E092: Process Improvement in Nonprofit Daycare with Elisabeth Swan

In today’s episode, I interviewed Elisabeth Swan, who has over 30 years of process improvement experience with a great background working for consulting firms like Rath & Strong and Pivotal Resources. She has lots of experience working with nonprofits, government, hospitality, healthcare, entertainment (including work on “Saved by the Bell”), and the for-profit sector. She teaches Lean and Six Sigma at the University of California-San Diego (UCSD), is the co-host of the podcast and video series (with our last guest Tracy O’Rourke) called the Just-in-Time Cafe, and is a co-author of the book, The Problem-Solver’s Toolkit: A Surprisingly Simple Guide to Your Lean Six Sigma Journey.

In this episode, she shares some specific examples of her work with a nonprofit healthcare organization called Cape Code Health Care, and how she helped them achieve Green Belt certification and implement improvements in a daycare setting.

You can also watch the video of this podcast below, or go to https://www.youtube.com/watch?v=ths_QNkGi7c


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Have you ordered the new book, “Lean Six Sigma for Good: Lessons from the Gemba (Volume 1)?” The book is made up of 8 chapters written about experiences from Lean and Six Sigma practitioners, to give you tips and tricks to help you work with nonprofits in your area. All proceeds donated to charity. We are also close to releasing Volume 2, so check back for the latest news.


Brion (B): Hi, everyone. Thanks for joining us today for the Lean Six Sigma for Good podcast. This is Brion and I’ve got my friend here, Elisabeth Swan, joining us today. Hi, Elisabeth. Thanks for joining me.

Elisabeth (E): Hey, Brion. Absolutely.

B: Can you tell me a little bit about your background in continuous improvement or process improvement?

E: Sure. I realize now it’s over 30 years, so it’s decades, but if I think about my start, there’s a couple of big things that stand out. I was working, kind of helping, more setting up projects, things like that, for a process improvement firm, and they had been around since 1935, Rath & Strong. They were part of the rebuilding of Japan after World War II, and I learned about set up protection and Just in Time Cafe– I mean just-in-time. I’m sorry, I went right into what that means to me now, but I really did learn it years ago. This guy Ed Hay that wrote about just-in-time manufacturing and I learned at the feet of all of these greats. It was an astounding group of consultants.

I was kind of working in a minor role, and then – and this is important because it drove my career – I went and saw I think it was a benefit for Au Bon Pain, like their 10th anniversary, and I was helping a friend there and Improv Boston performed, so I watched them just do a skit. They made it up about being in an Au Bon Pain, that’s a coffee shop in Boston, of being in one of those and I just thought, “This is magic. How are they even doing this? This is crazy.” And I found out where they performed at Inman Square in Cambridge and I went to see them and they were astounding once again. One of the guys in the troops, I swore he was looking at me, like we were making eye contact and he was really cute and I thought– and then they said they offer workshops and I thought, “I’m going to do workshops. I’m going to meet this guy.”

The guy, who is still my friend, who ran the workshops, he’s a phenomenal improviser, turned out not to be interested in me or any women, but I loved the workshops. At first, I thought what are we scientists, consultants, teachers, firemen? This is not going to be funny. But I realized, oh, everyone’s hilarious. The skits are hilarious. It’s about mistakes and seeing where things go. I ended up performing with them for years. I performed in traveling troops, I performed all over the country, and then I realized that I could do anything. I was like if I can stand on a stage with no script in front of thousands of people and make stuff up in a scene– and eventually, we did musicals, so we did improvised musicals. I just look back and go how did I even do all that? but it gave me the courage to leap.

It was in ’89 I was working with these guys, and by ’96, I thought enough people were telling me, “We’d love you to do this, we’d love you to do that,” and I thought I can go independent. So that was exciting to make that leap and that was afforded by improv, which I kept in all of my work. I always think about, in process improvement, as improv, that you could go anywhere and you’ve got to be working with people. So improv is solving problems on stage, so you’re constant collaboration, you’re listening really intently to see what are they offering and where is this going to go, and it’s the same things that make great process improvement efforts. So anyway, that’s a little background.

B: Were you doing that full-time or is that also you were still doing work as a consultant and doing improv at the same time?

E: Improv was weekends. It was at nights and weekends. It’s odd for people to hear you practice. We practiced at night. We had rehearsals during the week, rehearsing how to make things up and it’s structured. It’s very structured and back to that structure sets you free. We work in structures, so does improv. But, yeah, I did that at the same time until the thing that stopped me with improve was really my career taking off and becoming what a lot of us called being a road warrior. I was now traveling too much to be relied upon to be at shows, so that changed, but it was good. It was great. I never left that, but it sort of propelled the rest of my career.

B: I remember the Rath & Strong materials from early 2000s that I’ve seen around Lean and Six Sigma and some pamphlets I remember going through and maybe some workbooks or little pocket guides maybe. I feel like I’ve found a few of those things over the years.

E: That’s true. Colleagues of mine, I think, worked on one of the pocket guides. within GOAL/QPC, I think they were the great producers of the pocket guides. But, yeah, there’s a lot of great authors, a lot of great work came out of them and, yeah, that was a great experience.

B: How did that transition into maybe going on your own at some point or some of your more recent work?

E: There’s a couple of pivotal transitions, and one of them was I kept running into people from a firm called Pivotal. So I kept being drawn to this group and I met them, this was back– it’s also mid-90s and GE became the big, engulfing all Lean Six Sigma people everywhere. So I went to bake-offs where it was like, okay, which consultants can work which gigs, which led to a really hilarious string of gigs at NBC because GE owned NBC back in the day. So I was out in LA with a whole group of consultants, a lot of them from Pivotal I got to know, and we were working. We were running simulations on the set of Saved by the Bell, which is so cool. We were working with execs, weathermen, everyone inside of NBC, which was a big education.

B: Can you explain some of the examples? because I think that’s a great one to figure out, oh, it can’t possibly apply to entertainment and TV. What were some of the problems and issues that they were working through and experimenting on?

E: That’s a great question and it reminds me of a hilarious story of just the process of tape to air if you think about people in the field. There’s a beekeeping segment and somebody’s out there interviewing somebody who’s doing this great work in their community and that’s on a tape, and then the tape has some numerical and alpha designator. There’s a tape room, then there’s people who remove tapes because there’s multiple segments on a tape and that might go anywhere. And NBC’s on multiple floors and you’ve got to get– first of all, find the tape. If someone took it out, did they sign it out? and then which floor are they on? can you find them? Can you find the tape?

I don’t know if you saw the movie Network News. There’s this great segment where I think there’s an intern that’s just racing through floors and people with a tape. And, at the last second before someone’s saying, “And here we go,” and getting into what was then probably a VCR, and then it’s like, boom, it’s on air and that’s what it was like. It was this crazy hunt and torturous racing around and a lot of interns being beaten up like, “Where’s my tape? Where’s my tape?” So just processes like that were great for explaining it and how could this go better. That was a good one, yeah.

B: Nice, yeah. That’s cool.

E: From there, like I said, that’s where I met all these folks at Pivotal and got to know them and they reached out and they said, “Hey, there’s another Northeast project we’re looking at, which is Starwood Hotels and Resorts. They’re headquartered in White Plains, New York and would you be interested in helping them? They want to do a transformation.” That’s something that lasted decades for me on and off just working with training everybody. They had 800 properties. That sent me all over the world. I would be training people. I know that your heart’s going to bleed for me. I had to go to Venice, I had to go to Dubai, I had to go to Croatia, Jordan, Egypt. Just the classes and the people I met were incredible and those are still a big part of my world. Even when they got bought by Marriott, I still know the folks there.

And then it’s a really interesting thing because working with people in healthcare, it’s the same. I’ve even worked with people in prisons. Getting people in and out of beds with different sense of urgency and protection and rules, it’s similar processes. Obviously, lots of differences but. Yeah, that informed– and if you can imagine, I’m sure we all tell stories to help people learn. Everybody gets being in a hotel, so those stories also stick with me for, okay, this’ll be easy to get in terms of the story. So anyway, that’s a broad swath of how I got from there to here.

B: That’s great. That’s a lot of different industries and different experiences that you can leverage when you’re teaching or coaching teams and I think that really helps people understand. Especially like you said, hotels and something that they’re familiar with can really resonate.

E: And then what I really wanted was local work. All of us, at a certain point, you’re like, “Do I have to fly every week into Cedar Falls, Iowa? Is that part of my life now, I’m just going to be doing that?” This was serendipitous at a moment of let me think about who’s local because Cape Cod, I’m in Cape Cod, Massachusetts. It’s kind of I think it balloons to 30,000 in the summer or something, and then it’s tiny in the winter. Anyway, there was a woman who ran the Cape Cod Child Center, which is throughout the Cape, they have agencies. She googled Lean Six Sigma Cape Cod and found me. Now, I think Tracy joked, when she was on your podcast, that if you google Elisabeth Swan, mainly you’ll get Keira Knightley who played Elizabeth Swann in the Pirates of the Caribbean. But luckily, she didn’t know my name. She just knew Lean Six Sigma consulting and Cape Cod and she found me. She was in a town maybe 25 minutes away and she said can we meet at a Panera Bread right between us and I said sure.

So we met and she just said, “Look, I’m working with Cape Cod Healthcare and we are providing services for the folks that need it the most on the Cape. We run head start programs, we help teen moms. We really do a lot around education. It’s a nonprofit and would you like to help? I want you to train my people, all my staff to be Green Belts. I want to do projects and raise the bar on how we run stuff. I want to grow. I want us to grow and help more people,” and I was like, “Sign me up. This sounds amazing,” and also, just as I’m sure– one of the reasons I admire you is that you’ve made that a focal point, but it was suddenly this feeling of, oh man, this is exciting. This is exciting to do purpose-driven work and I happen to have worked for them as a teenager.

This was just a week, but my mom, when I was in school and she wanted to be available to us, she worked a job that would make her be home by the time I got home from school. She worked at the daycare center and the daycare centers also were run by Cape Cod Healthcare and it was very new. She worked with them way back very early when they started and she was a cook. She cooked for the kids at the daycare center and she had an assistant. She got really good at working on a budget, like how do I feed all these kids on this much money. They actually, when she moved on, they were like, “Can you please explain to us how you did that budget? how did you manage to do that?” So my mom, I see, has little glints of Lean in her, so I should’ve thought about that. But she wanted to go on a vacation and she said, “Elisabeth, could you come and just be the assistant to my assistant? She’s going to cook for the week, but if you could help the rest of the jobs in the kitchen, prep and clean and stuff like that,” and I was like, a teenager, like, “Money? Yes, I could do that.” So I just told this woman, the new CEO, I was like, “I worked for you guys when I was a teenager, so this is a great full-circle for me,” so that was a great beginning.

B: That’s awesome. What was the desire to do Green Belt? how did they arrive at that? what was the problems they were trying to resolve with that? or they weren’t quite sure, they just knew that they probably needed some training?

E: The CEO had come from corporate. She had made the shift. She had been in healthcare, but she wanted to go into the nonprofit side. She had been trained as a Green Belt and she had seen how much they could save and how much they could basically improve the way they ran their business and she wanted to bring that into the nonprofit. She saw we’re running on a shoestring and the more we save, the more we can help folks, and she wanted to give back to her leadership. She wanted them to be trained in something they could use anywhere, to have these problem-solving skills. So see she just saw the possibilities and she knew if she framed it right, she’d get a grant to bring me in, which she did. So she got a grant to train all her people and then we started looking at what are some good things to tackle, which was also a really cool experience.

B: That makes sense with the grant to try and get funding because I’m sure that’s not easy to go to the Board and say, “We’re going to invest thousands of dollars into training our people and, hopefully, we get that return later. Trust us.” And here’s some techniques that most people aren’t familiar with probably on the Board, so I bet that’s probably a good route for them to go is through a grant, a workforce development grant of some sort I’m guessing.

E: Yeah, that is a great idea. I’d forgotten where she got the funds, but that makes a huge difference for anyone wanting to do stuff like this. Hey, you’re going to help the business. You’re probably going to save money. You’re going to free up bodies and cash and time and labor, all that stuff. So yeah, good point.

Yeah, we got together and we said, “All right, what are some things, the classic fix what bugs you, what’s bugging you? what’s costing money? what do you see that could be better?” one of my favorites was the office manager. She said, “Oh man,” she had this great term for it. Ordering supplies was called “order as you wish.” It was just like whatever. People just had credit cards and it was just like– and it was all last-minute and it wasn’t from any particular vendor. So she went about, okay, let’s– and she had to get, she didn’t have positional authority over some of these people, they were higher than her, so she had to get her boss, the CEO, to say, “I back you on this. Let’s work this process,” and a lot of pushback on little things. Like don’t change the soap. I like the soap. I like the way it smells. Do not buy a new soap. I’m used to this. And don’t fix what’s working. There’s nothing broken here.

But she said things like there’s daycare centers where they had dishwashers but they’re still ordering up paper plates and napkins and plastic silverware and so she said, well, that was unnecessary. But the more she poked, the more she got pushback until she finally realized, she said, “Hey, wait a second. If we save the amount of money I’m trying to save, then we can afford a mortgage on another daycare center,” and that shifted everybody. It’s not only nonprofits where people need to know why, but just a reminder to come back to your purpose like why are you doing this? What’s the purpose here? that shifted things in such a way that people started telling her about ideas they had for saving money. But generally, people got on board and she shifted it enough to get the new mortgage. That was exciting and it was a lesson for her in like, oh, okay, I need to explain what this is about.

But she also did like demonstrations like, “Here’s the new soap I got. I tried this one. I’m going to show you how it works like here it is on me.” And then she said, “They use it in NICU units,” the neonatal intensive care unit, she goes, “So it’s definitely safe for us.” She just put herself more in there, listening to them and responding to them. The other thing she found was that she was looking at the phone bills and she’s like, “Are we using all these phones and something called Wi-Fi sticks?” and I don’t even know what those are. So then she started looking at the usage. She’s just looking at the invoices and she saw, okay, if nothing’s happening on this phone, then let’s just turn that off. I think, right away, that was 1500 a month, so just massive savings on just starting to scrutinize how does this happen. Yeah, so that was a big one and that was a cool one.

B: That example with the soap is very typical though. You almost have to do some of that detail work of even small changes like that have to get vetted a little bit and bring people in. You might think, “Oh, no one’s going to care about that,” but until you do it, then you find out there was a lot more stakeholders than I realized who cared about these things. It feels like I think people get a little frustrated like I have to do all this effort. Why don’t I just tell people what to do and then I’m done with it and they just have to live with it, but they’re not seeing the long-term effects that that brings. It frustrates people and then they feel like they don’t have a voice. And so it feels like a lot of work, I think, initially, but once they see that it goes smoother and people are enjoying it and they’ll bring forward other ideas, I think it does pay for itself when you invest that time in too. Even little changes like that can really derail things if you don’t include the right people.

E: And then building on that notion that you just said, include the right people, another really interesting one, and this was a woman who was monitoring what was happening in the daycare centers and there were like 39 incidents a month. That means an accident, furniture damage, a kid might get hurt. All these things come under incident, which was high and she’s like I want to lower that. But she went to the gembas you and I would say. She went to the daycare centers to understand what’s causing this and she watched and she wrote up room layouts, if you can imagine, like spaghetti charts of how the kids moved. What she saw was if they had these really open areas with these low bookshelves, the kids would use the bookshelves as launch pads. This was places to jump and it was just kind of like just a place to run, so jumping and running and crashing into other furniture was the norm. So she was like, “Okay, we need to create safe spaces. We need to create here’s a reading nook, here’s a nap nook, here’s a play area, and let’s move these things out of the way that it looked like launch pads,” and that dramatically dropped incidents. I think it was down below 15 a month after that.

And then in one of the daycare centers, she saw it creep back up so she was trying to understand that. She went to one place and it was the one place where she redid the room over the weekend. She didn’t have time to meet with the folks but she knew the floor plan that worked, so she just did that one over the weekend and when she came back, you’re going to tell me, guess what she saw?

B: Everything put back the way it was.

E: Everything put back the way it was and she was like, “I didn’t work with them. I didn’t do it with them.” And so as Tracy would say, people don’t like having process improvement done to them; they want you to do it with them. So that was a big lesson there. But mea culpa, she went back and said, “Okay, let’s work on this together because we’ve seen it work elsewhere, and you tell me. Do you have some ideas beyond what I came up with?” So that was a great one but back to your point of people want to be included in that process. That was a good one.

Another one was… Let’s see, this one was the hiring process and that just reminded me that process comes up everywhere. Isn’t that just a bugabear everywhere?

B: Everywhere.

E: I think it was like 72 to 172 days to hire people. Imagine now you’ve got the great resignation. You’ve got to work fast, man. People are like maybe they’re going with you, but you’re too slow. I’m going over here because I’ve got options. She dug into the boxes of old data because another thing they had to get used to was we’ve got to have some data folks and they were like, “Data?” Just that whole like what have you got? Anything. She’s like, “I know where the emails were when I got a hiring manager saying I need somebody, and then I’ve got when people are hired.” Great, okay, so we’ve got something to work with. So she built that and that’s when she was floored at how long it had been taking. She was like what’s going on here? so she started looking at the different processes. Each hiring manager had a different way of going about this, and you’ve seen that. People say there’s no process and it’s like, yeah, there’s a process; there’s just a lot of variation in the process.

So she looked at that and she saw also they were entertaining incomplete applications or applications from people that really were not qualified. You shouldn’t spend time here. So it was like let’s weed out and let’s make our applications a little bit easier to fill out so that we don’t get the incomplete ones. I don’t know about you, but I find a lot of things go back to the form, like what the form is making people do. You think it’s so silly, it’s like it’s just a piece of paper, but there’s some places I worked with there was like a Forms Department. I worked with Alberta Health Systems up in Alberta. They were like, “Oh, but it says a VP’s signature on here, and we don’t need a VP signature anymore,” and I said, “Well, let’s just get that off the form,” and they’re like, “Oh no, we have to go to the Forms Department. That’s like three months right there.” I like, hmm, that’s not good.

B: That’s another improvement area.

E: The good thing about some nonprofits is they’re small so it’s like, “Change a form? That’s me, I change the form.” Awesome.

B: “It’s done.”

E: “It’s done, man.” So she did that and that made a big– yeah, so anyway, she completely altered that process and they knocked it down within a couple of months, so that was great. So that was forms and another interesting forms one, and this is a term I learned from them which you probably understand, is in-kind, that term.

B: Donating services?

E: Donating services. And so even me, I could donate some of my consulting time and that became in-kind. For someone who’s donating it, if you want to keep track of that, you make it formal and you put it on your taxes and you say I donated this time and that becomes part of what you register as your donations. And that was that term and that notion, but she was working on a project that she said, “We’re not capturing the in-kind services we’re getting, and because of that, we’re not getting the grants we could.” Like some grants will give you more money the more in-kind services you are actively getting.

B: I see. I was wondering why they would track that or need to know that.

E: Yeah, why would they care, which I learned that too. So I didn’t know that that could impact grants, like the more you are, on your end, getting in-kind services, the more they’re interested in giving you grant money so they want to see you doing that. So she looked at their forms once again and she realized that people couldn’t figure them out, but she also realized there’s a lot that was the same every time so she just prefilled. She’s like I don’t need people to try to figure this out. I know those figures. I know that information. I can just put that right in the form, so that made a huge difference.

So clarifying forms and the other thing, it had a bonus of once parents started hearing that your in-kind services increased grants, then they wanted to offer more services like, “Let me help. I can donate time for the daycare centers. I can donate time at this particular center,” so that also went up. Their in-kind went up for both better recording of it and also people were offering more, so that was a cool outcome.

B: I’ve found that that’s pretty typical. Once you start tracking something or saying this is important, then sometimes that skews the data a little bit because people start recording things or not recording things depending on that, but just the fact that you say this is important to us and, all of a sudden, you magically just start seeing better results or increases just because there’s now a focus or a priority on it.

E: Yeah, and maybe before it wasn’t even– I did not know that term, which I felt kind of like, boy, I’m a dope. Why didn’t I know that term?

Another great one was an office manager who the whole process that drove her crazy was they had all these providers, people who were working at the daycare centers and things like that, and they had to submit timesheets, here’s what I worked. Then they’d get a payment voucher, and the payment voucher would turn into a check, then they’d print the check, and then it would go to the CEO, and she signed the check, and there was infinite rework around getting the right attendance record. There were lots of different bugaboos, some of them were hilarious, but one of the main ones was people were just emailing these things in formats that were too huge for people to read so they just couldn’t figure out what they were looking at. So one of the fixes was just here’s how to send it in. Here’s the easy way. There’s all those, you probably use apps like Scannable, things like that you can immediately make an easy PDF of things. It was like just do this and then just, boom, you’re done, it’s in and we can read it, so that was one.

They also realized there they were constantly printing vouchers on this pink paper so that meant, again, small scrappy office, there’s only one printer, so then they put the print paper in, so then what happens? everyone’s printing their stuff and it comes out on the pink paper. So it’s like, “Not to pink paper.” “Take it out, sorry.” There was constant reprint, print, tossing stuff out, and ordering special paper until finally she asked, “Why do we have to do these on pink paper?” This, of course, you’ve seen this. It goes back I don’t know a decade or more, like Ron from accounting had this idea. It served a purpose, I’m sure, but no one even can remember the purpose, so let’s just not do that anymore. Let’s just not do that.

The hilarious thing in my head was someone told me this story a long time ago about Goodyear. This was a project at Goodyear and they were trying to Lean out the process of shipping tires. At one point, they questioned why are we putting tires in boxes? these things are going on the road. Why do they need to go in a box? they traced it back to the 80s when whitewall tires were the thing and you had to put the tires in a box so that you wouldn’t get any mars on the white. It’s like, okay, so not selling so many of those anymore, so let’s just stop doing the boxes. And I told them that story with the pink paper, so that was good.

B: I heard another project that someone was working on getting rid of staples. They were just trying to get people to quit stapling papers together and so they went through all this effort. But it was saving a bunch of time and cost of staples because they were doing thousands of thousands of these documents. The effort just to get people to stop stapling two pieces of paper together or something was just so difficult to get people to do, but you’re going back to just like, “We don’t need to do this,” and I thought it was pretty good, really simple example. But they really struggled, like it took them a long time to get the process rolling.

E: It’s almost like you’ve got muscle memory. Like, “Yeah, but I’m still supposed to be…” and you’re like, “No, no, don’t do that anymore. There’s no reason to do that.” Yeah, it’s almost emotional like, “That’s wrong. Don’t do that.” “How are you taking away the stapler?” Yeah, those things die hard.

And then the last piece on hers was why do we have physical checks? we could just wire this money, just do electronic payments and then, voilà, no going to the CEO to pull her aside every week to do all the signing of all the checks that have all been printed, hopefully, not on pink paper. So it’s like they saved so much time and effort on that and a little bit of money here and there, but that one just was a lot of people’s time, also big in nonprofit. There’s a lot of work to be done, so you don’t want to do that.

B: Yeah, and they’re already overwhelmed with work. It seems like that’s been the common theme is that people are got a long list of things they need to do or a lot of things that are broke or their mission that they have, they’re so passionate about it and they see the huge gap from where they want to be and so it just feels overwhelming at times. The last thing you want them doing is caught up in these terrible processes that are eating up a lot of non-value-added time when they could be doing work that’s actually meaningful and helping the mission of the organization. And so it’s almost these are necessary improvements that you have to have or you’re going to burn people out and they’re going to get frustrated because they’re not actually working on the things that they signed up for when they joined that organization.

E: So true, freeing people up to do– especially in an arena like that, there’s so much where you’re going to be adding value. And you just reminded me of one last project that really touched me because it’s back to the things you don’t think about in terms of emotional impact on people. This woman was trying to understand people who she knew were homeless, and then they could help them if they were, would not identify as homeless. She realized it’s a point of pride and it was a way of seeing yourself. I don’t want to see myself as a homeless person. I’m just bunking with a friend for a little bit. I’m just using my brother’s spare room. Whatever it was, they didn’t see themselves as homeless.

So once again, the form that she used, she realized nobody was checking the box homeless. So we said, “Okay, do you know the criteria?” and she goes, “Oh yeah, absolutely. I know all the things that, for us, qualify as homeless,” you are somebody’s couch, you are using your car, whatever. So I have other questions I could ask that help me make that designation to get them to help, then they qualify then I can get them help. So that was another one, like let’s rephrase that and just do do you fit any of this criteria, and not use the word homeless. And then the amount of people responding went up, and then the amount of money they got to fund went up, and again, it was a great series. But being mindful of what does that feel like for the human being you’re dealing with.

B: Absolutely, and then it goes back to the data quality because you’re looking at these forms and saying, “The problem’s not as big as it seems,” or, “We’re not getting as many people as we think there should be,” and if you just trust that data then you don’t uncover those types of issues. If you go back and say you know somebody’s homeless, you have them fill it out, and then you’re like, “Wait, they didn’t even put homeless on there. What’s going on there?” So that helps uncover the gap in the data, which is really driving a lot of the process, not seeing those things marked, so that’s cool.

E: It’s a good example, too, of really getting to know your customers, that you can’t make these assumptions. You can’t do this in a room. You’ve got to get out there and have the conversations and experience it and then that’s where you get the big a-has or your assumptions go by the wayside.

B: Those are great, yeah. I think there’s a lot of good projects in there. Thanks for sharing those. I know you’ve done some other work in other sectors, like government work. Is there anything else you want to just highlight from some of that work as well that people might be interested in?

E: Sure, yeah. There’s little things that stick with you in terms of what made the difference. Another big government agency I worked with was Centers for Medicaid and Medicare and was working with them to train folks to be problem solvers. I was working on a project or coaching a woman on a project and she was vision impaired. Her metric was to increase the amount of alt text people were using and, once again, had no idea what she was talking about. So what she said was, “I rely on that information. If I’m online, if there’s a photo, if there’s things that I can’t– I have a way to read text, but I don’t have a way to figure out what a photo is. So if someone doesn’t describe what’s in the photo, then it’s lost to me.” That was one of those things that I never forgot. I post on LinkedIn all the time and I put photos in all the time or I put drawings in all the time and I always go to alt text and I try to give the best description possible of what is in that image and I always think of her. I think that was such a great learning for me, that there’s a whole world of people I wouldn’t have known. I would not have known the impact of processes, that piece of a process, that piece of the internet on people. That was big.

B: Yeah, I just learned about that too. I knew that that existed, but I didn’t know who uses that in presentations until I gave a presentation to an organization that focuses on blind and deaf-blind. They were like, “Please, for every photo in your presentation, put a description of that photo,” and that was just last year.

E: Yeah, you come up against it and you’re like, okay, got that. Another big organization, big government organization was the Alberta Healthcare System. That’s a huge network across the province and it is government-run, which means it’s also in the news. When I was pulled in, the team I was pulled in with, that was back when I was with Pivotal Resources, that we were brought in basically to bring a transformation, start one that they could continue. They knew it would take a while to transform all the facilities into Lean Six Sigma facilities. What started it was the newspaper headlines by the opposition candidates showing the lines of people and the cots crowding the hallways in emergency rooms and just the complete mayhem and inability of the system to process people. That gave me that sense of, ah, they’re in the news. This is huge, this is touchy. Everything we do is going to be something that could be relayed positive or negatively to the public.

We had what we call a war room in this basement in Alberta. And just as an aside, because I’ve worked in the Bahamas, I worked with the Bahamian Telephone Company and I felt like it was penance I got sent to Alberta after that. I had a team meeting and people were late because the gas froze in their cars. It was 45 below zero and, at that point, it doesn’t matter if it’s Celsius or Fahrenheit. So that was a big learning for me.

So now I’m in the basement of this hospital and we are mapping from the ER, from admission all the way to discharge, and it goes wrapping around this massive concrete wall and lanes of doctors and nurses and PTs and OTs and labs and you name it. We built this great swimlane and then we were working on the pain points, so nice big pink Post-its for everywhere that people were like, “My goodness, once I could see a patient, it takes me like 15 minutes or 45 sometimes to get to somewhere where there’s a computer where I can put my notes in. That’s just a huge waste.” Or patients being left out waiting for labs. And so just everywhere there was a pain point, but then I also realized it was a meet point. People would bring people down there. They’d say, “Oh, come see the map,” and they’d show it off like here’s what we did, and then people would add more pain.

I was in there one day when there were ER nurses and then general medicine nurses, and there was a handoff of a patient that had been admitted and the pain point was from the GM nurses, general medicine nurses, saying we just don’t get enough information and we’re calling back to get this information about patients for multiple times. The ER nurse was there and he said, “Oh, we could fix that easy. I got it,” and they solved a problem just by being together at the map, and that was really inspirational. So I feel like that became this great focal point where doctors and nurses and people could just get together and discuss some of the stuff that crossed the lanes and it stopped being like their problem and us/them. So that was a big uniter.

That took 10 years and at the 10-year mark, one of the doctors involved wrote me because she’d been heavily involved in it and she just said, “I just want you to know we’re there. We’ve arrived. We have an amazing, amazing system. We are problem solvers everywhere.” And then she retired and I still get cards from Alberta. Just every year, “What are you doing these days?” Anyway, so that was incredibly– again, it felt really good. One of the people we had on the teams was a patient advocate talking about her dad going through the system, so again, it was like really getting to know people and how this affects the human beings going through it, so that was a big one.

B: I’ve heard that too from people who’ve had bad expenses with healthcare is they really just want the process to be fixed. They don’t want others to go through that, so I can imagine that they could see these problems getting resolved and they’re like it that’s exactly what we want, just to not have other people go through the same experience we went through. So yeah, that’s amazing to live through that whole transformation and see that. It is pretty rewarding to be on the backend of that.

E: Yeah, you don’t often get to see that.

B: Very true. Great, there’s some awesome examples here. What are you working on now? Tell us about the Just in Time Cafe, any other activities, projects that are going on, how can people get a hold of you, stuff like that.

E: All that good stuff? So I’ll just say, anecdotally, I’m working now with UC San Diego Health, so another educational and healthcare facility, teaching and coaching Green Belts, people to become Green Belts and do projects. And so it’s great to be in healthcare again and back to, like I said, it’s getting people in and out of beds, like those same processes I remember. So that’s exciting right now to be back there.

And the Just in Time Cafe, that, Tracy and I just incredibly proud. Just making it a hub for where we can pull people like you and other people in our community who have great things to offer, whether it’s we do webinars with people teaching other folks like how do you use Lean to fight racism. We’ve got one coming up, which is how do you lower the bar and make it easier for people to get involved in Lean Six Sigma. Don’t make it so challenging for folks to get involved.

B: Is that the one with Amanda?

E: Yeah. I’m psyched about that. Amanda Zimmerman’s going to be presenting all the way from New Zealand. And then the podcast, I feel like that, like you and me now, you and I have been on– we were on the Lean Communicators together, but I was thinking, “I want to get to know Brion better.” This is a great way to get to know people. This podcast is relationship building, so that’s a real exciting thing for us to get to know people in our community. These days, we can do it all over the world, so we’ve interviewed from Dubai, from faraway lands. And then we also just wrestle with the issues that our compatriots are wrestling with and stuff like that. So that, I think, just fills both of us with joy. That’s a thing that we believe a rising tide lifts all boats, so just helping to spread that just feels great so that’s a labor of love.

And then the thing that I’ve been working on lately, which has been exciting, for a year now, I’ve been writing a post a week. I illustrate it usually. I’ve got a little bit of a sense of humor because you have to be a little bit humble about what we run into all the time. There’s just stuff that, no matter what we do, we’re going to hit this problem all the time, so just bringing a little bit of fun into it. But just telling the stories over the past 30 years, so many stories of different things that bring an issue to life for me, and then just asking my colleagues how do you deal with it. So generous colleagues all add really nice ideas on how to deal with it. I just got a publisher asked if we want to pull that together into a book and that could be something that people can then take those issues, look at how people dealt with it, and think about how do you do want to deal with that, like experiment. So I’m pulling that together now, so that’s a new labor of love.

And if people want to get in touch with me, they can reach me at elisabeth@jitcafe.com. I’m not a believer in acronyms, but when it comes to emails, you have to shorten things so people don’t have to spend too much time typing.

B: And it’s Elisabeth with an S.

E: Oh yeah. Just like Brion with O, it’s Elisabeth with an S. Both of us, our entire lives have said, “Actually, my name is spelled… If you wouldn’t mind changing that.”

B: Or, “That’s fine, close enough.”

E: Actually, you’re like me. I’m like, “Z? fine, whatever.” I take what I get. But with email, it’s important, yeah. It won’t get to me if it’s a Z.

B: Thank you so much, Elisabeth. Anything else you wanted to add?

E: No, it’s just really great to talk to you and it’s great to remember these projects. These were great, these were fun, and it’s just that’s a great part of this work, getting into it with people and seeing them succeed and have a big impact on the world. It’s great.

B: Yeah, and I think that your examples are really going to be helpful for people to think about how this might work in other settings and other industries, especially nonprofit and healthcare, so that’s awesome.

E: Great. Spread the love, Brion. Spread the love.

B: I will, all right. Thanks, Elisabeth.

E: Thank you.

B: Bye.