I was recently invited by our friends and partners at the Shingo Institute to present a webinar titled "Use Your Crisis Muscles to Accelerate Your Organizational Excellence Journey." Thanks to them for this opportunity.

In this blog post, you can view a recording of the webinar and you can also read a transcript of it that follows.





Mary Price: Welcome, everyone. Thank you so much for joining us today. My name is Mary Price. I'm the events and marketing manager at the Shingo Institute at Utah State University.

I'm so excited to have Ken Segel with us today. Ken has served in many different roles in his lifetime. Currently, he's the co-founder and managing partner of Value Capture. Value Capture is a Shingo licensed affiliate. They're certified to teach all of the Shingo workshops.

Their primary focus is health care. However, they have worked with clients in many other industries, as well.

I'm sure you'll see from Ken's presentation today that he's very passionate about helping healthcare organizations improve their systems so they can eliminate all risks to patients.

With that, Ken, I'll turn the time over to you.

Ken Segel: Thanks so much, Mary. It's great to be with everyone. I hope everyone had a wonderful Thanksgiving.

Safety First

We always start our meetings with a reminder of physical and psychological safety. As we return from, perhaps, gathering with family and friends from across the US.

Let's take a moment to consider how we might best protect those not in our immediate circle during the five to seven day window when an unwitting COVID exposure might convert from one of us.

I also want to acknowledge the psychological and physical safety burden of yet another COVID variant of significant concern.

The Inspiration for This Discussion

I'd like to begin my talk by noting the moment the idea for this podcast and webinar cemented for me. Toward the end of 2020, I was speaking with a senior vice president in a major health system.

He told me that for the fourth time in the pandemic, the middle managers were pushing like crazy to enter incident command mode, a very formal designation in health care with formalized structures. Their reasons went beyond coping with the current COVID wave.

"Tell me more," I said. "They know they can quickly escalate issues they need help solving, get answers and help back with 24 hours at the most," she said, "in great contrast to normal times.

"Not to mention in incident command mode their safety as employees and the safety of their patients now seem to be firmly at the top of the agenda. Not only for themselves, but for the health system's top leaders every day."

I realized I'd been seeing very similar examples everywhere right from the beginning. Places where the shock of COVID was forcing us to change dramatically how we operated. Changes that were, in some cases, very positive improvements to help bridge big, longstanding gaps in our cultures, systems, and performance.

Therefore, astute leaders realized that the crisis has revealed potential for greater levels of operational excellence in our organizations than existed before the pandemic. The trick is how to get there.

The challenges include the reality that crisis operations aren't sustainable indefinitely.

More than a year into the COVID crisis, most organizations are in a desperate search for ways to rebuild resilience for both leaders and teams.

How to proceed? Like a lot of things, the power starts by asking the right question. I think for leaders, the right starting question goes something like this.

How do we preserve not just the what, a few of the specific changes that have occurred by necessity, by consciously and explicitly learning the deeper lessons of why they worked or, in some cases, didn't work, and organize ourselves around those reasons in a relentless journey of improvement?

From that question, all is possible.

How Principles Guide Us

The Shingo guiding principles offer a powerful framework to help us do this. They can help us understand why elements of our crisis operations worked so powerfully for a period and how they can be successfully converted, embedded, and sustained into the work system, improvement system, and management system of the organization.

This hypothesis is backed by evidence, by the way. The underlying deep organizational research base of the Shingo Institute about why some organizations outperform others sustainably across time and the fact that the early data suggests that the organizations that were deeper along the take-up journey I will describe have performed better than their peers through the extended crisis.

Before we talk about how to do that, a bit of background.

What are the Shingo principles, if you're not familiar? For that matter, what is the definition of principle?

In the Shingo movement, we posit that leaders' fundamental role is to bring these principles to light in the culture of the organization. It's important to understand what they are.

Shingo defines a principle as:

"...the foundational rule that governs consequences, whether we want to believe in the principle or not."

That last part is really important.

Whether we want to believe in it or not, the principle is operating in the background. When our actions, which we call behaviors in the Shingo movement, align with it, good things happen. When our actions don't, bad things happen.

We say principles are timeless, universal. They apply everywhere, always, to everyone, and evident. That means they can be discovered, researched, proven.

Stephen R. Covey taught us that values govern our reactions but principles govern the consequences of our actions. A good analogy is gravity.

You do not have to believe in gravity for it to govern consequences.

Notwithstanding this little bit of office satire, if you jump from a height without protection you will fall and may be injured. If you instead to choose the stairs and hold the handrail as a way to get down because you're aware of gravity as an universal force, or don't attempt a back flip off your colleague's desk, you are more likely to be safe.

The Shingo guiding principles are the gravity of organizational performance.

They can explain at a fundamental level why certain aspects of crisis operations mode have answered deep, preexisting unmet needs and how we can create sustainable systems in our organizations based on those insights.

Shingo also offers leaders a powerful framework for thinking through how they do this, starting with their role in the core strategy of driving those principles into the organization via the organizational systems they oversee, anchored by their own behavior, of course.

We refer to this as the Shingo Diamond. I'll return to it as a bookend at the end of our few minutes together.

Specific Examples of Crisis Operations

Now, it's time to get more concrete with specific examples from the healthcare industry with which we're most familiar and do most of our work but not all, as Mary said.

To do so, I'm going to give an example of crisis operations, talk about the unmet need that it filled for the organization and its customers, and then tie it to a particular Shingo principle or a set rule, and explain how it can be applied to embed the right behaviors into the organization going forward sustainably.

The first example is one where the simple force of the pandemic produced a breakthrough for a wide variety of organizations, but there's a great risk of missing the deeper connection and therefore the profound potential benefit.

The second example is from a specific organization that was further into its operational excellence journey when the crisis hit. Their conscious use of the principles offers the rest of us something of a template for how we can successfully capture that same power into the future intentionally.

As I do this, know that in my article on the Shingo website there's both a bit more detailed explanation and a chart with examples illustrating this flow with the majority of the Shingo principles.

First Example

For my first example, in March 2020 as the first sudden Covid shutdowns were ordered, hospitals and health systems immediately set up command center or incident command structures anchored by a top tier daily or twice daily meeting right at the CEO, C suite level.

In those meetings, critical organizational priorities were determined and deployed. Learnings were shared amidst profound uncertainty in the interim. One of the first great urgencies they faced was how they could continue to see patients safely beyond those coming to them with COVID.

You may recall that most healthcare organizations had to immediately shut down all elective surgeries, a major source of revenue and profit margin and that patients pulled back on most primary care.

Standing up telehealth so that doctors and patients could interact over video and phone safely became an incredible priority. Most organizations who had dabbled and struggled in prior years to get telehealth going created and deployed fully capable platforms within one to two weeks and were amazed that they could do it that fast.

The government also cleared away payment barriers in the same time, also amazing.

Obviously, a major health and business case existential threat drove this breakthrough. Now, here's the important part. Once stood up at scale, amazing discoveries happen. It turns out that many patients and family members prefer telehealth visits, such as many frail elderly who now didn't have to struggle with transportation and exhaustion from long appointment waits.

Many physicians appreciated it, too, for creating more flexible work options Rapid studies showed that for many types of care, quality was not adversely affected.

In the case of expanded access to mental health care in particular segments and modalities, access and outcomes were improved.

Pre-COVID, before widespread telehealth, deep customer needs were there all along but were unmet. One of the Shingo principles governing here comes from the enterprise alignment dimension of the Shingo pyramid. Create value for the customer.

This principle dictates that this has to be an anchoring, constant drive of any organization which is to sustain itself, and certainly to be excellent. What was happening in health care prior to COVID?

The truth is that we in health care are not usually truly anchored to create value for customers.

We use the profound fact that we are engaged in the healing arts as enough value creation and don't push deeper into what patients value and need in their total experience systemically.

Looking past Covid, the key for leaders is not just to focus on the what, keep telehealth. A lesson to learn is that a fundamental role of leaders is to create and to focus organizations on the most important big dot goals, to create enterprise alignment rooted in create value for the customer.

Really, how could we have not been rooted more fundamentally here in the first place, and coach aggressive aligned actions to achieve them more rapidly than you ever thought you could.

That means that strategy development is not a yearly academic exercise that, in fact, leaves 300 organizational priorities limping along but, instead, a dynamic process providing relentless clarity about where the organization is going and the most important immediate targets to get there.

Ones that broadly make things better and teach a new way of thinking that spreads and makes lots more things better in a virtuous cycle.

Your crisis operations center should not go away. Transform it for this purpose, to, in part, anchor the whole organization moving in the same direction every day toward these relentlessly revealed and clearly defined big dot goals and, of course, tie it deeply to daily operations.

But remember, it's about more than preserving the right elements of your crisis system with tools. Let's reflect on this.

Good organizations tie linked management system huddles for each level of the organization to a visual management center and problem solving up and down the organization on a daily, weekly, and monthly cadence. Weaving everything together and focus strategy cascades and information flows.

Great organizations anchor these flows deeply and transparently to the Shingo principles like create value for the customer and the essential ideal behaviors required to bring them to life in the organization.

Second Example

Now for our second example. As I mentioned, because it comes from an organization that consciously sought to base its incident management operations mode and principles with explicit ideal behaviors to bring them to life, it offers us all a template for how we can make best use of our crisis muscles to capture future gains.

The Shingo principle, create constancy of purpose, also falls into the enterprise alignment category. Create constancy of purpose is explained as an unwavering understanding of why the organization exists, where it is going, and how it will get there enables people to align their actions, as well as to innovate, adapt, and take risks with greater confidence.

When a leader creates those powerful conditions for everyone in the organization, our hypothesis about principles governing consequences posits that good things will happen. If they don't, less positive outcomes for the organization will occur.

At one large health system, a chief safety officer and two peers, far ahead of others in the country, began preparing for the arrival of COVID, recognizing they would be dealing with both great fear and great uncertainty. Accordingly, they knew they had to establish key imperatives that would govern everyone, no matter what, when nothing seemed clear.

There were three. First, everyone, including every level of leader in the organization, medical and operational, formal and informal, has autonomy to take action as long as you follow the following two imperatives.

One, you may send a caregiver into harm's way. Zero harm to caregivers is the standard. Two, best care for every patient as long as it can be maintained. The health system alone will decide when care protocols must be changed.

Implicitly and tied to these imperatives was another. When you are at risk of not fulfilling one of these, get help. This strategy was geared amongst the profound fear at the time to keep people from freezing or fleeing and instead to focus together on the fight. It worked because everyone simultaneously had both agency to act, a key point, within guardrails from the behavioral imperatives.

This is one of the key powers of harnessing universal principles of excellence so explicitly. They simultaneously guide everyone in a complex organization in very positive aligned ways, while unleashing their freedom to act within those broad, powerful guidelines.

Those principle-based imperatives went to the top of the visual board and the top tier in the command center. Twice a day they'd be huddled and cascaded all the way down and back up rapidly across the organization.

Cascaded huddles and problem solving energized by these imperatives turbocharged the problem solving. More than 600 solutions and counting were delivered, tested, refined, and rerefined based on escalations from the front line.

This scientifically structured rapid problem solving to eliminate harm, guided by leaders who are very clear that they didn't have the answers but humbly would have to help their teams discover them by providing support and the systems to do so pulled in three other powerful Shingo principles. Lead with humility. Embrace scientific thinking. Seek perfection.

They really progressed the depth of their work on embrace scientific thinking, by the way.

Instead of solutions from on high which would be universally ignored or worked around, the front lines gradually got used to participating in rapid improvement cycles, starting with minimum viable products that, at the start of the crisis, by the way, drew comments like, "This solution stinks."

This health system'ssafety outcomes are far better than other health systems for patients and caregivers alike. They are much more stable than their peers today.

When Principles Aren't Followed

Now, for the negative consequences where the principles weren't followed. At health systems where safety had not been raised to the level of creating constancy of purpose for everyone in the organization before entering the crisis, more of a vicious cycle has taken hold,

Where leaders continue to act top-down or did not work to prevent all harm and scientific thinking was not embraced there is greater mistrust, more call-offs, more resignations and retirements, and less effective problem solving.

All of these compound pressures on remaining staff then lead to increased safety incidents and poorer outcomes.

Leading With Safety

Thinking post-COVID, what are the lessons that these interconnected principles guide us to? We at Value Capture believe there is no better way to organize the constancy of purpose that we all crave from our organizations than to lead with safety always, not just in a safety crisis.

Lead with safety not as a priority, but as a precondition.

Seeking perfection is the strongest foundation for your much more dynamic improvement in managing systems.

A focus on safety for team members and patients alike starts everyone's day with something that is unarguably most important and focuses on everyone on learning to be excellent at solving the problems that make a fundamental difference to us all scientifically.

Safety commitment lead by leaders built culture and belief in the organization, a belief many organizations desperately need to rebuild.

Also, remember the essential structure which occurred here and consider it could apply in your organization. They used principles to give both agency, freedom to act, and guardrails to everyone in the organization. The magic is this creates tremendous energy, and it's aligned energy.

To pull it off, it has to be crystal clear to folks what the principles that we will live by are and leaders have to continuously drive the evolution of their systems to support them transparently and continuously every day.

In your organizations, as we move from pandemic to endemic, what governing principles will you embrace? Remember they're operating in the background whether we acknowledge them or not, supported by what crucial systems?

Obviously this starts with a deep reflection cycle in our organizations from CEO to the front line. At the deepest level, what have we learned about who we were, who we are, and who we want to be? How will we work every day to get there?

While these conversations should not and can't wait, to do this effectively leaders need to learn the principles themselves, then learn how to build systems which embed them in connected ways across the organization. Then, you need to practice, get in the habit of applying, and build your skills to do so.

A key Shingo framework, which I mentioned, to help leaders recognize and define their role -- it's been quite transformative in my coaching experience -- has been the Shingo Diamond.

The leader's key role is drive principles into the organization, guiding principles at the top, via ideal behaviors derived from the principles which, taken together, create the culture of the organization right at the heart of the diamond.

It's those ideal behaviors that directly create the outcomes we seek. Those behaviors are what drive the outcomes.

Leaders drive this virtuous cycle via overseeing the construction and the operation of systems consisting of linked tools working together that make the ideal behaviors easy and non-ideal behaviors very hard to do.

Shingo helps you understand how to do that, to build and operate the organizational systems so that they tap into the power of the principles. There are three types of systems in an organization by broad classification listed here. Every system has five linked communication tools that together help us drive ideal behaviors that we seek.

By the way, this explicit systems design teaching concept from Shingo is a recent improvement from the institute itself, which of course strives to live the principles every day.

To learn more, my blog post with more examples is available on the Shingo website, but you want to go a bit deeper with the principles and their application. To do that, there are several paths to gaining this knowledge and capability which Shingo can help you with, starting with the foundational and powerful Shingo workshop series and helping coaching from certified Shingo affiliates like Value Capture.

Upcoming Workshops

We periodically run public workshops with a key one coming up, the capstone to the series "Build Excellence," with our colleagues at Penn Medicine, Lancaster General Health. A shout out to many of our colleagues from Lancaster who are on the call today. We're looking forward to that.

It is important, as you think about public workshops, or private, for that matter, to realize that Discover Excellence is the prerequisite workshop which you must take before the others. Move through system design to the deeper workshops, and then the capstone.

Private workshops are the other option for one single organization from us or any other affiliate. These are really powerful ways to accelerate a single organization forward.

It's been a great pleasure sharing these thoughts and preliminary learnings with you. For more help, please contact me or Value Capture through our website at valuecapturellc.com or the Shingo Institute at shingo.org.

I am excited and eager for your questions and learnings you wish to share. For us, it is always all teach, all learn. At this time when we've all been living through such an intense consequential moment and the power of universal principles are so evident in each of our lives, it's more important than ever that we reflect deeply together on what we've learned and how we're moving forward.

Please, what's on your mind? What would you like to share?

Questions and Answers

Mary: Great. Thank you so much, Ken. We do have one question so far. Just as a reminder for you, if you have questions, go ahead and add them to the Q&A. We'll get to them as soon as we can.

First question, given the high amount of turnover in health care right now, have you seen any differences in this turnover between organizations earlier versus further along in their lean journey?

Ken: Absolutely. It's a great question. I think it goes to the heart of this.

Organizations that were deeper into their lean or principle-based journey are seeing -- preliminary evidence suggests -- lesser rates of turnover, burnout, lower injury rates, etc., than their peers. It shouldn't surprise us because there was a deeper attachment to knowing what's...

I chose the principle of constancy of purpose, for example, to highlight here because when nothing seems certain, people that were in organizations that they felt that they could count on what would be true no matter what and that everyone would be in it together, working together according to certain known principles and connected in specific ways, it made it easier for people to hang in there.

By the way, the capabilities were already much greater for problem solving. People were much more used to transparency. People were much more used to moving more rapidly together. A problem solving that didn't work was not a big deal because you could then move on to the next thing very rapidly.

Everybody knew that drill and knew that way of staying linked. It shouldn't surprise us that, again, the virtuous cycle is close as can be amidst the great trauma and trial that we're all going through right here is in those organizations that were more mature.

Those having the toughest time, many of them, with a cycle that is not virtuous but, indeed, is vicious, are those where these fundamental principles of true excellence were not deeply set and where the faith was not there.

I wrote about this with John Toussaint of Catalysis as early as last summer. Some of the early data around harm that started emerge and how the organizations that were further ahead were forestalling much more harm than others.

Great question. I think we'll see more and more of this pattern emerge as good data starts to emerge from our organizations and look forward to further research from the Shingo Institute. Clear and health care and others who are certainly looking at this.

Mary: Great. Thank you. It doesn't look like we have any more questions at this time. We could pause for just a moment if anybody would like to ask a question.

Ken: Or share a learning.

Mary: Or share a learning, of course.

Ken: A great community of folks on this call. I look forward to what you noticed along these lines and what you recommend to make sure we learn the lessons and embed them deeply in our organizations going forward.

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