Welcome to the fifth episode of Habitual Excellence, presented by Value Capture.
In this episode, Geoff Webster, co-founder and managing director of Value Capture, has a conversation with host Mark Graban on the theme of “habitual excellence,” a phrase used by our founder, the late Paul O'Neill. What is habitual excellence? How do leaders create the conditions for habitual excellence in an organization? We'll discuss this and more.
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Mark Graban (2s):
Welcome to Habitual. Excellence presented by Value Capture. This podcast and our firm is all about helping you and your organization achieve Habitual Excellence via one unifying focus, one value based structure, and one performance system. In other words, it's about helping you Capture dramatically more value through achieving perfect care and perfect safety for our patients and staff to learn more about Value Capture and our services visit www.valuecapturellc.com. Hi, I'm Mark Graban. Welcome to Habitual Excellence we're joined today by Geoff Webster.
Mark Graban (42s):
Geoff is a co-founding principal of Value Capture. Geoff. Thanks for joining us. How are you?
Geoff Webster (48s):
Thank you. Mark having a good day. Thank you.
Mark Graban (51s):
Well, good. So what does Habitual Excellence mean to you?
Geoff Webster (59s):
Well, Habitual Excellence for me is really a state of being at, for an individual or an organization, um, where a, there's an understanding, that the things that you do every single day, the little things, and the big things are what have an influence on whether you get the results that you want. And so when you understand things that way and think about things that way, I'm the lens of what you do every moment of every day, uh, takes on a very different meaning and people form habits that enable really excellent results all the time, everything that you do.
Mark Graban (1m 46s):
So can you tell us about the origin of the phrase and, you know, sort of how this was introduced to Value Capture there's, there's some history that goes behind that phrase before we delve into it more.
Geoff Webster (1m 58s):
Absolutely. So that phrase, I certainly learned that I think many of my colleagues learn from Paul O'Neill, um, in Paul was the CEO and chairman of Alcoa who led one of the great transformations of an organization, uh, as he was CEO and chairman of Alcoa, um, starting with the idea of perfect worker safety that nobody should ever be harmed at work and what he understood in, in setting that goal. And it's as a lot of people who were there, um, in the early years when he, when he chose that as a spear point for excellence at Alcoa, was that once you think about perfect and the idea of harming nobody in this case, um, it causes you to think about all the things that can cause harm and those things at a place like Alcoa go for everything from a holding the handrail when you walk down the stairs every single time to making sure that people, um, follow the very few but important rules that there are about using the guards and personal protective equipment that are necessary and, um, and holding each other and each, each person individually accountable for, um, for their own and everybody else's safety, not just in the way he designed systems, but in their own behaviors.
Geoff Webster (3m 44s):
So, um, you know, they were able to get, uh, incredibly close to perfect worker safety figures, um, across the globe, um, when other organizations are still struggling. And I think at this moment are still 17 times safer than your average healthcare institution in terms of, of, of, uh, a harm to workers. And so we learned this phrase in, in that context and have been able to help leaders, healthcare organizations, um, learn to create the same kind of urgency through worker and patient safety, um, setting the goals that have perfect.
Geoff Webster (4m 29s):
And then by helping people, uh, learn how to build the systems that, that help people practice those habits every single day and in the context of COVID-19 and what we're experiencing right now, um, it's the same things that, uh, keep a healthcare worker or another patient from getting COVID-19 as it is for, for, uh, you know, many other pathogens that exist that are, that are rampant throughout hospitals, things that are droplet precautions, and that require masks and gloving and gowning and isolation procedures.
Geoff Webster (5m 16s):
Um, but it often takes a set of habits to do those excellently and, and keep anybody from getting hurt. And, uh, we're learning now to practice those things in this extreme context. Um, but it's the same habits that can be practiced every single day in every single healthcare institution that would enable, you know, literally hundreds of thousands of people not to be hurt each year, uh, in the hospital setting, in, in the healthcare setting. So that's where, that's how I think about Habitual Excellence is how to drive that situational awareness about the connections between every little action that you do every moment of everyday and the importance that they have for being as close to perfect, um, a, uh, in everything that you do every day.
Mark Graban (6m 15s):
Yeah. Now in an earlier episode, we talked with Ken Segel and we really focused a lot on the idea of aiming for zero harm and focusing on theoretical limits. So I was wondering if you, if you could elaborate on, on some of that, your, your views on this Geoff of why that focus on theoretical limits is a really important part of creating, um, as you're saying, the systems and the habits that lead to Habitual Excellence, it's not, it's not just setting a high bar, it's setting this theoretically high bar, or it might be a low, um, number when it comes to harm.
Mark Graban (6m 56s):
Um, so can you elaborate on how theoretical limits are an important part of the Habitual Excellence approach?
Geoff Webster (7m 4s):
Yes, I, uh, I think I can't just elaborate on it. I, I think that you actually can't have Habitual Excellence without aiming for perfect. And thinking about the idea of theoretical limit and the story that I would tell 'em, you know, it goes back to our days, um, working with, uh, with Dr. Shannon at the University of Pennsylvania and the wonderful people of the University of Pennsylvania and a model cell unit where we worked, where we were a little bit able to eliminate, um, central line associated bloodstream infections.
Geoff Webster (7m 44s):
And, uh, it had been done before, um, in, in other places that we had worked. Um, but we actually selected the, um, oncology units explicitly because, um, the, the people in those units and including the patients, um, that the patients don't have an immune system, basically, um, many of them have gone through bone marrow transplants, um, and had their immune system intentionally wiped out, um, for the purpose of, of making them healthier in the long run.
Geoff Webster (8m 26s):
But that means that any mistake, anything that exposes those patients to a pathogen, um, is essentially a, if not a death sentence, at least the, you know, severe, severe illness, the, with the threat of that. And, um, before we, we helped them think about the idea of eliminating all harm. Um, they had a rate of infection that was considered the norm. And, uh, when we first introduced the idea, um, many of the people there thought that it was a crazy idea and that's a perfectly normal reaction.
Geoff Webster (9m 14s):
Um, but importantly, the, the turning point, umm, first of all, is humanizing the, the, the picture of harm. And that's why safety is so important to this journey. Um, everything should be pursued at perfect, the theoretical limit, but safety is something that everybody can agree to pursue at perfect. And the reason is because you can humanize it. So what we did with, with those, those nurses and physicians and respiratory therapists and others, um, was, uh, was literally go through the last, um, I think it was 65 cases of people who had gotten central line infections and literally put names and faces and family stories to every single case.
Geoff Webster (10m 10s):
And by doing that exercise with, with those people, um, uh, it was not a push of the idea we need to be perfect. It was a rallying cry for everybody to say, look at all these people who we didn't mean to harm, but we harmed. And, uh, we never want this to happen to anybody again. And once that a groundswell occurred, the changes in the mindset about whether perfect was possible was, was almost immediate.
Geoff Webster (10m 52s):
And people began to understand that if you set the goal at 99% reduction, let's just take a, you know, very high number. Mmm. And therefore the expected rate is we'll, we'll have one this year. Let's just say then when one happens, do you know if that's the one that is expected for the one that wasn't expected? So it immediately takes the energy and sort of pops the bubble of, should we work on and solve this one and learn from it when you don't have that theoretical limit focus and the human face on the story.
Geoff Webster (11m 39s):
And the long and short of that story is that the 200 plus nurses and physicians on those units, um, took that energy and that learning to thrive deep down into the, of every process that they performed, that that could cause someone to get an infection and we're able to standardize those processes and then solve problems that they found along the way. And we're able to eliminate all infections for a period of more than more than five years when they were producing, uh, 400, almost 400 infections per year prior to that.
Mark Graban (12m 29s):
And the, in this type of, um, gosh, break through results and performance, um, don't, don't, don't come easy. It comes through that really just disciplined, diligent habitual approach to things. Right. And one other thing I've heard Mr. O'Neill talk about and maybe can share some thoughts on his, how, you know, focusing on safety and, um, creating habits and leadership practices and systems that lead to perfect safety, that, that has a few little spill over effects to other goals and measures that the organization is, is also trying to achieve, right?
Geoff Webster (13m 10s):
Absolutely. Um, so, uh, causing these habits in people once the switch is turned on, um, that it's possible to be perfect at one important thing. And that it's the little things that you do every day, whether you put your gloves on perfectly, whether you wash your hands perfectly, um, whether you insert a catheter perfectly, once you've proven to yourself that it's possible for hundreds and hundreds of people too, uh, to change those habits because the system helps them learn what things are most important and what to do reliably in order to produce those perfect results.
Geoff Webster (13m 57s):
The same is true for every single process that exists. And, you know, this is, what's so inspirational and exciting about, um, this work is that human beings have a limitless capability and limitless potential to, um, develop an understanding and learn how to get better at everything that they do all the time. Um, but it takes a certain set of leadership characteristics that, that established systems with perfect goals, with information about the outcomes that isn't retrospective or a historical it's it's it's day by day in real time and, and very actionable.
Geoff Webster (14m 54s):
In other words, if we had an, a, a fever on one of those units, the fever might not even be sign that they're is an infection. The fever is a sign that there might be an infection. And if what that causes is habitual activity to problem solve around what do we know then what can we learn? Um, it, it creates this incredible capability. And so we didn't just see improvements in the, uh, a central line infection rate. Um, we saw improvements in every other kind of infection rate, so that VAPs and MRSA and c.
Geoff Webster (15m 34s):
diff and, you know, I'll all of them. Um, but it also leads to, uh, just incredible downstream learning. Um, so one story that comes to mind from this period was a, you know, one of the processes we were standardizing was blood draws. And one of the things they looked back when they were trying to eliminate these infections was how do we draw blood? And there were seven or eight if I recall correctly, different kinds of vacutainers, these little, um, containers when you drop blood, but they, they attached to the needle and that sort of sucks the blood out and, and holds it so that it can be sent to the lab.
Geoff Webster (16m 22s):
And they started asking themselves to the question, how much blood do we actually need to do the testing that we're, we're asking for? So they went to the lab and asked that question, and it turned out that it was a handful of milliliters. And, but some of these, uh, vials were, were very large and how, you know, 20, 30 milliliters, like a lot of blood. And when, when we added up the amount of blood that we were taking from vitally sick people, um, who then we were actually paying blood banks, thousands of dollars to buy blood and put back in, we were actually making people anemic because we didn't understand the amount of blood that was needed in order to, to solve that problem or to, to, to understand their clinical condition and treat them.
Geoff Webster (17m 28s):
So it's this kind of detailed, habitual scientific method thinking that doesn't just fix one problem. It fixes all of the problems because we basically opened people's eyes to see what they're doing every day with the lens of, and then start just solving problems at a pace that most organizations can't even imagine and producing results that prior to that we're thought to be unimaginable.
Mark Graban (18m 30s):
So, you know, you talk about, you know, I mean, these are unimaginable times that we're in right now in, and what you were talking about in terms of habits. Geoff really kind of got me thinking about habits that we're all trying to practice now that I'm trying to be perfect about washing my hands. Uh, it's harder to be perfect about not touching my face. Um, it's easier to be perfect about not gathering with other people and, you know, these habits, um, are being put in place to of course slow the spread of COVID-19, but I've, I've heard that there's been spillover effect in terms of reducing, uh, the occurrence of, of just regular influenza.
Mark Graban (19m 12s):
And, you know, some of these habits are probably going to remain in terms of, you know, hand washing and who knows about handshaking. Um, but it, its it's, you know, a kind of made me reflect a, you know, it's, it's hard to change habits as an individual. It's, it's gotta be more difficult to try to do that on an organizational level. Right.
Geoff Webster (19m 34s):
Um, yes, I think that that's true. Um, but organizations, um, and the leaders of organizations have levers for changing behavior that umm, that the general population doesn't typically have. So in a, in a circumstance like COVID-19, umm, there's a huge amount of individual impetus or a will to, to change behaviors in order to protect your own safety in the safety of your family. Um, I think that one of the things that organizational leaders can do that, um, is vastly under utilized.
Geoff Webster (20m 23s):
And again, that gets back in this, um, this brilliance about using safety and perfect safety as the lever for our organizational transformation is create those human stories and that picture of the gap between where we are and perfect every single day, um, that, that, um, motivates that same kind of burning platform for the change of the behaviors. And then also giving people eyes to see, um, the habits that are most important.
Geoff Webster (21m 4s):
So you mentioned, you know, hand-washing and social contact and the current context, um, while handwashing, as you said, always has been important is a, there are tens of thousands of people every year, you know, somewhere between 20 and 75,000 people every year who died from influenza, um, it doesn't get the same practice it's sort of been normalized. Um, and so people don't act in ways that prevent the spread of influenza, but uh, if leaders can use their positions to, um, help people imagine a future where for instance, we didn't spread influence, uh, to each other and that we use the same habits and the same urgency that we're using for COVID to save the, the, you know, 25 to 75,000 people a year who, who die of, of influenza and that you extend that to all the other things that people get sick with a, the, the overall societal impact could be enormous.
Geoff Webster (22m 23s):
And the more that it society, the harder it is, cause it takes a leader sort of at the level of a president for, you know, a, a senior person with a lot of stature nationally to make those kinds of changes. But when you're running a hospital or a health system or, uh, or another kind of business, um, what it really takes is the leader of that organization, making clear the unarguable importance of aiming for perfect in the most important value space, things like safety. And with that, it's possible to flip this switch and get everybody acting in aligned ways towards the most important things and, and towards becoming a learning organization to be able to solve by on the other problem too.
Mark Graban (23m 17s):
Well, I think that's a great note to end on, um, Geoff, I'm sure we'll have you on other episodes of, uh Habitual Excellence so our guests has been, uh, again Geoff Webster a co founding principal of Value Capture uh, is there any kind of final last thought you said that was a good note to end on bro, give you a chance that you want the last word, if there's anything else you wanted to add.
Geoff Webster (23m 42s):
Yeah, I would just say that, um, you know, one of the things we teach leaders to do is to try to put on fresh eyes and go out into their organizations and look around for the habits that they can see that can tell them whether people are habitually. Excellent. And one great one that we've been taught is just stand to the staircase and watch how many of the employees and visitors use the handrail. And you can actually predict with pretty high certainty, the excellence of the organization by seeing the behaviors around something that simple.
Geoff Webster (24m 33s):
So I would, I would, uh, close with that note, um, that there are actions you can take to understand your current condition. And then once you learn those things, you can act on them and, and create systems that make things better.
Mark Graban (24m 48s):
Well, great. Well Geoff again, thank you so much for being part of the podcast here.
Geoff Webster (24m 53s):
I really appreciate it. Thank you. Mark
Mark Graban (24m 56s):
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 to learn more about Value Capture and how we can help your organization on this journey to Habitual Excellence visit our website at www dot Value Capture, llc.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."