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Welcome to Episode #74 of Habitual Excellence, presented by Value Capture.
Joining us today as our guest is Brook Ward, the President and CEO of Washington Health System (WHS) in Washington County, Pennsylvania, in that role since July 2019. From 2010 to June 2019, he served as Executive Vice President and Chief Operating Officer.
In his role, Brook provides leadership, direction, and administration across the entire Washington Health System, which includes a large community hospital, a small rural hospital, a 70-provider physician group, a community wellness center, residency and fellowship programs, a school of nursing program and onsite medical simulation center and joint ventures in the areas of hospice, senior living, home health, cancer center and others.
Brook is a graduate of Grand Valley State University, Grand Rapids MI, with a master’s degree in Public Administration (MPA). He also has a Bachelor of Science in Health Care System Administration from Ferris State University, Big Rapids MI and received an Associates of Allied Science in Radiology from Ferris State University.
Today we’re going to be talking about how the WHS has never (I repeat, never) used a traveler nurse in their system. Acknowledging the travel nurses are skilled and they're good people, Brook makes a compelling case that quality and safety is better with full time staff members who are not "strangers" to the organization and how they do things. Brook also discusses the program that they created (and continue to iterate) that's win/win/win for the system, staff, and patients.
In today's episode, Brook talks with host Mark Graban, about topics and questions, including:
- How bad are the staffing challenges in your area?
- Biggest concern - not just economics, but safety for patients and staff
- Great people, but there’s a risk… safety, morale, not knowing our systems
- It's their "fourth or fifth iteration" -- what's the latest iteration and change?
- Staff get almost the same comp by picking up extra shifts, without needing to travel
- Telling peers about it — can’t get people too interested?? Why?
- Expense gets talked about more… is there research about the impact? Future retrospective studies??
- Iteration — Impact of extra shifts over time??
- Meeting with nurses to learn what’s working and not working
- Risk of burnout and fatigue — constant dialogue
- PILOT — Inpatient innovation unit to pilot and test things around team-based nursing
- So speaking of safety, you created a safety index — tell us about that? "Washington Hospital Patient Safety Score"
- Tell us about the Washington Performance System — respect, their version of Lean/TPS — your key influences??
- "Permission to try things and fail” — how to create that culture?
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Mark Graban (2s):
Welcome to Habitual Excellence, presented by Value Capture. This podcast in our firm is all about helping you and your organization achieve habitual excellence via one unifying focus, one value-based structure in one performance system. In other words, it's about helping you capture dramatically more value through achieving perfect care and perfect safety for patients and staff. To learn more about Value Capture in our services, visit www.valuecapturellc.com. Well, hi everybody. Welcome back to Habitual Excellence, presented by Value Capture. I'm Mark Graban, and our guest today is Brook Ward.
Mark Graban (43s):
He is the president and CEO of Washington Health System in Washington County, Pennsylvania. He's been in that role since July 2019. Previously, for about nine years, he served as Executive Vice president and Chief Operating Officer. So before I tell you a little bit more, Brook, welcome to the podcast. How are you?
Brook Ward (1m 1s):
I'm great. Thanks for having me, Mark. I hope we have a good show for your listeners and your audience.
Mark Graban (1m 6s):
Yeah, well I'm really excited to hear what, what we're going to, you know, what you're going to share today and I think it's going to be great. Great. For the listeners. So Brook, again, as President and CEO, he provides leadership and direction and administration across the entire Washington Health system that includes entities including a large community hospital, a small rural hospital, a 70-provider physician group, and, and, and much more. He's a graduate of Grand Valley State University in Michigan, has a master's degree in public administration. Brook also has a Bachelor of Science and Healthcare System administration from Ferris State University also in Michigan, and has an associates of Allied science and radiology from Ferris State University.
Mark Graban (1m 49s):
So I grew up in Michigan. Did you as well, Brook?
Brook Ward (1m 53s):
I did, yep. And I'm a fan of the Lions, all Michigan teams in spite of the fact the lions lose all the time,
Mark Graban (1m 59s):
Thankfully, we don't really have to talk about that here to here in the podcast. We have more interesting and more important things to talk about. And you know, there's a lot we can unpack in terms of the Washington performance system is, you frame it and, but I, I think one of the key headlines here, and I think this is fascinating to right into never using a traveler within the health system. Like tell us some of the, the, the history of that and, and how and why.
Brook Ward (2m 29s):
Sure. Well, the, I guess to start, the Washington Health System's been around for 125 years, our anniversary year. And you know, since the very beginning, since the day the organization was chartered, the School of Nursing, we have a diploma program here has been in existence. And so I think early on in our history, that's what's helped prevent us from having to use a travel RN. Now we have used a couple of travel med techs at our small rural hospital, but we've never used a travel RN, you know, at the main facility going back 125 years. And we've maintained that during this period of time where we've had the great resignation, the great retirement, you know, we are down in staffing like everyone else.
Brook Ward (3m 10s):
There's no doubt about it. Before the pandemic, we would have somewhere between 30 to 40 open positions at any given time, maybe five to 10 of those RNs. Now we're running around 240 with about 90 of those RNs. And so we have a demand just like everybody else in the country. But we wanted to take a different perspective. And our biggest concern beyond economics, which cost all of us a lot of money, frankly, when you're talking about travelers, was just safety. And so we were talking about how do we create an environment where we can maintain the safety for our patients and for our team members as much as possible. And travel RNs, they're great people, there's no doubt about it. They fill a role, but there is a risk when you bring those into the organization because they don't know your systems, your processes, your people, your medical staff, they don't know the team.
Brook Ward (3m 58s):
They also create a morale issue, sometimes inadvertently, because you have loyal RNs who work for you forever, working side by side with someone who makes more money that they have to often feel like they're training on the spot. So when all this started, we talked about all those dynamics and how do we avoid that? And it wasn't really about maintaining our tradition of never using a travel RN if we can, but it was more around that safety focus. And because of that, we designed a program where, well, instead of having our own nurses potentially quit and leave to go get these lucrative travel RN positions, how do we set up a program here where we can incentivize 'em to stay home basically? And so we set up a program about a year ago, we're on our fourth or fifth iteration of that at this point, where if a nurse who works for us works one extra shift a week and maintains that over a period of time along with their regular pay shift differential and overtime, we would bonus them in a way where it would get them close.
Brook Ward (4m 55s):
Not all the way to, but close to what they would get if they were a travel nurse. Now, keep in mind, if a hospital pays a travel company 200 or $250 for per hour per nurse, the travel nurse is not getting that. They might be getting $70, $80, $90 an hour, right? So we bonus 'em trying to get 'em up to that area, so, so that they feel like they could take advantage of what's happening and in the market. They don't have to quit their job, lose their seniority, lose their benefits, go to a strange place, and then we don't have to bring travel nurses in to do that as well. And so that has worked for us for the last year. Currently, we have about 120 of our nurses who signed up for the latest iteration of that, and we can ramp that up and ramp it down every day based on need.
Brook Ward (5m 36s):
And so we don't use 120 nurses every single day, obviously. But that flexibility working with our nursing staff in a program like that has not only saved us a lot of money, but frankly it's maintained our quality and our safety. And it's been amazing. And I, and I've been telling all of my peers that, you know, at hospitals around Pittsburgh where we are about this and, and I can't get people honestly that interested in it. And I don't understand why, because I think we found a good solution to a problem that is sort of plaguing our industry right now.
Mark Graban (6m 10s):
Well, that, that's certainly a fascinating dynamic. I mean, that, that, that brings me back to think about the lack of spread around other innovative practices that drive really breakthrough results. You know, organizations that, for example, you know, drive hospital-acquired infections of certain types down to zero. And I've heard similar things like, well, we try to share what we're doing and like, let me frame it as a question, but I mean, how often do you run across, it seems like people get really grounded in this assumption of like, well, this is just how it is, this is how it has to be. And does that do, do you think that creates a mental block to, to learn from work like you're doing?
Brook Ward (6m 56s):
Well, I, I don't know, honestly, Mark, I think, you know, there are certain circumstances where organizations may have a union in their nurses and that might create a barrier, right? And there's some things you can do in a union environment that, you know, or in a non-union environment you can a union. But sometimes I think it's just work, right? It's, you know, it's extra work to take the time to sit down with your executive team and design a program like we've done. And I think everybody I talk to wants to get rid of the travel, the expensive travel nurses, but they're struggling with a way to do that. They don't have an alternative. A lot of people, a lot of hospitals in our area set up their own travel companies and they've just sort of shifted it from external travel company to their own, but they have the same dilemma.
Brook Ward (7m 45s):
So it's a great question Mark. I'm not sure why others aren't interested. And I don't know if it's pride. I don't know if it's, you know, you know, they're busy. I, I don't know. One of the other things we've been working on, we've been doing Lean, what we call the washing and performance system for well over a decade. And early on in that journey, we picked an inpatient unit that we made our innovation unit. And we would often test, try pilot things there often fail, frankly. And failing on new things is often as good as coming up with success. And so, you know, we're, we actually have a pilot going on in our innovation unit right now trying to staff that unit differently. And we're going back to an old concept in nursing called team nursing.
Brook Ward (8m 27s):
So instead of having one nurse assigned to four or five or six patients and sort of working in silos, taking care of his or her assignment, we have the, the same compliment of staff sort of assigned to the entire unit. And we've designed the work differently. Now we're only six weeks into the pilot, we got another six weeks to go. But the early results are people are leaving on time, documentation is done more accurately and timely, nurses are getting lunch breaks and they're normal breaks that they, they are otherwise skipping. Sort of teamwork is grown. And this is all getting back to safety and retention. And so one of the things we heard with nurses over the last year when we hired and brought them in, because people are so, you know, busy and we're dealing in an environment where we have less resources from a workforce perspective, long gone are the days where you have an experienced nurse who has time to spend with a novice nurse and help them gain that knowledge and experience in comfort level.
Brook Ward (9m 24s):
And so in this team-based nursing model that we're piling right now, it gives that novice nurse the ability to work in a team with experienced nurses in a way that there's some mentoring and coaching and they don't feel like they're on an island by themselves. And so, you know, I'm very excited about this pilot we're testing in the innovation unit. I think the results so far, it's early, but the results are good. And then our challenge, as you know, mark, and as you said earlier, is once this we get done with this pilot at this point, the evidence looks like it's going to work, is then how do we spread that across our own organization in a way that makes sense? And so we've been capturing sort of questions and answers as we go along with the innovation team.
Brook Ward (10m 4s):
So then when we go to spread, we already have a document that sort of lays out some of the early concerns, some of the problems, the lessons learned, and to help speed that along. We also have staff from other units now not rotating from a work perspective, but going down to the innovation unit now, while the pilot's happening asking, how's this working? What's going on? So that hopefully when we're ready to spread it to other areas, there's been some exposure to that. And I think sometimes it's just maybe communication and exposure that helps people get comfortable with these ideas and maybe that's what my peers at other organizations need to do as well. Yeah.
Mark Graban (10m 40s):
And you know, seeing what's possible is, is one way that yeah, maybe moves people along that path to, to break this mental model of, of what is possible. So showing, demonstrating something new is gonna be helpful and maybe we can sometime next year come back with you and or nursing leadership and sort of, you know, talk about the full assessment of the full pilot and what some of the next steps are. We could yeah, I'm sure take a deeper dive into that.
Brook Ward (11m 6s):
That'd be great. We'd be happy to do that with you. Yeah.
Mark Graban (11m 10s):
But I, I do wanna come back though to what you've done with nurse staffing and the, the language you use around, you know, pilots and experiments and you talked about iteration, which I think is so powerful. You mentioned the fourth or fifth iteration. Can you give an example of what you're learning and iterating over that year with this model?
Brook Ward (11m 34s):
Well, with this model where we're incentivizing our nurses to pick up their shifts and sort of be an internal traveler, although we don't really call 'em that, you know, we, we meet with them fairly frequently about what's working. And our biggest concern from an executive team is, all right, so we don't have these strangers, these travel RNs who don't know us and bringing that risk, you know, into the organization, but we have the risk of burnout and fatigue. And so we have this constant dialogue with our nursing staff around how you doing, how you feeling, how's the stress, how's the workload? Those kind of things. Generally the feedback we've gotten back from the nurses here is, you know, they prefer this to bringing in strangers in a, in a travel environment and bringing those folks into the thing.
Brook Ward (12m 17s):
But the most recent iteration was they wanted some flexibility. So we're getting ready to go into the holiday season and in the old couple models we had, you had to work so many weeks in a row working that extra shift and have this bonus sort of accumulate to sort of earn, you know, what we had calculated that someone could get well with the holidays coming up, someone might wanna take the week of Christmas off or Thanksgiving and then they're sort of back to square one and starting over. So this most recent iteration talking with the nurses was, okay, during the next 12 weeks you can sort of miss a week and not have to start over and allow for some of that flexibility. And so it, I think it comes back to sort of getting their feedback, having dialogue about what they liked, what they don't like, and then trying to wrap that in and tell 'em you've heard 'em.
Brook Ward (13m 2s):
And with this most recent version we heard what you said, we've modified it to try and adapt for that. Now, as you know, mark, we can't satisfy everybody's requests in everybody's need, but we've been trying to make changes that make sense for the organization and for our team members.
Mark Graban (13m 18s):
Well, you know, I I, I love hearing about that constant dialogue of, of, of that feedback and, and, and not guessing what needs to be iterated, but getting that feedback and keeping, you know, safety in mind, you know, guarding against fatigue and or, or, or burnout or things that might drive someone to leave or retire. I wanted to come back though and you know, you mentioned, you know, I, I love that you're emphasizing the safety or I'm sure there's, you know, quality and patient satisfaction components as well. I think broadly in the media you hear so much focus on the expense, the labor cost of travelers.
Mark Graban (13m 58s):
Maybe there are studies still being done or studies that we could go and and and look up. I don't mean to put you on the spot, but like are there ways of quantifying that risk that you're avoiding in terms of particular types of, of safety risk or quality outcomes?
Brook Ward (14m 16s):
Yeah, that's a great question Mark. And I don't know, I have a great answer for you honestly because I'm sure you know, a year or two from now as an industry we will be able to do retrospective studies and take a look at what happened in hospitals and healthcare and we, I'm guessing we will see sort of a downward trend in patient satisfaction, safety, and quality. And I'm hoping we can buck the trend now we're struggling a little bit with our patient satisfaction scores and it really has to do with access. And so in our physician practices for example, we're struggling with staffing our call center. And so, you know, that's where we're getting really hammered on our patient satisfaction scores is I can't get through to set up an appointment once we get 'em into the office, we're getting great scores.
Brook Ward (15m 1s):
Same thing with the ED. Our left without being seen is a little higher than we like, although admittedly still much lower than many of our, you know, our peers around the region. But you know, it's those kind of areas where we're struggling a little bit from a quality and safety perspective. Though interestingly enough, and I don't know Mark if you want to go here now or not, but you know, I was telling you in a pre-call we had for a decade plus been tracking what we called our total patient harm. And these were 12 things that you never want to have happen to an inpatient at any time that would penetra cause harm or or lower quality. And year over year we were driving that harm score down, which was great. Our challenge with that was we couldn't benchmark it against anybody else.
Brook Ward (15m 43s):
So comparatively it was tough to know how we were doing, although we were doing better than we had compared to ourselves. So right before the pandemic we got a team together saying, okay, let's flip this script a little bit. Let's look at how do we improve patient safety and quality. What are, you know, the biggest indicators from an inpatient quality and safety perspective, how do we track those and let's benchmark every single one of them. And we ended up creating what we're calling the Washington Health System patient safety score. There's 16 items on there that we want to get in the top decile and we only get credit as an organization if we get it in the top decile. So we're trying to get from whatever it was, seven out of 16 in the top decile to eight, those kind of things.
Brook Ward (16m 25s):
This last fiscal year at the conclusion, we actually drove it up from the pilot year because we ran it originally side by side with our old patient harm score and we had the new patient safety score and then when we converted, and so this last year we finished with 10 out of the 16 in the top decile and we had two other categories that were really close to being there. We set the target this year to be hired and we're on track to achieve that. And so, you know, from a an executive perspective, I think if we had a large number of travel RNs in here, I don't think we would've had any hope at improving that safety score, driving our quality and safety scores up, you know, with a group of well-meaning highly skilled strangers basically working in our building and having them rotate in and out.
Brook Ward (17m 10s):
I don't think there's any way we could keep that initiative going and driving our scores up with that. And so, you know, back to your original question, I don't know if there's any data yet, but I suspect there will be soon. But I'm confident in, you know, sort of how this has played out in our organization Yeah. And what it's allowed us to continue to do. Yeah.
Mark Graban (17m 28s):
Yeah. And, and, and I'm not challenging it, it all sounds directionally correct. Like it makes sense those connections and as you're emphasizing that these are systemic issues, it's not that travelers are poor quality nurses, but it's everybody working. You know, putting a new stranger into a good system changes the system in ways that are not the fault of the traveler.
Brook Ward (17m 52s):
Exactly. And you hear about these stories all the time, right? There are organizations who are struggling staffing, they'll have 20, 30, 50, 90 travelers in, sometimes they'll have entire inpatient units staff with travelers. Well as you said, they're high quality, well meaning people, right? But they don't know what they don't know. And it's just a tough environment to provide good care. And that's what we're trying to avoid by working with the current staff. We have incentivizing them to stay and then continue to drive forward with our quality improvement patient satisfaction activities.
Mark Graban (18m 25s):
Yeah. So Brook, how, how did you address the benchmarking issue? Cause I know a lot of times in healthcare there is a focus on benchmarking on, on certain types of infections or certain types of patient harm. You, you, you added measures. Was it matter of changing what some of the measures were or how did you address that so you have better benchmarking capability?
Brook Ward (18m 46s):
Well, when we had the total patient harm score, like I said, it was those 12 things and not all of them are things that other organizations we even track and measure. Some of them are, but they're not like publicly reported. And some of them were not sort of apples to apples. And so we were track tracking falls with injuries and it's tough to find necessarily, like, you know, how does that compare and our, you know, 50 bed rural hospital compared to a, you know, a thousand bed, you know, trauma center kind of stuff. And so when we converted it over and we switched from sort of the total patient harm to this patient satisfaction, this patient safety score, one of the things the team were required as they were building it was any measure we felt fit that criteria we had to have a reliable national database that we could go to and benchmark to, to find out across the universe what is the top decile for that.
Brook Ward (19m 39s):
And so we've created this index where, like I said, we have these 16 measures and every single one of those we can drill down and say, okay, in this national database for this particular item, where do we fall? Or we at the 50th percentile, the 71st, the 31st or the 91st. And then how do we drive it forward using best practices, using lean and, and those kind of things. And so, you know, it's sort of enlightening. Everybody thinks they're doing a good job, right? I mean, everybody I've ever talked to my entire choir, we say, well how do we get better and should we get better? Everybody's immediate instinct is we're doing great. And then of course then you follow it up and you say, well how do you know, right. You know, where, what's the data and how do you compare it to the benchmark? And a lot of times people do have data, but they don't have that national perspective, you know, so when you challenge 'em and say, okay, we've got data on how we're doing, but how does that compare to the universe of other radiology departments or nursing units or hospitals, whatever.
Brook Ward (20m 33s):
That's often as an industry where we fall down and once you find out it's difficult as a team not to wanna get better, right? I mean, we've all had examples. Once the data is transparent, you know, where you fall, people have pride, right? They want to do good work, they want to improve, and now all of a sudden there's activity. But when you're in the dark, there's this automatic assumption that everybody's doing great. And, and and we're, we are at the best. And as I tell our team members here, you know, our board sets our vision to be a leader in healthcare quality, safety and value. And our board defines the word leader as the top decile. Mm. Well there's lots of things we're doing, we're in the top decile and that's great, let's work hard to maintain them so that, you know, using standard work and other things we don't slip, but there's also lots of areas where we're not.
Brook Ward (21m 21s):
And that's where it's incumbent at everybody from the brand new employee who started with us yesterday to myself to try and improve and get better every day to achieve our vision and make sure that our patients in our community get the very best care they can possibly get. Yeah.
Mark Graban (21m 35s):
Now I'm, I'm, I'm guessing the answer is yes, but I'll ask it anywhere. Are you willing to share that model of how it's constructed that patient safety score index if others want to use the same model so that they can help compare?
Brook Ward (21m 50s):
Absolutely. And our next iteration of that mark is, okay, so these are inpatient focused and now we've got a similar team pulled together who's doing a rapid improvement workshop around, okay, what are the best indicators for patient safety and quality on the outpatient side and how do we track those and what do those look like and what are the benchmarks going to be? And once we figure those out, then we're going to have a dialogue about do we wrap these in and have one big index for the entire organization or do we run sort of separate indexes, inpatient, outpatient, and I don't know the answer to that yet, but we're working on that outpatient side so that we can drive improvement in that area as well.
Mark Graban (22m 30s):
And you use that phrase, I mean a lot of people are afraid to say what you did there. I don't know the answer to that, but that come, that comes back to pilots and experimentation and iteration and figuring it out. I mean that comes through very clearly and strongly in everything you're talking about here today.
Brook Ward (22m 47s):
Well, I mean, truth is none of us know it all. Right? And, and that's part of why we like lean as a process improvement is because it gives you permission to try things and fail. And you know, like when we launched in our innovation unit, this new team-based nursing model, you know, I went up with our chief operating officer, our cno, we talked with the team up there and what I said was, we are likely to fail with a lot of the things you're going to try over the next three months and that's okay and we'll learn from that. But the failures are going to help us get better as well. And we'll you know, track those along with what's working and it's going to get better. And so I think sometimes just giving people permission to test and try eliminate some barriers, right?
Brook Ward (23m 29s):
Cause if you're worried you're going to fail and that's going to be, you know, sort of reflect on you. You're not likely to want to try and test and pilot, right? Because you want to make sure it's guaranteed win. And that's a culture issue that sets people up for failure. And so just acknowledging the fact that you don't know you're probably going to fail. It might take us 10 times and we're all in it together, I think helps set the environment in a positive way.
Mark Graban (23m 54s):
Yeah. And that to me sounds like, you know, good lean thinking and former Toyota people I've worked with, you know, would talk that same way. One other thing you said I wanted to follow up on and let's talk more about the Washington Performance System. Toyota people I've worked with would, would very often say, what do we know and how do we know it? Right? Going from assumptions to data or knowledge or fact. So it's, it's interesting to hear that, that language from you. But tell us more about the Washington performance system. Like what were some of the key influences in terms of developing that?
Brook Ward (24m 31s):
Yeah, well we started this dialogue here probably about, honestly probably 12 years ago. And, and what we realized was, you know, like I said earlier, if you went around the organization said from a quality safety, you know, patient status, how are we doing? And people say we're doing great. And you would say, do you have data? Sometimes they would, sometimes they wouldn't. And if you said, well geez, you got data, how's it, they often didn't have the comparison. But what we realized pretty quickly was there wasn't a universal way, sort of one way here where we drove process improvement. And so that got us out looking at a number of different methodologies and of course we could have picked many of them, right? And, and they had the possibility and the likelihood of succeeding.
Brook Ward (25m 14s):
But lean ultimately sort of appealed to us and using that as a methodology. And so we're, and one of the things we did early on, this was going back probably 11 years ago, is we did two saves where we took almost the entire executive team plus our board chair. We went up and spent a couple days at ThedaCare, couple days at Virginia Mason, a couple of the organizations obviously in our nation who were early in adopting it in healthcare. And we got a chance to sort of see how they deployed it culturally in their organizations because everybody's got their own deployment and sort of version of lean right? And what we liked about that and I think, you know, coming back from those two site visits, it just affirmed for us that using Toyota the lean, the process improvement fit for us and was the right methodology then it was a matter of trying to adapt it to our culture and make it our own.
Brook Ward (26m 5s):
And honestly, maybe contrary to how other organizations did it, we purposely stayed away from the, a number of Japanese and sort of traditional lean terms because we didn't want to make it sort of this difficult thing or, or we didn't want people to be sort of challenged with learning the terms. And so, you know, we tried to make it our own. And so we early on branded at the Washington Health System performance system, the Washington Performance System, we, you know, we brought in people from industry and internally and put together what we called our pro process improvement, our performance improvement team. We didn't call it the Lean department, those kind of things.
Brook Ward (26m 45s):
And then we basically had them sort of teaching and coaching people across the organization about how to do lean, how to do process improvement. And then of course we introduced concepts like standard work, you know, in rapid improvement workshops and innovation units and those kind of things. And so, you know, it's been evolving over the last decade, but that's the early beginnings for us and, and how it started. And today, you know, admittedly our process improvement, our performance improvement team is smaller than it was a decade ago because as we had people retire and move on, we realize that we didn't necessarily need as many people there because it's been ingrained in the organization. So there's less coaching and mentoring that needs to be done along those concepts because, you know, we have leaders who've been doing it now for a decade plus and they can help do it without necessarily having that many resources here.
Mark Graban (27m 37s):
Yeah, well that's great. And that's what a lot of organizations are, are working toward it becoming the culture, the way we do things around here. You know, how do we do the work? How do we improve the work, how do we lead? And again, there, you know, comes back to, you know, this evolving and iterating over time. That's, that's, that's not surprising. But, you know, one, one question I'm going to throw at you, because I'm sure back in the day you got it, you might even get it again. Now, you know, the, the, the question if you, if you start talking about Toyota, and maybe you don't talk about Toyota as much internally anymore, but if someone says, well, hey Brook, we, we, we, we don't build cars here. We're, we're not a factory, but like, you know, how, how, how would you sort of try to bring somebody on board about adapting and making it relevant in healthcare?
Brook Ward (28m 24s):
Yeah, I think, you know, we got that earlier on more than we do now, but I still occasionally get someone, you know, mentioned like how does this work in healthcare and those kind of things and you know, and I always remind them, you know, our industry is famous for stealing the best ideas from not only our peers and others, right? I mean healthcare has been great at sharing what works and what doesn't and we all sort of take those things and internalize. And so why wouldn't we take something that's working in an automotive industry or manufacturing or whatever and apply that to our industry. And you know, you might recall there was a, a famous book, I'm drawing the blank of it, talking about nuclear power plants in the lessons learned in there and how to apply to healthcare.
Mark Graban (29m 9s):
This was probably Steve Spear. Yeah. The High-Velocity Edge.
Brook Ward (29m 13s):
There you go. Yeah. And so, you know, there's lots of examples. There was another business book years ago about captain of a submarine, a Navy submarine. Yeah. And so, you know, you could obviously point to all of those and say, well geez that I, you know, I don't work at a Navy sub, I don't work in a power plant, I don't work as an airline pilot, I don't work at Toyota. Right? But the fact of the matter is there's lessons learned there that can be applied across the board. And are there some things that we do that are different than building a car? Of course there are are, but if we really wanna achieve our vision, why wouldn't we go outside our industry and look for, you know, the best and brightest, the best techniques, those kind of things and apply it.
Brook Ward (29m 53s):
And early in our journey here, mark Winne, we found out that the local Caterpillar plant four miles away was busy doing Lean because Caterpillar had deployed Lean. And so we spent time at their factory over there looking at how did they use Lean, how did they use it with their manufacturing, what does it look like on their line? We had some of their frontline employees and managers over at our organization looking at our visual management room, looking at our huddle boards. And so we learned a lot from this Caterpillar manufacturing plant a few miles away. And honestly, I think having people go there and see how it's applied and say, oh this is how it works, I see now helped us deployed here and eliminated a lot of that, you know, those barriers.
Mark Graban (30m 36s):
Yeah. And, and I think as people have learned, it's not about copying tools but it's more conceptual or principles based, you know, problem solving, engaging employees, iterating. And I just want to come back to one other thing that you said that again is like, this is core Toyota culture that I think is, you know, super transferable. You have the permission to try things and fail. Yeah. And, and really having honest scientific plan do study adjust cycles. Like it's possible someone could adopt the language but you better not fail. So there's no real study in adjust. You might call it, you know, plan. Do stubbornly justify why it was a good decision.
Mark Graban (31m 17s):
And the follow up question I wanted to ask you though, Brook was, you know, you talk about saying things as a leader that we're likely to fail, we'll get better, we'll learn from it. Can you share an example of, of what I've sure is followed in terms of action of not just saying this but reinforcing. Can you, can you think of a time even recently of how you reacted as a leader to an experiment that failed?
Brook Ward (31m 45s):
Yeah, sure. I mean there were some things, I've been down to our innovation unit numerous times over the last six weeks during a pilot pilot to get an update and they give me an update about something they've implemented while they're working on it. It didn't work. And I actually sort of, you know, congratulate them on that. You know, it's, that's how I saved, like that's great, you tried this thing and it didn't work. That's wonderful. And I think they think I'm crazy, but you know, the point you're making is the one I agree with, which is if they understand that there's not a penalty for trying something in that context, right? And trying to make it improved and then we realize it doesn't work, that's not a fail. You know, that's not a failure in the true sense that someone's in trouble. We've just learned from that.
Brook Ward (32m 26s):
I think where we can sometimes get in trouble is if we've got standard work and we've deployed universally across the board and we think this is the best way in the moment. Cause we all know that standard work can be constantly improved. If someone varies from that, that's a different issue, right? And, and sometimes it's in the context of, you know, we wanna test and pilot, but if someone varies from the standard of work outside of that, now it's really about re-education about why we have this standard of work in place by varying from the standard of work our performance is actually getting to Dee not get better. It's more around education and training there. It's not about scolding someone, you know, those kind of things. And, and I try and model that in a lot of little ways.
Brook Ward (33m 6s):
For example, outside the door in the hallway here I have my standard work posted and I think I'm on version 24, right? I try and remember to update it occasionally, but I literally had an employee about four months ago come by and say, Brook, your standard work has not been updated in a while. I can see a couple things that are not current here. You need to get on it. I said, you're right, you know, I need to fix it. So I pulled it down that day and I went through it and updated, put it out there. So sometimes they, you know, they call me on it as well, which is a good thing.
Mark Graban (33m 34s):
That is, that is a good sign. That is a good thing. So Brook, maybe one other topic just real quickly here, and this is something I'm sure we could do a different deep dive into, but building on what you've already shared about safety and emphasizing not just patient safety but staff safety. We know unfortunately workplace violence is a huge threat and a sad reality in a lot of healthcare settings. Can, can you share a little bit about some of the approach that you've taken to, to help prevent workplace violence?
Brook Ward (34m 8s):
Sure. And you're absolutely my right Mark. It's a serious event. As I told our board numerous times, you know, as a leader it's probably the one thing that keeps me up at night. Cuz I'm concerned that it's not a matter of if we'll have, you know, a serious event or an active shooter on campus, it may be just a win, right? That's sort of the reality in, you know, in our society right now. And so, you know, we've done a lot of things like a lot of organizations have around improving sort of physical safety features, proximity badge access cameras, security features, those kind of things. But you know, one of our corporate values is respect. One of the lean principles, you know, is respect.
Brook Ward (34m 50s):
And from my perspective, the number one way we can show our team members that we show them respect and we respect them is individuals, is to try and keep them safe. And so the Joint Commission came out with a new standard around providing training for workplace violence. And so we're actively going through and doing classroom sessions for all almost 3000 of our employees. And so we're people, we're pulling people essentially off the line and they're getting two hour, five hour and seven hour training depending on our assessment of how risky their particular job is in the organization. And a good part of that training is around de-escalation and how to handle situations where someone's escalating, but there's actual physical training, not about how you would fight, but how you would protect yourself if someone is physically attacking you.
Brook Ward (35m 39s):
And when I do the introduction and I do the introduction for almost every one of those sessions for our employees, I always tell them, this is around respect for you as an individual. If we can provide an environment where you can be safer, you know, that's a sign we're showing you respect. And if that helps them in an event that happens at our healthcare organization, you know, that's great, but it might also help them at their church, at home, at school, at the theater, at the mall, those kind of things. And if it's skills they can take beyond that, beyond here to help them in any way it's worth doing. And so we're undertaking that as we speak. We have, I think about 600 of our, almost 300 employees done so far, and it's going to take us a while, right? It's probably going to take us another year to get through that.
Brook Ward (36m 21s):
But the early feedback from the people that did the two hour recession is they want the five hour recession. And most people don't sign up to sit in a classroom and go through more training unless there's been some value provided there. So what would I've been telling our folks is let us get through everybody first run and we can come back and do some additional training for those people who want the longer session.
Mark Graban (36m 42s):
Yeah. Well it sounds like there's been some good word of mouth where people are hearing from their colleagues that it was valuable and you know, I appreciate, you know, thank you for, for that emphasis and that investment and that, and in that focus, you know, Paul O'Neal, who you know, deeply influential to all of us at Value Capture would always say as CEO at Alcoa, you know, everyone says employees are our most, you know, valuable resource. But back to the question of how do you know, how do you know that's true? Like measuring employee harm to him was the clearest way of demonstrating that statement to be true.
Brook Ward (37m 16s):
Yeah. And we've been doing that for actually a long time. One of our pillar goals, you know, said differently at one of our North Stars has been employee loss time injuries. It's been on our pillar goals for a decade plus. The very first year, this is shameful to say, but the very first year we looked at it, we had 38 employees who got hurt so badly at work, they missed at least one shift, if not more. And that was at our main hospital alone. It didn't count all of our other entities. And so we've been working on that ever since. And I want it to be zero, right? I love it to be zero. This last year we finished at 13 and it was every one of our 20 entities where we started with 38 and one entity. And so we had brought it down, but not to zero.
Brook Ward (37m 59s):
And that, you know, that's our continual challenge
Mark Graban (38m 2s):
And there's continual work and continued focus. So, gosh, I I appreciate that and it's really inspiring to hear you share everything that, that you shared with us here today, Brook. So I appreciate your, your sharing your willingness to, to share with others. I I hope this podcast episode reaches others who, who are hungry to learn more and, and, and people can I'm sure figure out how to reach out and contact you. But, you know, we've been, but I'm sorry you were going to say to that.
Brook Ward (38m 33s):
Well, I was just going to say, if any of of your audience wants further information about our patient safety score or just wants to talk about lean, the deployment of Lean or anything they heard today, I'm happy to jump on a virtual meeting with anybody and, and pursue that further. And, and if there's anything we can do to help Value Capture either through a future podcast or anything else, you know, mark, please know that we're here for you guys as well.
Mark Graban (38m 58s):
Well, thank you for that. I am definitely going to take you up on that. So I think early 2023, we'll, we'll figure that out. So again, we've been joined today, Brook Ward, president and CEO of Washington Health System. I'm sure you get tired of emphasizing to others. Not in Washington state, but in Pennsylvania. Right,
Brook Ward (39m 15s):
Right outside of Pittsburgh, but, yep.
Mark Graban (39m 19s):
Well, Brook, thank you again for, for all the sharing and the great conversation today.
Brook Ward (39m 24s):
I appreciate it. Thanks for having me, Mark on having me on Mark, and I hope you and the audience have a great holiday season.
Mark Graban (39m 30s):
Okay, thanks, you too. Thanks for listening to Habitual Excellence presented by Value Capture. We hope you'll subscribe to the podcast and please also rate and review it in your favorite podcast directory or app. To learn more about Value Capture and how we can help your organization on this journey to habitual excellence, visit our website at www.valuecapturellc.com.
Written by Mark Graban
Mark Graban has served healthcare clients since 2005. Mark is internationally recognized as a leading author and speaker on Lean healthcare. His latest book is "The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation."