Better Never Stops VMI Podcast Cover featuring Guest Speakers | Virginia Mason Institute

Podcast | Scaling and Spreading a Management System with Chris Stewart and Jackie Hartke

Virginia Mason Institute

In our first episode of Better Never Stops, Chris Backous, Executive Partner of Transformation Services, interviews two of Virginia Mason Franciscan Health’s improvement experts, Chris Stewart and Jackie Hartke, as they discuss the challenges, successes, and approaches that they’ve taken while fostering the spread of our management method across a newly expanded health system.

Chris Stewart has over two decades of experience with Virginia Mason and has spent the last 6 years as a Virginia Mason Production System Specialist at Virginia Mason Medical Center. Chris works in the Kaizen Promotion Office (Virginia Mason’s team responsible for accelerating the application and impact of the Virginia Mason Production System throughout our organization) and oversees various quality process improvement initiatives occurring throughout the Virginia Mason Franciscan Health system.

Jackie Hartke is also a Virginia Mason Production System Specialist at Virginia Mason Medical Center and brings over 14 years of experience from her previous roles as a Kaizen Specialist and Supply Chain Director at Marshall Medical Center in Northern California where she helped to launch Marshall Medical’s Kaizen Promotion Office. 

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Episode Transcript

00:08 intro

Thank you for joining us for Better Never Stops our podcast for healthcare leaders and everyone everywhere committed to transforming healthcare. In this podcast series, we’ll be interviewing leaders from our partners around the world, as well as leaders right here in Seattle, Washington, where they work daily to create and maintain a culture of learning and improvement at the Virginia Mason Franciscan Health system. Today we’ll explore a philosophy of “go see ask why show respect” as we cover observations from the front lines across our organization. We’ll talk about decisions made and outcomes we’re seeing as we explore the leader’s role in this work and in maintaining a culture of learning and respect. My name is Chris Backus and I work to transform health care across the globe as an executive partner for the Virginia Mason Institute™, which is part of the Virginia Mason Franciscan health system. We are a regional health system formed by the merger between Virginia Mason Medical Center and CHI Franciscan Health here in the Pacific Northwest, the Virginia Mason Production System, or VMPS, as we call it, is fast on its way to becoming the management system for all parts of our organization. Today, you will meet two VMPS specialists who are hard at work engaging leaders from our 300 care sites, including Virginia Mason Medical Center in Seattle and St. Michael Medical Center across the Puget Sound in Silverdale. Washington will discuss how they’re helping leaders learn and use VMPS to know run and improve their part of the business every day. Chris Stewart has over two decades of experience with Virginia Mason and I spent the last six years as a VMPS specialist. Chris works in the Kaizen promotion office or KPO, as part of the team responsible for accelerating the application and impact of VMPS everywhere. Although she’s based in Seattle, Chris oversees various quality improvement initiatives occurring throughout the Virginia Mason Franciscan health system. Jackie Hartke is also a VMPS specialist and brings over 14 years of experience from her previous roles as a Kaizen specialist and supply chain director at Marshall Medical Center in Northern California. Well that Marshall – Jackie worked with the Virginia Mason Institute to launch Marshall’s Kaizen promotion office and approach to transforming healthcare.

Chris and Jackie, welcome to our podcast. This is so excited to exciting to have you here. How are you feeling about joining us on a podcast talking about transforming healthcare?


Well, I think we talked about transforming healthcare all day, right? That’s what we do for a living. So I think I can probably speak for Jackie, that we probably feel pretty comfortable having this conversation.


Yeah, it’s pretty exciting – just to be a part of it and be able to share some of the learnings and journeys that we’ve had over our experience with Kaizen.


You know, it’s funny, because – when you think of the term ‘transforming healthcare’, it just feels big, doesn’t it? And, and yet, really, our work is about going out to Gemba. You know, seeing with our own eyes, engaging people where they work, seeing the work they actually do. How do you help people who are new to the experience, realize that this big methodology has very powerful and simple meaning for them in just the small scope of their work?


So I think it really starts with the people, right? It can seem so daunting, this huge task of where does transformation start? And there’s just so much that’s embedded within that. But as we’ve started going out to newer gammas, and newer areas, we’re seeing that the work really starts with the team. And it’s sometimes it’s just getting back to those basic fundamentals of spending time with the team, hearing what their pain points are, and also hearing what their solutions are; because they’re often the ones that are going to drive this work forward.


Yeah, I think that’s absolutely right, Chris and Jackie – It’s just getting out there and watching what they’re doing. Right? That’s where you start is those observations, which can seem a little bit overwhelming for some teams. But really, it’s how you approach it, just here to watch what you’re doing. Just do what you would normally would do. And then just listening, right? To the things that are coming out of their mouths. What are the things that they’re really struggling with?


You know, I remember, in the early days of starting VMPS; even before the Virginia Mason Production System was the name. I mean for six months prior to the executive trip to Japan in 2002, we didn’t have a name, you know. We kind of called it Lean, but we stopped calling it Lean because it had such a negative connotation. But I remember, people being really excited to start using the tools and the method. And then they do their first waist walk. And you know, as a frontline supervisor and manager, they’d see that poster with just flooded with post-it notes. And you just almost had to put your hand on the back. And it’s okay, we need to see that it’s not your fault. Have you had those experiences as well?


I think we had that experience at St. Michael’s, my goodness, when we recently did some work there. Just after two days of observations, we had so much data, we had so many things in places that we could start, it was a little overwhelming, and then we had to meet with leadership and orient them to that. So we had that experience of having to pull them in and say, Hey, we know it’s overwhelming, but we’re here to help. And here’s what we think we can start.


And that experience at St. Michael’s because that’s a newer organization embracing the Virginia Mason production system. So they’re kind of new. So it’s almost like my experience back in 2002, just starting off, because they honestly are just encountering the meaningfulness and the method the first time, right, yeah.


I think we learned a big lesson at St. Michael’s working with that team in that you don’t have to speak the language of VMPs in order to do process improvement. Right? We didn’t go in there with a lot of big words. We didn’t even say PDSA, right? We just said, Hey, do you want to try this for an hour? And we didn’t use experience-based design? We just said, How are you feeling about this process? So we just simplified it. And the method of VMP is, it’s intuitive. It actually is simple. And it’s intuitive. And so big graphs right on to that?


Well, Jackie, you’ve had the experience well of coming in with brand new experience on the method because you came to Virginia Mason from one of our clients through the Virginia Mason institute that we had been working with. And so what was it like to almost instead of going backward in time, like Chris and I have been talking about what’s it like to go forwards in time and see where the culture is years after where you are starting with your old organization?


Yeah, it’s been kind of a journey. And it’s been really exciting, because, you know, I started with a place of no VMPS training, no real formal training, no method to help him develop that method. And then actually, I’ve lived it back out to be a supply chain director. And actually practically using the method, which was really impactful to see that, yes, these tools and these methods do work and can make some great improvement. And then with the opportunity to even advance those skills even more. It’s really exciting. And then as we’re branching out to newer gamblers to newer hospitals, that maybe aren’t so solid in their foundation, it’s it with, with these improvement tools, it’s amazing to see, just, it kind of takes me back to that beginning place of you may not know, or you may not understand what’s happening, you might not understand the tools like Chris was saying you might not understand the nomenclature. But it’s just a method and a way of doing things. So I think it’s really assessing the culture, right, and the culture is so important. And seeing St. Michael’s and seeing just how culturally they were so ready for this improvement, and then just hungry for something and being able to see that grow. It’s just it’s really exciting.


So I remember my very first RPIW, rapid process improvement workshop, five days of focusing on test results reporting for internal medicine. So we worked between the general internal medicine clinic and the lab and one of our sponsors was the at that, at that time, the Medical Director of the clinical lab, and I remember her comments at the end of report-out on Friday after we shared all of our work and she said, You know, I want to invoke the powerful words of Yoda from Star Wars because she was a sci-fi nerd like me. And she said, you know, Yoda said Do or do not there’s there is no try. And, and her point was, you know, just go do it. You know, give it a try. Play with the tools, learn as you do. Do you find that people are comfortable just taking the tools and learning as they use them? Or do you feel like people still kind of hold back and really want to be perfect before they go out there?


I think it’s kind of dependent on the person, right? I mean, some people are just willing to just dive in where others, you know, we’re used to perfection. And in health care, we want to be perfect. We don’t want any defects. However, it’s a, as I think they say at the institute elite journey is a learning journey. And so we’re always learning. And so really, there is never a perfection state to get to right. And I think that’s been a chat and then in the very beginning, for me was quite a challenge, because I’m trying to battle and remember that, you know, quick and crude is best, just try it. Just think with your hands. It’s okay, just to get out there. And as we’re going to these newer Gemba’s, it’s exciting to see that, you know, they don’t know anything, or they have a very minimal background. So we’re able to kind of take some of those things and just say, let’s just try it, we don’t have to use the complex terms we don’t have to use, we don’t have to inundate you with all a bunch of tools. Let’s just try something, let’s take your idea and run with it and see what happens. But I think it’s important to create that safe space where people feel empowered to be able to do that.


You know, I often spend a lot of time with folks, really thinking about future ideas and future opportunities, you know, because we have the rapid process improvement workshops and the Kaizen events to kind of fix things incrementally. But then there’s an opportunity for new and big and exciting and take a giant leap forward. And we call those the three P or Production Preparation Process workshops. And one of the biggest challenges to is to get people from that brainstorming, just thinking about things to what we call try storming is don’t just think about it do something because I think we’re kind of all experienced that value of if you do something you learn so much more quickly, you know, those rapid learning cycles? Chris, I’m wondering, what’s it been like for you? Because you’ve been in KPO for a while and supported many people across the organization? Is there a common hesitancy or barrier that people have to overcome when they first work with the tools and method?


I think for most people there is there’s the rare person, right, that’ll just grasp the tools and just run with them. And that so those are future KPO-er’s? Right. But there’s, for most people, there’s hesitancy because they’re scared to fail, and they’re scared to look silly, right? And so even though we teach fail forward, right, there’s always learning even in a failure. I think a lot of people just have to have a ‘see, feel, change’ experience before they can really be like, Okay, this is it. And you know, that happens at different points in people’s journey. So we try to get them that see-fail change experience as soon as possible because that’s the catalyst usually that really sets them forward with using the tools and methods.


So I guess the question to both of you because, you know, I often think this is the best job ever. And then you have a day where nothing works. It’s like, but then, then you just go to gamba. And you just see something click for someone, and then you remind it again, join the work best job ever. How do you feel about that? You know, what makes you know if it is the best job ever, what brings the joy in this work because you know, our joy is uncovering everyone’s problems and barriers. And, you know, granted, we help them overcome. But it’s like, the first thing we do have to do is hold up the mirror to the current state,


I think what really keeps me going is I can help somebody understand how to remove that non-value added work, that they’re doing the rocks in their shoes, the things that drive them nuts about their day. And love allowed them to be doing value-added work. So at the end of the day, they go home, satisfied with their job. It’s all about that, right? Because that’s what’s going to prevent burnout and health care. That’s what’s going to keep people in this in this culture in this job. And so it doesn’t take a lot to do that it doesn’t take a lot to help them realize what they’re doing that’s not value added. And get them moving on the direction of removing that.


What I love and I think what has drawn me back to KPO, from being in a leadership role was really just I love that inspiration that you can, that you can inspire people to think differently. And it doesn’t take much and sometimes it’s just a small crack. But if that small crack can grow into something bigger, where people are now looking at things from a different perspective. We talk about patient-first and patient really being at the center of everything we do. And it’s so easy in the tasks that we have to do every day to lose sight of that and the world we live in; there are just so many complications. So sometimes bringing it back to those fundamentals and being able to help people and inspire people – people to be thinking just differently about their own work about the impact of their work downstream or upstream. I think it breaks down silos and it just makes it seem like a more cohesive healthcare team. And being Capezio, you can kind of, you can be that person that really helps drive some of those conversations that ask those questions that just get people thinking. And that’s really what inspires me and gets me excited about being in KPO.


You know, I had a really cool moment. Last week, I was helping one of our clients on their referral process and, you know, referrals that don’t move through the process back up, and, you know, the, to the credit of the team, as much as we were documenting their ways, they were constantly coming back to the awareness that patients are waiting, our processes making patients wait, and I wanted to give them the credit for that. But it was also helping them see that it’s, you know, we can think about our patients, and we can think about you, you know, it’s that fear of that what’s in it for me, voice. And sometimes we have to listen to both, you know, I always joke, I said, there’s two really important radio stations, you have to tune into WIIFP, what’s in it for patients, but then you also have to listen to the companion station, which is WIIFM what’s in it for me, because there is an opportunity we can have flow for patients and quality work for each other. And I think that’s an important thing to consider right now, given where people are with burnout. And so what’s been your experience in linking kind of the waste and burden of work, to burnout? And have you seen some of the burnout lift as you’ve helped people move things to a better state,


we often say like, no waste is too small, right? Because it could be just this minor process, this minor thing that drives us crazy, and not even realizing that somebody downstream then has to deal with it, and then somebody downstream from that. And then it compiles and compounds and becomes this bigger system-wide problem. And so I think there’s a component of that, that if you can remove just those small pieces of waste out of processes, just the impact the sheer impact that that has, not just on that singular person, but on a team and sometimes even on a system. So I think that for me is something that is really relevant, but also to as we start doing improvement work, and we’re bringing teams together and we’re problem solving together. There’s an element of engagement that happens. And again, in this world that we live in, that has so many complications, and so many tasks that were driven with, sometimes taking us out of our silos out of our little space that we’re used to being in can really just broaden our perspectives and make us feel more excited and more engaged about work. Yeah.


You know, we’ve we all in just this conversation. So far, we’ve used the term engagement a lot. And I think, I think that can mean many different things to different people. I’m just kind of curious, what is what does engagement look like or sound like or feel like to you when you’re out on the Gemba? With teams? You know, because we always look to? Are they engaging? Are they not engaging? Are they detractors, or are they you know, embracing the change? We’re talking about? What? What’s the engagement look like? For you all? What do you see? What do you hope to see as you get out there?


Yeah, that’s interesting. I don’t actually think it’s as hard as we think it is to just go out to just get out on our Gemba’s our shop floors, and just observe and be curious and ask questions. And really, whenever we can empower and give people permission, to tell the truth. And I think that’s what gains that trust in those conversations. And once they know you’re listening, they’ll continue to tell that truth. And that truth is what’s going to lead to the process improvement because you just gave them a voice. And that’s really all it’s about. It’s just giving somebody who maybe didn’t think they had a voice, a voice.


Well, you know, think about our senseis always say, or senseis would come from Japan, just to keep us honest and growing with our method. And one of the first things I hear them say, on almost every visit is, remember it’s all lies until you see it with your own eyes. Right. So that Jackie, what’s what’s the engagement like for you?


I think as Chris mentioned, it’s simple, right? It doesn’t have to be overcomplicated. But I think when you have a team who is sharing with you their ideas, who is being honest and truthful, who shows up? I mean, we talk about huddles, and the importance of huddles and bringing teams together. But what’s happening at your huddles? Are your team’s leading those, or is somebody else driving those? So I think there’s always an opportunity for more engagement. But I think, to what Chris was saying, we really have to make sure that our teams have that safe space, in order to speak up and feel free to speak up. And that can be a challenge, especially in some cultures, where maybe that’s not as apparent. But I think it’s working with the teams and walking side by side walking in their shoes. That helps create that space. So for instance, when we went to St. Michael’s, which was a brand new Gemba, for us a brand new area who didn’t know us, they don’t know what Kaizen is. They don’t know what KPI is, they don’t know what the VMPS is. But where do we start? And sometimes that starting place is, can you just show me what your day-to-day looks like? Can you just tell me about your job? What excites you here? What frustrates you? And then being able to spend that time and actually take that time, and from the suggestions, they give you or the ideas that they have – giving them that space to let’s work on it now. So and then that’s, I think, where you get the sweet spot of engagement? Well,


And I think what you’re alluding to is, some of the work that we’ve been engaged in for a number of years, and that’s really looking at things from a lens of respect for people. And you would use the walk in their shoes, you know, and so Chris, you were talking about, you know, go go to their work, go see them work. And you know, Jackie, you said to walk in their shoes understand the process, from their perspective. And that’s really that one of those key elements of showing respect, you know, listening to understand speaking up allowing, like, Chris, you were saying allowing others to speak up. So how much do you think the respect for people approach helps us with engagement?


Respect for People principles, as we define them, are common sense, right? These aren’t, these aren’t new, they’re not like some concept that is hard to grasp. It’s their common sense principles. So I think we didn’t really have to even say we’re doing respect for people, you’re just respecting people by engaging with them.


Right? That’s, that’s a really interesting point. Because, you know, you could say the same thing about pretty much everything of VMPS. It’s common sense. But I think it’s when you’re intentional, with a very, you know, I remember talking to someone last week, who was hearing about the tools and methods of VMP’s for the very first time, and they said, Well, that’s what I normally do, I just didn’t have a name for it. So I think sometimes when we take the time to kind of call it out, make it visible. It’s kind of like making the work visible, right? You make the principles visible, you’re intentional, and you’re deliberate and connecting dots to important things, they become more meaningful because it’s just out there until we help people see the value of it. Right?



Well, I think some of that falls into like your own self-reflection, in your intention when you go out to the Gemba is, you know, was I been respectful? And how could I have – what did I do really well? And what have I, what could I have done differently in this case, because although we may come out with the best intention, sometimes we need to do that reflection to say, oh, but maybe I got it wrong this time, or next time, I want to try this. And I think that’s where a lot of growth happens personally and professionally, and also with our teams. And that, you know, sometimes we might go out and we might ask a question that might offend somebody, and we’re like, oh, but we need to really reflect on that and think, did we, you know, how could we have approached that situation differently, and being honest and truthful with our teams, because we don’t want to shut them down, especially if they’re opening up to us and they’re giving us that that safe space? So I think that’s also an element of respect for people that we need to take into account when we’re working with our teams.


Well, you know, when I think about – like you said earlier Jackie, the walk in their shoes and I think sometimes one of the ways that we in the KPO’s, the Kaiser Promotion Office, the process improvement teams to transformation health teams, everyone has their, their term, but basically, we’re the teams who really have ownership of advancing the methodology into the organization. It’s, we’re not necessarily walking in their shoes, we’re walking in our shoes alongside them, to help them get started. Do you find that that’s a more effective approach with folks when they’re first learning the process improvement tools and methods? When they come out of a training, do you really think they – we should expect them to be successful? Because they’ve had the training? Or do you think that’s where the journey begins? I’m a believer that’s when the journey begins. And our work of creating real value with them is where we take off and walk side by side. What do you think?


I think I actually agree with that, Chris. So when they come out of training right there, you have to let them learn, learn on their own. So, you can coach them, right, but they have to learn, they have to fail forward, they have to use the tools, they have to figure out the benefits on their own. I think that elbow-to-elbow comes in later. That’s something that we might do with operational leaders who have already been through our classes. They’ve already had daily management in place, and maybe they need something done, but they just don’t have the brain the capacity, they need somebody there to noodle over it with them. Or they just need somebody to come and just help them set something up. So that’s, that’s my belief. I think people have to have to, they’re just not going to absorb that information. Unless they do it. They have to see it and do it.


You know, I think I think about our we’ve all well, I know Chris, you and I, we kind of worked in KPO, under the guidance of our one of our former chief operating officers, Sarah, and she was really fond of you know, don’t try and do everything, just find that one thing to get started with and that important one thing. Jackie did you find in your previous organization, there was true excitement for the method, but everyone was trying to do all of it, instead of just trying to do one thing. Does that resonate with you at all?


Absolutely. Like this whole conference,


I might know a thing or two about your old organization, you know.


so I remember back early in the day, and I think this is where we talk about success, right? What does success really mean? Yeah, and sometimes, you know, we put our minds so far in the future to this future state of what it could be and what it should be and hold a candle to another organization that it should be. But we’re not celebrating the incremental successes that we’re having. So I can remember, there was a group that came through and actually went with VMI, supports, went through ambulatory flow. And everyone was super excited and loved the tools and was just, I mean, over the moon, about everything, and everyone went back out to their Gembas, went back out into normal life. You know, they had successes. And then we pulled the team back together about three months later, and everyone was so despondent, they were so sad and just defeated. And they’re like, it’s been three months, we’ve done nothing. And so what we did is we took poster sheets, you know, the big sticky poster boards up, posted a wall up and said, Let’s go, you know, cardiology to oncology to all these let’s go group to group. And let’s share what have you done in the last three months, and our whole entire wall was completely full of successes. And everyone was just kind of paused and stunned. Oh, my gosh, we’ve done so much. It’s like, so I think there’s a big piece, as I talked about reflection a little bit earlier, we need to reflect on those successes and recognize those successes and make them visible because otherwise we just pass them by and pretty soon, it’s easy to get into that place of we’ve done nothing when really, we’ve done so much. It’s just It is a journey. And it never truly ends. I mean, even at Virginia Mason. We’re nowhere near perfect, and there’s still a lot of growth to be happening. But if we can celebrate those successes and continue to recognize them, I think it helps drive our work forward.


Yeah, you know, I feel like in our work, as kind of the stewards of adopting the method and moving the method forward, we often have to reframe for folks, it’s like, you know, this is a long game you’re playing, you’re changing. I remember one of our former finance leaders, who has since retired from the organization said, it’s like turning the Queen Mary. And I said, Well, you know, the Queen Mary was anchored as a hotel in Santa Monica. And he said, Oh, I know, try turning that with a pair of flippers. And you know, and sometimes it’s hard to help people see that, you know, not everything is going to be an out-of-the-park hit, but you’re moving forward. And you know, have you ever used the term or the concept of better, is better. And I find that doesn’t really lend well with folks. You know, have you tried messages that haven’t quite landed well with audiences? Oh,


My gosh, I’m trying to think because we recently started teaching the VMFH foundations courses to the entire organization. And I think – they’re very VMPS naive, right? And I think there’s definitely messages that we’ve had to scale back. Once they don’t land well, they don’t necessarily understand why we do some things they don’t understand yet why, why we involve patients in our improvement work, right? Or why we’re so big on equity pauses here and how that really plays into your daily and, and VMPS. So I think we and that’s just knowing your audience and reading people and when we have a message that doesn’t land well, then then we shift courses, we reframe it, we actually teach that in that course, reframing right. Yeah, and I think that’s just part of being a skilled facilitator is, is knowing when your message didn’t land well, and then reframing that so that they can understand what it is that at the core, you’re trying to get out?


How much of this is also a good parallel for what we, you know, how we work with leaders and help leaders see the importance of their role. And, you know, it’s the how do we get that superhero to fold their Cape up? Because we all know, from The Incredibles movie that, you know, Edna said, capes are a bad thing. So how do we get them to fold up their cape and really kind of frame problems instead of solve problems for people? And, you know, how much of is it? Is that reframing work we do with those executives? You know, what, where do you think the, you know, the opportunities are working with new executives. So you know, VMFH, Virginia Mason, Franciscan health is our new organization. We’re only two years old. So the VMPS isn’t everywhere. And that’s, that’s a hard thing to say. But that’s our reality. So what is the opportunity with these new executives to engage them in engaging others?


I think that when it comes to engaging our executives, the opposite the real opportunity is getting them out on the Gemba. Because they’re just not. They’re just not right. And so and if they are, it’s infrequent, a Gemba walk once a quarter probably isn’t going to suffice. And so not only getting them out on the Gemba but getting them out on the gamba in a structured way, like what are you there to see? What are you there to check on? What are you there to ask the team? It’s not getting out there and being like, Hi, how are you? How’s it going? So in a very structured way, engaging, engaging the leaders of that Gemba, and helping them remove barriers. And so I think that’s how we’ve really tapped into our executives when it comes to the VMPS. And I think it was one of the main things that we’re trying to drive home with them is the importance of those Gemba walks and getting on the Gemba.


And one of the things that I’ve seen with working with teams that you know, have minimal experience is to like what Chris is saying is that, you know, we want to support them to do the work that they want to do. And there’s a lot of work that we all know we could be doing. But we’re constantly putting out fires. And we hear that all the time, like I’m putting out fires. And that’s, that’s my day-to-day. And so –


Will I ever find the time to do this work? Right?


Yeah. So the question is why? Why are you always putting out fires, is it because we’re just solving symptoms, we’re so used to solving symptoms, the fires, you know, the fires going, so we put it out, but we never actually remove the kindling or the fuel that is creating that fire. So I think it’s developing that new lens of, maybe we need to get down to the root cause on some of these issues. And really, as a leader, I don’t need to be the one that has the solutions to this. There’s, I don’t have them, I’m not out in the work every single day. So it’s kind of just developing that lens and that new framework of I wonder what my team would think of this. And I think we spend excessive amounts of time trying to noodle over solutions and figure out what is the best path and method and – without actually bringing the true people who do that work into it. And I think that that is where I’ve seen such success with our teams is when they’re just like, well, let me go ask my team. And you know, it’s such a concept, and they probably already know a lot of those root causes. And pretty soon your fires become less and less. And with the work that the executives want to do, or leadership teams want to become easier and less burdensome because it’s not just on the leader to do that work. It’s on the team. Because, right it’s the whole group coming together to solve the work that needs to be done.


I remember, I remember working with a manager whose husband was a firefighter and she said, you know, he’s constantly telling me, why are you fighting so many fires? I don’t fight as many fires as you do, and it’s my job. I spend most of my time on fire prevention, so I don’t have to fight fires. And she said that’s when it clicked when he realized I can use this method as my fire prevention strategy. And maybe that’s where the time comes from, you know, so it was the, you know, it’s you said something that made me think of that, Jackie, you said, you know, it’s just something so simple just clicks for people. What do you think has to click for people when they’re just getting started?


I think it can be different for everyone. But I think there really is, I think Chris mentioned it much earlier, the see field change moment that happens, where you truly just try something. And maybe that something is completely successful and is fantastic. Or maybe not so much. But either way, you’re trying something. And there’s that beauty and trying, and then learning from that, and then applying those learnings to the next thing that you’re going to try. And so coming from an organization where that was, you know, the very starting point, it’s like, how can we just create that, as mentioned earlier, just that little crack, that’s going to spread and create something bigger and grander?


I mean, I totally agree with this the field change experience, and it’s different for everybody, right? But I know sometimes that ‘see, feel, change’ experience is just seeing better experiences for other people. So if you’re an operational leader, and you were able to improve the work life of one of your employees, many of your employees, whatever that is, and that’s what you’re there for. And so often, it’s that, that happens, that really drives people to continue with VMPS, like, oh, this really does work, we I’m going to keep doing this and keep improving their lives. And, and, and the operational leader’s life.



One other thing that I would add to that, too, is connecting it back to the patient because we’re all patients at one point or another. And it’s so easy to lose sight of that. And I think, working amongst many different teams, you can see that, you know, our one connection piece, our underlying purpose and reason why we’re in health care is for our patients, because we might be that patient, or a family member might be that patient, or our child might be that patient. So how do we improve their experience? Not just some unknown person that we’ve got, you know, behind a screen or behind data? Or, like you’re talking about a referral? That’s in a queue somewhere. What if we were that person waiting in that referral queue? What if we were that patient who was waiting to receive care? And I think, bringing it back to just that fundamental concept of we are all patients, we all might be experiencing this at some point or another gets people to think a little bit differently.


So the ‘see, feel, change’ experience, you know, I think we’re all kind of hoping for the positive ‘see, feel, change’ experience. But what happens if the ‘see, feel, change’ experience is like the ‘see, feel, oh-no feel,’ like the not-so-great field change experience? I mean, is that something, you know, that that we can use to help people understand the value of the method as much as the one that wins the effort to try that experience that wins? Because you know, Chris, you talked about fail-forward quickly. We say that all the time. But who wants to be the one who fails? And how do we coach them when they’ve had their failure?


Yeah, I mean, it happens, right?


I mean, we’re human. Yeah,


We’re human. Right? I think you can find a lesson in everything, even that failure. So what is that lesson? What is that learning that you’re going to carry forward? I mean, a PDSA is meant to fail, right? It’s meant to get to the, you know, plan do in the study part. And then oh, that’s not working. Let’s go back to the plan part. So it should just be part of the way that we’re thinking, I think you’re doing it wrong. If you’re having success after success after success. If you’re not seeing any failures, you’re probably not doing it right. And our VMPS minds are probably going to say, you’re probably not doing this right. Let’s look at what’s going on here.


Well, I think sometimes we’re programmed to think like, oh, it’s a failure, just brushed it under the rug, because, you know, sweep it away. Just don’t ever think about it again. But sometimes if we just pause for a moment, just like one moment, and go, what happened here? Why did that not sit? Well? Why did, like we were talking about earlier about conversations not sitting well, or verbiage not sitting well, what in that did not sit well and why? So again, it’s like, you know, something didn’t work right. PDSA failed. Well, what happened with that? Why did that happen? And sometimes the learning is, we’re just not going to do that. Again. You know, that’s not the right approach. But where the learning happens is what are we going to do about it next time when the situation comes up again, or we’re faced with our next PDSA? We’re faced with our next trial, we’re faced with our next challenge. What endless failure can we learn and make sure that we apply to this, that our future work that we’re doing? So I think it all kind of comes full circle.


Well, you know, just last week when I was working with the referral team, you know, we mapped out the future state process that everyone was excited about. And then, just by, I have no magic other than it was top of mind. So I asked the question- I said, Is there anywhere on this future state process that we’re anywhere we’re at risk for failure, and 45 minutes in two packs of post-its later, we had all the reasons why for our failure. And, and I remember looking at the group saying, I really hope they’re not defeated. And then someone said, Oh, great, that’s our work for the rest of the week. You know, because if this is so valuable, now we know, and it better to know now then, you know, fail forward quickly, Chris, right. And it’s like, wow, you just reminded me of things I remind other people about and so we’re always learning to write. So we have just a few minutes left, and we have those, we’re trying out a section of our conversation we’re calling kind of looking back and looking ahead because that’s always you know, we learned from both. So if you were looking back to your former self, when you just got started from the place of experience you have today, what’s one thing that you would share, as you look back to that, that starting self in this in this work? Chris, I see you laughing, so maybe we can start with you.


I’m laughing because I actually remember 20 years ago when I had my ‘see, feel, change’ experience. Okay, so I was working under the same vice president who, who gave you the Queen Mary quote, and he had, we had just rolled out VMPS. And we were just starting with what we called everyday lean ideas. And he was really trying to promote this like, concept of the people who do the work making the improvements to the work because it was just really foreign to all of us. And so I had an idea. And I implemented it. And it’s still going on today. And it was just I can remember the power. I was like, whoa, I’m a frontline worker. And I was just able to implement process improvement. That just solved a big huge problem that we had. And, and I have that power. And I’ve always just wanted to give everybody that power. Because it’s it’s just if you haven’t had that ‘see, feel, change’ experience. It’s amazing.


To add to that, and my vice president, let me.


Yeah, no. Yeah, he came to a staff meeting. And he said I want you guys to do this. And then afterward, he came by and told me what a good job I did. I mean, it was just so empowering.


Jackie, what if you were looking back? What would you say to your starting self in this work?


I think it’s just reinforcement of you know, this is a learning journey, and never truly stops; and just be patient with yourself and capture those successes, those failures, and learn from them as we go. Because I remember coming up and learning at VMI. And I was with a couple of colleagues. And we went after we had this extensive training, and we were both just so defeated, thinking we’re never gonna get there, we’re never gonna get there. There’s so much work to be done. And it’s true, there’s a ton of work to be done. But time keeps going, regardless if you’re doing work on it or not. And so what can you apply every single day? Or how can you engage and encourage every single day, your teams, because of those small impacts that you do those times that time that you spend out on the Gemba? It is so rewarding, and it really helps you see, you know, years later, you see some of that impact, much like Chris’s story, you see some of that impact still remaining. And so I think that would probably be my biggest thing is just be patient, and try not to focus too far into the future.


Well, you know, and it’s, you know, it’s important to look back and learn from the past to inform and help improve the future. So if you were to look ahead into your future self, let’s say 10 years from now, and you were able to have a conversation, what’s the thing you would bring to mind your future self about from where you are right now, today? I think I think I just remind myself, just trust the process. I mean, that’s, that’s the thing that just comes to mind is you’re going to learn by doing and you know, you both have been talking about that. And it’s just such an important reminder. Just give it a try, learn, open, be open to failure be open to success. But what about you too?


I think for me, just the power of remembering the power of collaboration and always be curious – those are kind of my two North Stars.


ABC. Always be curious. Right? Yeah. JACKIE,


I’m thinking, for me, it’s always to keep it simple, meaningful, and up to date. Because I think sometimes we try to overcomplicate things we try to build processes or things where it really we don’t need that complication. So I think just keeping it simple, but meaningful, but also up to date, so that way, we’re not retrospectively swimming in past data or past information. Right?


Well, we’re at the end of our time, I just really want to thank you both for the conversation. And just you know, before we end, is there anything left unsaid that you’d like to say anything top of mind that you want to make sure we remember?


There’s actually a quote that I got from actually earlier this morning, when we are doing our work at St. Michael’s, we didn’t even realize that it actually was prompted by a patient, a patient story that came through, and Chris and I had the honor to talk to her and close that loop on her story in the emergency department today. And it was really powerful. But what she said kind of stuck with me. And so I wrote it down, which was – She said, “Anyone can be a leader if given the permission, the space, with minimal barriers, to take the ownership of their work.”


That’s awesome. I think with that, we’ll end so Chris and Jackie, thanks so much for joining us. I really enjoyed the conversation. And I look forward to just continuing working together. So thanks for your time. And have a great rest of the day.

Thank you, Chris.

I’d like to take this opportunity to thank both Chris and Jackie for such a great conversation. It’s my hope that you gain more insight on going to see the work, asking our teams why in order to uncover opportunities for improvement, and showing them respect by engaging them to turn their ideas into meaningful, measurable action. Stay up to date, and enjoy more conversations like this one by subscribing to our podcast wherever you get your podcasts. Get in touch with us and submit your questions through social media accounts on Twitter and LinkedIn. Also, feel free to email us at Thanks again for listening. Remember, transforming healthcare isn’t just about the pursuit of the perfect patient and staff experience. It’s also a mindset, that we can always do better, because better never stops.

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