, and we're, "Well, the problem's actually something else," or, "Here's our solution," and say, "Time out. Have we defined the problem properly?"

Lynn: Exactly.

Mark: Then you get into your DMAIC process.

Lynn: A lot of times, I feel like...or we get called in and they're like, "We don't know really what's wrong, just that something's not right." We do, a lot of times, even helping them figure out "what is the true problem of what's going on here?"

I definitely think our department, I would say, has a lot more liberties, freedom of opinion. A lot of times we're allowed to push back on those leaders and present the facts of what's going on. That makes us feel good too in our department that we can help guide leaders and say, "This is what's right."

Mary: We're coming from a good place. We're trying to improve the processes for the patients and for the employees. We're coming from the right perspective.

Lynn: Yeah, so they respect that.

Mark: When you've touched on some of this a little bit, we talk about facilitating projects. You've already talked about a shift from doer to helper to coach. Do you remember, was there a point in time, was there a light bulb moment where you started to make that transition or was it more of an evolution as this work is developed?

Lynn: One of the major decision points was right before I joined to this position. They shifted to requiring our leaders to complete our Yellow Belt program, which you have to complete a Yellow Belt project to graduate. The team that was here originally then started coaching the leaders on how to complete those projects.

That shifted because that's a heavy load. In fact, I forget how many people were in that first class. I think it was 300 or something like that. It was a huge number of people to get through initially. We've continued to do that twice a year. With COVID, we split it up into the smaller classes that we're doing a little bit more often.

We shifted to dedicating that time to helping them work the project versus us coming in and telling them the solution, so forcing them to slow down. It's been two years since we implemented this VE project, so that was us getting matched up with a director and coaching them through projects. Then in the last year, we shifted to systemic value enhancement projects.

We will do system-wide projects and facilitate with frontline staff and the leaders in those organizations and work sessions, all of us working on the same projects or the same goal. We still do go in. I'm on a project right now on a psych unit where I am the one facilitating or doing the project. I'm going there. I'm living there.

We have other people on our team that are living in other places, but it's more coaching because we do have so many leaders, Mary Beth talked about. We have buildings, an hour in both distances. We're in Ohio and West Virginia, and we continue to grow. As we continue to grow, we continue to gain more leaders. We are continuing to spread that word.

We also have started allowing frontline staff to be in our Yellow Belt as well, so that's more coaching. As we coach more, and Mary Beth's going to talk about belts more. That was the shift. They're like, "OK, the Process Excellence team can't do everything. They can't do this." If we want this culture changed, we're going to have to have the leaders own this and listen to their people.

Again, it's forcing them to slow down at least for that one project, and we have people that go on to do more and some that we have to pull through the projects. [laughs]

Mark: That's a good segue to our last topic. Mary, if you can talk a little bit more about the belt training and certification process. What are some of the levels? How does this work?

Mary: We have different levels, and it's all the training done by our team. We have White Belt which is the majority of our frontline staff. We have it online now through Teams. We do a one-hour training session. They walk away with some to-dos. They do a waste walk in their area. Getting them to look for their waste in their work.

Then based off of their waste walk and what they see, they are entering an opportunity for improvement in the KaiNexus. Auditing our frontline that are involved in their work and want to improve their work into KaiNexus. Their improvement goes to their leader.

Once we've started pushing for this White Belt, in the past, our five-year goal was to do 1,000 frontline staff. I think we did in about three years. That's a huge win that we have the frontline who want to be involved and want to work on their work.

By doing the White Belt, we've also got a lot more interest from the frontline into the Yellow Belt, which like Lynn said, is required for all the supervisors and directors in the system. We've been doing the Yellow Belt for four, five years now, I'd say. Before my time in the department.

Lynn: Six years.

Mark: Six.

Mary: [laughs] When they started. We've grown that a lot. It's a two-day training in person in a classroom. We've adapted it. We do a simulation in a healthcare system food delivery. It's something that everyone can relate to and understand.

As we do the sim, we do the tools that we're requiring for Yellow Belt. Not only are they learning about the tools, but they were able to see how you can apply the tools when you leave. When we coach them, each person that goes through, we assign a coach from our team. We help coach them through their A3.

Each of their projects are submitted in KaiNexus. We've built a template, and it has the DMAIC phases in it and the different tasks that we require on each phase of the DMAIC. I know a lot of us when we're coaching, we have KaiNexus up. That's what we are following. It's their guide and it's our guide to keep us on track of their to-dos.

Once they complete all the required tasks, they get to present leadership roundtable to each of their fellow leaders, or we have them present just one or two at our monthly meeting with the admin team. That's been a huge win for our leaders getting to do that.

Our admin team are paying attention. They are super involved and they're asking questions and follow-up questions. It's been a great connection showing our admin team as well the work that our leaders are doing improving their areas.

Once they complete their Yellow Belt, we do have the option for Green Belt. That is an additional three A3s that we require. We have a different template built for Green Belts in KaiNexus.

Again, they still have their one-on-one coaching, but we are more hands-off with them. They don't require as much...I don't want to say hand-holding, but as much one-on-one time because they have completed already and they do know what the expectations and how to do the tools.

Mark: It's an effort and a culture that has really grown. I had the opportunity to come visit the main hospital maybe eight years ago when your director, Mike McGowan, was doing the MBOE program at Ohio State that you mentioned earlier.

I was coaching and mentoring him, so I had a chance to come to visit. It's just been great to hear how the team and the effort has grown over time. As he's been put into this role, the team has built and grown. We're happy that you all are KaiNexus customers and that we could be part of that equation.

Mary: To show that more people are involved, we also have leaders who are going for their Black Belt. It's not required for their job. We have some nursing leaders and our quality department as well who are going for their Black Belts. We're definitely growing the culture little by little here.

Lynn: I was going to touch on, Mary Beth, that our team is required to do a Black Belt program. As a new member, that's basically your first year. Your job is to complete the Black Belt through MoreSteam, which that's two projects and a test. That's your first year.

Mike, when both of us joined, our director, he made sure to put us in areas that we weren't super familiar with. I didn't go to clinics. I didn't go to inpatient. I went to pharmacy. Just to help us grow. We actually have two new team members that aren't healthcare at all. It's been interesting to see them adjust to that role as well.

Mark: When you're sent to an unfamiliar area, you can't fall back on, "Well, I've seen this before. I know the answer." That shortcuts the DMAIC process, or undermines it.

Lynn: Definitely.

Mark: Thank you for sharing so much about what you've done and what you're doing. Maybe as a final question, what's one thing that's on your mind in terms of what's next for the rest of this year or beyond? What's next for you or for your process excellence team?

Mary: You can go ahead.

Lynn: For what's next for us is we're just continuing to dive into inpatient world. While the first ever big project they did was throughput, I feel like we even went more to worry about outpatient clinic operations, that kind of stuff.

We're diving back into inpatient ED throughput, and like I said, connecting the outpatient world that we know so much about and the inpatient flow that's so broken, which in healthcare is even more challenging.

COVID pushed a lot of people to a lot of different places. We've changed how we're staffing and all kinds of different things. That is what the main focus for our team is going to be in the next year, is focusing on the patient's experience and how outpatient/inpatient affect each other.

I feel like we're at that point. We have some great physician leaders as well that are behind that. We're having the right talks and the right people there. I don't know personally. [laughs]

Mary: I know for myself, I'm working on observations and all the different areas that use our EHR. Seeing how we can improve their processes by improving the HER, how our EHR can help us. That's one thing I've been getting to start on.

Again, go to all these different areas, even if it's not a project, observations. We're able to pass the information on that needs to be passed on.

Lynn: A lot of times people come to us because they're like, "You just see things so differently." Mary Beth, the person from IT works with our team pretty closely and wanted someone from our team to go and watch. Even though they have people from IT looking, they want us to look, too.

Mark: That's another big effort. You described the whole patient flow experience as world hunger. Maybe working on EHR, that's world peace. That's another big one to take on.

[laughter]

Mary: Both things that I don't think we'll ever stop working on in our careers. [laughs]

Mark: Keep working at it. I'm glad that you're doing that. Again, our guests today have been Mary Huck and Lynn Howell. They're both continuous improvement specialists with Memorial Health System. Thank you for being a guest here today. Thank you for being a KaiNexus customer. Thank you for sharing about what you're doing. Really appreciate it.

Lynn: Thanks.

Mary: Thank you. This was fun.

Lynn: It was fun.

Mark: Good. [laughs]

Thanks for listening to the KaiNexus continuous improvement podcast. Please follow, rate, and review. If you would like to find all past episodes, look in your podcast app, or you can go to kainexus.com/podcast.

To learn more about KaiNexus and how we help organizations in virtually every industry, you can go to kainexus.com. That's K-A-I-N-E-X-U-S.com...