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Hi, this is Mark Raven. 
Welcome to episode 280 of Liam 

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blog audio. 
This is going back to a post 

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that was published on. 
May 31st 2019. 

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It's titled. 
When having a process 

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Improvement idea means you're 
weak the question mark, so I 

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guess I'm wired for improvement 
or it's just become a habit or 

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it's both. 
I mean I celebrate moments when 

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I can identify an opportunity 
for improvement in my work. 

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I tend to be pretty transparent 
about problems and Even 

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mistakes. 
Like the time, I forgot my socks

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and that's something. 
I something I blogged about. 

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I haven't made that mistake 
since if you want to read that 

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blog post or seed links to other
stuff I mentioned here you can 

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go to lean blog dot org slash 
280. 

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I'm sorry. 
That's lean blog dot org. 

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Slash audio 280. 
There's a mistake. 

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I didn't plan on doing that. 
It just happened. 

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But if you're a regular listener
to this podcast, you know, the 

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link is always lean blog Dot. 
Org slash audio and then the 

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episode number. 
So anyway, back to the post, the

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Toyota ISM of no problems as a 
problem. 

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That's that really resonates 
with me. 

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I mean, identifying a problem, 
shouldn't bring blame and shame.

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It's the first step in improving
the way work is done. 

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Now. 
I'm fortunate that we've built a

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culture at Connexus where 
problems and opportunities or 

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celebrated. 
It's safe for people to speak up

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and problems lead to 
Improvement. 

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Not punishment. 
Our book Healthcare Kaizen that 

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I wrote with Joe schwarcz that 
book, share, stories and 

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examples from organizations that
have built a strong and 

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sustained culture of continuous 
Improvement. 

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Like his self Health System, 
Franciscan Saint Francis. 

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And by the way, I'll interrupt 
and mention you can come and 

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visit Franciscan in October. 
We do this great site. 

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Visit. 
This is the fourth time. 

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We're doing it. 
You can learn more by going to 

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www.hsn live.com. 
So anyway, you know, with that 

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culture. 
A Franciscan and other places. 

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I almost take it for. 
Granted that Improvement is a 

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positive thing. 
But I sometimes get reminders of

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the challenges that people face 
when working in an organization 

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that is not a culture of 
continuous Improvement twice. 

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Now, in recent weeks. 
I've heard a story from 

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Healthcare professionals, one 
American and one on another 

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continent, one of them a nurse, 
you know, she's the type who 

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seems wired for improvement. 
She tries speaking up. 

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She aims to be constructive and 
pointing out the ways. 

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As the work of patient care 
could be easier, but she gets 

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told things like, well, this is 
nursing. 

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The implication is that she 
needs to toughen up and get 

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better at dealing with the 
waste. 

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This mindset is really hard for 
me to wrap my head around. 

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I mean, I think nursing should 
include the opportunity to 

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improve the nursing work. 
So there's a small real example 

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from a different organizations. 
Let's say a nurse notices that 

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patients ask for ginger ale to 
drink when they're nauseous and 

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there's no ginger ale on the 
Unit. 

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So the nurse has to go upstairs 
to a different unit to go get 

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ginger ale, or the patient's 
request, maybe doesn't get met. 

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If the nurse is too busy. 
It would be easy to say we don't

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have any sorry, the nurse points
this out to the manager and 

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suggest it would be nice to 
stock ginger ale on their unit. 

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The manager could say things 
like well, you know, suck it up.

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That's the job. 
Go get the ginger ale even if 

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that means walking. 
I mean, nurses today. 

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I want to have it so easy. 
Good grief. 

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And don't you dare say you're 
too. 

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Busy to do it. 
It's part of your job. 

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That's the end of the made-up 
lecture there. 

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But in a culture of continuous 
Improvement that manager thinks 

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the nurse for pointing this out 
without saying things like, 

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well, why didn't you mention 
that before? 

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The manager might contact 
dietary services to change? 

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What beverages are delivered to 
the unit or the manager might 

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teach staff how to contact 
dietary Services as needed but 

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not every organization. 
Truly Embraces continuous 

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Improvement. 
It's sad, you know, it's really 

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sad to hear a health care. 
Professional have an idea that 

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could be implemented right now 
at little cost only to be told 

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things like you have to 
understand. 

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This is how Healthcare works but
it doesn't have to be that way. 

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The work could be easier. 
The culture could be better, the

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implications of comments like 
these from managers include how 

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dare you point out a problem 
that's offensive or you need to 

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toughen up or you should be more
resilient or Out with that waste

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when I was a nurse. 
So why can't you handle it? 

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It almost reminds me of the 
cycles of hazing that happened 

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in organizations. 
People say, well, I survive 

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this. 
So I'm going to make the Next 

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Generation suffer through it 
too. 

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So again, this is all very 
puzzling to me. 

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I'm curious. 
Have you experienced similar 

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situations? 
I mean, how can we help change 

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this? 
So if you want to read the post,

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if you'd like to share comments,
you can go to lean blog dot org,

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slash audio 280. 
There. 

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I did it right. 
This time. 

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So there's a lot of comments and
discussion on the post already. 

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Baba Milian e wrote in part. 
That hazing is a wonderful way 

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to express the problem. 
I've experienced the blame and 

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shame for identifying problems 
and multiple contexts past and 

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present a beat eight wrote in 
part. 

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Thank you for shining a light. 
On this issue. 

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I've worked in healthcare for 15
years, as a bedside caregiver, 

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and now in performance 
Improvement. 

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I believe the only way this 
problem can be solved as An 

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executive team Who quotes from 
quote-unquote gets it and is 

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committed to instilling these 
Concepts into existing 

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leadership and only hiring new 
people who already get it or are

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willing to learn it. 
In addition, the executive team 

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must actively demonstrate the 
desired behaviors and hold 

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accountable. 
Those who don't? 

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I agree with all of that. 
Very strongly, Joe Lopez wrote 

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in part. 
There's clearly a generational 

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component here as well, working 
in a flawed system, for a 

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lifetime making do in perfecting
workarounds. 

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It gets worn as a personal can 
do badge, and change can be, 

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especially difficult for those 
who have had to work this way. 

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And then, Dan route from a 
patient perspective. 

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He posted a comment. 
Says, he was in a room for 10 

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days to get a heart attack. 
I overheard nurses talking about

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having no time to enter patient 
info into the computer. 

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They walk 9 to 12 hours per 
shift. 

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They told him that's half their 
time walking to get things and 

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deliver things, but nobody knew 
how to do anything to fix it. 

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And then he Said he shared some 
observations and the doctor and 

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nurse team were shocked about 
his observations. 

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And he said, it's as if time has
stood still 50 years regarding 

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Improvement, waste teams Etc 
there what he experienced in 

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healthcare so we can do better. 
It is possible to create this 

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culture. 
They've done it at Franciscan 

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st. 
Francis Health. 

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And again, if you want to come, 
visit them with me and Joe 

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Schwartz and other hosts, there 
you can learn more by going to 

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Zen live.com.