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My guest for Episode #519 of the Lean Blog Interviews Podcast is Jarvis Gray, the Managing Director of The Quality Coaching Co. He offers more than 16 years of strategic planning, quality improvement, and operations leadership experience in the healthcare industry.
Through his firm, The Quality Coaching Co., Jarvis and his associates help healthcare organizations foster cultures of system-wide quality improvement by offering customized Lean Six Sigma coaching, training, and certification programs centered on improving the quality of their care delivery services and health outcomes, eliminating waste and achieving cost reductions, and enhancing the patient experience.
He's the host of the Excellence in Healthcare podcast (where I have been a guest). His new book is MASTERING HEALTHCARE EXCELLENCE: A Leader's Guide to Getting World-Class Results by Aligning People, Priorities, and Processes.
In this episode, we explored how to build a sustainable culture of excellence in healthcare by aligning people, priorities, and processes. We discussed the importance of integrating Lean Six Sigma principles with data-driven decision-making to improve patient outcomes and streamline operations.
Jarvis shared insights on establishing frameworks for healthcare excellence, including data cataloging and dashboarding, to track and leverage key metrics. We also delved into the evolving roles within healthcare quality improvement, the lessons learned from working closely with healthcare professionals, and the unique challenges of managing patient-centered processes. Lastly, we touched on his experience as a business owner, applying continuous improvement to his own consulting practice and the value of disciplined operations in achieving long-term success.
Questions, Notes, and Highlights:
- What's your origin story with quality, Lean Six Sigma, and healthcare?
- How did Florida Power & Light's quality culture and Deming Award influence your approach?
- What's changed in the role of “management engineer” in healthcare since you entered the field?
- When did you start the Quality Coaching Company, and what led to that decision?
- What's the central message or goal of your new book, Mastering Healthcare Excellence?
- How do you use data in healthcare to achieve excellence, and what tools do you recommend?
- What's the healthcare excellence business model you promote in the book?
- Can safety or quality serve as a competitive advantage in healthcare? Any examples?
- What key lessons have you learned from healthcare professionals as an engineer?
- Do you have an example of aligning people, priorities, and processes effectively in healthcare?
- What improvements have you made in your own business from lessons learned in coaching?
- For consultants and coaches, what small business coaching insights have helped you?
The podcast is brought to you by Stiles Associates, the premier executive search firm specializing in the placement of Lean Transformation executives. With a track record of success spanning over 30 years, it's been the trusted partner for the manufacturing, private equity, and healthcare sectors. Learn more.
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Automated Transcript (Not Guaranteed to be Defect Free)
Here is the full transcript with spelling errors corrected:
Mark Graban:
Well, hi, welcome to Lean Blog Interviews. I'm your host, Mark Graban. We are live streaming this today on LinkedIn, but you might also be listening or watching, listening to or watching the recording. So we have an opportunity, I think, to bring in possibly some live questions as we go from the LinkedIn audience. So we are joined today.
Mark Graban:
Our guest is Jarvis Gray. He is the managing director of the Quality Coaching Company. He has more than 16 years' experience in strategic planning, quality improvement, and operations leadership experience in the healthcare industry through his firm, again, it's the Quality Coaching Company. Jarvis and his associates help healthcare organizations foster cultures of system-wide quality improvement by offering customized Lean Six Sigma coaching, training, and certification programs centered on improving the quality of their care delivery services and health outcomes, eliminating waste, and achieving cost reductions while enhancing the patient experience. Jarvis is also a podcaster, he hosts the Excellence in Healthcare podcast, and he's also an author.
Mark Graban:
His new book is Mastering Healthcare Excellence: A Leader's Guide to Getting World-Class Results by Aligning People, Priorities, and Processes. So Jarvis, welcome to the podcast. How are you doing today?
Jarvis Gray:
I'm doing great, Mark. Thank you for that introduction and just the opportunity to hang out with you and Claudia and Abdullah and all the other folks hanging out on our call today. Thank you.
Mark Graban:
Yeah, Abdullah is joining us from Saudi Arabia, we've got Claudia from Peru. So the international interest, I think, in healthcare quality improvement is active and here with us today. So we would love to hear your questions if you want to put those in the chat at any time. So we're going to follow as far as deeper introductions. Jarvis.
Mark Graban:
If I have a standard question that's evolved over time, I like to ask people their origin stories, and this is probably a combined question of however you want to frame it. Quality origin story, Lean Six Sigma origin story. I also want to know your healthcare origin story. There are some different origins to kind of meld together there perhaps.
Jarvis Gray:
Yeah, I was, I was bitten, marked by a radioactive spider that was loaded. No, no, Mark. So kind of the, the very long story short. Long story short.
Mark Graban:
Yeah, we have time for the long version.
Jarvis Gray:
No, so I, I graduated with my bachelor's in industrial engineering from the University of Miami back in 2004 and came out of school and landed my first job at Florida Power and Light down in South Florida. And the kind of, the big claim to fame, at least for FPL at the time, was that they're the first U.S.-based company to win the Deming Award. So yeah, so that was my first exposure to just that high-powered, high-quality culture and their culture of safety given, you know, the work we were doing in electric utilities. That was really my first exposure to a lot of things, Lean Six Sigma worthy.
Jarvis Gray:
In 2006, roughly, I moved to North Carolina with my wife while she was in grad school. I ended up getting a great opportunity with a small electric utility consulting company and loved it. Honestly, to this day, it was one of the best jobs I ever had. They loved me too. They offered me the opportunity to promote me, willing to pay for me to go back to school and get my master's in electrical engineering, go through the process, and become a certified engineer, a PE. But it had to be in electrical engineering, and I was not interested.
Jarvis Gray:
As an industrial engineer, I loved the project management work. I loved all of the design work that I did, but I didn't want to make the official cross to electrical. So I actually turned down the promotion opportunity. The way I describe it is it's kind of like if you ask somebody to marry you and they say no, then everything gets real weird and awkward. So I was looking for a way out, and about 2007, I found an opportunity at Duke Hospital.
Jarvis Gray:
And that was my first step into healthcare as a management engineer was a position that it's called. And again, for me personally, I kind of tell the story. I didn't expect to ever end up in healthcare. It was just me not wanting to be with that group after I turned down a great opportunity, and I fell in love with it.
Jarvis Gray:
By the end of my first year working at Duke, I was having conversations with leaders like, “How do I make this a career and how do I grow and everything else?” But that's where I officially became certified as a black belt, got involved with Baldrige and a lot of other projects at the time. So yeah, that was really what kind of got me onto this path, and then making a full commitment to continue to grow as a healthcare leader and a healthcare improvement leader.
Jarvis Gray:
That was the origin story.
Mark Graban:
Yeah, well, there's a little more we can unpack there. The similarities in being industrial engineers starting outside of healthcare–for me, it was manufacturing–but there's the shared Deming influence. So I'd love to dig into that a little bit more. Was your first exposure to that at Florida Power and Light?
Mark Graban:
I'm curious what that represented in terms of their approach and what was taught about the direct influence of Deming's philosophy and approach.
Jarvis Gray:
Yeah, so again, you know, FPL, Florida Power & Light. They are headquartered down in South Florida in the Jupiter area, which is just a little bit above Miami. So needless to say, their presence down in South Florida was big time. And the chief operating officer for the company at that time was IE. So they made a really big push to hire a bunch of us IEs during that time.
Jarvis Gray:
So they brought us in kind of almost like a cohort of IEs. It was probably 20, 30 of us. To this day, I'm still very tight with a number of folks that I came in with. But that culture is kind of what they promoted. They were like, “We want IEs because of our backgrounds with critical thinking and process improvement and our ability to design and, you know, kind of come up with the most efficient ways for those projects.”
Jarvis Gray:
But what I remember most 20 years later really is the culture of safety. Like the things that we would do with our crews, the huddles that we were doing before huddling up was a thing. We would do stretches in the yard just to make sure that our bodies were ready for the day's work. And I was a design engineer and I would still collaborate with these crews, really big with their safety committees and everything that's similar now, I would say, in healthcare. But all those things, I don't know if it came from the influence of the Deming program or if that's what they leveraged as a part of their growth and journey on the Deming award process, but those were the things that again, to this day, stood out.
Jarvis Gray:
And they were really, again, I'm speaking 20 years ago, but at that time, they were really intentional with the kind of project engineers they wanted to hire and the culture that they wanted to instill us with. And then it was completely voluntary, but they had their own internal Lean Six Sigma. I think this was yellow belt that I got involved with, but it was completely voluntary. Like, “Hey, if you're interested, here are some things we'd like you to learn.” And I went through their yellow belt program.
Jarvis Gray:
But yeah, it was just, it was a part of the culture. It was like a normal part of business. It wasn't it? I don't remember it being an option. It was a part of the culture and it was just a part of the expectations.
Jarvis Gray:
If you knew, you know, growing as an engineer within their organization was going to be the long-term plan. It was like, yeah, here's our yellow belt program and here's all the other leadership development programs that we're setting in front of you. So the culture and the growth opportunities, it was pretty well laid out from what I recall.
Mark Graban:
Yeah, that's great to hear. And, you know, there are through lines and influences pretty directly from Dr. Deming through to people who are still active in healthcare leadership today. When I think of, you know, the patient safety and quality movements, you know, people who studied directly with Dr. Deming or, you know, very closely with somebody who was part of that lineage through people like Don Berwick and the Institute for Healthcare Improvement, I still hear more mentions of Dr. Deming in some of those healthcare circles than I think I do in manufacturing land anymore. So very practical, very timeless things, concepts. And, you know, one of those leaders now at Duke. I got to spend some time with the Duke University Health System up through 2019, early 2020, and then COVID interrupted things. But, you know, there are great efforts, ongoing efforts there, including an executive I've interviewed before, Dr. Richard Shannon, who I believe is the chief quality officer for Duke University Health. So their Lean journey continues, and I want to give a shout out and recognition to, you know, the people who are still leading that and involved in that, like you said, almost 20 years after your time there. So, for those who don't know the term in healthcare, Jarvis, “management engineer,” at least at the time, was a pretty common label given to industrial engineers in healthcare. I think some of that's gone a little bit by the wayside. Would you agree? Or tell us a little bit more about that role and what some of the expectations were in healthcare.
Jarvis Gray:
Yeah, I believe so. When I came into healthcare in 2007, I think “management engineer” may have been one of the few terms given to us at that time. And I believe Duke, again, speaking from a very old brain right now, Duke was probably one of the largest departments in the country hiring industrial engineers to do a lot of the improvement work at that time. Nowadays, I think you're going to find a really good mix of other, you know, position titles. I just saw something posted recently.
Jarvis Gray:
I mean, they are literally saying, “We just want engineers, industrial engineers,” which, at one stop in my career path, I did have a chance to launch an industrial engineering department for a hospital, and we kept it pretty straightforward. We want IEs who are willing to learn the healthcare world. You'll get a lot of project managers, quality or safety leaders. So it's a really good mix of terms nowadays. And even a lot of our nursing or clinical quality improvement terms will have components of their job descriptions that really are industrial engineering-based.
Jarvis Gray:
So it's a mix now. But 20 years ago, “management engineer” was a catch-all for a lot of stuff.
Mark Graban:
Yeah, yeah. I mean, I'd see where the word “industrial” didn't resonate because they'd say, “Well, we're not industrial.” But, yeah, I think maybe some of the terms people are using nowadays, there's so much variation. Operational excellence…
Jarvis Gray:
Yeah.
Mark Graban:
…facilitator or coach or engineer. So there's just a lot of terminology, and maybe it's better to be focused on, like, you know, some of the goals as opposed to some of the other terms.
Jarvis Gray:
I'll speak on this. One of the mindsets I still lead with today, for all of us as industrial engineers in the healthcare setting, is that our goal should be to not have to be there. So regardless of the titles, if I can download my brain into the teams that I'm working with, and then I can go spend half of my day fishing, that's a good–that's really the goal. So I think that's why we see the mix of titles nowadays, because some organizations are just like, “We want to be a Lean shop, so we're going to call all of our project managers Lean operations people or Lean this.”
Jarvis Gray:
And then you have some organizations who are going to be the PDCA shop, so they're going to call all of our people facilitators or whatever. So I think that drives a lot of the variation, the type of culture that they think they're generating with the methodology.
Mark Graban:
Yeah. And we're going to say hello also. We've got some people joining us from Bangladesh and from Brazil. So again, wow. We don't have North–no, nobody has said hi from North America yet, but we've got a lot of continents and regions of the world joining us here live. So then, Jarvis, when did you start the Quality Coaching Company? I'd love to hear that story.
Jarvis Gray:
Yeah, so I started it back in 2017. And the way I tell the story, Mark, is I started it–well, I started on purpose, completely on accident. I had an opportunity. I was working here in Atlanta at Emory University Hospital, and I had a chance to start teaching some of the Lean Six Sigma for healthcare courses at the university itself.
Jarvis Gray:
And folks who were in my classes just started reaching back out. “Hey, Jarvis, it was a great class.” They just had extra questions or wanted to jump on a quick Zoom call. So I tell folks, like, I was on Zoom before Zoom became popular.
Jarvis Gray:
So we would do those things. And then one of the students actually asked me, “Hey, can you come out to my hospital and kind of walk me through some stuff?” And that's when I was like, “Hey, I think this is consulting now. Like, I think we just crossed the line.” So I figured as I'm doing all these, and this was just me being nice, so I wasn't charging anything.
Jarvis Gray:
I figured I'd just go ahead and kick off the LLC, just in case. So I tell folks I went onto, was it LegalZoom? One night, I was up with my 3-month-old daughter, and, you know, we were just sitting up, and I was kind of rocking her back to sleep. And so I was like, “LegalZoom.” In 30 minutes and $300 later, I had a business.
Jarvis Gray:
And then I just slowly started to build the pieces of the business from that point. So I kind of reverse-engineered it. I started it and then built the business plan and all the strategies to grow from there. But it wasn't intentional when I started. It was just like, let me just do this to make it look like I'm a business.
Jarvis Gray:
And I figured it out ever since.
Mark Graban:
Yeah, that sounds like that should be a LegalZoom commercial. You know, the father, 3 a.m., holding a baby, and it's so easy to just go online, click, click, click. I mean, like, that's, that's a vivid scene.
Jarvis Gray:
Yeah, well, and I remember when I finished the process, I was like, “That's it?” It was not as, you know, I don't know. I think a lot of folks are intimidated by what they don't know, right? So I'm thinking starting a business was going to be this super complex thing, and 30 minutes of just, you know, filling out some key information and it was like, “All right, just swipe a credit card.”
Jarvis Gray:
I'm in business, quote-unquote. Now, growing a business? Totally different conversation. But starting a business, not that hard.
Mark Graban:
Yeah, growing and managing, and then you start thinking about your bookkeeping and your tax filings, and even as a small business. You know, I started my business; it's an S-corp. But, yeah, like, it was easy to start. And then, thankfully, you know, boy, there's a CPA to keep me in line with everything that needs to be tracked and followed. But, so then, I want to talk more about–well, let's dig into your book. And again, we're joined by Jarvis Gray.
Mark Graban:
His book, available now, recently released, is Mastering Healthcare Excellence: A Leader's Guide to Getting World-Class Results by Aligning People, Priorities, and Processes. So I've got some, you know, specific questions to dig into, but I'd love to hear your overview of the book and what it covers.
Jarvis Gray:
Yes, this was, I would say, my attempt to connect the dots. You know, I'll say the book was inspired by a lot of different business excellence methods that are already out there. A little bit of Baldrige, a little bit of EOS. I don't know if you're familiar with EOS, Mark.
Mark Graban:
Yeah, Entrepreneurial Operating System.
Jarvis Gray:
Yeah, things like the E Myth, you know, just a lot of different methods that I think are out there. But in my opinion, not a lot of them offer the tools or the prescriptions on what to do next. The frameworks are amazing. So when I had the idea for the book–and I've been wanting to do a book for a while, but just trying to figure out, like, what do I want to do, what do I want to do? So my idea for this particular book came because when the pandemic kicked in, like everybody, I pivoted because all of my healthcare clients were out saving the world. So I did pivot into doing small business coaching, which has been a great experience across the board.
Jarvis Gray:
I will say honestly for me, I became better at business when I started teaching business to small business owners. The tools and the strategies that I've learned and adapted into my business, I've worked with clients, and most of my small business clients, Mark, are still healthcare business owners. So like I've had clients that
are owners for, you know, end-of-life services. I've had business owners who are clients and owners of hydration services, and a lot of other healthcare-based services. And so with the tools that I was learning to teach them better business, I started using myself. And then, long story short, I started adapting.
Jarvis Gray:
When I slowly started getting my foothold back into the healthcare consulting work that I do, I started sharing it with a lot of the other groups that I work with, and that was really it. So I hope what readers will find is I'm, you know, providing a framework, kind of, again, my version of a business framework that works. It's proven with a mix of clients, but I'm also giving the tools. So I am prescribing, like, “Here's the framework and here's a great tool that will help you go through the process.” That's really kind of where the inspiration came from.
Jarvis Gray:
And I wanted to find something that would just really promote the business of healthcare, because I think many of our leaders, I think, have the clinical quality components of healthcare tightly knit. What I want to promote is, let's also be better at business. Let's connect the dots as leaders. Let's make sure we have the focus on our customers and our patients. Let's understand all the processes they're going through, the data.
Jarvis Gray:
So I'm really pulling it together and hopefully, again, just offering the right tools and promoting the right tools on how to use them that will make healthcare a little bit better for all the leaders who check it out.
Mark Graban:
Yeah. And you know, you can find the book on Amazon or probably, I'm sure, also through your website, Jarvis.
Jarvis Gray:
Yeah, my website, Amazon, Barnes and Noble. That's been a whole other process, Mark. I'm sure we could talk about that, because you've written some great books and published yourself. I'm now in the process–I had to reach out and find a freelancer to do the audiobook, and now I'm going to republish an audiobook. I did an eBook as well.
Jarvis Gray:
Again, all the things you kind of figure out as you go but all the different formats of a book and how to publish it. But I'm trying to make it easily accessible, and then I tell folks, if you connect with me on LinkedIn and we have a conversation there, I'll send you a free copy of just the PDF. Right? It's not a “get rich” type of a thing; it's like, “Here's a different way of doing business as healthcare leaders.”
Mark Graban:
Yeah, yeah. And I, I bought the Kindle version, you know, it's $1.99. The paperback or hardcovers are, are inexpensive, and yeah.
Mark Graban:
I mean, just random aside, like, writing a book is not a “get rich” anytime, let alone get rich quick, but you…
Jarvis Gray:
Especially if you go through Amazon. I am, I am shocked at the things I'm learning about Amazon, and it's not a bad thing, but like, the split, between, you know, what Amazon gets versus me. I was like, “Really?”
Mark Graban:
Well, it's a better split than traditional publishing, so that's…
Jarvis Gray:
Well, and that's a fair statement. I don't know the traditional so…
Mark Graban:
Yeah, yeah, I know “it could be worse” is not the most reassuring thing to ever say, but it's been a…
Jarvis Gray:
Really fun process though. This was just a goal career-wise and my contribution to the industry. But it's been a lot of fun. I've got three more book ideas that I'm starting to organize around, so I think this has inspired something new for me because I'm an engineer.
Jarvis Gray:
I never brag about being creative or anything, and this pushed the creative limits, and it was a lot of fun.
Mark Graban:
Yeah, well, congratulations on that milestone. It's a great predictor that, yes, there are future books. You know, there are some authors that say, “One and done. Oh, it was so hard. It's not me, but I did it and I'm proud.” And then there's others, like, “Yeah, I kind of tapped into something there. I'm going to do more.” So like, you know, there's probably a lot of people who do one and then… Actually, I bet people who do two end up doing three or four. It's probably kind of a split distribution there. But I wanted to dig into, you know, this idea of excellence and world-class results in healthcare. I know you write a lot in the book as engineers, and being involved in Lean or Lean Six Sigma, being data-driven is like second nature. We can't help it. How do you define those terms in healthcare?
Mark Graban:
In a way that is data-driven and not just an opinion. It's one thing–hospitals can put up a billboard that states an opinion, that “we are world-class.” But what does that mean to you? How would we measure that and determine that?
Jarvis Gray:
Yeah, so I would say specifically in the book, I actually have a chapter dedicated to data and leveraging data to achieve excellence. And the tools that I'm promoting in that chapter of the book are around data catalogs and data dashboards. So, you know, as healthcare business leaders, whether you are an executive or a department manager, right? You should have–and I say “should” because this is what I would propose and promote for all leaders–you should have a firm understanding of all the key data within your respective areas of leadership. You should know where that data is coming from. You should know how that data is defined. You should know how dirty the data is and what manipulations may be needed to clean it up and make it usable.
Jarvis Gray:
That's what I'm promoting from that side. There's nothing I'll say “special” about dashboards. We all know some elements of dashboarding, but what I really wanted to call out there was really the data cataloging piece or data dictionaries, which I've been at a lot of different organizations. It's questionable about how in-tune leaders are with the data. And then, again, as the data goes from the lowest level of the department or the organization to the boardroom…
Jarvis Gray:
Right. Do the board leaders know where the data is and how trustworthy it is? Do the executives? So that, to me, is how we start to really wrap our head around data excellence in healthcare. And I'm sure, Mark, a lot of these things will apply to other business models, not just healthcare.
Jarvis Gray:
Because again, when I spent time–and I still do small business coaching as well–but I've coached businesses across the board. One of my clients had a dog walking company, so we're still talking about the same things. Okay, so now it's lead generation, it's the different tasks that she has with the dogs. But in healthcare, where the data is a life…
Jarvis Gray:
Right. We need to understand what all these things really connect into. So yeah, that's where I'm going from a data perspective and leveraging data appropriately. It's not just using the data. I've developed all kinds of reports both in my business and in my corporate life, and just the process to go through it, having those formally documented, understanding there's still a lot of opportunities. But I did want to publish again and just make those points very well stated and hopefully challenge thoughts. And I welcome the challenges too. I've had a couple of folks be like, “Jarvis, this is good, but here's some more thoughts.” I'm already working on some revisions. But the premise is, do you know where your data is coming from? Do you know how it's created?
Jarvis Gray:
Can you tap into the sources and really justify what we're doing?
Mark Graban:
Yeah, and I think there are huge opportunities in healthcare to embrace a culture of safety–the culture of measurable safety. You know, going from being, you know, data-driven, safety excellence as opposed to hopes or opinions. You know, I think it's difficult. Like, I think even as an occasional–thankfully, just an occasional healthcare consumer, myself as a patient, you know, trying to find data on safety or quality. You know, I just turned 51.
Mark Graban:
I did another colonoscopy recently, and I chose basically off of location. That was the data that I looked at, asking Google Maps, “Who's relatively convenient and who was in my insurance plan?” Now, you know, I wasn't thinking of that as the highest of high-risk procedures, but I made that decision. It's not like Google showed me, you know, infection rates or complication rates or quality survey data, you know. Within the Google search, I get more information about the quality of a restaurant looking for a place to eat, you know?
Jarvis Gray:
Right. Well, and it's interesting, you know, it's the things you think about, like after you've taken months to write a book. A story that I wish I'd told in the book as it relates to data. I was working on a project with a team around reducing surgical site infections. And one of the…
Jarvis Gray:
One of the precursors to this outcome is whether or not antibiotics are given timely before the case is done. And for this… and real-life stories, real-life examples. But for this one, one of the chiefs of surgery was, you know, just completely in the know, “Jarvis, we don't have a problem. We always give, you know, antibiotics before our case. For the last 10 years…” And he pulled out his graph.
Jarvis Gray:
“For the last 10 years, we've been 99% every month.” I said, “Sir, that is a problem. Statistically, we're already like, we're just talking about statistics. That is impossible. You're 99% every single…”
Mark Graban:
Exactly 99 for the last 10 years.
Jarvis Gray:
Right. So, “Not a problem, sir? Let's go to the Gemba. Let's go do some observations.” And Mark, we spent a full couple of hours, like four or five hours in the OR. Every touchpoint of the process where the antibiotics should have been given was a fail, fail, fail, fail, fail. And this gentleman, he came out and he was just like, “I'm so glad we did that. I see that something's wrong, something…”
Jarvis Gray:
You know, now again, it's the source. How's the data being documented? What's really coming through? But those are the things that we just have to be a lot more in tune with. Like, first of all, your data is 99% for 10 years in a row, and you're not asking questions. So I just want to challenge those.
Jarvis Gray:
But after I thought about it, when I
got the final copy of the book, I was like, “Oh man, you just think of more stories, and I'll figure out how to slip those stories in later.”
Mark Graban:
Well, and that leader… Well, to that leader's credit, when you pushed back, they didn't end the conversation.
Jarvis Gray:
Correct.
Mark Graban:
Right. Because some people would react in some sort of… “Who are you to challenge me?”
Jarvis Gray:
We…
Mark Graban:
“I told you, we don't have a problem.”
Jarvis Gray:
Yeah, no, and to your point, when we went and we saw the fails, when I say, it was like, “Jarvis, what do you need to fix this problem?” And we did an amazing job on that work. I mean, it was a really good project afterward.
Jarvis Gray:
But the process to get there… Right, yeah.
Mark Graban:
So one other thing that stood out in the book–normally, there's a lot of talk about, as the subtitle of your book emphasizes, people, priorities, and processes. One of the things that jumped out fairly early in the book was what you call the healthcare excellence business model. So framing things at that high of a level really kind of piqued my interest. Tell us about that.
Jarvis Gray:
Yeah, again, that was my inspiration coming from like a Baldrige excellence model, so to speak. And I'm kind of geeking out–I saw Baldrige just updated some of their models. That was my inspiration to kind of put my stamp on it. But from a people perspective, you're going to find elements of leadership focus.
Jarvis Gray:
So strategically, how do we do strategy as leaders, how are we connecting with our customers, and then how are we developing our people? Because if the people don't get it, even if the leaders are doing all the leadership things, there's still going to be a disconnect. So it's the people, the priorities, and the processes. I have a whole section around process documentation and, and how are we compliant with the processes? Right? We have policies and procedures, but we don't have documented processes a lot of time in healthcare.
Jarvis Gray:
So how are we really connecting the dots? So that's the inspiration, and I'm going to continue hopefully refining it. I don't know if it'll hit as hard as Baldrige, but it really is a good model, and again, I've tested it with a couple of clients, and they love it. The responses and the feedback to help them simplify how they are focused on their day-to-day operations within their healthcare organizations has been really positive.
Mark Graban:
Yeah, I think it's interesting to think through for which healthcare organizations safety or quality can be a competitive advantage, let alone a business model. One organization that comes to mind–I never had the chance to visit, but I did interview their now-retired CEO–is the Hospital for Special Surgery in New York City. Orthopedic focus. People are willing and able to travel there, you know, for procedures. And that really did sound like their approach to excellence was very much a business model in terms of attracting patients. Not just, “Hey, who's closest?” but people who are looking for an answer to the question of “Who's best?”
Mark Graban:
You know, they've gone a very long time without certain types of post-op infections, and it's not a matter of luck; it's a matter of, probably, you know, thinking back to people, priorities, and processes, and a business model around retaining staff. Not constantly battling the revolving door of people leaving because they're frustrated or not feeling aligned with the organization, so they choose to leave. And then we hire new people, and there's the hiring and the ramp-up costs, and then we're short-staffed, and that leads to more frustration, and then maybe more people leave. There's something to be said for not just the stability of your processes, but the stability of your people as being, you know, a potential business model in healthcare.
Jarvis Gray:
Well, I think another risk to that same example is, you know, if you are the staff member who's leaving Hospital A because of those frustrations, but then you get to Hospital B, and it's the same frustrations, and then you bounce to Hospital C, and it's the same frustrations. And then you say, “You know what? I'm done with healthcare, and now I'm going to go sell phones at T-Mobile.” Right? That's what we're also seeing is that a lot of folks are just leaving healthcare altogether because of their mix of frustrations. So, you know, that's the call to action for a lot of, you know, the healthcare leaders I work with. We have to focus on the business of healthcare, which is all around, you know, making sure we're doing everything to keep staff.
Jarvis Gray:
Oh, another inspiration, Mark, behind this was last summer I took my wife and I–we took our kids to Walt Disney World. And while we were the crazy parents, you know, getting there right as the gates were opening that morning, I'm standing behind a bunch of grown adults with tattoos of all these Disney characters on their body. And it stood out to me. I was like, “What would it take for a hospital or any healthcare organization to be so good that patients tattoo the logos on their body?” I think that's a worthy challenge.
Mark Graban:
Yeah, thank you for saving my life, or thank you for consistently great experiences.
Jarvis Gray:
Yeah, I mean, that, that was, I was like, “Hold on. These people have, you know, Beauty and the Beast tattooed on their body.” But that's, that's the challenge for healthcare leaders. What would it take for your patients in your community to get a tattoo? At least a bumper sticker, if nothing else.
Mark Graban:
Right.
Jarvis Gray:
You know, maybe wearing a T-shirt.
Mark Graban:
Yeah, yeah.
Jarvis Gray:
You know, those are the things that really kind of got my brain working. I was like, “You know, let's create something and just put it out there and see how people react to it.”
Mark Graban:
Yeah, well, I want to say hi to a couple of people who have joined the live chat. We've got John from Ireland–again, a very global audience. So we've got the EU with us now today. So if there's anyone from North America, feel free, say hi, let us know where you're from.
Mark Graban:
There's a comment here from Claudia. She says she's a gynecologist and almost 10 years ago started in healthcare administration and is now very interested in Lean, learning a lot from the engineers. So thank you for that, Claudia. And, you know, I want to hear your thoughts, Jarvis. I'm sure you're like me in terms of being able to learn a lot from the doctors and the other healthcare professionals that we're partnering with.
Mark Graban:
What are some of the key things that you've learned from healthcare professionals that have helped you as an engineer?
Jarvis Gray:
Yeah, so my very first project when I came into healthcare–again, being at Duke University Health System–I was dropped into emergency services, and it was going to be, you know, your classic “improve the ER” type of thing. And Mark, I came in, I was like, “All right, guys, this is what we're going to do. And you over here, and you do this.” And I just came in brand new, and the senior nurse on the team was literally, she was like, “Hey, new guy, sit down.” And I sat down.
Jarvis Gray:
I was like, “Okay, now what, are we ready?” And she took over the meeting, and she led the project. And that was, you know, right there on the spot, I realized I wasn't in electric utilities anymore. There's a culture here that I need to understand and respect.
Jarvis Gray:
So I spent a lot of time from that point on, Mark, really spending time, like getting out of the suit and tie and going to spend time in scrubs with these care teams and the doctors and the nurses. So, I mean, literally everything I know about healthcare is because I smartened up pretty quickly to learn from all of my care partners. And every group is different. I spent a lot of time in emergency services, but the culture in that department is totally different from the culture of a surgery department, for example. So, you know, for any of my…
Jarvis Gray:
Anyone, you know, checking out the conversation today, if you are in healthcare considering, just know that, you know, you really got to spend the time. But the only reason that I'm as intelligent as I am right now is only because I learned from a lot of really good teachers who were completely open to teaching me. Because Lord knows I came in the very first meeting, and I thought I knew my stuff. I'm solid in process improvement, but healthcare… it was an uphill thing to learn, and it changes every day.
Jarvis Gray:
So even today, I still kind of take the same approach.
Mark Graban:
Well, and to your credit, you were open to the feedback, and, you know, if there was a mistake of trying to dive in a little too hard or too–being too directive–at least you listened to that pushback. And, you know, as they say, feedback is a gift. I'm sipping water out of my My Favorite Mistake coffee mug here.
Mark Graban:
Different podcast, but, I mean, it's the PDSA cycles of life. You know, if you made a mistake in that moment, you were able to correct and learn from it.
Jarvis Gray:
Yeah, no, well, thank you for that acknowledgment. That's the only thing I can attribute. I know when to shut up and listen, and that was definitely the right moment. But that's the cool thing with healthcare too, is that the majority of the industry, it's loaded with great teachers. You know, that's how a lot of these leaders learn.
Jarvis Gray:
They precept each other, and they teach. And so, yeah, I just follow suit, and it has been
very rewarding. I've built great relationships.
Mark Graban:
So, yeah, I want to say hi. We've got people who've joined. We have the U.S. represented now, Charleston, South Carolina, and San Francisco. So welcome to the live stream. And if any of you have questions for Jarvis, feel free to put those in the chat, and we'll try to work those in.
Mark Graban:
I was wondering if you had, you know, speaking of stories or that you like to tell, or examples, like aligning people, priorities, and processes. Do you have an example where a couple of those were misaligned and then improvements were made that brought those three things into alignment? What did that lead to?
Jarvis Gray:
Yeah, misaligned. So the funny stories… I feel like I might be on the wrong podcast. I might need to be on My Favorite Mistake conversation.
Mark Graban:
We can do that someday too.
Jarvis Gray:
One of my quick learnings, again–and this did kind of factor into my thoughts while writing the book–I was working on a project and completely left out a key department as part of the process we were working through, which was our finance department. So how we were charging patients as they were registered into the department.
Jarvis Gray:
And so we implemented a project to reduce some of our length of stay. Again, this was another ER project–they followed me throughout my entire career. We introduced a process and had about a 45% improvement or reduction in length of stay in the first three days with the new processes we put in. And it was immediate.
Jarvis Gray:
Like, me and the team, we're cheering, we're celebrating. So two interesting things came out of that. Engineer mindset–I won, I defeated a process, we achieved the goals. We exceeded the goals from an operation standpoint, but we left out a key department. So when that department leader came to me, it was like, “Jarvis, there's something weird going on in the department, and we're missing people, and we're down $50,000 this week.” I was like, “Time out. That wasn't my goal.”
Jarvis Gray:
So we had to reconstruct the process that we had put into place to account for their work, which it slowed us down a little bit. Not much, but it was an easy fix. But, I mean, not having all the right players in the room and not really vetting out the entire process.
Jarvis Gray:
But then we started getting feedback from patients that the process was too fast for them. So we were moving people through the department so fast that they felt like it was very impersonal.
Jarvis Gray:
They… someone said they felt like cattle being herded through the farm or something. I mean, we started getting that. And, of course, this is the engineer talking. I was like, “I don't care; you got through my department faster.” But the healthcare administrator in me was like, “Oh my God, our efficiencies are now making people mad.”
Jarvis Gray:
So that was a conflict that I had to battle. We did what we set out to do, but we still had to meet the needs of the people and the patients. So that was an interesting discussion, but we literally had to, again, kind of peel back the process and add a little bit more time for the interpersonal relationships in that area of healthcare. But, again, it was just not having the full picture in mind or just seeing the needs of the process, but not the customers and the people going through the process. So, yeah, it was an interesting thing, and that one still sticks with me when I'm starting up projects. I'm like, “Okay, I want to make sure I balance this the right way on the front end.”
Mark Graban:
Yeah, well, but again, I mean, I hear the PDSA cycles, you know, you planned, you did, and you studied and realized, okay, well, it helped in some ways, but now it's created some other issues, and let's adjust accordingly. Instead of dismissing, you know, being open to the feedback and being willing to adjust is such a great habit to have. It's good to hear those stories. Those aren't failures; that's adjusting to win.
Jarvis Gray:
Absolutely. Well, you know, but it's… I think the struggle, though, is the engineer in me was like, “You better not touch my process.” Because we want optimized processes, and this was kind of going down that path. So yeah, I mean, to your point, it was great learning, but we were literally making the process slower. So that was just a really good learning for me as a young engineer in healthcare. And like I said, all these years later, that still sticks out to me.
Jarvis Gray:
Another really quick story is for a lot of the rapid improvement events that I facilitate, or when I'm teaching rapid improvement events, I keep a picture of my grandmother in my wallet. And so when we start to get to our solution conversations in our rapid improvement events, I'll take the picture of my grandmother out, and I'll put it on the board. And I say, “At this point, it's time to start coming out with solutions to the things we identified, and that's the person that you're figuring out these solutions for.” So it's not about what process is going to work best for you or the doctors or whoever in the process. It's about my grandma. And I take it personally now because that's my grandma. So those are different ways that I try to make sure we connect into the right focus with the work we do.
Mark Graban:
Yeah, that's powerful. I don't know if you found an organization that was open to having an actual patient or community member in the room, realizing it's the voice of a patient, but at least to represent a human being with all their feelings and perceptions and needs, as opposed to talking about the customer or the patient as a sort of broad, amorphous entity.
Jarvis Gray:
Yeah, I would say it's kind of a hit or miss. Some of my clients are always open to it, so I always recommend it. And some of my clients are more open than others, for various reasons. It kind of depends on the focus. But it is, I think, a best practice.
Mark Graban:
Right.
Jarvis Gray:
If we could have the customer in the room with us. Now, I will say, for all of our process improvement folks online with us, if you do bring customers or clients into your improvement events, be prepared to coach them up as well. They're not allowed to just come and hang out and be belligerent and say what they want to say. That's what I've also learned from that process: we have to educate our customers, our clients, and our community on what real life in this facility looks like. So when we bring you in now, you can give us really good insights that are realistic. But that came because I actually had a customer on a project who was just… she came in ready to fire off on everybody and share her thoughts, and so we had to remove her. That's the balance to the customer focus.
Mark Graban:
Yeah, you made me think of… maybe it's a matter of how you vet and prep people. If they need to vent, is there another channel for them to get that off their chest so they can be constructive and professional in the event? I've seen where passion lines up with people's needs and experiences. I remember one improvement project where we had a surgeon get really impatient and frustrated in the early problem definition phase, saying, “This is a waste of my time. I know the answers; if you would just listen to me, we'd get this stuff fixed,” and basically stomped out.
Mark Graban:
And there was an opposite situation instead of trying to remove someone, it was about trying to find a way to draw them back in. Their input was valuable, and if they didn't want to be there, we couldn't force them to. But we tried to repair some of that relationship and say, “Look, we do want to listen to you, but we've got to follow a methodology here.” And I think it took some time, but it was like, “Okay, I'll come back tomorrow and get plugged back in.”
Jarvis Gray:
Yeah, well, I have been fortunate to coach coaches throughout some of my work, Mark. One thing I teach my coaches when I'm teaching them how to facilitate events or projects is to still be authentic with their personal selves. The story that I tell is I had a medical director on a project I worked on who started in a similar way–like, “Listen, just let me tell you, I'm going to do this…” and was completely unhinged. And I looked at him, and I said, “Sir, are you always an a-hole, or did you just wake up like this this morning? Is this a now thing or an always thing?” But that's my personality.
Jarvis Gray:
I'm going to respect you as a person, and we're going to treat each other respectfully, but I'm going to call you out when you go the other way. That was the best partnership that I've ever had on a project. Like, for him to be called out–he's the medical director; nobody ever calls him out. And I was just like, “No, sir. Are you always an a-hole, or is this just today? I just want to know because…”
Mark Graban:
Are you one or are you acting like one right now?
Jarvis Gray:
Right, exactly. And so, I want to say that to all our facilitators: be yourself. If you have certain principles that you lead with, lead with them. I will ask you to leave my meetings and remove yourself, but I'm going to give you a chance first. In that moment, it worked out really well. He caught himself, and he was a great leader from that point on. Challenge the leaders. This isn't about titles; we're here to improve processes for the hospital and for the patients. This isn't about you.
Mark Graban:
It sounds like you went through the classic forming, storming, norming, and performing. There are norms about how we're going to behave and how we're going to treat each other. I'm always torn because I'm empathetic to whether it's a surgeon who stomped out and said, “No, if people would just listen to me…” He was probably not being listened to; he had good ideas. Now, he may have been leaping to a solution, and there was a need for other input or some testing or iteration. The root of the frustration is often very real, and understanding that can go a long way. They may come back from that stomping-off moment and say, “Hey, let's try this again.”
Jarvis Gray:
Yeah, absolutely.
Mark Graban:
Well, before we wrap up here, and again, to recap, we've been joined today by Jarvis Gray. So you have minor mistakes. I don't know why I almost said Green! Jarvis Gray, the managing director of the Quality Coaching Company, his book is Mastering Healthcare Excellence, and his podcast is Excellence in Healthcare. As we wrap up, since we probably have a lot of consultants or coaches watching or listening, I'd love to come back maybe for a final thought about the small business coaching that you've done. What are some key lessons that have come back to yourself as a small business? Improvements that you've made to the quality of your work and your services? We're all too small to apply for a Deming Prize or the Baldrige Award, but I hear your commitment to learning and improving.
Jarvis Gray:
Yeah. So, one, get a coach. I did invest in getting a business coach who inspired me in a lot of ways to clean up my processes. These are things that, as I worked on myself and my business, I could translate over into the work I'm doing with clients. Here's where I'm at now, business-wise: a good
business is boring because I have SOPs driving a lot of things, and daily disciplines drive a lot of my actions. Boring is good; boring is profitable. I teach all the business owners I work with–and even my healthcare clients when I get into these conversations–it's not about the revenue. Business-wise, are we earning a profit? Because, at the end of the day, it's the profit that allows us to stay open so we can have an impact in the work that we do. I have a standard cycle of 90-day sprints that I run in my business to strategically stay on top of things. Again, I'm very much driven by process and disciplines to manage my business.
Jarvis Gray:
Right before we jumped on the call, I was telling Mark that I was doing some work with a local chamber. But having those processes set up allows me to do other stuff and collaborate differently because I know I still have the right operations running in my business. But it's not about me; it's about our clients we support. Do our clients have standard operating procedures? Do they have daily disciplines that they're managing their work with? And are they constantly focused on things working to produce excellence, the optimal results for their patients, communities, visitors, and so forth? Everything that I try to practice, I try to preach, and vice versa. I'm constantly trying to take in new things that I can apply to myself, my business, and my clients. It's come full circle at this point.
Jarvis Gray:
And I wish it was almost a requirement; every leader should try to at least start a business. There should be like a two-year “go start a business and figure it out” challenge, because you're going to grow personally through that entire experience. I try to bring all that to the table when I'm working with clients now.
Mark Graban:
Well, it's a great thought to end on. Jarvis, thank you for being a guest on the podcast. Thanks for suggesting turning this into a live stream, and thank you to everybody from around the world who attended. Hope we can do this again sometime.
Mark Graban:
Maybe we'll get you on My Favorite Mistake. It'd be great to have another conversation.
Jarvis Gray:
Yeah, I was going to say, clearly I've got a bunch to talk about. But, Mark, I appreciate what you're doing, I appreciate your audience for hanging out, and whatever I can do to continue to support you. I want to say this for your audience's sake, too: reading your books very early in my healthcare career helped also motivate me in everything I'm doing. So, Mark, thank you, and I just want to give a big shout-out to you.
Mark Graban:
Well, thank you. I appreciate that. Take care.
Jarvis Gray:
Take care, everybody.
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