• In building a culture of improvement, what’s the explanation and expectation for new caregivers?

• Example of small improvements?

• Manager and leadership role?

• Impact of Covid on your improvement work?

• Using KaiNexus for idea system - 'Innovation Station"

• Why a phased approach to roll out?

• Tabulating stats and results numbers?

• 90,000 ideas — putting the old ones into KaiNexus
  
  

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Transcript:

Mark Graban:  Hi, and welcome to the KaiNexus continuous improvement podcast. I'm Mark Graban, Senior Advisor with KaiNexus. We're joined today by Cliona Archambeault. She is the director of process improvement with one of our customers, UMass Memorial health. Cliona, thanks for joining us. How are you?

Cliona Archambeault:  Good. Thanks for having me, Mark.

Mark:  Sure thing. I'm glad. There's a lot to share and explore today about continuous improvement and your Idea System and everything that you've been doing these recent years there at UMass Memorial health. Then to touch on how KaiNexus has supported you more recently.

First off, Cliona, can you introduce yourself? Tell the audience a little bit about your professional background and your path for how you came to start working at UMass Memorial Health.

Cliona:  Sure. I've been here at UMass Memorial Health for six years. Started as a senior process improvement specialist supporting mostly the perioperative areas and the OR, and became director of process improvement about a year and a half ago. I manage a team of 12 black belts and master black belts. We are responsible for Lean training, especially at the green and black belt level.

We co‑own the Idea System here with our HR colleagues, and we support transformation, Lean Six Sigma projects, for the system. Prior to being here, I worked at the Veterans Health Administration in Boston. Earlier in my career, I was an industrial engineer at Intel.

Mark:  I'm biased as an industrial engineer myself that there are transferrable skills, both from industrial engineering backgrounds and from Lean and related methodologies and to healthcare, as you've seen now in a couple different places.

Cliona:  Yeah, for sure. I always had an interest in medical. Started as a biomedical engineer in school, but worked my way into the industrial engineering department at Intel. That's where I learned Lean and was thrilled to hear that I could transfer those skills to healthcare.

Mark:  It's an important purpose and mission. That was true even before all of the disruption and change and this year of the pandemic. This year, plus. It's great that you have the opportunity to contribute to that in different ways.

There's a couple follow‑up questions. When you talk about the belts, is that under a label of Lean Six Sigma or what kind of terminology...? I'm curious, the boundaries of the belt training because that varies from company to organization.

Cliona:  Sure. Our UMass Certification Program for Green Belt, and it's a Lean Green Belt and Lean Black Belt program.

Mark:  Then can you share a little more about co‑owning the Idea System with HR and the implications of that?

Cliona:  We have great partners in our human resources department for Lean training and Idea System. There are big cultural enablers to help prepare our army of problem‑solvers here at UMass Memorial Health. Our HR colleagues manage the white and yellow belt training, that acculturation training. White belt is part of our new caregiver orientation.

We partner on the content design and back each other up as needed, but they own white and yellow, and we own green and black. Then with the Idea System, it's a co‑ownership.

We're working hand in hand with our caregiver experience colleagues within our human resources department to support Idea System generally in the way that we celebrate and recognize caregivers and their innovations, and in our innovation station deployment specifically.

Mark:  We recently, at KaiNexus, hosted a customer panel discussion that I moderated that included one of your HR colleagues there, Rob Pitney, who shared some perspectives. He's relatively new to the health system, he said, just six months.

Cliona:  It's been fun welcoming him into the team and helping to onboard him with our Idea System.

Mark:  He's got a lot of enthusiasm for the approach from his background and previous experiences with Lean and continuous improvement. One other follow‑up question, it's great to hear that this white belt training is part of the orientation for all new caregivers. How much time is spent on that as part of orientation?

Cliona:  It's about a three‑hour training. Of course, prior to the pandemic, it was in‑person during that new caregiver orientation week, but we modified it last summer so that it can be delivered virtually.

We're doing it three times a week currently because we have a goal by the end of fiscal year '22, to have 100 percent of our caregivers. We started doing it as part of our new caregiver orientation about three years ago, but we do have a gap to catch up.

Mark:  Of existing employees...

Cliona:  Exactly.

Mark:  ...who've been around for...OK. I'd love to hear more, maybe to bridge to the idea of the goal of having a culture of continuous improvement and engaging every caregiver in improvement. I know from your CEO, Dr. Eric Dicksoon, that he believes in that very strongly and passionately as he's worked to build that culture through you and others.

How is that introduced? Maybe we'll frame it in terms of, new employees who are coming in, how is continuous improvement and the Idea System framed for them in terms of what it is and what the expectations are for them as a new caregiver?

Cliona:  They hear about it coming in right away, even on day one. White belt isn't actually in day one. It's a couple days later, but they hear about it right in day one from the leaders and the professionals teaching that class.

We also teach standards of respect, which are six behaviors that our caregivers came up with over a couple of years. The behaviors that demonstrate how our caregivers feel respected. They're exposed to that during new caregiver orientation, as well as white belt.

Our white belt centers around our Idea System. We teach waste and value, and we teach true north alignment, and then we go into the Idea System, which, at its root, is A3 thinking. Our idea card is, what is the problem you're observing? Why is it happening? What's your idea to solve it?

Mark:  I love how you focus on, it sounds like taking this principle of respect in the Lean methodology. Toyota has a phrase that gets translated either to mean respect for people or respect for humanity. That might seem vague.

I love hearing about how it sounds like these specific behaviors are more detailed examples. Can you share an example of at least one that supports the idea of engaging people in improvement and how to do that successfully?

Cliona:  Sure. One is, listen. That can be a really important manager behavior. People put ideas on the idea board, and even if the idea that they come up with isn't initially the right idea, the problem is real.

Listening to understand, what is the problem? Why is that happening? Even if the idea that's initially proposed isn't a good fit, for whatever reason, how do they get to a yes there by understanding the problem?

Mark:  Working to yes, that's a key principle. You guys are ahead of the curve there at UMass Memorial Health. When other KaiNexus customers asked us for coaching, and feedback ‑‑ and we've got some videos online that talk about the behaviors of leaders ‑‑ working toward yes is certainly one of those behaviors.

On the topic of listening, you can think of not being dismissive. I've seen this in other organizations, unfortunately, where someone says there's a problem and a leader says, "No, that's not really a problem." We have to listen. We have to respect that perspective.

Cliona:  Exactly. Another is, be a team player. Which I think our Idea System isn't something that a manager needs to lead necessarily. Sometimes, any champion who's on the team can be a leader in the Idea Systems space even if they don't have the formal authority, so enabling that teamwork behavior.

Mark:  When we think of small improvements, what are some examples that come to mind?

Cliona:  One of our clinics, the medical assistants were starting to help out with telehealth appointments. They were doing that along with their other appointments, and so they found it to be a bit disruptive to their workflow to be helping with patients in clinic as well as preparing the telehealth patients.

One of them proposed the idea to dedicate that workflow. They have a day that rotates when they are on point for the telehealth appointments. They proposed that idea to change the assignment workflow and that was implemented.

Another on our pediatric unit, they noticed that some parents who were at risk for some precaution or breastfeeding parents who shouldn't maybe be in the cafeteria with the COVID risk, but they needed to eat. They had the idea and worked with food services to make box lunches available to those parents.

Mark:  That example there especially typifies the focus on serving the customer. I love how there's this focus, and you and Rob mentioned this when we did the panel discussion, on looking at a wide range of benefits, what might be surprising to some, of not focusing on cost savings.

Because that box lunch wasn't aimed to save money. It was to provide a better experience for visitors to the hospital, right?

Cliona:  That's right, yeah. A lot of the ideas are focused on making the work‑life better too. A lot of our teams have been working remote and some of them will continue to work remote, or we're in trials for that.

Another idea that came from a remote‑based team is to update their new employee hiring standard work for their department to include tips for managers and the new employee on how to work effectively remotely.

Mark:  These ideas are mainly evaluated within the team?

Cliona:  Yeah.

Mark:  I always like to try to compare and contrast. What you're describing as an Idea System is not the type of thing where everything gets shot up the chain to an executive team. That decision‑making and the ability to try things out is kept, for the most part, at the local team level. Could you share some of the perspectives on why that is and how that's effective?

Cliona:  Absolutely. That's really important. That's where we get the power of the 14,000 people who work here. We have some great leaders here at UMass Memorial Health, but they can't do everything, and so then the army of problem‑solvers of 14,000 people.

It's pretty rare that those ideas have to go up the chain. We try to make it be something that they can do on their own, get them connected to the right resources, if needed, to remove barriers but enable the teams to solve their own problems.

Mark:  When you talk about identifying small problems, or small solutions, you mentioned earlier the A3 thought process, or the A3 format. Is that idea card ‑‑ we'll talk about more electronic stuff in a minute ‑‑ but that paper card, do you think of that as a mini A3 or how do you frame that?

Cliona:  We do think about it as a mini A3, conceptually. We don't call it that. We just call it idea card, but it is A3 thinking and we referenced that in the white belt, and especially in later trainings when we're making that connection, that it's A3 thinking even though it's just an idea card.

Mark:  Either way, it's that structure of, if you use terminology around plan, do, study, adjust, or plan, do, check, act, or whatever kind of iterative test of change type thought process, that's a big part of it, right?

Cliona:  Yes, for sure. That's been one of the best features of innovation station. Is the ability to complete an idea and then schedule a reminder for, we need to check in on this idea and see how it's working.

Mark:  You're talking about those reminders. Maybe let's talk a little bit then about use of the KaiNexus system, and then we'll come back and before wrapping up, hear more about how COVID affected your improvement work. I think these issues are probably connected.

Let me go to go back and ask it in the other order. Walk us through COVID times. Before that, you've got cards, you have physical boards, what played out last year?

Cliona:  Most of those cards and physical boards, the practice of huddling around them or of putting cards up became very difficult and in most cases stopped. There may be some teams that were able to continue in‑person.

Between the distance restrictions and just the busyness and the stress for our clinical caregivers who might have met in person, and then our other caregivers who were working from home, obviously, they weren't able to huddle around the whiteboard in the office.

That discipline and those huddles halted in many cases. The innovation didn't halt, and our caregivers did some amazing things in terms of innovation and coming up with ideas to meet the challenge, but getting them captured in the Idea System, we had some teams, a lot of teams actually who experimented with different ways to do remote Idea Systems.

We had many Trello boards across the organization, Google Docs, and Spreadsheets shared through Zoom or WebEx. Lots of teams moved in that direction. We had a small handful of teams pre‑COVID that were doing some of that work virtually. During COVID, many, many teams started experimenting with that.

Mark:  Then the decision was made to look at and then become a KaiNexus customer. That rollout began very early this year, 2021, correct?

Cliona:  Correct. Yes, we launched with some pilot teams in late January.

Mark:  In the panel discussion we did earlier, Rob said that some of that rollout, it's a little bit more than halfway in terms of how many caregivers in the organization have access to the system yet?

Cliona:  About halfway, yes. We have our academic medical center goes live on June 1st. That'll be the majority and the rest of our caregivers to go live.

Mark:  Can you share a little bit about some of the strategy for deciding where to start, how to progress as you spread it?

Cliona:  Sure. We decided pretty early on that we needed to do a phased approach or wave approach in order to be able to work with the entity leaders and make sure they were prepared in order to set up the system with the right locations, and permissions, and all of that.

We wanted to start also with our corporate parent groups that a lot of them were working at home because they were still working at home, of course, in February and we still are today. It met a need for them, so we wanted to start there.

Then also it gave us a chance to learn as we go to our largest deployment on June 1st with the Medical Center, it gave us a chance to learn with some smaller groups and be prepared for them. We rolled out every three to four weeks to our next entity.

Mark:  One other things, just to come back to...I love how you brought up the idea of automating the follow‑up, the review, of coming back, and maybe doing an extended study to see if there's a need for an adjust at some timeframe.

Our other customer who joined us on that panel is from a food products company. They've been a customer for 18 months‑plus, and he talked about that same dynamic of how they use the software. That the past, they would implement something, and then it would be forgotten. I think there's a helpful discipline of having something remind you to come back and take a look.

The one thing that comes to mind is you can automate some of that administrative work. Computer systems are great at setting a clock and six months later, it will notify you, but the software, it doesn't automate problem‑solving.

Want to hear your thoughts on how it's a communication platform, very specific to something like an Idea System or innovation station, as we call it. Can you share a little more about that?

Cliona:  Sure. When we were building our version of KaiNexus with Kade and Taylor, it was important to us that we mimicked as much as possible what our current Idea System was.

The card is the card in the innovation station and the board is very similar too so that it felt familiar to people and it worked. More importantly, it is our Idea System. It has that level up. It has the reminder afterwards for PDSA, it has task tracking and reminders associated with that.

It's transparent. We made the decision for the system to be open to everybody so any team anywhere in the organization can look at any other team's ideas. We think that's important for motivating teams and sharing as well as being able to recognize and spread ideas.

Mark:  You've got this opportunity across multiple sites, across units, to look and see what other people are doing. How do you talk through with people the idea of taking an idea that works someplace else? What would you suggest somebody do with that if they see something that catches their interest?

Cliona:  We've been talking a little bit, we're still working on that in terms of the technology piece of it, but we encourage people to steal with pride in terms of if there's an idea that has worked for a similar team to understand what about it made it work and think through how it can work in your setting.

It's an opportunity to get the advantages that they have in a much accelerated timeframe because they've done some of the work in terms of figuring out how to do it.

Mark:  What I've seen in other organizations is there's room for balance. There's opportunity to learn from others, and sometimes, like you said, steal with pride.

Some say, like Norman Bodek, who trained me on Kaizen would talk about, scaling shamelessly. That's OK within an organization like that. At the same time, when we see what somebody else has implemented, that might also spark us to further refine what was done.

Cliona:  That's right.

Mark:  That we don't have to just copy‑paste. We can copy and improve or be inspired and said, "Well, that might not work here, but that gets us thinking, we've got the same problem, we want to try something else." Those are some of the connections that you can start seeing in an organization that is as big as UMass.

Cliona:  Yeah, for sure. We're learning about the honor roll system in KaiNexus and thinking through how to turn that on and how to make sure that we're pulling those great ideas that can be shared. People can go out and look, but then how do we also kind of highlight ones and recognize teams.

Mark:  Teaching people how to search the system and filter and find things that might be applicable. That is one of the things that that's clearly a benefit of an electronic system. Giving that transparency, visibility, searchability, or even to do some things to automate the sharing of ideas that match certain keywords or department names.

One other final question, I know you're still relatively new as a customer, but what are your thoughts or what have you done so far in terms of using KaiNexus to help tabulate statistics? Everything from the number of improvements, participation rates, time to completion, other measures. What are you thinking about or doing already in that regard?

Cliona:  We do appreciate those benefits of KaiNexus and we've built a couple reporting dashboards. We've always measured our ideas since 2014. We've implemented about 90,000 ideas at UMass Memorial Health.

Certainly, one of the activities that Rob is working on is putting all those historical ideas in there. We want to be able to an innovation station, see that odometer turnover to 100,000. We got to get them all in before that happens.

What we've built on our dashboards is a number of ideas by month. We can see it by entity and by area. We've got some of the metrics in there around engagement in the system, the percent of people who have logged on, who have used the system.

I like the participation donor, in particular, because even for caregivers who haven't logged on...of course, we encourage everybody to log on, and everybody has an account and they can log on and see everything.

Even if they don't, if they're participating in the Idea System from the perspective of they're contributing to an idea, they own an idea and someone else scribed it for them, perhaps, they will still show up in the participation. We like that metric.

We are also doing adoption scorecards specific to the deployment where we're looking at, is everyone assigned to the team? Does everyone have a team? We have some features on the idea board that teams can customize. We look to see, did the team customize those sections? Has the team submitted at least their first idea?

That gives us a checklist for every team, and we send a rollup to the leaders so that they can help encourage their managers and their teams to participate.

Mark:  It's exciting to hear about the progress. You have such an improvement history. That does sound like a daunting task of giving that history put into the system, but I think that creates a number of benefits to do that.

That'd be worth that effort of that data entry. Cliona, I appreciate you sharing both some of the broader perspective of continuous improvement at UMass Memorial Health and some of the detail about how this works and how KaiNexus has become a part of that.

I'd like to turn it to you may be as a final word, is there any other thought that you'd like to share as we wrap up? Is there something you wish I would have asked you about this work and the progress?

Cliona:  Oh, gosh. I would say that our leadership has been very important in the deployment and in the Idea System in general. Our executive leaders have done a great job of sharing the vision and explaining that this is how our Idea System will be moving forward and setting those expectations in a very positive and exciting way.

We're grateful for that as people are deploying the system. It makes a big difference in terms of the culture as well. That's it. We've been grateful to KaiNexus' customer service and partnership with us in this deployment as well.

Cliona:  That's great to hear. We have a great team here at KaiNexus and I'm personally very happy that you've all become a customer of KaiNexus. I appreciate what UMass Memorial Health has been doing here in recent years.

Again, our guest has been Cliona Archambeault. She is the director of process improvement at UMass Memorial Health. Cliona, thanks again. Thanks so much for joining us today.

Thanks for listening to learn more about KaiNexus, the company, our software, and our team. You can go to www.kainexus.com. That's K‑A‑I‑N‑E‑X‑U‑S.com.