Lean Tours at Seattle Children's Hospital Featuring Jay McNally

Just-In-Time Cafe: Lean Six Sigma, Leadership, Change Management

This month, Tracy will be interviewing Jay McNally of Seattle Children’s Hospital where we’ll hear all about their famous Lean Tours.

Today’s appetizer is a powerful app that everyone has and most people under-use. During the Bulletin Board segment we’ll discover how the El Paso Fire Department saved taxpayers millions and then we’ll move to Boston to find out why a Chief Information Officer claims software is not the answer. For Tools of the Trade we’ll discuss a new book that combines wisdom from the likes of Anderson Cooper, Colin Powell and Diana Oreck of the vacuum family dynasty. Last up, some Q&A from a subscriber who asks: Are Fishbone Diagrams just for the Analyze Phase or can they be enjoyed elsewhere? Join us as we bring “Farch” (February and March) to a close at the Just-In-Time Cafe!

Also Listen On:

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Timeline

• 2:10 Appetizer of the Day
  • Outlook
  • iCal
• 5:45 Bulletin Board
  • City of El Paso Saves Big Using Lean Six Sigma
  • Shields Health Care Group Embraces Six Sigma Methodology
• 10:55 Tools of the Trade
  • Ask More by Frank Sesno
  • Read Our Book Review of Ask More
• 16:50 Special Request (Q&A)
  • Are Fishbone Diagrams just for the Analyze Phase or can they be used elsewhere?
• 19:50 Today’s Special
  • Interview with Jay McNally of Seattle Children’s Hospital

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Podcast Transcript

Welcome to Just-In-Time Café, GoLeanSixSigma.com’s official podcast where we help you build your problem-solving muscles. We share best practices from over 20 years of success helping organizations from the Fortune 500 to small and medium-size business to government achieve their goals using Lean Six Sigma.

Introduction

Tracy: Hey, Elisabeth. How are you today?

Elisabeth: Good morning, Tracy. I confess, I have a slight cold but I’m good. I’m getting better.

Tracy: Oh, that’s unfortunate. I hate that.

Elisabeth: Yeah. But what is good is coffee. So let’s get some of that. What do you say?

Tracy: I think that’s great. I’ll meet you in the dining room.

Elisabeth: Meet you in the dining room.

What’s on the Menu (Podcast Agenda)

Tracy: So Elisabeth, now that we have our cups of coffee and we’re snuggled into the corner of this little dining room, what’s on the menu?

Elisabeth: I’m glad you asked, Tracy. I am psyched for today. First, we’re going to discuss a powerful app that everyone already has on their computer. I know. And then on Today’s Bulletin Board, first we’re going to find out how El Paso Fire Department saved the city almost $2 million. And then we’re going to find out why a Boston Health Care Center says its software is not the answer, and that came from the head of IT.

Tracy: Oh, I love that.

Elisabeth: Yeah. And then in Tools of the Trade, we’ve got a book that we’re going to find out what Diana Oreck of the Vacuum Family Dynasty, Anderson Cooper, and Colin Powell all have in common.

Tracy: OK.

Elisabeth: And then on Today’s Special Request, we’re going to answer a question about the fishbone. Let me get to that. And then for Today’s Special, we’re going to find out what you can learn by wandering around the Seattle Children’s Hospital.

Tracy: Very nice. Looking forward to it.

Appetizer: Outlook and iCal

Tracy: So, tell me Elisabeth, I’m very curious to know what is this fabulous app that we already have at our disposal?

Elisabeth: I’m so glad you want to know, Tracy. This may sound simple but the app we’re talking about is your online calendar. So that could be Outlook, it can be iCal, whatever. It’s totally underused.

And here’s my big pitch to anyone who has not done this. I used to make to-do lists all the time. I don’t know about you but I would make a list and then it’s back in my notebook somewhere I’m constantly flipping to find the list.

Then I’m adding to the list and I’m crossing out the list and it’s getting messier and at some point, I rewrite the list because I want it further up in my notebook. I don’t want to have to go back so far to get it. So this was just constant rework, constant – it just didn’t feel good.

And then eventually, I had abandoned it. Then I finally get back to it. So the to-do list just wasn’t working for me.

And what I found was and I forget where I got this and I apologize to anyone who told me where the book that I got it out of. I forgot. But calendaring your to-do list, and that does two things. So if someone says, “Can you get this done?” or you realized there’s something you have to get done, go to your calendar and put it right in the hour and the minute you’re going to do it.

So now, you have an alarm that says, “Hey, you said Tuesday at 10:00 o’clock, you’re going to update the podcast.” And then how long is that going to take? Oh, I left myself 45 minutes for that because that’s how long it’s going to take.

So you got to both plan, when are you going to do this thing and how long is it going to take you. And I don’t know about you but that has altered my life.

Tracy: I really like this idea. I have not done that myself but you have piqued my interest because what I find is, my to-do list is always much longer than what I have time to do. And maybe if I calendar time for these to-do items, I would actually be more realistic about what I can accomplish in a day and feel better about actually finishing what I was supposed to do for that day.

Elisabeth: Yeah.

Tracy: So, thank you for that. I would also chime in and say that this is a great way – I think one of the biggest excuses we hear in process improvement is, “I don’t have time for process improvement.” Well, have you ever actually put it on your calendar to actually schedule time for process improvement, scheduling time to do a process walk, scheduling time to walk the process or interview a customer, or what have you?

So, I agree. I think so far if it’s not on my to-do list, if an item doesn’t make the to-do list, it doesn’t get done. So, do we actually have process improvement on our to-do list? And even better, do we actually have that on our calendar?

There are a lot of activities with lean culture that we are helping leaders develop as behaviors like huddle meetings or updating their visual management boards. And if it’s not on their calendar, they don’t have time.

So, I love this sort of reinvigoration, Elisabeth, as something that we already have that is probably underutilized.

Elisabeth: I’m with you, Tracy. It’s not just a calendar.

Tracy: It’s a way of life.

Elisabeth: Right. OK. Coming up next is our Bulletin Board

Bulletin Board

Elisabeth: OK Tracy, tell us all about the El Paso Fire Department.

Tracy: So I always love hearing about process improvement in government and cities is definitely a part of that. And this is a great article about the City of El Paso implementing a Lean Six Sigma program and saving taxpayers $252,000 for just looking at the fire department programs which I think is pretty exciting.

And this is a great article about the City of El Paso implementing a Lean Six Sigma program and saving taxpayers $252,000 for just looking at the fire department programs which I think is pretty exciting.

And they looked at something – they looked at their equipment inventory management, their communications and recruitment training time. They also looked at firefighter’s job injuries and lost work days and how to reduce those.

And so to me, these are very compelling projects as well because if we can reduce that stuff, firefighters can spend more time fighting fires and really, these are the only people we want fighting fires, really not in the office. We don’t want people fighting fires. We want firefighters fighting fires.

Elisabeth: That’s funny. It’s always our analog. But these are actual firefighters.

Tracy: These are actual firefighters. And so ultimately, their whole program is saving $1.6 million and 41,000 hours which I think is a definite tribute to people figuring out how to make this work in government, which I love.

Elisabeth: Yeah, because that’s directly to the taxpayers, which is great.

Tracy: Yes.

Tracy: So I’m dying to know what is this about a software not being the answer.

Elisabeth: This is fascinating to me because this is from the Chief Information Officer of Shields Health Care. This is an MRI and ambulatory health chain and this is based in my backyard. This is up in Boston. And they are trying to relieve their revenue cycle issues.

So their biggest issues are patient collections. They are not getting the money in that they need. And the root causes they came up with were silos. You and I see that every single organization we work with, so this separation of these departments. And then he said the data was different depending on who you ask in which department.

And then a reality for all of healthcare, there’s just constant changes in healthcare reimbursements. You got to be ready for that.

And he said like we’ve seen many times, they threw software at it and it didn’t help. It’s so great to hear this from somebody who is the head of IT, right?

Elisabeth: Right.

Tracy: So he said with Six Sigma, they got them structured problem-solving and that’s kind of the more what you expect. But he said the biggest deal was that they worked across silos. They improved their communication and they actually formed teams that combined people from customer service, people from revenue cycle, people from reimbursement, and people from IT.

So it basically gave them a method to handle conflict, a method to test solutions and it drove everything based on data. Back to our favorites, it’s not assumptions. It’s what does the data say? And those were huge.

So just – I know we – it’s preaching to the choir or me telling you, but the hard stuff, the hard skills kind of how do you make a Pareto chart, how do collect data, that is not hard to teach and it’s not hard to do. It’s work but you can do it. But the hard stuff is the people side and generally, a result of this separation. People are in these silos. They are not talking to each other. And it hurts the process.

Well, the offshoot of these guys was they improved patient collections by 622%.

Elisabeth: What?

Tracy: Which is crazy, and a lot of it was just upfront collection, right? They just put in a new step upfront as opposed to waiting for billing and adding all those steps. And they saved $6 million. So healthcare again, that money now, it’s available for actual healthcare, the money that’s going into the MRIs and the ambulatory are, not chasing around trying to find the money.

Elisabeth: I just have a quick story on this. I was at a client and this person came up to me and he was a student of mine, a Green Belt student, and he goes, “I remember something you told me two years ago.” I go, “What?” And he goes, “Well, I said that we needed to automate this to make it better. And you said, ‘Well, automation isn’t always the answer.’ And I remember thinking what the heck is she talking about? Of course, that’s the answer. I have no idea what she’s talking about.” And he said to me, “I know what you’re talking about now.”

Tracy: Now, I know.

Elisabeth: So I think he got the idea that IT doesn’t solve everything. Software doesn’t solve everything. You got to still look at the process.

Tracy: Absolutely.

Tools of the Trade: Ask More by Frank Sesno

Tracy: So Elisabeth, what I’m dying to know as well is what do Diana Oreck, Colin Powell, and Anderson Cooper have in common?

Elisabeth: I’m so glad you want to know that, Tracy. This is a fabulous book. I know you know I love it but I just read this. It’s fairly recently out. It’s called Ask More and it’s by Frank Sesno. He’s a CNN reporter.

And these three people are three of the people he interviewed about inquiry. So the whole book is about asking questions, the art of inquiry. It’s put out by American Management Association. And I thought, OK, he’s a journalist. What does this have to do with me? And someone recommended it to me knowing my field so I thought, “OK, I’ll buy it. Let me see what this has to do with me.”

And one of my favorite quotes in the book is from Diana Oreck who I just mentioned of the Vacuum Family Dynasty. And she said, “We have a ratio of 2 ears and 1 mouth.” Do you love that?

Tracy: Yes.

Elisabeth: And that’s what inquiry revolves around, it’s listening. This is about listening. And each chapter covers a different type of inquiry. So he has got reporter questions, if you’re trying to get someone to acknowledge wrongdoing. One of the kinds of questions that help you, how do proceed. So there are diagnostic questions. If you’re trying to understand problems, that’s the kind of stuff we deal with.

Tactical questions for military leaders. There’s Colin Powell. There are great questions to get at missions. Missions matter a lot to us and to Lean Six Sigma efforts.

Creativity, again, matters to us when you get to the improve phase. We always say creativity before cash. Well, what are some good questions to get out that creativity?

And problem-solving. So there’s a ton in here for Lean Six Sigma, process improvement practitioners.

There are also questions that this is more sort of personal in nature but this is great and it really got me thinking. Questions for ageing parents. And these are questions to try to understand what kind of wisdom would they like to impart to us. And these are the questions that you think, “Somebody I’ll ask my parents about this. Someday I’ll do this.” And then they’re gone. So this made a huge impact and it made me start thinking, what are some of the questions that I’d like to ask?

And I think where I left with this and what was such high impact is it’s kind of a book about how to be a good human being. It’s about having empathy. And that is the greatest way to work with others within an organization. It’s the key to running good projects. You have to listen to the experience of other people.

What are they experiencing with the process? What do delays do to them? What do they see as the issues? And really listening will help you solve process problems. It also in the bargain, you get an ally. You get someone who owns the process just as much as you do. And that’s huge. I know you know that. But that’s huge.

Tracy: Yes. I really enjoyed this book. This was one of those books that struck me pretty hard. And what I mean by that is I had a lot of ahas out of it. And I think that one of the interesting things is if we think about DMAIC, the process, the methodology of Six Sigma, I mean we tell people to ask the 5 Whys, but really what this book made me realized is there are so many more opportunities to ask really good questions when you’re doing a process walk, when you’re trying to build profound knowledge of the current state. There are so many good questions you could be asking there.

It naturally creates – process walks naturally create an environment where you become empathetic if you see what people are going through. But when you’re asking empathetic questions like Frank mentions and recommends, I think that can add so much more to what you walk away with in terms of building profound knowledge. It’s not just knowing the process, it’s knowing what people go through. It’s seeing and feeling the pain people have with the current process setup. So I really thought this made me really reflect on how do we insert more opportunity for people to ask good questions about process?

…process walks naturally create an environment where you become empathetic if you see what people are going through.

This also struck me personally because the legacy questions as you mentioned, Elisabeth, when you have aging parents or even friends that are leaving this world sooner than they should. It really makes you think about questions that you could ask to really connect. My mother passed away at a very young age and I was reading that and I didn’t get to ask her some of those questions. And it made me sad and I don’t want to make the same mistake with other people. So it hit me in that respect too and I really appreciated the book in that way.

I think your comment about being a good human being, he mentions something in the book called perspective taking. Questions help you take someone else’s perspective. And if that’s not human, I don’t know what is. I mean humanizing and creating this experience where you’re taking different people’s perspectives and seeing what people are going through I think is the greatest gift on the planet. And I just really appreciated this book and I’m so glad we read it.

Elisabeth: Me too, Tracy. Ask More by Frank Sesno.

Special Request

Elisabeth: So up next, Tracy, there is the Special Request, what is the Q&A that we had coming in from a subscriber this month?

Tracy: So, this is probably related to the webinar you just completed on fishbone diagrams, Elisabeth. But this one is about fishbone diagrams. And the question is, can you use the fishbone diagram in other places besides in the analyze phase?

So I love this question because I would say absolutely yes, you can use the fishbone diagram. These are all tools and if you can find a place to use them in a productive way, use them. We teach DMAIC linearly but it doesn’t necessarily mean that tools have to be used in just that spot. And so, I have used the fishbone diagram in particular in the define phase quite a bit. And a lot of times, sometimes people just have no idea where to look for a problem. They don’t even know what process that they’re looking at.

Sometimes we start with a fishbone diagram. We start with a problem in the stinky fish head and then we just brainstorm possible root causes to why that problem is occurring. And sometimes from that work on that fishbone, we can identify a cluster of root causes that are living in a specific process, and that helps a lot in terms of reducing the scope for a project team.

So I have used that actually a number of times in the define phase. So I hope that helps.

Elisabeth: That’s a great one. Thank you, Tracy. I actually have seen it used two other places. One is to brainstorm before the measure phase so you can figure out if those are the suspected root causes then those will be the things that you measure, right?

Tracy: Yup.

Elisabeth: And the other one is future focused. Like if this is the change in the head of the fish, what are the categories of things that would change? So looking at it in terms of if we make this happen then what would happen? So those are two other aspects.

Last up, Tracy, is Today’s Special. And tell me, who did you talk to about wondering around Seattle Children’s Hospital and what was that about?

Tracy: So Today’s Special is with Jay McNally from Seattle Children’s Hospital. And he is going to talk about his experiences working for Seattle Children’s Hospital as well as one of the things that he is primarily responsible for and that is lean tours in Seattle Children’s Hospital, which are world-renown. And he is going to talk about kind of what you will experience going through a lean tour, some of the people that come, and some of the things that you would see and how this really affecting the culture. So I’m really looking forward to talking with him today.

Elisabeth: I’m looking forward to hearing about it. Thanks, Tracy.

Tracy: Thanks.

Today’s Special: Interview with Jay McNally of Seattle Children’s Hospital

Tracy: Hey, Jay. Welcome to the Café. How are you today?

Jay: I’m doing great, Tracy. How are you?

Tracy: I’m great. Did you want a cup of coffee?

Jay: No, I’m good actually. I roasted up something this weekend, brewed it up this morning. I am – I have something delicious. Thank you.

Tracy: Really? So you roast your own coffee?

Jay: I started this a few years ago. I started roasting coffee in a popcorn popper and discovered that you could get amazing flavors that you would never taste if you bought off – compared to the coffee that you buy at the store. And so, it’s something I’ve been practicing for a few years now and I am fairly obsessed with it.

Tracy: Really? That’s very interesting. You are a coffee I guess connoisseur then.

Jay: I don’t think connoisseur is the right word but I’m certainly obsessive or fanatical. I think connoisseur means you actually know something about it. I am just obsessive.

Tracy: Well, thanks for joining us today in the Café, Jay. I’m really excited to talk to you. Jay is from Seattle Children’s Hospital and he is the Program Manager for Outreach and Education for Continuous Improvement and Innovation. So tell us a little bit about what you do at Seattle Children’s Hospital, Jay?

Jay: Thank you. That is my title. It’s long and it’s wordy and it’s actually a little bit hard to describe. I see my job as being the interface between lean here at Seattle Children’s Hospital and lean everywhere else in the world.

So my goal is to help bring best practice from other folks, bring it into our hospitals that we can implement that best practice or apply that best practice here and improve or accelerate our own lean journey.

On the kind of converse side, my other job is to help other people from around the world who want to learn from our own experiences and our own learning. So I work with people who want to come and see and sometimes do and share our experience so that they can go back and take our – learn from our mistakes and learn from our successes, I guess that’s the way to put it, and go back and apply lean in their own businesses.

Tracy: Very nice.

Jay: That means there are a couple of aspects to that. So I will say one more thing. It means I manage tours since I was kind of mentioning there. I also manage our own internal education program for all of our staff here who go through classes and learn about lean basics here at Children’s.

Tracy: Wow! So tell me a little bit about the journey of lean at Seattle Children’s. What has – I know they’ve been on the journey for a long time but I’m sure our listeners would love to hear a little bit about what’s going on over there.

Jay: It has been kind of a crazy journey. I was actually just talking with one of our Senior Vice Presidents about this a couple of days ago in that it’s really – it’s interesting to go back and describe it as a journey with discreet phases or very specific phases or eras. But really, in the process of that journey, it just felt fluid and it has not been quite as clear where we’ve been in this these phase. But I’ll describe it really quickly.

Tracy: OK.

Jay: So, we were one of the first Lean organizations really in the world to start practicing lean or really at the time experimenting with lean. That was back in 1999. And like I said, we were one of the first. It was really a proof of concept at that point. We were looking to see whether it was possible, how it would work, and what results we would get.

We dabbled for the first few years primarily in areas that were away from medical, medical systems really. We worked in the warehouse. We worked in supply chain. We worked in those places that it seemed logical.

Once we had that proof of concept then we moved into the areas that were closer to the clinical world but not quite there yet. So we worked with the lab and the pharmacy and things like that. They’re very production in nature and very manufacturing in nature and they started to make life better and show improvement for the people who are actually delivering clinical care. So that was where we started to hook people. We started to bring people in to the work.

Over the next few years then we started getting closer to clinical care. I’ll gloss over some of those details there. And eventually, in 2007, 2008 or so, this is where we really started to invest in a big way. This is where we started to use lean to design buildings. This is where we started to think about our organizational value streams, really big processes as opposed to little point improvements. And that’s where we started to experiment with clinical standard work.

So whereas I said, initially we stayed away from clinical practice, it was around 2009 or 2010 where we started to get all into the clinical standard work to define standard care pathways that physicians and staff could follow to get the best results at the lowest price.

Tracy: OK. Very interesting. Would you say – so you said that you guys got started in about 1999. So are you saying that you were one of the first in the world for healthcare in particular?

Jay: There’s an ongoing fun debate about who is actually first. I will say we were among the first.

Tracy: Who were some of the others?

Jay: Virginia Mason is the other notable people who they were starting almost exactly the same time. Then there are a couple of others around the country who are right in that same late ‘90s, right around 2000.

Tracy: OK. Wonderful. So Seattle Children’s has been on the lean journey for a long time. And I bet some of those challenges or some of those phases were pretty challenging at times.

Jay: Yeah. There have been a few very challenging phases. I mean in hindsight, it has all been challenging. I guess that’s kind of the nature of the journey. But there were some critical pieces there where we tried to fold it more closely into the clinical work. That was a challenge as we needed to think about things differently and do things differently.

Around 2000 where we started to think more about management systems and apply management systems, that was a big shift in our thinking about what this actually means. And so, that was a challenging piece.

A few years ago, we had some safety issues, and that was a challenging piece not just because we – because it kind of shook our confidence but because we knew we wanted to maintain our lean methods but we also needed to integrate these new thinking into it. So there were a couple really critical pieces there that were challenging.

I should also say that there were a couple of CEO changes along the way which you always wonder a little bit whether the CEO is going to toss out the door and say they are moving on to something different or they are just going to adjust it or they’re going to just embrace it as is. And so, we’ve been lucky but those have been some challenging moments.

Tracy: Right. Yes, absolutely. I could see that. And what was the reason why Seattle Children’s Hospital wanted to do their lean journey so early? So I think being a trailblazer in lean is a very – what is it the drove that? Is there – do they just want to be the best in the world? Did something happen? Do you have any insight into the start of the journey initially?

Jay: Some of it was lucky happenstance that someone brought lean to us, lean as an option to us. But the problems that were facing us, I think that’s more of an interesting story. So we had bad access. We couldn’t get patients – the patients that wanted to come see us, they couldn’t come in quickly. We had challenges.

We knew we were a great place to get care and our community knew that we were a great place to get care but if a doctor wanted to get his or her patient into us, sometimes the wait was multiple weeks to get a first appointment. So we had a challenge there and even getting patients in the door. We knew that we were a good first with safety but had way more that we could do better with.

Tracy: Yeah.

Jay: We had some challenges with staff engagement at the time. And our cost was not great and we knew even back in 1999 or so, we knew that healthcare reform was coming eventually. So there was that – if you think about those things, they fill out that quality cost, delivery, safety, morale, sort of pillar there. And as we started thinking about those challenges and we benchmarked to Toyota, we saw that they were really good in those same pillars. And it was kind of just a hypothesis.

If Toyota can accomplish great quality, great cost, great delivery, great safety, great morale and those are the challenges that we were facing, maybe we can apply the same methodology and same tools and get similar results.

Tracy: Wonderful. OK. That’s great. So my question is, the tours, I’m sure there’s a lot of interest in what these tours are about at Seattle Children’s Hospital, what someone might see during the tour and kind of about the program in itself. Could you tell us a little bit about that?

Jay: Yeah. That is the bulk of my work and honestly, it’s the most fun piece of my work. We host somewhere between – well, roughly one tour a week here at Children’s, a little bit lessen up but roughly one tour a week. And the nature of a tour is we wanted to be a great learning experience. We wanted to be a great learning experience for the people who are coming to visit us. We also wanted to be a great learning experience for the people here at Children’s who are hosting or who are presenting.

It’s a fun way for us to kind of be pseudo-consultants. We’re not going to go back to your hospital and tell you how to do the work but we can share our story and kind of teach along the way.

The tour itself, I’ll describe a generic, basic agenda for our tour.

Tracy: OK.

Jay: We start of in a conference room, the boring part of the – the boring which is my presenter – one of my hosts yesterday said, “This is the least value-added piece of your tour.”

Tracy: Nice. It’s always nice to get that feedback, right?

Jay: Yeah, yeah. Totally. And especially at the first part of the morning. But yes, we start in the conference room because we think it’s important for people to understand the context about our organization.

So we sit in the conference room and this is usually led by one of our Senior Leaders, Senior or Executive Leaders. And we talk about that 17-year journey, the things we’ve done and the things we’ve learned along the way. And we end up with – by talking about some of the specific tactics and the purchase that we have right now.

And we think it’s important for people to understand that, to hear that because for the rest of day or the rest of the morning, we’re going to walk you around seeing those things in place. And if you don’t have that context, it all just seems boring and picked up as the narrative. It doesn’t really make sense.

Tracy: Right.

Jay: So, we spend about an hour giving good context and good history and some good conversation about our challenges and the organizations who are visiting us, their challenges.

From there, we go out and we spend most of the rest of the tour going and seeing. And we craft the agenda based on the learning objectives for the visiting organization. So I’ll use yesterday again as an example. They really wanted to learn about management systems, daily management systems.

So I picked a bunch of presenters or a bunch of hosts, a bunch of Children’s desk who are doing interesting stuff and have good learning regarding management systems. And some of them are further ahead in their systems or elegance and well-functioning and some of them are in the middle of a transition right now.

And while the system doesn’t – quite as glossy and finished, the learnings that they are experiencing right now are really quite profound. And so, it was an interesting comparison I’ll say to the finished system compared to the people who are really in the midst of learning. And depending on what type visitor you are, either one of those can work. But in conjunction, they both work really, really well. You see the finished product but you also get to experience the messiness of it.

Tracy: Right, the construction and the creativity of what’s going to work better. We see that a lot in some of the places I go is the deconstruction of visual management system or a visual board or a daily management system and how is this going to work better and the ideas people have and the engagement. So that’s really exciting that you share both.

Jay: Yeah. I think if we went and showed glossy or glossy fanciness, it would not be believable. And quite honestly, it wouldn’t benefit us because we don’t get to reflect on the challenges and struggles along the way.

Tracy: How long is the tour? Is it a whole day? Is it half a day?

Jay: We have two different options based on what our clients, our visitors need and want. But we do either. We can do either a half day tour, roughly 4 hours or we can do a full day which will usually, I’m going to say usually running from about 8 in the morning until 4:00 PM.

Tracy: OK, good. And what kinds of people come to the tours? What kinds of groups of people, if you don’t mind sharing, are coming lately? Is it from healthcare? Would you say that there are a lot of people from different kinds of industries and companies coming to see? I’m interested to know.

Jay: It’s a fascinating mix. And it really is – I just have to say that it’s a fascinating mix. I’m always intrigued of what next call or what next email I’m going to get from somebody saying they want to come visit. So the majority of it is healthcare and I think that’s just because we are most known in the healthcare world and because people are looking for other healthcare peers or other healthcare examples.

But we’ve done a lot with government. We’ve done a lot with organizations who are involved in supply chains or logistics. We’ve done – those are the basic ones. Finance, we’ve done a fair number of things with finance. Those are probably the higher- the most frequent visitors.

Tracy: OK. Wonderful. And would you say that they come from the United States or are they global? What is the mix there?

Jay: It’s all over the place. This is again one of the fun pieces. And actually, also one of the challenges. But in the next month, I have people coming from the Netherlands. I have people coming from Switzerland. I have people coming from Austria, not Australia, Austria as well as all over the United States. We have people coming from Southern California. We have people coming from – just yesterday, I had a group from Sacramento. So they really come from all over the place.

And again, there’s a benefit for us in that we learn just the way they think about healthcare in different regions or different parts of the world is very different than what we think about here. So some of the things that we think are really innovative, my groups from Switzerland a few months ago, they looked at me and said, “Well, everybody in Switzerland does that.”

Tracy: Oh!

Jay: And it was kind of – it was humbling.

Tracy: Yeah.

Jay: So if we think about our organization or if aspire to our organization as being kind of cross-pollinator. I hope that we learn from something that – from a group that comes from Switzerland for example. I hope we learn from that and start applying it and start doing it.

And then a couple of months down the line, a group from, I’ll just go back to this group from Sacramento, they come and visit us and they take it back to their organization. So I hope that we’re kind a hub of knowledge and improvement and innovation.

Tracy: Wonderful. And my question is too, you had said that you were also bringing new ideas potentially to your organization as part of your job, do you get to see other tourist in other organizations as well and sort of report back or is it more that you gain the knowledge from the people that are visiting?

Jay: It’s both. I do get to lead our program, our study trip program to go visit other organizations. And the other aspect that you just mentioned but we try to do our best to capture the learnings from the organizations for you.

Tracy: OK. Wonderful. So a question I have is and I think this would be an interesting question that maybe our learners would like to know too. Why is it important for organizations to have lean tours? What do you think that does for Seattle Children’s Hospital or any other organization that might be considering doing or providing a tour?

Jay: I have a hypothesis. My hypothesis about these tours is to be fooled. The first piece is that it’s not so much a hypothesis as a statement. I believe that anything – we have an obligation to teach. And so, if we have learned something that other people can take back to their organization and improve the lives of their patients or the lives of their staff or the health of their business, I think we just have an obligation to do that.

But kind of answering your question more directly, I think – I know that we learn by teaching. I know that every tough question we get is going to cause my hosts and my presenters and me to reflect and challenge ourselves and figure out the right way to either answer that question or to do our work differently. It’s wonderful to get outside eyes, fresh eyes, people who are not accustomed to our way of talking and our way of thinking and for that matter, our preconceived notions about the best way to do things.

So I know that we learn by teaching and that’s a pretty cool piece. I’ll actually add yesterday – no, a couple of weeks ago, we had a manager who has been in her position. She is brand new to the organization. She has been in her position two weeks and she led a tour. And that was kind of crazy. I mean it really is crazy. She doesn’t have historical perspective. She doesn’t have the nitty-gritty details.

But she knows enough to talk about what she knows now. And she knows that by jumping in and getting the questions and sharing what she knows, her learning journey is going to just – it’s just going to be crazy exponential. And so, she actually volunteered to start hosting tours as quickly as possible because she knew she could learn by teaching.

The third reason why we do these is that we think it’s actually a really, really cool way to show respect for our staff. Our staff talks to these visitors or sees these visitors and they hear their German accents or they know they’re coming from someplace else.

And the fact that our staff knows that their work is impacting healthcare or impacting business worldwide, that’s really, really cool. I think they really value the fact that they’re able to bring value to people around the world as they either try to learn more about lean or as they actually just try to go improve their own business results.

Tracy: That’s wonderful. And I hope that encourages others to share some lean tours. I always love to hear about lean tours that are available in different places. And the ones that I’ve gone on, I absolutely always learn something and it’s really nice and inspiring as well to see what people are doing with lean and process improvement, how it’s making their processes and their products and their services better.

So I have maybe a final question for you, Jay. It’s a two-part question. One is anything else you’d like to share about the tours. And the other one is if someone wanted to sign up for a tour, how would they do that?

Jay: Two-part question. I can answer both of those parts. The first part is a little bit tricky actually so I think I’ll just add that we are as always, we’re rethinking about how we want to do tours and what we want to share during our tours. So, we’re trying to be more intentional, I’m going to use the word intentional, during our initial meetings, initial conversations with clients to figure out the best things to go and see and the best things to do.

In a couple of weeks, we are hosting our first Kaizen workshop. So we’re bringing in a group from Europe and they’re going to come and they’re going to spend a day improving processes with us.

Tracy: Wonderful.

Jay: We’re really just going to get in and get dirty and start improving process so that they can learn same things that we have learned about how to do that, how to identify ways, how to work with a team, how to affect change management. We’re creating kind of an artificial situation to learn a lot of things really quickly. But really, it’s real process. It’s a real process out in a warehouse.

So we’re offering new products, new services in pursuit of meeting different learning objectives for other people. We’re also getting really into the nitty-gritty about healthcare processes in the future so we are actually going to start hosting workshops about how create clinical standard work.

Tracy: OK.

Jay: So things like that. So we’re always in the mood for something new, something different and we love to talk with our clients about what that might be.

And then how to contact me, we are just right in this very second actually, adjusting our website and so it’s a little bit funky. It’s a little bit hard to find me. The easiest thing to do right now is to email me directly. My email address is [e-mail].

Tracy: OK. And they can also find you on LinkedIn as well?

Jay: Sure.

Tracy: But you prefer an email. Is that right?

Jay: Email is best.

Tracy: OK. Wonderful.

Jay: And Tracy, I’ll get you that information and you can share it on your website as well.

Tracy: That would be great. Thank you so much today for joining me in the Café today, Jay. I really appreciate it. I think our listeners are really going to enjoy hearing what Seattle Children’s Hospital is doing and the opportunity to potentially see a tour. So thank you.

And for our listeners, I hope you enjoyed this episode and found it valuable. We’d love your feedback on it. Please leave us a review on iTunes or on our website and don’t forget to subscribe and don’t forget to give us some feedback because we’d love to hear it.

And so for now, we’re going to say goodbye. Goodbye, Jay.

Jay: Goodbye. Thank you. This was a good opportunity to talk more about what we do.

Tracy: Yes. I’m really excited. So thank you so much. Bye-bye.

Jay: Very good. Bye-bye.

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