A webinar by Mark Graban - July 27, 2017 Amongst other topics: In this webinar, you'll learn: Where your best ideas for improvement come from Why bottom-up improvement is a critical component of an improvement culture The ROI of engaging everyone in improvement How to engage more staff in improvement How to keep up with all of those new ideas

1. Strength in Numbers:
Improving from the Bottom-Up
Mark Graban
VP of Improvement & Innovation Services
Mark@KaiNexus.com
@MarkGraban
Greg Jacobson, MD
CEO and Co-Founder
Greg@KaiNexus.com
@GregHJacobson

2. Webinar Logistics
• Presentation (45 minutes)
• Q&A (10 minutes)
– Use the GoToWebinar
Meeting Panel to
submit a question at
any time
• Recording link & slides will be sent via email
– Also – see the “Handouts” feature and Chat box

3. Two Key Questions
1. How do we get front line employees to
participate in bottom-up improvement?
2. How do we get executives to sponsor and
support the idea of bottom-up improvement?

4. Bottom Up

7. From "Top" to "Bottom"
CEO
VPs
Middle Management
Supervisors
Front Line Employees

8. Turn That Frown Upside Down
CEO
VPs
Middle Management
Supervisors
Front Line Employees
Customers

9. "Command and Control"

10. A Problem Solving Problem
0
25
50
75
100
Patient Satisfaction

11. BOTTOM UP
IMPROVEMENT IS
POWERFUL

12. The Idea-Driven Organization

13. The Idea-Driven Organization
750,000 per project
200,000 per project
4,650 per idea

14. The 80/20 Principle
• “Coca-Cola improvement data reflect what we have
come to call the 80/20 Principle of Improvement:
• roughly 80 percent of an organization’s performance
improvement potential lies in front-line ideas, and
• only 20 percent in management-driven initiatives.”
– The Idea-Driven Organization

15. Consistent Findings
• "We started collecting data whenever we came
across it, and over the years have found it to be
surprisingly consistent. Across organizations in
services, manufacturing, health care, and
government, 80 percent of an organization’s
improvement potential lies in front-line ideas."
– The Idea-Driven Organization

16. THIS BEING
FACTUALLY CORRECT
DOESN'T LEAD TO
EASY ACCEPTANCE

17. ThedaCare's Evolution
• Early days:
– Focus on Rapid Improvement Events
• More recent years:
The Idea-Driven Organization

18. WHY DON'T WE
HAVE MORE
BOTTOM-UP
IMPROVEMENT?

20. Don’t Blame Employees
“Many companies assume
that the failure of the
suggestion box approach is
with employees that don’t
care, but if we dig a little
deeper we find it is the
system itself that squashed
enthusiasm.” Bruce Hamilton
GBMP
(Mark)

21. "I don't care what
employees think"

22. BUT WE NEED
TO IMPROVE

23. "I'm going to
TELL them to
participate in
improvement."

24. The Definition of Irony

25. The Definition of Irony

26. WHY?

27. "The Righting Reflex"
• "… the desire to fix
what seems wrong with
people and to set them
promptly on a better
course, relying in
particular on directing."

28. How Does This Work?
• The "helper" thinks they must
– "confront the person with reality,
– provide the solution, and
– when you meet resistance turn up the
volume."
• "People tend to feel bad in
response to the righting reflex,
and causing people to feel bad
doesn’t help them to change."

29. Telling Them Hurts The Cause
"a 'telling' or more directive style
is likely to elicit arguments against
change, which translate into a
decreased likelihood for change."
Wilcox, Jason; Kersh, Brian; Jenkins, Elizabeth. Motivational
Interviewing for Leadership: MI-LEAD (p. 36). Gray Beach Publishing.
Kindle Edition.

30. WHY?

31. Source: Ron Oslin & Larry Anderson http://onesystemonevoice.com/
"Belief to Results" Model

32. "OK, I know I need
to change my
leadership style,
but…"

33. AMBIVALENCE

34. "Change Talk"
"OK, I know I need
to change my
leadership style,
but…"

35. "Sustain Talk"
"… I'm afraid that
staff will walk all
over us as
leaders."

36. AMBIVALENCE
ACTION

37. YOU CAN'T
TELL PEOPLE
TO CHANGE

38. DON'T BLAME
THEM FOR NOT
CHANGING

39. "CHANGE TALK" IS
THE BEST
PREDICTOR OF
CHANGE

40. WHY DO LEADERS
PERSIST WITH A
TOP-DOWN
APPROACH?

41. Source: Ron Oslin & Larry Anderson http://onesystemonevoice.com/
"Belief to Results" Model

42. Based upon material from Ron Oslin & Larry Anderson http://onesystemonevoice.com/
Poor results
Lack of
engagement
Ordered
carpet for the
units
Generally
doesn't visit
the units
Doesn't ask
for input
Staff don't
have ideas
They're too
busy to
participate
I'm smart,
successful,
and have great
ideas.
I get stuff
done

43. "Beyond Emancipation"
• "I spent eight years
telling foster kids
what to do… and it
was exhausting."
2017 Lean Coaching Summit
http://beyondemancipation.org/

44. "Beyond Emancipation"
• “We believe that
the person closest
to the problem is
closest to the
solution."
2017 Lean Coaching Summithttp://beyondemancipation.org/

45. John Toussaint, MD
Source: John Toussaint, MD, Management on the Mend

46. John Toussaint, MD
Source: John Toussaint, MD, Management on the Mend

47. John Toussaint, MD
Source: John Toussaint, MD, Management on the Mend
• "The idea might be difficult for some
to accept, but in humility there is
great freedom.
• We can stop pretending to know everything.
• We can walk through our hospitals without
offering lectures."

48. Why don't senior
leaders change
their behaviors?

49. WE CAN'T TELL
EXECUTIVES TO
CHANGE, EITHER

50. Source: Ron Oslin & Larry Anderson http://onesystemonevoice.com/
Executives
aren't
actively
engaged in
Lean / CI
We're trying
to "train"
them on
Lean
Emphasis on
teaching,
telling,
lecturing,
judging
Executives have
other priorities
They don't care
about this stuff
They can't
change
I'm smart,
successful,
and have great
ideas.
I get stuff
done

51. Why don't staff
participate in
improvement?

52. Why don't they
accept MY
improvement?

53. Are we pushing
change or
creating pull
for change?

54. Why don't staff
CHOOSE TO
participate in
improvement?

55. Why do they
CHOOSE to not
participate?

56. We Have Resistors?

58. "People don’t resist change,
they resist being changed."
– Peter Scholtes (1938-2009)
We Have Resistors?

59. PEOPLE ARE
"RESISTANT TO
CHANGE?"

60. PEOPLE ARE
"RESISTANT TO
MY IDEA?"

61. "Their resistance to
change is directly
proportional to your
lack of leadership."
– Stephen Parry

64. "… human beings are hard-wired to prefer their
own ideas over those produced by others. A
recent research study (Feldstein Ewing,
Yezhuvath, Houck, & Filbey, 2014)…"
Wilcox, Jason; Kersh, Brian; Jenkins, Elizabeth. Motivational Interviewing for
Leadership: MI-LEAD (p. 27). Gray Beach Publishing. Kindle Edition.
"People own what they create"

65. Brains! (and fMRI)
"when the ideas came from
within the individual
considering change or were
self-generated, the part of the
brain that influences change
became more active. "
Wilcox, Jason; Kersh, Brian; Jenkins, Elizabeth. Motivational
Interviewing for Leadership: MI-LEAD (p. 28). Gray Beach
Publishing. Kindle Edition.

66. BOTTOM UP
IMPROVEMENT IS
POWERFUL

67. THIS BEING
FACTUALLY CORRECT
DOESN'T LEAD TO
EASY ACCEPTANCE

68. ROI of Improvement
(KaiNexus Customers)
https://www.kainexus.com/roi-of-continuous-improvement

69. It's Not Just ROI
• 54% of all improvements impact quality
• 13% of all improvements increase the safety of
staff and customers
• 54% of all improvements increase staff and
customer satisfaction

72. "167 patients have been switched within 3
months – resulted in 409 prescriptions and
$638,225 in revenue from April to June"

76. How Do We Engage People?

77. How to Handle a High Volume?
https://www.kainexus.com/webinars

78. From Telling to Evoking
• "You need to implement this"

80. From Telling to Evoking
• "You need to implement this"
• "You need to improve"

82. From Telling to Evoking
• "You need to implement this"
• "You need to improve"
• "You need to make your work easier"

84. What is Evoking?

85. What is Evoking?
"An evoking style elicits
information about the "what",
"why", "how", and "when"
from the individual instead of
imparting that information
onto that person."
Wilcox, Jason; Kersh, Brian; Jenkins, Elizabeth. Motivational Interviewing for
Leadership: MI-LEAD (p. 36). Gray Beach Publishing. Kindle Edition.

86. From Telling to Evoking
• "What do you think we could
implement?"
• "What possible improvements are
important to you?
• "Why is it important to you to improve?"

87. The "Spirit of MI"
1. Collaboration between the practitioner and the client
2. Evoking or drawing out the client‘s ideas about change
3. Emphasizing the autonomy of the client
4. Practicing compassion in the process
• "Your MI hat includes an approach that emphasizes
partnership, acceptance, compassion, and evocation."
https://ytp.uoregon.edu/content/spirit-motivational-interviewing

88. I ACCEPT YOUR
CHOICE TO NOT
ENCOURAGE
BOTTOM-UP
IMPROVEMENT

89. I ACCEPT YOUR
CHOICE TO NOT
PARTICIPATE IN
KAIZEN

90. Key Question #1
• On a scale of 0 to 10, how important is it right
now for you to change?
• Why do you say ____ instead of zero?

91. Key Question #2
• On a scale of 0 to 10, how confident are you that
you can make this change?
• Why do you say ____ instead of zero?

92. ARE WE
PUSHING CHANGE
OR
CREATING PULL
FOR CHANGE?

93. Book Recommendation
Forwarding link to book:
http://www.leanblog.org/MI-lead

94. Announcements
(Then Q&A)

95. Our Next Webinar – Aug 10
• Register at www.KaiNexus.com/webinars

96. Ask Us Anything!
• Mark Graban & Dr. Greg Jacobson
• Next Episode (#14) August 15, 1 pm ET
• Register & submit questions via
http://kainexus.com/webinars
• Past episodes available
on YouTube

97. Other Resources
www.KaiNexus.com

98. Podcasts
• www.KaiNexus.com/podcasts
• Subscribe via:
– iTunes
– Google Play
– Stitcher

99. Thanks!
• Web:
– www.kainexus.com
– blog.kainexus.com
• Webinars on Demand:
– www.kainexus.com/webinars
• Social Media:
– www.twitter.com/kainexus
– www.linkedin.com/company/kainexus
– www.facebook.com/kainexus
Mark Graban
Mark@KaiNexus.com
@MarkGraban
Greg Jacobson, MD
Greg@KaiNexus.com
@GregHJacobson