Mark: Today on PowerTips Unscripted, we talked to Liz Moisan, product innovation specialist at the Virginia mason Medical Center. Toyota pioneered lean manufacturing and I get it, houses aren’t cars. But then again, neither are people. And yet, Virginia mason Medical Center has applied lean since 2002. Liz is here to share how they’ve applied the lean principles to their industry, and share ways you can use the same principles in remodeling.

Victoria: Here just. Hi, I’m Victoria Downing and welcome to PowerTips Unscripted where we talk about tips, tactics and techniques to help you build a strong, profitable remodeling company. And I’m here with my co-host, Mark Harari.

Mark: You sure are.

Victoria: You know, this is awesome because, you know, I believe in learning from other industries.

Mark: All the time. The best stuff comes from outside of your industry. I mean.

Victoria: You can’t just see all all myopic and state all everything that has to be done within an. So we’re going to learn from a pro in another industry today, which is very exciting.

Mark: It’s super exciting. And you can get the best stuff out of looking outside of your own world.

Victoria: You know, in it. And in addition, we’re going to be talking about one of our hot topics, which Doug Howard, our director of consulting, is all over, which is lean.

Mark: Lean. Lean.

Victoria: Process.

Mark: A lean Toyota rocked it, right? Everybody’s picking up the ball and carrying it.

Victoria: And while we know that lean has been applied to manufacturing for many years, it’s now so much going through the service industry. So I’m very excited to talk to our guest today. Shall we start?

Mark: Let’s go for.

Victoria: It. All right, Liz Moisan. She is the wife of one of our roundtable members, Matt Moisan, which is awesome because he recommended that we speak to her. We’re very excited about that. She’s been, again, a practitioner of the Virginia mason production system vamps since 2008. She teaches, facilitates, and works to continually evolve how Kaizen, or lean, is applied in the health care setting.

Victoria: And so again, we’re excited to have you welcome, Liz.

Liz: Yeah. I’m excited to be here. Thanks.

Victoria: So you’ve had a lot of education in this area, right?

Liz: I have, very homegrown here at Virginia mason. And, that’s kind of initially what attracted me to Virginia mason is knowing that they had this culture of continuous improvement. And so I came here. Really? That was all I knew about it. And then I have learned from being here. Now, is your.

Victoria: Background in health care?

Liz: My background is not in health care. My background is in theater.

Mark: Wow.

Victoria: So that’s a stretch.

Mark: There you go.

Victoria: Yeah. So how did you make this transition?

Liz: I had often found myself in careers just doing management. And, when I knew someone that worked here and socially and often, we were talking about our work, and she talked about how Virginia mason had this culture of continuous improvement and how they were often empowered to make these changes. And it just very much intrigued me. And so in a position opened up here, I applied and I’ve been here since 2007.

Victoria: Now tell me, what is Virginia mason?

Liz: Virginia mason is, medical center in Seattle, Washington. We’re located downtown for our main hospital. We have clinics out in some of the suburb areas as well.

Victoria: So when we talk about you being a practitioner of the Virginia mason production system, what does that mean?

Liz: So what we have done here is we’ve taken the Toyota Production System, which is lean manufacturing. We’ve modified it to health care. And so we’ve done that over many years of evolving. We have senses that come over. Senses of your senses. Senses. So that’s the Japanese word for teacher. We work with a company called Changa jitsu. And so they have some folks that started out in Toyota and left Toyota to have their own consulting firm and still work very closely with Toyota.

Liz: So they come over and they they keep us on at certain things, push us, make sure that we’re staying true to the tools and also evolving for health care.

Victoria: So you’ve been there quite some time. So you’ve seen a lot of this evolution.

Liz: I have, I have, and that’s what my current position really focuses on. Evolution. So I’ve been I work in our Kaizen promotion office. So kaizen means, continuous improvement. And we partner with the operations, and we go into areas and we study processes, and we really work to decrease waste and to eliminate defects. One thing that we really resonate, I think, with us is that Toyota Production System focuses on empowering the worker.

Liz: It reduce the burden of work on the worker by reducing waste. And we’ve really looked at that as well. So how can we reduce the work of our frontline staff? Waste, walking defects, which are mistakes that go uncorrected. Right. And in the process, to support the person to do the best work.

Mark: The whole process, you don’t look at the entire elephant as they say, right? You find one specific little thing and say, okay, there it is. There’s a problem, and let’s fix that. Is that correct?

Liz: Correct. So we start with, studying and process by value stream mapping. So a lot of lean does this. It’s a methodology of do you decide what your start and end points are. So it could be anything is high level as from the time a patient checks in until the time that they leave for the day. And you could also just have your value stream beyond the checking process itself.

Liz: So we often describe it as are you looking at the forest, the trees, the leaf. Like how how close are you getting in to study. And your value stream map can reflect that. So your steps are either high level or you zero in nice and close. So in the case of remodeling you could look at, is it the time we’re doing client intake until the job wraps up?

Liz: Or maybe you’re looking at a particular just the estimation process.

Mark: Could you give one specific example of something you identified and then what you did to fix it?

Liz: Sure. So we do this a few ways. We have what we call daily kaizen, which can be there’s little small fixes often identified by frontline staff, where they can just say, hey, we’ve noticed a very recent one that just happened was a nurse was noticing we have these, units that stuck out medications, that nurses badge, and they take the medication they need, they scan it and they the machine walks again.

Liz: And the most highly used medications were actually being stocked in the bottom shelves. So there a lot of bending and twisting they were doing on a daily basis. So they worked with their pharmacy technician, ran some reports to see what the most highly used, most frequently used medications were on that floor. And they reorganized the cell so that the point of view was right here at waist level, eliminating not bending and twisting.

Liz: And it was so important because for nurses, they have a lot of back injuries. There’s so much they can do. So anything that we can do to keep our workers safe is very important. And that’s something that we’re going to be able to spread to different levels in the hospital.

Victoria: You know, I’ve I’ve heard that there are the eight different types of waste travel, movement, inventory and yada yada. Do you find that the wastes that you see tend to accumulate in one particular category, or is there one most popular kind of waste that you see?

Liz: I think the easiest one to see or to feel in healthcare is waiting.

Mark: I can attest to that.

Liz: Something from a patient perspective.

Mark: I’ve I’ve spent many times in an emergency room and I’m tired of waiting.

Liz: Exactly. So you’re waiting for that next service to happen? And so I think there’s often a waste will fall into a couple of different buckets. One of the first things we do in our classes is have people take, we’ve got a sheet and they go out and they look for wastes in their areas, and we have them identify seven different, areas that those wastes are happening.

Liz: So, really identify what is a waste of transportation that’s happening in your department or what is a waste of inventory when there’s too much of something. And we’ve done a lot of work in that too. So in exam rooms, really trying to understand how many, pieces of equipment or supplies do you use? If you have too much sitting there that’s going to expire?

Liz: And, all of those things go into why health care so expensive?

Mark: I love I love that you brought that up, because it seems to me that that’s that’s an inherent human fear, though. I don’t want to run out. So isn’t that like an issue? Because I’d rather have a little bit more and not have to run out, right?

Liz: And so I often think about lean. Sometimes lean gets a bad rap because people think lean is just not having very much of something, when really it’s having exactly the right amount when you need it and where you need it. And so you have to understand your demand is to know how many you go through. And, being able to replenish.

Liz: And if you think of the downside of that is if you have too much, if it’s squirreled away somewhere, the last thing you want to do is use an expired, supply on a patient, and that could that could harm someone. So it’s really working with our supply chain and our medical assistance and everybody to really understand how many syringes do go through in a day.

Victoria: But so is there a bad is it bad to have more? I mean, like for syringes, for example? Is that a bad thing?

Liz: Well, it’s not a good thing, for that reason of expiration dates. So especially with supplies and that’s also that’s money that could be invested into something else. Sometimes if you have too much in a drawer, you can’t close it and you’re going to jam it shut and things. Okay. So it’s all of those little things, but when that’s happening in 300 rooms, it adds up.

Liz: So really trying to understand what’s the right thing to have.

Victoria: Now, you mentioned something about when you’re training people, right. So how many levels of employees do you train and, and what are some of the most important things you do to train them?

Liz: This is one thing that I think makes Virginia mason unique. A lot of health care systems have, process improvement consultants or, a group or a department like we have. And the process improvement really lives with them. So Virginia mason is different because every single employee gets an introduction to the NDIS. So everybody has a baseline learning when they start so that they understand when we’re talking about waste.

Liz: That that has some kind of a context. And then all of our leaders supervisor all the way up through vice president, they have, what we call the MPs for leaders. So that’s usually about a year long. There’s several classes, and by the end they are trained and able to run what we call a kaizen event, the improvement workshop.

Liz: And the expectation is that at a minimum, they have one of those a year that they lead. The next level is advanced to the MPs. So that’s required for our higher level. So administrative director or vice presidents, it’s required for them to take, everyone in my department is required to take that. And then how people can apply and that’s deeper learning, deeper understanding at the culmination of your what we call certified.

Liz: And you’re able to lead our five day workshops.

Victoria: Okay. Wow.

Liz: And then we also have a fellowship and that’s a year and a half long. They choose a small number, usually six people. And those are people that want to continue to learn even more. And they have one project that they really do some intense learning and coaching on.

Mark: Liz, this is it. It’s like when you hear somebody that’s doing it and actively participating in it just kind of sounds like a forehead slap like, yep, sounds great. Obvious. But when you’re just starting out, you’ve never done it before. Where do you start? Because I’m hearing you and it sounds great. But then I turn around, look at my company and think, now what?

Liz: Know what? Good. So I would start by learning about the wastes. So and that’s something that you can Google. So you can Google. So Titan was really the founder of the Toyota Production System. And he had seven wastes that he started with. So we also talk often about going out in your own circle. So channel to Jono.

Liz: And that means look around and watch something with big eyes, big ears and little mouths. So it’s really hard for those of us that are leaders and managers or owners to don’t intervene. Just watch and just try to understand the process. And from that, engage. Engage your folks and engage the people that work for you. To try to understand what it’s like from their perspective.

Liz: What are the things that are their rocks in their shoes? So those little things that are can be annoyances, but every day they’re developing work arounds. And so what you’re doing is you’re partnering with them and empowering them to say, tell me what’s bothering you. Tell me what’s a rock in your shoe and start chipping away at those.

Liz: And that’s how you earn the buy in for any future bigger changes.

Victoria: Do you find that some employees have a difficult time moving away from the status quo? Yes. They just can’t see another way to do it. How do you how do you help them see?

Liz: So I think those people are the great ones to start with, to ask them what’s bothering them and be able to work with them for the solution. So moving away from that culture is you’re my manager, so you fix it and moving more towards, let’s fix it together. Often the people that are closest to the work best know how to fix the work.

Liz: So really partnering with them and usually they’ll see some, they’ll see some success. We have always had a history of there’s some people that have really resisted it, especially with the hierarchy of medicine in the past, I think there was a lot of, well, I’m the doctor, the surgeon, so I know the best way to run my O.R..

Liz: And that was a big culture shift that had to change. And, really led by our CEO and our president of saying we’re all on equal footing in improvement work. And so breaking down those walls and breaking down those barriers, I think, can start to create that culture of improvement.

Victoria:

Mark: Liz, earlier you mentioned the sensei that came in. So do you think it seems like. Well, yes, you can probably do this on your own, but do you think you should have a guide someone outside of your organization to help you out? Or should you try it on your own? How do you how do you feel about that?

Liz: I think that everyone can start it on their own. And then if you get to the end, some of it depends, I think, on how how big is your company? Do you think you get to the point that you’ve exceeded kind of your self learning and you need to get help? I really like the idea of RA, where you’re able to connect with, others in your industry and other people that are struggling.

Liz: And we always say no one should. Kaizen alone does.

Mark: Not.

Liz: It can be a tough thing to do on your own, and to stick to it, and to know how to try things from other areas. You know, it’s all about transparency and and pushing ourselves to improve. So, our vision here is to transform health care. And we really look at that as not just making Virginia mason better, but really transforming all of health care.

Liz: And so you have to do that by partnerships and sharing kaizen. And so I would see it in your industry having to do the same thing.

Victoria: So there’s a point to all this. Right? But we’re not doing this to just do it. We’re doing it for a reason. Increased productivity, more efficiency. So do you have any statistics that you can share with us about your organization? And maybe some of the changes, some of the improvements that have happened over the years?

Liz: We have done things and I don’t have exact numbers in front of me, but we have done a lot to reduce our length of stay in the hospital and so that is one that is something that cost will follow, but also it keeps patients safer. Or the longer you were in the hospital, the more it has risks of additional infections or injuries or falls.

Liz: So patients safer to get them home or into the facility that they need to be in. And then also, cost savings happen with that, dramatic improvements in a lot of our supply reductions. So when we actually learned good by this and figured out, what are the number of supplies that we needed to have and also working with our vendors.

Liz: So that’s something that Toyota did a lot to. They really pioneered saying we don’t need to get our shipments. When you say and in this push matter, we can pull and work with our vendors to make sure that they’re dropping off things in ways that we need. So a lot of time reduction. So both time in clinic and then time in the hospital, patient satisfaction has gone way up, as well as staff engagement and staff satisfaction.

Liz: If a lot of patients and sometimes it’s a little less tangible. But I was just doing some interviews of surgical patients, and a lot of them were saying like, something is different here. I see a lot of teamwork. I see how your process seems to click along. And so I think that’s also really satisfying when when your end user notices something’s different.

Victoria: Now, you mentioned five as we explain that.

Liz: Oh yes. Sorry. So there are five S’s and they are sort simplify standardized sweep and self-discipline. And so that is a way to organize a way to keep your workplace safe and organized is by this, I really knew that it was embedded when Matt came home one day and had mentioned something about needing to finesse the garage.

Liz: Nice to meet my husband. Happy.

Victoria: I really just.

Liz: Proves that a lot of these lean principles are things that we already know, and they already resonate with many of us, and this just gives us a common language and a way to identify it. So if you’re trying to get tools out of a workshop and it’s a mess, you’re wasting time. You’re most likely going to have damaged tools because they haven’t been taken care of.

Liz: So that’s something that we learned from the factory, and that’s something that can also, I think, be one of those baseline improvements. It gives you the foundation. And once you have that, you’re able to maybe move on to the next list.

Victoria: Do you have any books or any other resources that you might recommend? I mean, we have a great website that we’re starting to populate heavily in remodeling.com, but do you have any other books or resources that would help people really get started in this process?

Liz: I think you can start with the Toyota way. Okay, that’s a great one to start with. That explains Toyota’s history with it. And we also, if you’re interested in healthcare, there’s Transforming healthcare, which is Virginia Mason’s story. Nice. Yeah. So those are those are great ones to start with.

Mark: You mentioned the 55SI I’ve got a sixth s for you. Okay. So are you ready for the lightning round.

Victoria: Sorry.

Mark: Some of oh and now here’s the reminders. And these lightning round.

Victoria: It’s a draft.

Mark: That was a each okay. But hey that’s what I do okay. All right. Are you ready? I’m ready. All right, let’s do it. What’s your favorite business book and why?

Victoria: So my favorite business.

Liz: Book is actually Crucial conversation I.

Victoria: Love it.

Liz: They choose the why is it you can use this at work. You can use this at home. It focuses on when there’s strong emotions high stress and opposing opinions. And so I think we can all identify when that happens. And with change management that can happen a lot.

Mark: If you weren’t a product innovation specialist, what do you think you’d be doing?

Liz: I think that if I hadn’t started on this path and realized this whole thing existed, I would probably still be doing something with theater.

Mark: What are you not very good at?

Liz: I am not very good at hiding what I think. So everything I think passes across my face.

Mark: Your room, your desk or your car, which do you clean first?

Liz: So, using the principles of best, I make sure that my desk is what we call swept every every night.

Mark: If you had a theme song, what would it be?

Liz: Don’t stop believin, my journey just.

Mark: And if you had a time machine, would you go forwards or back?

Liz: I would have to go back. And I’d really have to see Shakespeare in action.

Victoria: Oh, wow. That’s cool. Hey, this has been wonderful. Liz, thank you so much for spending the time with us. I love learning from other industries. I think it just it’s just so cool to hear how other people are putting together the things that can work in our world.

Liz: Thank you. Me too. Thank you for having me. It’s a pleasure to be able to talk about this and share it.

Victoria: Now, before you go, though, yes, I want you to share with our listening audience your five words of wisdom and why they resonated with you.

Liz: Okay, so my five words are focus on relentlessly removing waste.

Victoria: Okay, I like that. Okay. So why is that?

Liz: I, I think that will lead you to the principles of Kaizen. I think if you focus on removing waste instead of focusing on cost reduction, you’re really going to find what matters to the people. And this is all about people.

Victoria: That’s great. Wonderful. Thank you so much, Liz. That was very profound. I liked it. So tell your husband, mayor, our roundtable member, then we thank him very much for recommending you. And thank you so much for being here.

Liz: I will thank you. It was my pleasure.

Mark: Thanks, Liz.

Victoria: I tell you, I have that book, The Toyota Way on my bookshelf. I’ve read it once, but it’s been quite sometime. I am picking it back up tonight and going to read it again.

Mark: It’s good stuff and it’s great to see how.

Victoria: You.

Mark: You know, I think it’s funny that she was going to be in theater. Why? And then she went into medicine. I don’t know, because I’ve experienced a lot of doctors and I think they’re all actors because they don’t know what the heck they’re doing. So now I’m starting to see a a common theme there.

Victoria: She was great. I mean, you could tell she was very passionate about it. Yeah. It’s not portable. So I wonder how she, you know, how long it took her to get from theater to being such an expert on this? And the other thing about bringing in a what a sensi like.

Mark: Wow. Sensei. Sensei, did you ever watch The Karate Kid?

Victoria: I did.

Mark: Sensei. Wow, that’s sensei. Sensei. But yes, bringing someone in to help out. And I think that’s very much the case. I mean, isn’t that with most things? Yes. You can start out on your own. You can give it a shot, but eventually you’re going to need someone to help you, guide you through it. I would definitely need a sensei to help guide me because of one thing she said.

Mark: Big eyes, big ears and little mouths.

Victoria: Yeah.

Mark: That does not work with me.

Victoria: So I think for you to strive towards.

Mark: Yeah, I tend to have a big mouth.

Victoria: Well, this is a good one, I like it, I like learning from outside the industry. We to get more people from other, other aspects of life to come in and share their stories with us.

Mark: Yes, it’s good stuff. I mean, this is probably a third or fourth episode on some aspect of lean. I think it was a great perspective. As always, we have lean remodeling to come, but, we need to keep filling that with resources because it’s far from complete. So this is a topic that I think will resonate with everyone out there.

Victoria: Yep.

Mark: We want to thank Liz very much for being here and sharing her insights on lean. And as always, we want to thank you for joining us week in and week out. I am Mark Harari.

Victoria: And I’m Victoria Downing. We’ll see you next time.