DailyKaizen

About a week ago, I was walking past Wall Street in New York City around the end of the day with the leader of a health system there as he told me the story about how he was able in his career to create a great health care system for a group of patients in his community that would not otherwise have access to this. This parable came to mind as we talked about helping the most needy as we walked through one of the most resource-abundant sections of our planet.

The parable was allegedly written by Heinrich Boll, but I came across it in Tim Ferriss’ The Four-Hour Workweek. Enjoy.

A boat docked in a tiny Mexican village. An American tourist complimented the Mexican fisherman on the quality of his fish and asked how long it took him to catch them.

“Not very long,” answered the Mexican.

“But then, why didn’t you stay out longer and catch more?” asked the
American.

The Mexican explained that his small catch was sufficient to meet his
needs and those of his family.

The American asked, “But what do you do with the rest of your time?”

“I sleep late, fish a little, play with my children, and take a siesta with my wife. In the evenings, I go into the village to see my friends, have a few drinks, play the guitar, and sing a few songs … I have a full life.”

The American interrupted, “I have an MBA from Harvard and I can help
you! You should start by fishing longer every day. You can then sell the extra fish you catch. With the extra revenue, you can buy a bigger boat.

“And after that?” asked the Mexican.

With the extra money the larger boat will bring, you can buy a second
one and a third one and so on until you have an entire fleet of trawlers. Instead of selling your fish to a middle man, you can then negotiate directly with the processing plants and maybe even open your own plant. You can then leave this little village and move to Mexico City, Los Angeles, or even New York City! From there you can direct your huge new enterprise.”

“How long would that take?” asked the Mexican.

“Twenty, perhaps 25 years,” replied the American.

“And after that?” the Mexican asked.

“Afterwards? That’s when it gets really interesting,” answered the American, laughing. “When your business gets really big, you can start selling stocks and make millions!”

“Millions? Really? And after that?”

“After that you’ll be able to retire, live in a tiny village near the coast, sleep late, play with your children, catch a few fish, take a siesta with your wife and spend your evenings drinking and enjoying your friends.”

Now that I have temporarily left the cocoon of the transformation I helped start (with an emphasis on helped, there are many bright people continuing the work now), I am back on the lookout for LEAN in my new east coast environment. The really great news is that every organization I have spoken with regarding the work I’m doing for the new few months is studying LEAN somewhere within it. Typically, the person I have been speaking with knows someone applying the principles, so only 1 or two steps removed from my contacts. In my very unscientific survey of various innovative health care systems, there’s good interest in LEAN.

Very soon I hope to find “the people who are studying LEAN” in the organizations I am working with, which is fine considering that I am only at day 11 (is that 11 days too long? :)). I find myself giving a short elevator speech with every contact I make about LEAN, whether or not it’s the primary subject of the conversation. Why wait to continue transforming the medical profession? If anyone knows practitioners in our nations capital, feel free to send me their way…

Speaking of waiting, though, this blog is going to go on hiatus for a few days as I take an Internet holiday for about a week and Lee regroups from his travels. Comments will be closed for the time being to keep things protected, but will reopen on our return.

There’s two this week, since there’s only one of us posting.

The first, from “Toyota Talent,” by Jeffrey Liker and David Meier:

The variation within an industry rivals the variation across industries.

I “reappropriated” this quote when someone asked me what I would say if someone said, “Our patients are different in this organization, so we cannot do things the same way as others can.” I brought up this quote as a way of saying the variation within a health care organization rivals the variation across organizations, because, I theorized, every patient wants to be empowered, every physician and nurse wants to deliver excellent care, and everyone wants it to be affordable.

The second, from a leader of a health care organization I am working with this week in New York City:

We don’t use the Toyota model. We use the Vespa model - we hang on for dear life.

This was a joke, of course, but I used it to select this week’s “Photo Friday” on my sabbatical blog. I am here observing and shadowing care systems that are different than ours to understand patient empowerment using technology. I am not here to be a sensei or LEAN consultant, but I suppose the words slip out now and then, and the quote comes from that. The great thing about what I have been able to do, thanks to these incredible people, is act LEAN in what I am doing, by observing patients receiving care, and bringing these ideas into the conversation. The quote comes from a leader who’s open to new ideas and can laugh along the way.

I was listening to Mark Graban’s most recent podcast and it reminded me of several conversations involving this word with medical leaders from other organizations recently, and they have all gone a bit like this: “Ted, we would like to do the patient-centered thing X that your organization did, but we anticipate pushback.” As it so happens, I could actually relate to this feeling, because we ourselves did something new in our system recently that was different. In our case, this was the addition of several pieces of data to the printed summary that patients get when they come to our medical centers, including a complete medication list, upcoming health maintenance, and a complete list of lab tests ordered.

The thing that Mark’s podcast brought up for me was the idea that in the Toyota Motor company, staff understand why a certain thing needs to be done a certain way because it is explained to them as part of the process of training.

I reflected on my own response to the thing that we did, and in all honesty, the word “pushback” didn’t come into my mind (and why should it in a LEAN organization - a dictionary definition of it is “to repel the enemy”).

What I knew and told the team was that we were doing something a little risky, using a technology tool to drive behavior, that we do this only for very specific reasons, and that it would definitely start new conversations about why and how we support a safe health care system.

We did launch the new features, and we did have the conversations, before, during and after, and they were new conversations in many cases. In each case, they weren’t conversations about whether we would continue to do this patient-centered thing, they were about why we were doing this, which every physician I talked to understood well. We needed to know why we were doing this and how it would help patients in the first place, and we spent as much time on this as we did on doing the work. If we didn’t know why, then we wouldn’t be able to explain it to anyone who asked. And then we’d feel….the p-word.

As I have said on here before, people who choose health care as a career are really outstanding individuals - they have to be - and want to do what’s right for patients. I suggest asking, “Why are we doing what we’re doing, and what are the conversations that we’ll have before, during, and after we do this” instead of, “How will we handle pushback?” This puts the accountability where it belongs, I think.