Rethinking Lean: Delivering Value with Purpose

Speaker A: Hello and welcome to Beyond Leadership, a, uh, Cleveland Clinic podcast, where we explore the many dimensions of leadership. I'm Kelly Hancock, Executive Vice president, Chief caregiver, and Administrative Officer here at Cleveland Clinic, and I'm thrilled to have you join us in this podcast series. We'll feature conversations with remarkable thinkers and uncover how their insights and experiences are shaping the future of leadership in healthcare. Now let's turn it over to our host, who will guide us through today's enlightening conversation.

Speaker B: Often, lean gets a bad rap. Too many people hear the word lean and think cost cutting or doing more with less. But in healthcare, Trulien is the opposite. It is about doing what matters most better. It is a powerful tool for creating real value, supporting our incredible caregivers, and ultimately transforming patients. Hello, everyone, and welcome to today's episode. I am your host, Elizabeth Pugle, and this is Beyond Leadership. I am joined today by Dr. Lisa Urian, Chief Improvement Officer. Good morning, Lisa.

Speaker C: Good morning, Elizabeth.

Speaker B: We have Dr. Gutierrez, Enterprise, Chief Primary Care Institute. Good morning, Jim.

Speaker D: Good morning, Elizabeth. Great to be here.

Speaker B: Thank you. And we have Dr. Jeff Chapman, Chief Quality Officer of Cleveland Clinic, Abu Dhabi.

Speaker E: Good morning, Elizabeth, and good afternoon.

Speaker B: And we are excited to talk about Lean today. Together, we will improve how Lean can be purpose driven, how it engages caregivers in improvement, and how it supports both well being and sustainable impact. Lean is not just about cost reduction. It is about creating value. At its best, Lean helps organizations focus on what matters most, creating processes that improve outcomes and minimize waste. Lisa, let's start with you. What is lean? How do you explain it to a team that might not be familiar with the term?

Speaker C: Yeah, it's a great question, Elizabeth, and I think it's a good place to start this discussion. Primarily, lean starts with purpose. Every organization team has a purpose. There's some value that we're creating. There's a reason that we're together doing this work for the Cleveland Clinic. It's about patients, it's about our communities, and it's about our people, our caregivers. So we look at our purpose and say, okay, what is the value that we deliver? Why do we fundamentally exist as we seek to create that value, to take good care of our patients or to make our communities healthier? We encounter problems, we encounter challenges. There are processes that we implement to create that value. We can improve those. Lean is about figuring out how do we constantly solve the problems and improve the processes to enable us to give more and more value to our customer. In our cases, that's the patient. When we Talk about Lean. What we're really talking about are, uh, the methods, the tools, the capabilities that we need to identify and solve those problems, to improve those processes, to ensure we can create more and more value for our customer. And what we see in health care repeatedly is that people like being able to take better care of patients and to be able to do it with fewer problems and less effort. And that becomes a virtuous cycle. People enjoy it and want to do more and more.

Speaker B: Great, thank you. Jeff, do you have a powerful example where a Lean initiative created value that went far beyond the bottom line, something that truly transformed a, uh, a patient's experience or improved how caregivers deliver care?

Speaker E: Yeah, I do. I have a great one. And echoing what Lisa said, this started from the primary care team who had a purpose because they knew with our data that we weren't providing mammography, breast cancer screening to all the patients that could benefit from it. And they knew it was important, they wanted to improve. And we got a team together with that purpose to guide us along. And this is where lean gets a little fat. Because although we had a drug, we often found a first barrier. Did we have the right access to the data in the emr so the physicians knew who needed a mammogram, and that was just a first step. And this is where lean gets fat, is that it's usually not just one simple drive to the truth. That's a straight line. You have to go through the cycle several times. And each time we went through it, we found other barriers because our patients are complex and our processes are also complex. So what we uncovered through the whole hospital was we were able to accurately know who needed a mammogram. We weren't able to easily order it by the physicians, and then scheduling it and paying for it was also difficult for our patients and rescheduling if they missed it. So every iteration, every month, people were concerned, yet another barrier. But I thought, this is great. This is another turn of the cycle. And that's where the people need to have the passion on the front line and they do have it to improve. And, ah, when they see those small steps adding up, because rarely is it just one obvious fix and everyone's happy, usually those multiple little turns that really, by the end of it, then everyone's really proud and they're proud of caring for those patients so well.

Speaker B: Jim, beyond the numbers, how do you measure the true success of a Lean project for patients, for caregivers, and for the overall care team?

Speaker D: Beyond the numbers, I suspect you Mean beyond the dollars and cents or the FTEs, because I think it is important with any lean effort, you know, we have measures and metrics that we can follow to really determine are we being successful. I would get back to what Lisa said at the beginning, which is thinking about, number one, what is our purpose, and really focus on how can we measure the impact on that purpose. And that starts with our patients. You know, for Lean to be successful, we want to see patient experience improve, and that is something we measure and we get feedback on. One of the things we ask our patients is what is their perception of the teamwork, uh, in the care setting, whether it's the inpatient ward or the outpatient clinic. So, you know, are we seeing our patients feel that the caregiver team is actually humming more smoothly over time? You know, how easy is it for them to get their needs met or to schedule an appointment? That's also something we measure. And, you know, we look at how likely our patients are to recommend our practices. Are they satisfied enough that they would actually recommend to their friends, to their family, to their neighbors, whatever Cleveland Clinic practice or situation that they've been in, I would argue that satisfied patients translate ultimately to better outcomes. So I think looking ultimately at are, uh, you driving better outcomes for your patients? And that could be better in primary care, preventive care, screening rates like mammography, or chronic disease control for things like diabetes and hypertension. You know, I think lean also impacts our caregivers, and we measure caregiver engagement on an annual basis. But that's something as a leader or a manager. You know, I think we try to have our pulse on throughout the year. I think when you're in a situation and working with a team, you know, when they're engaged, when they're happy, when they're at their best and when they're not, you can look at retention. Turnover has been a huge problem in health care for many years. And you know, are we moving the needle on people staying in their positions and growing and developing in place, and even absenteeism, just feeling that day to day burnout because of inefficient processes or wasteful processes and ineffective teamwork and feeling like, I've had enough, I just can't take it today. I'm going to call off. So, you know, these are some ways that we can really say, are we having the impact beyond just looking at what our expenses are, what our revenues are, what our volumes are on a daily basis.

Speaker B: And Jim, you mentioned that lean starts with a clear purpose. What mindset shifts are needed for leaders and staff to see Lean as an opportunity and not as a threat.

Speaker D: Yeah, I can think of at least two. I think it needs to start with simply being open minded or having what we sometimes refer to as a growth mindset. I think it's important that people, when they undertake an improvement process using a Lean framework or really any framework, they need to be willing to look with fresh eyes at what they're doing every day. They need to look at themselves not as much as cogs in the wheel, but someone who actually is enabled to look at how can we make those wheels turn better and more smoothly? I think more for leaders. It's also too important to understand that there has to be an investment in this. I think you have to give people the space, the time and the support to actually step back a bit, get together and work on this. And that doesn't need to take massive amounts of time and day long retreats that could be very short meetings, huddles, any opportunities during the day where you can get the right people together from across the different functions of the team to really share their thoughts, bring ideas to the table and then think about which one should we implement and move forward. And then when we do that, how can we continue to iterate and continue to cycle and get better?

Speaker C: Yeah, I appreciate Jim's comments. I'd like to share a few other things that are a bit sensitive but I think are real barriers to us sometimes as leaders. If there are problems, ah, in our processes that people point out, we feel vulnerable as a leader, we feel like we should be able to solve the problems or that we're not doing a good job as a leader. So we might feel defensive if somebody says, hey, this isn't working as well as it should. Or uh, to use Jeff's example, we're not getting our patients in for mammograms as often as we should. So I think that's one. I think there's uncertainty when your team begins to use tools or techniques that you're not as familiar with. I think you could feel insecure or uncertain because you're not as familiar or confident. I think it can question the leader's role. I've seen some managers and leaders become really inspired by how Lean helps them transform their team, improves engagement, reduces turnover, all the things that Jim mentioned. But there are other instances where people begin to question their own role because Lean really emphasizes empowering the worker. Respect for the worker is one of the key tenets. If your worker, your team member is now Fully empowered to solve problems. Your role shifts from you solving the problem to you really fostering an environment and capability for them to solve problems. That might be good in the end, but at the beginning it can feel very vulnerable because you're no longer the one who the team comes to to solve problems. And that might be uncomfortable for folks. The last one I'll hit on. And I think it's really important for creating a true culture of improvement, as we say, a lean culture, where everybody is fully engaged in identifying and solving problems every day. And that is around our fundamental beliefs. Do we fundamentally believe in the value of every caregiver and every caregiver's ability to effectively identify problems, understand root cause, do that analysis and go through those cycles that Jeff referred to of, uh, iteration, progress, learning, hit the next challenge iterate, figure it out. Do we believe that people are capable of improving value to our patient in that way? And we've seen a lot of reactions. Those are some of the reactions that can create challenge.

Speaker B: As Lisa has mentioned, lean is most effective when frontline caregivers are part of the process. Their insights drive innovation, they boost morale and lead to sustainable improvements. Jeff, what are some of the most effective ways you've seen leaders meaningfully engage caregivers in these initiatives?

Speaker E: And it's really the caregivers also engaging the leader, because they will often bring up an event or a problem and say, this is an issue where we don't think we are doing as well as we can for our patients, either giving them the optimum care or the optimum experience. And then the leader with that sensitivity to operations, needs to then take that. And usually there's a barrier somewhere. It may not be in that team, but as Dr. Mihaljevic mentions, we're all a team of teams. But it may be that first team having an interaction with another group. And that's where as a leader, you've got to facilitate those merging of the teams. Because often both groups are frustrated. Both groups want to do better. And that's where you can sit down and achieve a common purpose. As we started, it's all with the purpose. Get a common goal of what you want to improve. And occasionally I'll say this as a leader, sometimes I'll say, this is something that we're not going to be able to solve. This is inherent to the complexity of this patient. And it's hard work, but sometimes you can bring them together and you can say, we can simplify. Let's improve what we can. And that gets to that defining part of, uh, once you have your purpose to define and as the leader, bringing those teams together, eliminating those barriers, and then sometimes also saying, I don't think that is possible right now. And that may be a tough conversation, but you have to have it, because then they will get frustrated. And that's where the process breaks down when people don't see improvement a futile goal.

Speaker B: Lisa, will you walk us through an example of a workflow redesign where caregivers were truly involved? What did the process look like, and how did it affect patients and team dynamics?

Speaker C: Yeah, so actually just recently saw a team share a really exciting one, and it was around reducing the, uh, risk of patients falling and getting hurt. Our teams have actually hit our enterprise target this year, and the way they did it was really to combine a few different lean practices. So we introduced daily visual management boards. That's a great place to bring the team together in a huddle and talk about how things are going. Are we succeeding in our goal or not? And if we didn't, what's getting in the way? They paired that with another lean tool that they call a K card. It stands for a Japanese word, but basically it's a card that shows some standard process that we need to follow. How to check it. Each unit has a box of cards, and every day leaders pick a card from the box, and they go to the patient's bedside, and they talk to the patient and they talk to the caregiver to see, did we follow that standard? And the card shows how to check the standard. And if we did, great, that's fantastic. We'll mark it on the board as green. We'll celebrate it with the team. We'll use it as an opportunity to share and learn and remind everybody. If we didn't hit the standard, then the flip side of the card shows what it is that we need to do about it. We put the standard in place. We talk with the patient, we talk with the caregiver, we go make sure that it's been applied correctly in all of those patients. We put it on the board in red. We talk about it with the team the next day. So the team together really worked through. How do we not only create better processes, which I think we often emphasize the invent better processes. How do we actually engage our teams in making sure that we're following them every day? And I think that requires constant attention, focus, feedback, learning cycles of improvement. Those are really mini cycles of improvement that Jeff referred to occurring every day on the floor. So the teams have seen great progress, and they really like the process, it's collaborative, it's transparent, parent, it's relatively simple compared to many other ways we've tried to solve this really complex problem. And so now they're looking at how do we start to use these cards for other important processes in our care to make sure that we are checking, following them, coaching them, following them on a consistent basis.

Speaker B: That's a great example with the cards. Jim, from your experience, how does authentic participation directly impact staff morale, psychological safety and overall buy in?

Speaker D: Yeah, Elizabeth, I think in answering that, I'd like to reference some ongoing work that we're doing in our primary care practices to really improve the efficiency and standardization of how we're handling various types of messages and work that comes into our physicians and our advanced practice providers in baskets. I don't think primary care is unique, but perhaps more than any other specialty, there's a huge burden of messages coming into the electronic in basket every day. And you know that on top of the day to day, face to face patient care is a key driver of burnout. And you know, that's not only at Cleveland Clinic, that's documented across primary care in general, we see a lot of wasteful processes in how we handle messages, messages not being handled by the appropriate member of the care team, messages being bounced from one to another person. And that really multiplies things. So one by one in our practice is we've undertaken what we call Project Joy, because we're looking at this to really bring some joy back to the practice of primary care on a practice by practice basis. We're getting the key members of our care teams together, the physicians, the advanced practice providers, the nurses and the medical assistants and the clerical staff, and really getting them together, uh, to do what we've been discussing here. They're the closest to seeing these processes. They know where there is waste and they're in the best position to identify what are some better workflows. And then once we determine those, how do we hardwire those into our practices? And you know, I can tell you one of the challenges with our new organizational structure or op, uh, model at Cleveland Clinic is that at the practice level, those various groups kind of sit in different areas of the organization in terms of how they report, but yet they're all working side by side in the practice. A lot of this work was getting them together, giving them a little time offline, and then really getting them to get to know each other better, share their challenges and together work on solutions and drive that buy in. So we saw a huge impact Just by doing that. And I think more importantly, we really laid the ground for ongoing improvement and success by just really assuring that, you know, those teams get together and meet on a regular basis, which wasn't happening in all of our practices for the last few years. And you know, that again, that builds trust and trust is a, uh, force multiplier. Trust really, you know, enables people to work together and it also enables people to tap each other in the shoulder and say, hey, you're not following the process, I'm not criticizing, criticizing you, but you know, I want to make sure we're doing things the way we agreed is the best way to do them, you know, for us and for our patients.

Speaker B: Appreciate hearing a little bit about Project Joy. Jim, what did you notice in terms of the quality of patient care when caregivers felt ownership of the improvement?

Speaker D: Well, you know, I think what we've seen in the practices so far, and I will admit it's early, is that, that there is more efficiency. You know, we've been looking more at how it's impacting that in basket work. So we're looking to see is there a lower number of messages. More importantly, are the messages being touched by less people and ideally being closed by the first person who touches them? You know, I have to imagine that because of that, as that improves, patients are going to see that their issues are addressed more quickly. Their refills are done, their messages are replied to, they're given appropriate appointments or care sooner to when they call. Ultimately that's going to lead to a smoother and more satisfying care experience for these patients.

Speaker B: Jeff, what challenges come with engaging frontline staff and how do you overcome them while still keeping patient and caregiver needs at the forefront?

Speaker E: Yeah, that's a great question because you've got to have the frontline caregivers, you got to have the caregivers buy in and start working on this. And as I often say, we all have a day job, we all have work we need to do and we know we need to get done. And then on top of it, we're asking them, well, we want you to improve your work and make it even better. And as Lisa said, you have to subtly approach that and not say you're doing it wrong or something is poor, but focus on the, we can do it better and we can make your life easier. And that's where you have to, as Jim said, give them the space. And it doesn't have to be a whole day long retreat, as Jim says, a focused time of getting the Right. People together who can define the problem and go on and start that first turn of the wheel. And that's where I think you really have to get the buy in. They have to see the purpose and then give them a little bit of space and say, I understand this is not your main job description, but at Cleveland Clinic, it actually is part of your main job description to do your job and then try to make it even better. Because in the end, when you go home, you'll feel better, your patients will be better, and your team will be, uh, happier.

Speaker B: The key to lasting improvement isn't just engaging caregivers. It is also about supporting them. Let's explore a core benefit of Lean. How it can reduce burnout and improve well being by simplifying work. Streamlined processes and less administrative burden don't just improve efficiency, they can be a lifeline for caregivers. This is all about retention, their well being, and ultimately patient safety. Let's talk a little bit about how Lean can directly help reduce burnout. Lisa, will you give us an example of a Lean project that was specifically designed to reduce an unnecessary workload for caregivers? What was the impact?

Speaker C: Yeah, so a, uh, very recent one. A few years ago, I was asked to take over responsibility for the contact center. We started by spending time in the place where the work is done, or the gemba, as we say in Lean. And what we saw was caregivers who were working hard, trying to help patients, but hitting roadblock after roadblock after roadblock. And it's pretty discouraging to try to be empathetic when you can't actually help patient after patient after patient. I saw one instance where a caregiver took 10 calls and was only actually able to schedule one of the patients because of delays and problems and barriers and blocks, et cetera, that have been over time had accrued in the system. So we did a few different things. One is we started tiered daily huddles so caregivers on a daily basis could bring forth challenges, problems, opportunities, ideas, and talk about them with the team. The second thing we did was introduce Kaizen. So our Kaizen system we actually developed in 2013. It's unique to the Cleveland Clinic and it is a way for people to bring forth problems that they face in their. We built that system, applied it within the contact center, and many of the caregivers work remotely, so we have a virtual card that team members fill out. Our CI team created 15 minute introduction sessions to Kaizen and waste and problems. I consider it Kaizen Express. I Watched it and I've been studying Lean for a long time. It is a fast explanation of Kaizen. And so the team members are really encouraged to, when they encounter a problem, to identify it, fill out a card, which is a short, quick process. And then the team huddles every week on the cards that have been submitted and looks at each one to decide, as Jeff indicated, which ones can we solve, which ones are within our power, which ones do we want to prioritize? Which ones do maybe we need to set aside, wait for later, give it to somebody else, engage a different team. Through that process, the team has solved almost 300 problems that they face in their work. They've improved engagement and retention. They consistently now achieve an 80% service level. So that means 80% of the calls into that team are answered within 30 seconds. Now, that's not all calls system wide, so it's not anywhere you call the Cleveland Clinic, but if you call the contact center, uh, 80% of the time you're going to get somebody picking up the phone in 30 seconds. And they're much, much more likely to be able to actually help you, which of course is much more rewarding. So we share that information back through the tiered huddle. So the team can see not only did my card or my idea get looked at, considered, solved, but look at the impact we're having collectively on our patients. And then we also feedback some of the other data points like Jim shared around patient experience. What are our patients telling us about, uh, how satisfied they are with how easy it is to schedule care. And what we've seen is year over year, we're improving about a DEC every year, which is pretty remarkable improvement if we look across the country at how quickly people are able to change access.

Speaker B: I love the idea of the Kaizen Express. Jeff, question for you. How do you, uh, balance simplification with the complex realities of healthcare where patient needs are constantly shifting?

Speaker E: Oh, good question. And the caregivers know that. They know how complicated are our patients are. And, uh, I'll use two HRO principles. One is deference to expertise. Ask an expert, what can we do here? Get some smart people to think about what our problem is, defining it, and what our possible causes are. And then also sensitivity to operations. I've seen many times where leaders have tried to solve a problem just by telling their folks or their teams to, to not cause the problem anymore or just to fix it. And that sensitivity to operations, to really walk in the shoes and do the Gemba walk and understand and that gets the Two way buy in of true understanding and then also know when to say, hey, sometimes you've got to phone a friend and call in an expert to get some input to guide you forward.

Speaker B: Jim, I'd love to get your insight on ensuring that lean projects remain focused on people and not just the process. How can we ensure that that is happening and that both caregivers and patients experience meaningful improvements?

Speaker D: Yeah, I think it starts with something Lisa, uh, brought up earlier. You know, to really be successful with lean methodology, it has to start with truly valuing and truly respecting every caregiver, every member of the care team. Because if you don't have that, then it's really impossible to fully engage and support that engagement. You know, beyond that, you really need to ensure that you're bringing the right people together and that you're being inclusive, really ensuring that all the stakeholders are involved. And, you know, we often forget patients in that. So, you know, Cleveland Clinic has a very robust program of patient panels and patient enablement that really encourages the pulling in of patients into many different design and decision processes, leadership groups, et cetera. And that's really important as well, because as we've said, it all starts with our patients as well as our caregivers. I think you have to ensure that the people who live this situation, live this work every day, are listened to, that the ideas that they bring forward are fully vetted and respected. And then finally, in terms of patients, you need to look to link our patient outcomes, ultimately the results of the care we're providing to the processes that hopefully we've improved to ensure that we're ultimately driving to that purpose, that outcome that we're aiming to from the beginning.

Speaker C: Jim, I have a question for you. I fully agree with you about the importance of having that foundation of the team, valuing each other, respecting each other. I'm curious, have you seen cases here where that's not the case and you need to start there first? And if so, how have you addressed that? Because I agree with you, I think it's going to be hard to make progress if you don't address that first?

Speaker D: Yeah, you know, Lisa, ah, that is not only, you know, something I've seen, but it's a frequent challenge in some of our practices. And, you know, I think a lot of that is because, you know, we're obviously very busy at Cleveland Clinic, you know, because of that operating model I mentioned. Sometimes, you know, people are, you know, receiving direction from, you know, various areas and there's not full alignment on that. And, you know, when you're busy and you're working hard and ordering on burnout. Sometimes it's easy to point to someone who truly is on your team, but you can perceive as being on another team and say, well, it's all because of them. So I think it really gets back to number one, just getting people in the same room and building that relationship and building that trust. And as you can imagine, more often than not, you realize we're all good people, we all want the same things, we're all driving toward the same purpose, and we can do this. Occasionally there are circumstances where there are significant issues, where with interpersonal interactions, and that's when we escalate, we escalate to leadership, whether that's at the local level, the departmental level, human resources, whatever the case may be, and really look for opportunities to mediate the situation. And fortunately, not that often. But occasionally, it takes changing some of the personnel to really get to a better place where everybody can lock hands and row in the same direction.

Speaker B: Simplifying work helps reduce burnout. And the ultimate goal of lean is to create sustainable value. When you get that right, you get lasting improvements in safety, quality, and the caregiver experience. Effective lean strategies prioritize safety, quality and caregiver experience. Cost reduction becomes a byproduct of value creation, not the main goal. Lisa, can you share the single most important thing leaders can do to sustain this momentum?

Speaker C: I actually think the most important thing is to feed back to the caregivers the impact of their work. We learned early on in our journey that the most impactful thing we could do was show people their ability to make a difference, what the impact was of their work on their fellow caregivers, on our patients. Seeing that through data was powerful. It feeds the beast. People want to make a difference. They want to find meaning in their work. And so the faster that we can get that in front of them, the better. And it's not always easy or obvious to know that we see the big picture data all the time we're talking about it, but it doesn't always make it back to our teams. And so taking the time to consistently make sure that your teams understand the difference they are driving is probably the most important, important thing that we can do.

Speaker B: Jeff, what advice would you give a leader starting a lean journey who want to avoid any common pitfalls?

Speaker E: Wow, that's a great question. There are so many common pitfalls. Like we've all said, uh, you've got to start from the buy in and the purpose. As we began this discussion and Then as Jim said earlier, you've got to have everyone on the team. They all may be a little different and have different expertise, but they've all got to to respect each other, work together and be rowing in the right direction. And I often say everyone wants to jump to the solution and solve the problem and move on. Let's spend a few more minutes trying to understand the cause before we jump to a solution. First understanding that that will just be generating more waste and be unlean if we go down a divergent pathway. So often those first steps of starting off slow or even not moving. And it's like when we all take care of patients, sometimes just watching the patient listening to them gives you the most insight. So understanding the problem, but then also realizing that the first problem you see is just the first problem you see. You're often, and as Lisa mentioned, you're going to turn that cycle many times and then once you've succeeded, like Jim said said, that's where it brings in the pride and that's where it's infectious when you've gone through those multiple turns and then have achieved something.

Speaker B: We've explored Lean as a purpose driven approach. Engaging caregivers, reducing burnout and creating value. Let's close with each of your reflections on the future of lean in healthcare. Jim, if there's one single misconception about Lean that you could clear up for our listeners, what would it be?

Speaker D: Yeah, I think that brings us back, Elizabeth, to where we started, which is, you know, lean is not fundamentally about doing more with less. And I think there's something about the word lean that immediately gets people who aren't familiar with what it means to go there. In fact, I'll, um, call out my wife. When I told her last night that I was going to be doing this podcast about Lean, she said, oh, what's lean? And that just sounds like doing more with less. And sorry, honey, if you're listening to this, but you know, really, you know, framing it to, you know, lean is about, you know, number one, having the right amount of resources to take care of whatever you need to take care of, you know, to do the job and to have the right processes that do the job with the right amount of resources and avoiding waste. And I think if you could help frame it that way, everybody can understand what waste is because we could look at our day to day work and identify a dozen things off the top of our heads that are wasteful. Unnecessary movement, unnecessary mouse clicks, whatever the case may be. If you really frame lean as a way to reduce that and do the job more effectively and efficiently and get to where we want to go with that purpose in mind, that makes it a much easier thing to sell.

Speaker B: Lisa, for leaders listening who want to act now, what is one small, lean, inspired change they could make tomorrow that would have a big impact?

Speaker C: I'd say spend time in the place where the work is done. Spend time in the gumbo. Time and time and time again, we have an impression of what's occurring or how it's occurring, and it's different from what actually is. I'll share a quick story. Many years ago, we were working with the sleep center center here, and the team was looking at trying to serve more patients. And of course, it started with probably a volume target, and they saw that one of their labs had the highest no show rate and they couldn't figure out why. So the manager of the area took it upon herself to drive out and visit. She couldn't find it. Suddenly she had a really good impression of why. Maybe we had a high no show right there. And of course, then, um, very quickly started to implement steps to make it easier for patients to find that lab. It's just so incredibly powerful. It shows respect for the work, for the worker. It helps us understand how value's created. Where problems exist or waste exist, that's getting in the way of value. And it's a really good way to build empathy and to understand what's getting in the way for our caregivers.

Speaker B: Jeff, same question. What is one small lean inspire change that could have a big impact.

Speaker E: As Lisa said, going to where the work is and walking the gemba, uh, and listening. And when someone has an issue or an event or a complaint or brings up a gosh, I hate it when this happens, to take the time and say, can we remove this barrier? Can we solve it? And then get the frontline involved? Because they know the barriers are right there and sometimes they are just aspects of the business. But many times we can help and we can remove them and that will get them inspired.

Speaker B: Thank you all. Your insights were absolutely brilliant. Thanks for joining me today on, um, Beyond Leadership. I hope this conversation sparked new ideas on the topic of lean and how we can put patients at the center of everyday process. If today's episode gave you something to think about, please share it with your colleagues and follow the podcast so you don't miss what's coming next. I'm Elizabeth Pugle, and together we'll keep building a better, safer, and more efficient healthcare system one improvement at a time. Stay curious. This concludes another episode of Beyond Leadership. You can find additional podcast episodes on our website, clevelandclinic.org BeyondLeadership or subscribe to the the Podcast on itunes, Google Play, Spotify, or wherever you get your podcasts.