E082: Improving Government, Healthcare and NGOs with Clare DiFrisco

In this podcast, I interview Clare DiFrisco. She is a Lean Six Sigma Master Black Belt and owner/co-founder of Cannsult, a consulting firm based in the US and Australia that also offers an e-learning platform on Leadership and Lean Six Sigma. She is a hands-on practitioner, leader, coach and facilitator with many years of experience across many diverse industries. We discuss how the pandemic has allowed them to double-down on their online training platform.

We also discuss her experience in the emerging cannabis industry, her work with many different government agencies and nongovernmental organizations (NGOs), her work with public and private healthcare organizations and even some work with law enforcement agencies.

In her bio, she mentions that she naturally gravitates to organizing clutter, and can be found on weekends collecting bits of plastic from beaches and alphabetizing the $5 DVD bin at Walmart.

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You can watch the full video of the interview here…



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.


Clare (C):  Thanks, Brion. I am happy to have the opportunity to speak with you today. It’s really fun to speak with like-minded people and talk about how Lean Six Sigma is evolving, and how we modernize it, and how we bring the value of it to different sectors and different people and different situations because the tools are so valuable and they’re so fundamental that they work really anywhere. It’s just being able to see how they can apply and how you can achieve amazing results. It’s great to be with you today to talk about that topic which we don’t get that much opportunity to talk with other practitioners, so it’s great.

My background, I started about 20 years ago. I was the Vice President of IT for a high-tech healthcare company in the Chicago area. Through a giant, five company merger and acquisition, the President of the company had heard about, at the time Lean Six Sigma was quite big, and said, “Hey, this is something that we might want to consider.” And in my role, he said, “I’d like you to lead this. Here’s a book.” And at that time, I didn’t know anything about Lean Six Sigma, so read the book and at the end of the book, I still didn’t know anything about Lean Six Sigma. It was a little elusive, so I hired a consultant to help me to figure out I don’t get it, how does it apply in a high-tech healthcare company through a massive merger and acquisition of five companies?

And so I learned the depths of Lean Six Sigma by rolling up my sleeves and working, in partnership with the rest of the company, to kick that off and it went great. Our integration was ahead of schedule, under budget, which never happens, and we really attributed it to the method that we used. We really stuck with it, leadership got behind it. After the success of that, a lot of our customers, who were the major health care insurers in the US, had contacted us and said, “Hey, we thought that this integration was going to mean disruption of service and all kinds of issues.” As a matter of fact, several of them hired additional support staff for the fallout through this acquisition. They were like, “We just wanted to be prepared.” And everything upgraded and improved and got better, so because of that, they said, “Can you help us do the same thing?”

I started going to our customers saying, “Yeah, we can help you do this. Let’s show you how to do it in your situation and your situation and your situation.” And before I knew it, my original role was running smoothly and I could step aside, and that’s how I became a consultant. Since 2001, is when the company was founded, and was Lean Six Sigma consulting. But truly, a lot of times, we didn’t even call it Lean Six Sigma consulting. For people that don’t know what that word means, it’s just business improvement. It’s getting through challenges, it’s succeeding through changes and challenges, it’s developing people, it’s solving problems.

That went that way for many years and about three years ago, I partnered– I’ve been more on the Six Sigma business transactional service side, and I met a specialist in Lean who had the same 20 years in-depth in Lean manufacturing. I was like I had less exposure to Lean manufacturing and he had less exposure to the Six Sigma in the service and business and transactional, that we put our heads together and formed a partnership. That partnership then has become our company now, which is Cannsult.

With the last year or so, we’ve taken a necessary pause over the last year and we decided, well, how do we bring this now to the next evolution, which is remote support, which is video support, which is teaching others how to solve problems when you can’t be in the same room. We’ve taken our methods and skills and learning and put that online with an online platform with support of remote coaching and on-site coaching and consulting. That’s where we are today, bringing what we think is Lean Six Sigma into the modern age and making it more accessible to people and more applicable to different scenarios.

Brion (B):  Is this on the direction you were already going with the consulting in terms of online support or did COVID accelerate that and is the fact that you’re kind of stuck in Australia, did that help accelerate things or was that kind of already part of the plan?

C:  It was really beautiful how it worked out because we had been trying for a long time. We have customers all over the world, so we serve customers here in Australia, in Switzerland, in Germany, a lot of places in Europe, Canada, of course, many in North America, Asia, so China, Malaysia. We’ve been all over and, many times, we’ve offered, “You know we can do this remote. We can do this remotely and support you and have great results,” and they’re like, “Ah, we really like the in-person thing.” “Okay.” It constrained us a bit and we had been already in discussions about how can we convince people and demonstrate that we can actually do this remote, plus have a blended option of delivery? through that, it was right at those times, we had probably been talking about that for two or three months and then COVID hit and we were like this is beautiful because now we have the necessary pause.

Business went to sleep for a bit, and while business went to sleep, we went crazy getting this stuff online and saying, “Let’s not just slap what we have online.” In the Lean Six Sigma world, I’m sure you’re aware, a lot of people regurgitate the same old materials and it’s random bits and pieces of templates from here and examples from here and a lot of old manufacturing examples. They’re old, they don’t apply, it’s hard to translate, people don’t understand them, they don’t see how that applies to my challenges of today. We took this pause as an opportunity to rethink it, upgrade it, make it more accessible and more modern and realistic. Now, that’s what we present to our e-learning customers.

For many of our customers now who are coming out of the COVID lockdown are saying, “Hey, now can we do a workshop?” Yes. You could do this module online and then we’ll do a remote workshop and kill it in the workshop because they already have the training under their belts. This blended e-learning with the remote support has been dynamite. It’s just been going great, so we’re really excited about it and it’s a way to bring it to people who didn’t have access before, which excites us as well.

B:  Yeah, that’s great. But I think you made a great point about having the customers also embrace this and say, “Yeah, we’ve got to figure out a way to work around this, and maybe it wasn’t ideal before, but we have to continue, right?” So, yeah, I think that’s really interesting.

C:  The nice thing is they had it figured out first. We were busy thinking how do we convince them and, instead, they came to us and said, “Hey, we’ve been doing a lot of video stuff. Can you guys do that too?” We’re like, “As a matter of fact, we can. Glad you asked.” it’s been nice that they think it’s their idea kind of thing. Well, it really was.

And also, we have a lot of the recovery from COVID, so for people figuring out how to change the way they work after the changes from COVID. We have some customers that have these massive facilities where they have 500 and 1000 employees at one place that are now all dispersed. How do they get the job done? by demonstrating how we get our job done, they say, “Ah, I see how that works. I get it,” and it’s really been a great opportunity to cut out the fat and to become more efficient. It’s been a necessary thing rather than a, “Hey, let’s try and do this on the side while we’re busy getting work done,” so it’s actually worked out great.

But I think what you asked me before about Lean Six Sigma in different sectors, we have done in business, in government, in non-government organizations. In the business side, we can break that down to service industries. We’ve been big into the hospitality industry and multiple kinds of service, in transactional, so banking, insurance, those are the kind of things that are pretty common for Lean Six Sigma, and then, of course, in manufacturing. We’ve done a lot in the major fragrance companies, flavors. We had a big company now in– We’re involved in cannabis, cannabis packaging, cannabis farmers in the legal states, of course. But that’s been a whole new experience as well because that kind of falls into its whole own category. These are people who are experts in growing a plant or in creating packaging, but can they do that efficiently? do they know who their customer is? do they know how to effectively and efficiently run a business? can they grow employees? do they know how to create a work environment that’s a joy to be in? no. They know how to grow a plant or they know how to use a plant. They know that, but they don’t know the other skills, so that’s been very exciting and interesting for us.

B:  I used to live in Portland, Oregon until last year. I was there seven years and a friend of mine who is a Lean consultant, he worked with some from farms and he just was trying to describe to me some of the challenges they have in the data and the transparency and the traceability of all their– every plant, basically, had to be documented and controlled and monitored where it went and just the regulatory piece of it. He said it was just a huge piece from a non-value-added perspective. To the state, it was important, but for the growers and the farms and the distributors, it just seemed so unnecessary and excessive. But starting off in this industry with so much pressure on there, I think they kind of went really heavy on the details and that just bogged down a lot of their processes.

C:  Well, you know what the interesting thing and the most unique thing about the cannabis industry is that, and I know this is a little bit of a tangent, but it’s a cool topic and it’s interesting when you have– it’s not that often that you get something that’s totally different that you can’t relate to. Well, you have a whole group of experts who have been forced to work in the black market and they’re experts at that. But when they have to work in the legitimate market with true regulations and all kinds of constraints, they don’t know how to structure a legal business, scale it to grow, and do all the things and jump through all the regulatory hoops that they have to. To them, it does all feel unnecessary, so it’s how to do that and still have their creativity and still let them bloom, so to speak, with their skills and their expertise. A lot of people in the industry have fallen out. They’re like, “Nah. I was very happy working in the black market. That’s my thing,” and not really interested, but those who can kind of grow into being the big boys, then that’s really where the excitement is. It’s because, “No, we can do this,” and it’s an exciting field. It’s different than any other. It’s been a real challenge in a very exciting way to bring it to that whole market.

B:  Maybe you can segment a little to the government side. You said you’d done some work in government. Could you talk to that a little bit in terms of just your experiences or your takeaways or what’s working well or how do these Lean and Six Sigma tools help the most in those areas, from your experience so far?

C:  Yeah, so we’ve done a lot of work in government. Some of the bigger contracts and customers that we’ve served are CMS, that’s the Centers for– most people in the US don’t know that it’s called CMS, but that’s Medicare and Medicaid, the Centers for Medicare and Medicaid Services. They’re in the Washington areas; in Baltimore is where their hub is. But we worked with them for about six years, which is a long term, but they, at the time, were led by Dr. Don Berwick as the Administrator and he was a big fan of Lean Six Sigma. Coming from the very top of CMS, he said, “I want everyone in the organization, top-down, to embrace and understand and start incorporating Lean Six Sigma to eliminate waste.” His whole goal, which is a great goal for CMS, was better health and better access to health. Very different aspect from working in business. That was on the health side.

We’ve also done a lot of work with school districts. The largest school district in the country is Charlotte Mecklenburg in North Carolina, and we did work with them. Putnam County, Tennessee, Williamsburg, James, and Virginia, so several large school districts. The difference between the government bodies and business– They have a lot of things in common. They all have ambitious goals, they all have competing priorities, they have resource constraints, they’re all trying to grow and scale in some way, but the difference is that, in business, they’ve got a paying customer. Someone is buying their product or their service. They’ve got competition, they’re focused on revenue and profit. A lot of times, their go-to solutions on the business side are hire more people, do more training, get better technology. It’s a whole different animal when you get to government or nonprofits. They’re serving a community. They’re serving a population, not a paying customer. They, many times, have a disinterested population that they’re serving. The population of the community they’re serving doesn’t even know that the service exists until they’re in great need of it, and then they need it and they need it fast. It’s a very different perspective.

At the government agencies and the nonprofits, they have a very different view of efficiency because they’re not focused on profit. They’re focused on retaining and achieving more budget and getting more funds, so it’s a whole different focus, which necessarily drives their efforts in a different direction. It’s a whole different aspect when you start to bring in these problem-solving skills.

Another big difference working with government or nonprofits is that, many times, the people they’re serving and the people inside the organization have very low expectations for efficiency. It’s like when you think you’re going to the DMV. You don’t expect, at all, to have a great, efficient experience. If things go smoothly, you want to tell your friends about it, “Oh my God, I went to the DMV and it actually went well. I got in and out in only two hours.” The low expectations and people inside saying, “Yeah, that’s just how it always is. It’s just how it’s always been,” it’s a whole different animal.

And then the other thing, I think the major difference, especially with nonprofits, is that many of them serve a worldwide audience and when you multiply that times the world, now you’ve got cultural differences, you have very huge gaps in standards of living and infrastructure, what’s available to people, how to get the word out. Where businesses are seeking more people, more hiring, more technology, in government and in NGOs or in nonprofits, they’re looking for funding, more budget, access to some kind of capital or funding, so it’s a very different kind of world. But for us, the interesting thing is that the same fundamental concepts of how to improve, create a great operation, it still applies. It really is about understanding the challenges, what’s different, so that you can apply it properly. You don’t go into a nonprofit or a government organization the same way you do a big manufacturing business or a bank. It’s very different.

B:  Do you find yourself starting off differently in those organizations than you would like at a traditional insurance or banking industry where maybe there’s, I would say, I guess there’s I think some more structure in place, I guess, on larger companies that you’re kind of building off of. There’s probably a process, maybe it’s even documented, but some of the other areas maybe you’re coming in without clear understanding of the processes. Do you find that you’re starting a little bit from more of the beginning stage, or do you find you’re starting about the same level, whether it’s a for-profit or a government or nonprofit?

C:  From a broad perspective, it’s really understanding what do we have to work with today in terms of how do their operations run, how much opportunity is there for improvement, what are their current goals. That’s a big thing is what are they– and we always ask the same questions. What are your current challenges and changes? if you ask those two questions, you get a lot of meat from that. And finding out where’s our support coming from. No matter whether it’s a business or it’s government, and I know we talked about CMS or Medicare and Medicaid, we’ve also done a lot of work in law enforcement. That’s the DEA, FBI, all levels of law enforcement, so very different from healthcare, but nonetheless, you go in there finding out where do we have support? where are our strengths? what do we have to work with? so it’s a bit the same.

When we go into an organization, we don’t know if we have one Supervisor level person who is trying to get Lean Six Sigma or let’s just say increase their operational excellence in a small area with no leadership support above that person. Our scope and what we can achieve is much smaller. Same thing in government is where do we have support from. Usually, that’s shooting fish in a barrel, trying to find ways to improve and make more efficient government and, typically, a nonprofit. They usually don’t have tight, efficiently run processes where, in business, the difference is they might have really inefficient processes, but it’s all automated, it’s really slick. They can generate defects faster because it’s all integrated in these huge automated systems. Where, in government, it tends to be more exposed, and that’s just kind of from the physical aspect.

But some of the favorite projects that we’ve worked in government that have been kind of interesting are in Medicare, for example. We had some huge cycle time projects. We took one, it was one of our first ones, that we took a process that took, on average, so for anyone who understands the average, you know this is just the middle, but on average took 220 days to complete this cycle. Yeah, almost a year. We got it down to, literally, four days on average. It was just a simple rapid improvement event, so it didn’t take months and months to get us to that point, but it was very exciting. And then people just were amazed. What did we do? if you had to take a four-day process and say, “Hey, make it 220 days,” you’d run out of ideas of how to expand it. Well, they didn’t so we had to kind of get that down and then it was now all these people that used to work in this process, how do we get them busy and productive elsewhere? that was the second challenge because we don’t want to displace people. We want to just make them productive and create an efficient operation. That was one with Medicare and we had quite a few of those.

With Medicaid, some of the things that we’ve done is when you think about the Medicaid population, you have patients who are not going to book in their iPhone calendar to go see a dentist every six months and to go get their routine preventive care and their physical every six months. They don’t have access and the desire or even awareness of preventive care that’s out there for them. One of our big projects was, in Medicaid, how do you get the Medicaid consumer or the people that we’re serving, how do you get them access to and aware of and taking advantage of the programs that are out there for them to have preventive care, which that was kind of a big focus there. We had some great successes. That’s a state-by-state run program, so when it worked in one state, then we moved to the next, moved to the next. Each state has its own challenges and its own unique infrastructure, and the uniqueness in their culture as well. It was interesting to kind of apply those concepts across state boundaries as well.

B:  Would you say that the projects related to that, is it a lot of mapping events? is it kaizen improvement events? is that a Six Sigma project? is it just business coaching and mentoring or are you doing project management work? what does that look like in terms of tools and approaches that are pretty prevalent that you’ve had to go through? Yeah, I’m just kind of curious about the type of things that you’re helping from the toolset or the toolbox, so to speak.

C:  In the first year with Medicare and Medicaid, we had supported and led 175 projects. You can imagine, with let’s just say 175 improvements, because they were different levels of projects. I would say probably 50% were rapid improvement events or kaizen events. Of course, the key, people use that term very loosely and we use it pretty tightly. We do it with rigor and we really do it the, what we think, is the right way, which is spend as much time on the prep and pick the right things. Not everything can be done as a kaizen event.

Those things where it was not a mysterious root cause, where we did have access to data, we did have the right people, we usually spent three or four days, did a really strong rapid improvement event. And then, of course, the key to an effective kaizen or rapid improvement is that follow-up piece where, in my experience, and our consultants have come from all different backgrounds, people, a lot of times, let it go after the event, but the real thing is making it sustainable and stick and seeing that improvement all the way through and then being able to replicate it as much as you can. Probably half of the work that we did was really strong rapid improvement events.

We had a handful that were pretty easy. It was truly just a group of subject matter experts in a series of day meetings, so I wouldn’t really call it an actual RIE or rapid improvement event, but more of just structured problem-solving. Let’s just do it, just more of a JDI. A little more teeth to it than that because they did all the easy stuff before we got there. Some that were just meetings with subject matter experts, and then there was a big group that were actual– we would go through the DMAIC phases and actually do a project. Most of them took, let’s say, three to four months. We scoped them nice and tightly so that we’d get rapid cycles of success and continued those. I would say it was a good mix. We had some that were actually designed from scratch where they were working on telemedicine and the Innovation Lab, and that was at CMS as well, so we did some that were designing whole new products and bringing in technology. Those were really fun because you don’t really think of innovation when you think of government, but they’re in there too. They’re just huge, so it just takes them a little longer.

With law enforcement, that was interesting as well because when you go into someplace like the DEA, these are people who have likely never even heard of Lean Six Sigma or structured problem solving, so it’s different. It’s like going to an island where people haven’t heard of the Kardashians. It’s like, “Huh?” You’re announcing it for the first time and they’re like, “This is amazing! where did this come from?” We know it’s been around for a long time, but working with a bunch of the DEA agents.

One of the cool projects that we did there, speaking of Miami where you are, is that Miami turned out to be the hub for the fake pain clinics that were just dishing out prescriptions and illegal prescription meds all over the place. Miami had more than the rest of the country put together all in one area, all in one geozip. The project that we did with the DEA was minimizing that pain clinic fraud, which was huge. That was fun because these are not business people who’ve gone to get their MBA or hospital Administrators. These are cops. These are law enforcement agents who are running these projects, so that was pretty cool as well and it was really fun to bring that to a whole new group, a whole new sector. That was very cool.

B:  I haven’t heard that much going on in like police and law enforcement area I think, but there’s been inklings of those types of projects. I think there’s a lot of opportunity there for every little element of the government agencies to get introduced to some of these concepts and principles. I can imagine, I just think about like fraud and data analytics and stuff, and just some of the opportunities there that maybe they’re already using some of these techniques and aren’t even aware that it has a name. Or maybe they have like systems that are guiding them, but they don’t understand maybe the analytics behind the scenes that’s helping detect certain primary spots or hot spots or potential areas to look into. I think that’d be probably interesting for them to learn kind of the origins of some of the statistical tools and analyses.

C:  Right on with that, Brion. That’s exactly right because if you think of, for me and when our team got in there, you think there’s so much more sophistication than what you see on TV, but they really were just using still the maps with a string tied to it and a push pin and following people and searching through like there were files and files and files of phone records and emails. But they hadn’t had the skills yet or the insight to not only how to go about collecting the right data, but then what do you do with it. They have all this information and now they’ve got stacks and stacks of paper. The next question, what do you do with it? what chart do I pick? why am I picking that chart? how do I draw conclusions and interpret that data? they haven’t really learned that, so you’re right about the data piece.

Now that everything’s electronic and all these transactions that are leading a trail, it’s kind of like finding the root causes to their problems is the DNA. We had the DNA to their crime-solving. It’s like there is a way to do this. There’s structure, there are tools, there are methods to help. Even being able to interpret these patterns in their data to lead them to the clues, in our experience, it was just a lot more fun than trying to find out why is there a crack in the windshield. It’s like finding the bad guys using the data. They’re leaving a trail, but us helping to teach them how to read that data.

It was very cool and, for us, we found even that even in these highly sophisticated transactional businesses, like one of our customers, they do healthcare banking transactions, so they’re big tech, they’re tons of data. They crank out data like crazy. If you walk into their office, they’ve got offices in multiple major cities, they’ve got all the big, huge screen TVs with their data all up and the charts are ridiculous. When we first started with them, like, “What is that telling you?” They’re plotted wrong, they’re upside down, they have wrong things on the axis. Not only are they displayed incorrectly, and this was a high-tech data company, people don’t know how to interpret it.

We’ve done a lot of work with people who are professional data analysts and data scientists who know how to chug through data and put it on a chart, they’re really good at the programming behind the scenes, but they haven’t necessarily learned how to really pick the right chart, understand why I’m picking that one as an analysis tool, and then how to interpret it. Whether it’s big data or the ex-cop who’s now trying to get the bad guy, it’s the same. Again, the same tools apply. It’s just how are you going to connect and talk with this person to let them know that, hey, we have something that can really help you to achieve your goals more quickly and to make your work more meaningful and joyful, which is really what it’s all about.

It’s been really interesting. I love that data topic because it’s something we’re particularly passionate about because we’ve seen it’s really unusual to find an organization that really understands how to interpret data properly. It’s just something that we think is pretty simple once you learn it. You don’t have to be a brain surgeon to know how to accomplish this. It’s pretty straightforward, but people just don’t learn it. It’s just not something that is a typical skill.

B:  Yeah, I think it’s just getting from having data and then displaying something, it feels like, okay, we’re done, but it’s like no, it’s not. If you don’t know what to do, what action to take or not take as a result of that chart, is it really doing what you think it is, or is it just looking nice and makes people feel like we’re managing the process, but if people can’t explain it or understand it or know when to take action, I think that’s kind of the next level to get to and I think a lot of organizations haven’t gotten to that level. They just have the chart up that says here’s our output for the week or here’s our total call volume or this is the number of transactions we had, but okay, and what about that chart do I need to know to decide if it’s good or bad, right?

C:  That’s exactly right. We see so many companies– probably I was just thinking about what’s the biggest mistake or the most common mistake that we see, and I think it’s pretty easy, once we’re in, we’re in a million different organizations, people like to put things on run charts. That’s one of my favorite charts too. We’re plotting our data over time and the common mistake is you see if it’s defects or mistakes, you see it go up and people, “Why are mistakes up? you guys have got to work harder, work better,” and then the next week, they go down. You can look at this pattern–

B:  “Good job. You did it.”

C:  “Great job, guys. What did you do?” they’re like, “I don’t know, but thanks. I’ll take the free pizza.” They don’t know why it’s gone up and down, but you look and once you really understand it, you’re like okay, processes vary. They go up and down. If someone asks, “Hey, it was up. Why was it up?” “Because it was down.” “Oh yeah? why did it go down? why did sales go down?” “Because it was up and things vary.” Now, why is it varying? how much is it varying? can we tighten that? can we lower the average? that’s the skill in really using your data to improve your business and that’s just not there. It’s just not.

I feel like every place we go is an opportunity to teach that and if we have two hours with the leadership team, I feel like we rock their world with just giving them that bit of information. It’s like just do this little thing right and it’ll change your life. And then I think it’s like now you bring it to the company or the organization that’s serving the vanilla farmer in Madagascar and how does that help him? how does that help the individual candle maker who’s trying to get ingredients for his candle that will burn for 20 hours?

A lot of what we’ve done as well, and this is why I love the topic that you’ve brought us together to talk about, is bringing it into these sectors or these areas that don’t have access or haven’t been exposed to business tools and business methods and theories but they need the structure and the proper way to do things even more than anybody else. It’s been really interesting for us to expand into these different sectors as well and see it work. It’s not just cars in Detroit or auto manufacturing in Japan. It really works everywhere if you have the skill to see how to make it apply.

B:  Is there some other projects? I think I cut you off, but is there some other projects you want to talk about or anything related to nonprofit or NGO work that you’ve done in the past?

C:  Yeah, I think maybe some of the things we haven’t talked much about are in hospitals. We’ve done a lot of work in different smaller hospitals, and then hospital chains, the larger hospital systems. Working in hospitals, that’s another whole different type of a scenario. Because, like I said, they all have a lot of the same general pressures and situation where they’re trying to do more with less, they have tons of pressure, they have limited resources, very unpredictable processes and customer demand, but hospitals, that’s been something– and there’s been a lot written and a lot talked about Lean and Lean Six Sigma in healthcare, so it’s not necessarily new there; it’s just not typical that it’s done well.

We’ve done a lot of work with hospitals and in all aspects from hospitals, like delivering better quality care. That’s where we always start out is their thing is first do no harm, so minimizing the amount of if we call it defects, so the amount of mistakes. There’s all kinds that we’ve worked on there. Wrong medicine given, expired medicine, patients given incorrect or delayed care, all kinds of things.

One of the biggest changes that we made in a hospital, and this is in the Chicago and New York area had the same issue, and that’s just an example of a project there, was in after-routine heart catheterizations, for example. Many doctors got into the pattern of putting their patient into ICU just for recovery whether they needed it or not. It was just kind of the default. You know what? my patients will get more intense care and the nurses will watch them more carefully in ICU, so they were flooding the ICU so that when a patient came in that needed intensive care, there were no beds available. There were several dire outcomes because of that pattern and working with doctors is a whole different type of culture, so trying to get them to change their behaviors.

We haven’t talked much about it yet in this conversation here, but understanding the culture and the behaviors that are acceptable and the behaviors of leadership, as well as everyone who follows those leaders, if you don’t tap into changing those behaviors, your likelihood of success and sustainability is almost nothing. It might be tiny and fleeting, but it’s not going to be big and it’s not going to be sustainable. In these hospitals, having them properly use the levels of care and the step-down levels of care, which is what they call it, from the most intense to the less intense, having them do that properly was, in our opinion, a major feat and having that be successful, and we did see a dramatic improvement.

And then with the hospitals, we do all kinds of things like just having the beds ready. If you think about how long it takes to check out of a hospital, you’re ready to go, you’ve been there for hours and hours and you sit and wait with your stuff in a bag for someone to say you can go, that can take six hours, seven hours. You feel crappy to begin with and you want to go home. There’s no reason for that. We’ve done a lot of work in minimizing and shrinking that time and as soon as they say you can go, you can go.

The work with the hospitals, it’s very satisfying because the staff at the hospital, they are, in general, running ragged and they’re trying to do the right thing and they have a million things that they can’t get to. And basic things, like 5S. 5S those supply cabinets, the supply closets because people hoard equipment and they hoard supplies and things aren’t there when they need them. You have a patient that needs a certain piece of equipment and the hose is gone or the cable is gone, it’s not there. These nurses, literally, spend hours out of their day just running around looking for pieces of critical equipment. Why? there’s so much more important things to be doing. They’re so thankful, that they’ll actually come in after-hours to learn how to run their project and to do their project work. They’ll come in on Saturdays and Sundays or whenever their off schedule is. It’s a different type of employee who’s like, “Please, help us. We’ll do what you say. Yes, we see it’s working. Just tell us how to do it,” and they’re game. It’s a lot of fun and very, very rewarding working in that type of environment.

But again, with all of these scenarios, and they’re all really different in so many aspects, but it’s what makes it work that is the same, and that’s active support from leadership. The worst thing leadership can do is push them in the other direction, is, “No, do things the way that we’ve always done them,” and not support the excellence, the good practices that they’re putting in place. The organization as a whole, no matter who it is, needs to have some humility and openness to look at where do they have opportunities to improve and not be an arrogant organization that, “We’ve been doing it this way for 30 years. We’ve been in this business, we’ve been in government for 50 years and it’s always been this way.” It’s like you have to have that humility and the calm to say, “Actually, let’s take a look. Let’s take a fresh look.” That’s really a required ingredient.

I would say another required ingredient, no matter what the sector, is the perseverance. Particularly with government, there’s a lot of influence with the who’s ever in political power. When you have political people on staff, meaning that they came in with the current administration, and they’re working with alongside people who are not political, in other words, they’re there because they got hired for the position, not appointed, is every four years, you have the potential for half the organization or leadership to go. When the new group of politicals comes in, they’re like we’re going to put our own fingerprint on this, trash everything you’ve done in the past. We’re going to come in with a new thing. That just destroys this ability to continually improve, so persevering and understanding where we have good things going and sustaining and building upon results is a real challenge in the government arena.

Being able to really solidify practices so that they’re not vulnerable, it’s not easy to unplug them and throw them away, it’s make this last. It’s much, much better to successfully implement just a few projects with lasting and meaningful impact rather than working on a ton of efforts that end up with temporary or poor results or that are just easy to unplug. In the end, a more methodical, slow but sure process is way better than taking on a ton and trying to make a huge splash with a million changes that are going to fizzle as soon as the next leader comes in.

It’s not totally unlike what can happen in the business world, but it’s just more prominent and, I would say, a little more extreme on the government side of things, so just something to be really aware of. It’s very apparent once you get in there and start working in the government. You’re like, whoa, this is different than any business. The culture is very different. But you figure out how to work within that to make these important changes.

We found, for 20 years in business, in the consulting business, up until we went electronic in this last year, we never did one bit of advertising or one bit of social media. We had a website, but that’s only because one of our customers required that we have one to have us be a proved vendor. The point with that is that our results kind of speak for themselves, and then these people move on to another organization or another part of government and they say, “Hey, can you come do here what you did over there?” “Yeah,” so that’s how we’ve grown our business and had a very healthy and exciting business for 20 years. Now it’s getting a little bit different. We’re moving into the e-space as well that requires a different approach, but the point is still that what gets us to be able to get in and make a difference is having successful, sustainable results. I think we’re all really proud, on our team, really proud that we can do that no matter what the sector.

It’s most rewarding when you get into the nonprofits and the government where it’s really untapped. It’s really untapped and it gives us huge opportunities, so it’s a lot of fun and the people really appreciate it and you can make some, it feels small at the time, but over time, you make enough small cultural changes and things start to shift. And then you see, after you step back, four years later or five years later for the biggest parts of government, you step back and you go, “Wow, this is actually working. It’s still going on. The culture kind of changed a bit.” You don’t really see it until you step back after a bit of time and you see how much improvement you’ve actually made. It’s been really exciting.

B:  Yeah, that’s great. I think that’s a whole host of different processes. I think it’s really cool that you’re able to kind of see the commonality between them and it’s like if I can just get down to that detailed level of kind of what you said before, I think is what’s the challenge and what was the change. Can you explain that again? you said two things.

C:  Yeah, the two things, and usually when we meet a prospective customer or someone who’s just interested in can we help, okay, a lot of people who can really benefit from what we do don’t even know to ask. When we speak with people, we’ll ask them those two things, what challenges are you faced with and what major changes do you have coming up. They will always have answers for that. “Oh, my challenges are we just had three people quit. We’re in a hiring freeze,” or, “We just had a major customer leave,” or, “A competitor’s just taken over our place,” so there’s going to be some major challenge that they’re faced with. If you say what changes are coming up, there’s always something.

When people hear changes, and we know the whole topic of change management is a huge one, but typically, people don’t feel great. “Hey, there’s a huge change coming. I’m probably going to have to work less and get paid more.” They never think that. It’s always like, “Oh God, here it comes again,” and at best, they feel like they’ve just got to kind of bury their head until the change passes because they’ve seen change done poorly a lot. When they hear, oh, we’re going to get a whole new system implemented, or there’s a new leader coming in, or did you hear that we’re going to be merging with our competitor? we just bought them. What’s going to happen? there’s always some change coming up that they’re faced with and that’s where we say we can help with that.

That’s really what we do is say those changes and challenges because the point is they’ve got big goals and they’ve got a job to do. When we come in and work with them, the skills that we provide, that we coach them with and teach and then give them, when we leave, now they have those skills, it’s not about the things that they already do well. That’s their work. It’s about removing the things that are going to get in the way of their work, that are going to prevent them from doing a great job and enjoying their day, and you know what, going home to their family, feeling great and proud instead of completely drained and enervated. That’s what we give to them. It’s about removing the headaches, the things that slow them down. That’s what our work is all about.

When we ask them what challenges and changes, you’ll hear this, blah, blah, blah. They’ve got them right at the top of their head, it’s front of mind. That’s when we can say, “Okay, we can see how to help with that,” and we start to create a plan that we don’t want to come in and say, “Oh yeah? well, we’ve got another big change for you. You’re going to start doing things the Lean Six Sigma way.” That’s like not what they want to hear. We listen to them and hear where are they starting from and now how can we support and teach and coach and guide to start removing, one at a time, those frustrations and the things impeding them from doing a great job. That’s the changes and the challenges.

B:  Okay, yeah. I like that. I think that gets them thinking more about not how we’re going to do that, but just laying out the problems or the things that are on top of mind. And then I can see how you can easily find your really good, important projects that are going to get management support and resources dedicated to it and, potentially, a budget to go work those because these are the things on top of their minds and these are the things that they’re concerned about or worried about. Yeah, I like that.

C:  You know what, too, we have a something. I think it’s unique. I’m not sure how many other organizations like us do this. For customers who are especially budget-constrained, so a lot of times that is, with government, they have an allocated budget and they’re right upfront. They’re like, “We have a grant for $25,000. What can you do with this? what’s the best you can do?” It’s very different than going into an organization that says, “Yes, we are struggling. We’re trying to serve this community; we’re trying to serve this customer base. We have no budget, so sorry, we can’t use your services. We’d love to.”

Well, we have enough confidence in our work that we put our fees at risk. We’ll say, “Sure, we have an option that says we don’t get paid, you don’t pay us a penny, unless you see tangible, meaningful results, and let’s talk about what those would look like. If you don’t save and grow and scale and increase your efficiencies, then we haven’t done our job; we’ll go away. But guess what? we will, so we’re not worried about it.” It’s putting our fees at risk to say, well, we have as much skin in the game, but we do have strings attached to that. You’ve got to meet us halfway. As leaders, you have to support what we’re doing. Don’t undo our work or we can’t be successful. For us, a lot of times, like that’s the best way to work because we can say, “You have to do these five things and we’re going to talk a lot and make sure that you’re with us there. You have skin in the game; so do we. Let’s make this work.” It’s really a great relationship and a great partnership with the customers that we work with, so it’s really been a nice aspect for us to be able to serve organizations that thought they didn’t have the access to us.

B:  Yeah, I think that’s really good. When I was in Portland, we have a little group of consultants that we get together and some of us have done some volunteer nonprofit work. That’s kind of a similar type of thing, like we know you can’t afford it or you’re not sure about the value it’s going to provide, and so why don’t we come in and kind of help when we can or on our free time a little bit to help at least introduce you and do some basic improvements, and then maybe that will kind of spur the need to say I want to put a little bit more time into it.

Usually, that’s been the case is they see at least the need for more training or some more coaching on specific help or what else can you help us with on the next part of this journey. I think for them to buy into it right away is just a lot to ask for them, but usually, once we’ve kind of gone in there and helped a little bit, they’re starting to see how things are changing. Some of the pushback has been, “We don’t want to work in a factory. That’s why we’re in the nonprofit sector,” so some of those barriers to get over of the perception of what this might be, seeing it is kind of really powerful and I think your approach of saying, “Hey, if we can’t deliver, then there’s low risk for you,” I think that’s been a great way to get them started.

C:  You know what the flip side of that is, which is pretty interesting? this happens in government. We’ve actually walked away from government contracts because they literally, and this is no surprise to anyone, but they have a big chunk of budget that they’ve been allocated and they’re like, “We don’t really want the results. We don’t care about that. We just need to spend this budget so that we can up it next year, so can you do a bunch of training?” We’re like, “What? No.” I mean, I’m sure you can find anyone. There’s a million companies who will do training and don’t care about the results. That’s the majority. Just take our class, we just are counting butts in seats and how many people registered. Good, go there.

We’re all about the results piece, so we’ve actually, and it’s part of our core values as a company, is we’re really focused on achieving significant results and doing it fast and making it sustainable. Just that kind of cranking through, churning up dollars, and churning through budget is something that does happen a lot in government, so for us, our ears are always a little bit perked is this just trying to spend money and gain funding, or are you really looking for results? because the funding piece, eh, not interested. It’s kind of an interesting spin and a different way to look at government as well because that does happen. I think most people are aware of that kind of spending, spend so that we get it next year.

B:  Yeah, you’re going to lose it if you don’t.

C:  School districts is another big one where we’ve played a lot, and I think that one that– I can hardly think of a sector that needs structure and efficiency and more focus on real, significant outcomes, and efficiency to get there than the education system, the public school system, and that’s really where you see it in our experience. I’m no expert in that area, but just from our experience, where you see a lot of spending to get the next year’s budget.

We had one large school district that we actually convinced them we can do both. “We can use your budget, sure, but how about if also we get really important results and we actually do focus on the education of the children and the efficiency and the structure that teachers can work within to let them to deliver education? how about if we do both?” And they were like, “What’s this you’re saying?” We had a bit of convincing, but we had some great success in that school district. But it took a bit of work to get them to care about the results. I think a lot of them are just like, “Oh, it’s way too complicated. It’s way too ingrained. It’s way too old. The status quo, it’s just how it is.” It’s like it doesn’t have to be. You guys are deciding to accept that every single day. In education, that’s someplace I think is another hugely untapped market, if you will. Very exciting, though.

B:  Yeah, and I think that’s another thing that drives me crazy is teaching someone, spending the time going through, and even as an instructor, yeah, I’m getting paid to be there, but I don’t really care about the training. It’s a means to get to results because that’s what I care about. I’m here to teach you so you get results. I don’t want to teach it and then you walk away and forget everything I learned. I just spent my time to teach this class to you, and if it doesn’t result in anything beneficial, what are we doing here? you’re wasting everyone’s time. You’re wasting your time, you’re wasting the organization’s time and money, and you’re wasting my time. If this isn’t going to result in actual results that you’ll be excited about, your organization will be excited about, and I will be excited about to see that you’ve gone through this journey and gotten the results and are excited to continue, then yeah, let’s drop it right here and let’s not pretend because that’s an ultimate sign of waste is just doing something like that and having nothing to show for it.

C:  Yeah, and we’re no different than anyone else. We’re doing a job and we want to have meaning in our lives as well, like what we’re trying to do is make a difference. For us to stand up and blah, blah, blah, blah to a room of people who don’t care to be there and we know it’s not going anywhere, what’s the point? there’s no joy in that. That piece and, as you know, like I said, for us, having that value be very clear, that that’s not what we’re about, we’ll go where there’s richness and where we can create great environments and make improvements and create joy at work for other people. It’s been a lot easier for us. We get very clear about that with anyone who works on our team and that’s what we’re about, but it works for our customers as well. It’s been a lot of fun.

B:  Well, it looks like we’re already at an hour. This was great. We could probably keep going another hour easily, but I don’t want to hold you up too much. Maybe share contact information. How can people reach out to you and your organization, the best way to connect, and then any other parting comments you want to make.

C:  Yeah, sure. We’re Cannsult, it’s Cannsult, c-a-n-n-s-u-l-t.org, and we have re-branded, a whole new look and feel over the last year in kind of locked-down mode, and we have put all of our – not all yet – we’ve got a good amount of our products and services online for easy access. We’re pretty active on LinkedIn and Twitter. On our website, we have a little button that’s coaching with Cannsult and you can talk to a Master Black Belt if you have questions or want to learn a little bit about something.

We have full courses and certifications. We’re accredited by the largest Six Sigma accreditation house in the globe, that’s CSSC, so we have Lean Six Sigma belt certifications. All of our courses we’ve broken down into bite-sized modules. You want to know how to run a great meeting? take this module. You want to know advanced brainstorming techniques? we have a module for that. You want to know how to understand and interpret a run chart and a histogram and a control chart and box plots? we have modules for that. Bite-sized pieces or the full-blown certification, and all that is I think pretty easily recognizable and available on our websites. I think it’s pretty fun to follow us on LinkedIn and Twitter because we do offer a lot of tools and templates.

One of the things that’s unique about what we offer is, like I said before, a lot of people in our work pull random templates and diagrams from over the years of finding things that work for them. For us, we have the whole kit. We have an online learning module, a workbook with practice that we talk you through, and then a template. They’re all Excel so it’s easily accessible to anyone. We don’t do anything in Minitab or the statistical software, which is kind of getting quite outdated now, so we’re really kind of upgrading to make it easily accessible to everybody.

For every lesson that we teach, every tool or technique, we have a one-point lesson, a nice one-pager. We’ve got tons of those if you just want a refresher. You don’t have to memorize what to do with the run chart, you just have the one-page lesson, the one-point lesson and it’s nice and easy access. We like to think of it as our everything you need kit and in bite-sized chunks or the whole certification, depending on what you’re looking for. We’re really proud of what we’ve done in the last year, staying productive over this weirdo year that we’ve had, and really proud to continue building that and getting it out to people so they have access as well.

B:  Okay, great. And so you are in Australia, but you are based in the US or you have people throughout?

C:  Yeah, we’re based in the US. We have offices in Florida and Nevada, and we also have an office here in Sydney. Once the borders open, we’ll be all over as we do work around the globe, so we do have offices. We’re a US company, though, so we’re actually incorporated in Florida but we work all over the place.

B:  Okay, well great. Well, hopefully, you get to come back soon. That’ll be great.

C:  Yeah, great. Thank you so much. This was fun, Brion.

B:  Yeah, I appreciate it too. I learned a lot and, yep, maybe we’ll have you on a future podcast.

C:  Cool. Stay in touch.

B:  Thank you so much.