Mark Graban & Greg Jacobson Discuss Continuous Improvement and Customer Experience Design

Join Greg Jacobson, MD, co-founder and CEO of KaiNexus, and me for another episode of the KaiNexus Continuous Improvement podcast.

Key Links Mentioned:

A Discussion on Habit Science and Continuous Improvement

In a recent podcast episode, Mark Graban and Greg Jacobson engage in a lively conversation on topics such as habit science, the upcoming conference sessions they will be participating in, their shared admiration for the Lean Leadership Podcast, and advice for those starting out in Lean Six Sigma or Continuous Improvement. Here's a summary of the discussion:

The podcast episode begins with Greg mentioning that he will be discussing habit science as a keynote speaker at the Society for Health Systems Healthcare Systems Process Improvement Conference 2024.

The discussion then shifts to topic number two, where they pay homage to their late colleague and friend Chris Burnham, continuing the conversation with standardized questions introduced in his Lean Leadership Podcast.

As the podcast nears its end, Mark and Greg express their anticipation for future episodes and the upcoming AME Conference in Cleveland, where they plan to share their reflections with the listeners. Greg also mentions that KaiNexus will have a booth at the conference, encouraging attendees to drop by and say hello.

Psychological safety is highlighted as a critical aspect to prioritize within organizations, ensuring that creative work and continuous improvement are facilitated by an environment of trust and vulnerability. Greg recommends attending his session on habit science, but also emphasizes the need for establishing psychological safety.

The podcast ends with Mark asking Greg for his advice on Lean Six Sigma or Continuous Improvement for beginners. Greg suggests reading as a constructive habit for professional adults, facilitating the introduction of new concepts or reimagining old ones. He mentions that he started his continuous improvement journey with a book.

Overall, the podcast conversation explores various topics such as habit science, conferences, podcasts to learn from, and advice for those starting out in Lean Six Sigma or Continuous Improvement. It is evident that Mark and Greg's enthusiasm and dedication to their work shine through as they engage with each other in an informative and animated discussion.

Don't forget to tune in to future episodes and visit the AME Conference in Cleveland to join Mark, Greg, and other professionals in the field.

Automated Transcript:

Mark Graban: Welcome to the KaiNexus continuous improvement podcast. I'm Mark Graban. We're joined again today by co-founder and CEO Greg Jacobson. How are you, Greg?

Greg Jacobson: I'm doing great, Mark.

Mark Graban: Well, it's fun to have another Kind of Conversational podcast here today. You've got a story of something that happened to you recently, right?

Greg Jacobson: Well, it's funny. I was about to tell you, and you're like, wait, hold on, don't tell me the story.

Mark Graban: And we're trying to eliminate wasted motion.

Greg Jacobson: There you go. We can just talk through it. So these two things happened one last night and one today. And I think it's related to process improvement, it's related to continuous improvement, and it's really related to respect when we talk about respect for people as one of the kind of main pillars of Toyota production system. But the other one is really respect for customers.

Greg Jacobson: And I think a big way to show that respect is just acknowledging that someone's there. Right. So last night went to as you know, I live on South Congress here in Austin, went to a local place, and it was one of those restaurants where you wait in a line and you go up to the cashier and you put your order there, and it was super slow. Whatever, it's slow, no big deal.

Mark Graban: Long line. And it just seemed like each transaction was slow.

Greg Jacobson: Everything was just kind of slow. But really, I'm totally fine with that. We ended up realizing that they had a huge party with a complex order, and it's all good. Then when we walked up to the cash register, there was no, hey, I'm sorry, that took a bit, or sorry to keep you waiting. And then there was no even recognition that we were there of like, hey.

Mark Graban: We'll get to you in a minute. Welcome.

Greg Jacobson: I see you, I acknowledge you. Give me 20 seconds. I'm wrapping an order up, or whatever this person was doing. And so I'm there for when does value happen at a restaurant? I guess you could argue, are you buying an experience or are you buying an actual food?

Greg Jacobson: But presumably if the food is bad, it's going to be really hard to say that the restaurant is part of the experience anyway.

Mark Graban: Unless you're at a place with a great view, people will tolerate bad food.

Greg Jacobson: There you go. But there's no reason to me this is free, right? Someone literally just say, oh, hey, I see you right there. Just give me 1 second. I'm wrapping something up.

Greg Jacobson: And so I turned Adrian, my wife, and was just like, I kind of don't really want to come back here for another it had been about six years since we've been it because of.

Mark Graban: A bad experience or you just hadn't thought about it for a while?

Greg Jacobson: Pandemic hadn't thought about it. It was one of these places that always had a line, and we're not going to wait in that line. But we hadn't even had the food yet. The food was great, by the way, but it was one of those things where it would have cost nothing and it would have just shown the respect of you being there just to look someone in the eye and just say, be with you in a second. And anyway, it passed off, right, so whatever.

Greg Jacobson: So then I went to a doctor's appointment, everything's good, got some wrist pain, whatever. And it's one of these places where there's like a window and there's three people on computers and so you kind of walk up and you don't really.

Mark Graban: Know which one of you am I talking to?

Greg Jacobson: Which one of you is going to help me? And so there's this super awkward kind of experience. And keep in mind, when is the value really going to happen here? Probably when I'm seeing the doctor and transacting information about my MRI result for my wrist. Nothing to do with this.

Greg Jacobson: I mean, I get it. There's value in knowing, but it seems necessary activity. Necessary activity. Thank you.

Mark Graban: Value.

Greg Jacobson: Right, to get to that point. And so it's just one of these things where it just seems like it would be free for one of them that's going to help me to be like, oh, come over here. Or look at me in the eye and just say, oh, I'm not the person to help you, or, I'll be with you in just a second. Why put me through this kind of awkward kind of situation? I've now been to this place enough where I just kind of like I'm just like effort and I just walk up to the first person and I'm like, should I be talking to you?

Greg Jacobson: And then the other person down the line will talk. But it just made me think that so much of, I guess what we traditionally call customer service is really respect for people. It's really just acknowledging someone's there. And I'd love to hear your thoughts.

Mark Graban: Yeah, well, I think that courtesy or kindness is free. It could be part of, if you will, the standard work or the training. But I think a lot of it comes down to the opportunity to be intentional about experience design and how the process design supports that. And I would argue there's elements of culture in training. There are some restaurants, even nothing fancy, fast food restaurants, where you can tell they have all been very trained, trained very well to do, like a high end hotel where you say thank you and they say, My pleasure.

Mark Graban: That's nice to hear and it's a little automatic, but still it's better than some of the other responses. I think some of that is intent. Some of that is creating circumstances where people aren't overstressed or overburdened. And I think that applies in healthcare because maybe throw a thought back to you as a doctor. Not to put you on the spot here, but I know doctors who in the context of trying to improve patient flow, we're trying to improve process which will improve the experience.

Mark Graban: And doctors who say, gosh ideal state for me would be to not start every interaction with a patient by apologizing for how far behind we are.

Greg Jacobson: Right.

Mark Graban: Anything but. It's better than it not being acknowledged. I feel that as a patient, 100%.

Greg Jacobson: In this case, the doctor came in 40 minutes after my appointment time, which if my appointment, let's say, is at 1050, I'm kind of probably expecting him to be taken back at 1050, I'm probably seeing the doctor. I don't know, maybe I'm waiting the room ten minutes after 1520 minutes, you're kind of starting to think like so it really does cost the doctor nothing to be like, oh, sorry to keep you waiting, and then getting into things. Having said that, I got really good medical care, and I think I got really good advice and I got good interpretation of my symptoms, and I think I got a very nice conservative approach, which is consistent with what I wanted to do. I just wanted to make sure I wasn't continuing to injure my wrist and I had no problem taking motion for it. So what's interesting is, I guess that core aspect of where was the value created?

Greg Jacobson: Was it the transfer of information? Was it making the diagnosis? Was it the treatment plan? Maybe there's kind of that core element, but then creating an experience around it, especially in the situation we'll pick on healthcare, especially because the patient doesn't know if it was good care.

Mark Graban: Right?

Greg Jacobson: They don't know if they got the right answer. I happen to not know about the risk specifically in this area, but I know the doctor was being thoughtful and kind of put me on a good path, way better than you would, for instance, just because I'm a physician. So it's almost like the entire experience helps create a trust in the moment where the most valuable part of the interaction happens as well. Which is funny that it happened last night, totally forgot about it. Then it happened again.

Greg Jacobson: I was like, this is the same industry, this is the same thing. Just like, acknowledge me when I'm there and I'm present.

Mark Graban: I agree with that point. Acknowledge the delay. And then there's the question of what else are we going to do? And I think there's a difference in mindset where I think a Kaizen mindset or continuous improvement mindset says, well, things can always be better. If we're not providing the ideal experience to each restaurant customer, to each patient, let's strive to do better.

Mark Graban: There's another view where a business owner or a practice owner might say, well, that's not the constraint in our business. We're serving as many customers as we can. As it is, if that one customer is annoyed and doesn't come back for six months for one, they're never going to know that you were annoyed and.

Greg Jacobson: Why you didn't come back.

Mark Graban: But they'll get away with that, I guess, until maybe it catches up to them if they say, well, there's really no need, or I heard it articulated by a patient once, a fellow patient. So I have early onset glaucoma. I have to go to an ophthalmologist a couple of times a year. I'm always the youngest glaucoma patient in the waiting room for this glaucoma specialist, and I just know it's always going to run about an hour late. I bring a book.

Mark Graban: I carve out my day. I know what to expect. I'm getting really good care from an expert. But there was one day I'll never forget. There was a patient who must have been maybe in her 80s.

Mark Graban: Her daughter had clearly driven her there. They were sitting together, and the 80 something year old patient, she said, almost with a sense of pride, she said, this doctor must be really good because look how busy the waiting room is.

Greg Jacobson: Yeah.

Mark Graban: I thought, well, that is a totally different lens than I would have viewed it through. But I'll go back. But there's a difference, though. I have, if you will, fired a primary care practice once, and I tried telling the office manager, you're always more than an hour behind. And every time I'm basically told, oh, today, it's unusual.

Mark Graban: It's crazy. I'm like, either I'm extremely unlucky, right, or it's really not that unusual, and it's easier to find a new primary care physician than it is to find a specialist. And I'm not saying people should make excuses for like, well, we don't. There's a question of, like, do we have to improve it or do we want to? Is it necessary for the business or is it just making the business and our results better?

Mark Graban: I guess that's a judgment call.

Greg Jacobson: I think certainly it will probably bring a little bit more joy to your life to kind of acknowledge someone and say, hey, Mark, I see you, or, oh, go, two windows down, that person's going to help you. I'm not even talking about the Kaizen that could happen there, which is they could put a little sticker on the window that's like, check in here. Right? Because there's literally three windows. There's no way to know which one to go to.

Greg Jacobson: We're literally talking about just creating a little bit more kind of human decency. I hear you.

Mark Graban: I'm with you. Yeah.

Greg Jacobson: Topic number two. Should we change topics?

Mark Graban: Yeah, let's do that. Topic number two. Let me preview topic number three because I'm excited. I attend the Society for Health Systems conference every year. Greg is going to be a keynote speaker.

Mark Graban: 2024. Let's come back to that. That's called a tease.

Greg Jacobson: Okay. That's a tease. I love it.

Mark Graban: But topic number two, and Greg and I are going to continue doing our our late colleague and friend Chris Burnham. We honored him last time we did one of these conversations, and we're going to continue answering some of the questions. Like, Chris had a pretty standardized list of questions that he liked asking people on his podcast, the Lean Leadership Podcast. So we're going to tackle another one of those questions here today. What piece of advice would you give to somebody just starting out in Lean Six Sigma or Continuous Improvement?

Mark Graban: Somebody who's brand new to this. Let's say they've just taken an introductory class or they're about to age.

Greg Jacobson: Am I going first here? Mark?

Mark Graban: I'm asking you to is that all right?

Greg Jacobson: So my advice is to read. I think that professional adults need to have a habit of reading in order to constantly be introducing their brain to either old concepts in new ways or to new concepts. And I think that is the way we get our professional muscle going. So I literally started my continuous improvement journey with a book. As you know, Masaaki Imai's book, Kaizen actually here.

Mark Graban: Look, for those watching, I have a copy sitting right here.

Greg Jacobson: That was not planned. That was not staged. Yeah, exactly. And so I was introduced to a whole new area of thought and of knowledge from reading. So get into a habit.

Greg Jacobson: My habit does not involve a book. Now it's all audiobooks and podcasts, but I think podcasts are a great source of knowledge. But I think also audiobooks are just like the book format is also a very good source. It just allows you to go deeper on a subject. I love when I find continuous improvement in non continuous improvement books.

Mark Graban: Yeah.

Greg Jacobson: And so I was just talking we were just riffing on a book. Scaled up. Is that what we pulling it up? Scale up. What was the exact title?

Greg Jacobson: Scaling up. Scaling so Mastering The Rockefeller Habits 20 So one, it has the word habits in it, which that's going to be the tease for topic number three. But it was so great just to be listening to this book and then all of it literally turned into a continuous improvement book. And so that's my recommendation for people starting out. What about you, Mark?

Greg Jacobson: What's your.

Mark Graban: Mean? So if I were to pick, I mean, we could do a whole series on maybe tips for people who are starting off. Or maybe we do a webinar together because there's a lot of ways of answering it. So just to build on your topic again, let's plug Chris's podcast, the Lean Leadership Podcast. He had more than 60 episodes, the KaiNexus Team.

Mark Graban: We're making sure that that podcast is going to stay online perpetually. So we want to thank Chris's wife for helping us with some of that handoff and to keep those episodes available as part of Chris's legacy. So podcast, great way to learn as well. But back to the question, what piece of advice would I give? I think one, maybe to that.

Mark Graban: Maybe it builds on the different ways to learn. I guess the piece of advice would be think of lean as something you practice. As opposed to like oh, I learned that, as in past tense. Like oh, I took the class, I learned it, I know it. That's just the beginning.

Mark Graban: And hopefully your instructors helped emphasize that. They probably did, but I think it helps to have that reminder. Doctors and lawyers get to say they're practicing in their profession. And to me, lean is very much the same notion. You learn enough to go and get started and then hopefully you have feedback loops of your own reflection, feedback from others, of thinking of this as PDSA cycles.

Mark Graban: I've learned some things. Now I'm going and engaging with people in improvement, hopefully engaging with others, not doing it yourself and getting feedback of like, okay, well now that didn't go exactly the way I thought. So I've learned something a little bit deeper about a lean tool or a lean method or I learn more about engaging people in change. I think just trying to encourage people from the beginning. Think of this as the beginning of a long learning journey.

Mark Graban: And I think back to one other thing I'll add. I'll never forget the example of somebody I was working basically as an outside consultant to an auto supplier 20 years ago, and we were going around the room, introducing ourselves, the lean improvement folks and the oldest, most senior. Guy in the room who's probably in his sixty S and he stands up and he introduces himself and everybody in the room knew who he was. But he stands up and he says, I can use his name. I think it's a positive story here.

Mark Graban: He says, I'm Jim Pell and I've been studying lean for 25 years. I thought that set a really good example. He wasn't standing there saying it is probably true, he probably knew the most of everybody in the room, but he framed himself as a learner. And that both struck me in the moment and it stuck with me.

Greg Jacobson: I think that's the difference. I think the term practicing lean or practicing improvement really works well because it correlates to lean is not just tools, a single tool. So it's one thing to say, oh, I know how to make a paper.

Mark Graban: Airplane.

Greg Jacobson: Certain way to make a paper, there's a right and a wrong way to do it. And that's that when you are doing an activity that has such a rich amount of knowledge behind it, and there's a recognition that what will work in one place or in one situation will not necessarily work in that one place in that one situation. So truly, we'll go back to the doctor. I saw from my wrist pain. He had never seen the constellation of MRI findings before.

Greg Jacobson: He's like, wow, you've got this really weird thing. And we concluded that I had this really weird thing. It's not causing the pain. So let's just kind of put that off to the side. And I think had I had been an 80 year old person or an 80 year old person, there would have been different conversations that went into that.

Greg Jacobson: So there is practicing something is understanding a body of knowledge so well that you're able to use that knowledge to come up with specific things to do that are tailor made for a situation. And having seen the patterns enough to know, oh, I recognize this pattern in this area, I'm going to apply this body of knowledge in a certain way. And so I think that's where you can say, because truly, if you go from hospital A and say, oh, we're going to do exactly what we did in hospital A, in hospital B and just think it's going to work, it's just not. And then especially when you're going across industry, so it's all pulling from this large body of information, but kind of understanding when to apply different things and in different ways and then being creative, that's when you get into a practice. That's why you are a practitioner.

Mark Graban: Yeah. And I think there are great parallels to what you described there, to the practice of lean. People in healthcare will say, and there's usually nuance and context around it, but every patient is unique. And you could say every KaiNexus customer is unique. Every consulting client is unique.

Mark Graban: We can learn from past experience. We can learn from other organizations, but people get in trouble when they try to copy paste. And I'll share one story that I heard recently, and I can link to the video from the GE Lean Mindset event that happened early September. Jim Farley, the CEO of Ford, he started his career at Toyota, and he was there 17 years before he joined Ford, maybe over a decade ago, and he became CEO.

Greg Jacobson: He's a displeasure of his Ford family.

Mark Graban: Yeah, he grew up in a Ford family, and he says but it was tense for a long time, so he came back in an opportunity to try to help really transform Ford in different ways. So he has all his experiences of what he knew worked at Toyota and as he shared at the event in York, like, he came in and recognized Ford's, a different culture. And the things that worked at Toyota wouldn't immediately work at Ford or you have to work on sort of trying to change the culture and or adapting methods and approaches. He described kind of in summary, that Toyota and I've heard this from John Shook and from others who worked at Toyota, there's a very heavy bottom up influence now. Top down leadership still plays a role right there's that balance.

Mark Graban: And we've talked about that. Our customers talk about that a lot. And then Jim Farley said he came in the Ford. He said it was an extremely top down culture, and you have to recognize that and realize the situation here is different. What worked well somewhere else just has know Jim Farley was trying to figure out, and maybe is still practicing this, of how do we make it work?

Mark Graban: Ford, that's different than if you were opening up a brand new Toyota plant and said, well, we're going to do the Toyota thing in this new environment. Now that's different than the existing plants even. But Ford was even more different.

Greg Jacobson: What I think is interesting is this dichotomy we started this conversation with, what would you recommend for people when they're beginning? And there is a dichotomy at the beginning. Things really need to be black and white because you need to be able to start building that knowledge base. And if you say, oh, well, we're going to do this, but in this case you might want to do it this way, in this case you might want to do it this way, all of a sudden to a new learner of something, there's too much nuance. Right.

Greg Jacobson: A medical student just wants to know, okay, this is pneumonia. What antibiotics should I give? Right. That's very different than a third year resident where you can start getting into the subtleties of let's talk about what are antibiotic possibilities and why would you want to pick these versus those. If you start with that conversation with someone, it's just like it's information overload.

Greg Jacobson: There's no way they can kind of categorize information. And so as you're beginning, I think it's okay to initially recognize, okay, I'm just going to put things in boxes and start learning things like the purest way they can be done. As long as you're open, as time goes on that you're going to see different experiences and you're going to become more nuanced and you're going to go from kind of learning something new into being a true practitioner, being someone that says, I've studied Lean for 25 years. Well, that's phenomenal, that's great. That means you haven't just learned it for six months and then just kind of applied that six month learning over and over and over.

Mark Graban: Yeah. And one other thing I'll add on this is it makes me think of the approach to teaching and learning and practicing Toyota. Kata like Mike Rother and others would be pretty directive of here is the starter kata. These are the questions you should ask in this sequence and these circumstances. But then they emphasize then over time, at some point you feel free to start tweaking it and customizing it at some point, yes.

Mark Graban: Whether it's a problem solving template. There are some people who say, oh, forget the template. If you're going to do an A three start with a blank sheet of paper, it's the thinking that matters. Like, well, when people are new to A three thinking, they want a template or they need a template. But I would add hopefully there's also coaching.

Mark Graban: So you're not just stuck with like, here's this template. It's overwhelming. You need that coaching and support. I think to be a practitioner, I.

Greg Jacobson: Will simply state that I'm playing guitar pretty regularly now for eight years. And about six years into it, I had just hit this plateau and I got a teacher coach. It has revolutionized my playing and my understanding of music. And so if you feel like you are hitting a wall in something that is a practice, we all need disciplined practice, intentional practice, but we all need a coach as well. So that will 100% add that nuance that you're looking for.

Mark Graban: All right, well, then to wrap up final topic, we'll put a link in the show notes here. I'm super excited, Greg, that you're going to be a keynote speaker, because I've attended this conference almost every single year since 2005 or 2006. The Society for Health Systems. Society for Health Systems? Part of the Institute of Industrial and Systems Engineers.

Mark Graban: That's my professional academic. That's my society, especially the healthcare part of it. So they do a conference every year. The Healthcare Systems Process Improvement Conference. It's going to be held in Atlanta February 13 to 15th, 2024.

Mark Graban: And Greg is one of the three keynote speakers. One of the other keynote speakers is somebody who does lean work at Chick-fil-A, one of these organizations where they're taught to say, my pleasure. I've interviewed David Reed before, so it'll be fun to hear from Greg. You know, I'm excited you're a keynote speaker. Give us a little bit of a preview of what you're going to be talking about at the event.

Greg Jacobson: Well, I'm definitely going to have a lot of fun. If anyone's participated in any kind of talk I do, I can't tell you exactly where we're going to go and what crazy stories are going to come up, but hopefully we'll have everyone laugh, at least part of it. I have been really interested in expanding my knowledge, my discipline, and my understanding of habit science. And I think habit science is a critical part of building cultures of continuous improvement. There's this whole body of knowledge that's really been developed over the last several decades that has given us a deeper understanding of how we form habits and how we have habits sustained.

Greg Jacobson: And thinking about those type of kind of areas of knowledge and applying it into an organizational structure I think is fascinating. I think you can really accelerate and leverage the amount of energy that continuous improvement coaches are putting into the system. If you have ten units of energy, why not use your ten units in the most efficient way possible to have 100 units of impact, if you will? And so that's what we'll be talking about. We'll be talking about habit science, and then we're going to be doing a oh, I can't remember what they call it, but it'll be more of a practicing portion as well, where we're going to get our hands dirty and build some habit loops and design some things out.

Greg Jacobson: So more of an action based workshop type of situation, so should be a lot of fun. I did not realize that this conference was so aligned with your history, Mark, so I'm not taking up a spot on the stage that you would have.

Mark Graban: Normally they were kind enough, I think. No, 2019, I was one of the keynote speakers.

Greg Jacobson: Well, there you go.

Mark Graban: Okay.

Greg Jacobson: I don't feel bad.

Mark Graban: Had that opportunity, but yeah, Greg's going to be up there. David Reed from Chick-fil-A, other keynote speaker, Heather Dexter, who's the president of a regional hospital division for Emory Healthcare based in Atlanta, of course. So there'll be a lot of opportunities there. This is some breaking news. You don't know this, Greg.

Mark Graban: My proposal to do what they call an intensive session was accepted, so I'm going to be doing an interactive session around psychological safety and continuous improvement.

Greg Jacobson: Perfect. The intensive session was what I was referring.

Mark Graban: Hopefully they didn't schedule yours and mine at the same time.

Greg Jacobson: Hopefully not. If they did, I will tell you go to marks habit science in my talk. But I do think psychological safety is another critical aspect to make sure that you're working on at your organization. Because the creative work that people need to do and the amount of vulnerability people need to have to do continuous improvement can't be done without psychological safety.

Mark Graban: Yeah, I will pull the andon cord in advance. They probably haven't set the exact schedule yet if they just decided a couple of days ago my proposal had been accepted. So hopefully people can come. I want to come to your session and I want to have you there in mind participating and sharing your experiences and thoughts.

Greg Jacobson: Well, good.

Mark Graban: This has been fun. 30 minutes goes by just like that, but look forward to doing another one of these with you. Greg and I are going to be at the AME conference in Cleveland, so we've got time to schedule. We have time scheduled where we'll share reflections from that conference together with the listener.

Greg Jacobson: That'd be great. And KaiNexus will have a booth there, so make sure to stop by and say hello. And I think we've got a number of customers there that will be we have a number of customers in Cleveland in general, so it'll be a lot of fun to hang out with our customers.

Mark Graban: So we'll see you there. We'll hope to see others there. And we'll see you guy next time. Thanks, Craig.

Greg Jacobson: Thanks, Mark.