E117: Transforming Healthcare with Lean Six Sigma – Interview with Sarah Cook

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In this episode, I interviewed Sarah Cook, a Lean Six Sigma Black Belt consultant from Pepper Foster Consulting in Portland, Oregon. She shares her journey from the VA medical center to becoming a performance engineer in healthcare. She discusses the application of Lean and Six Sigma methodologies to healthcare, the impact of COVID-19 on healthcare systems, and the critical importance of data-driven decision-making.

We also discussed practical strategies for process improvement in healthcare, building trust, and mitigating risks effectively. Learn about a project she worked on reducing surgical infection rates, implementing daily tiered huddles, and the significance of psychological safety in fostering a good improvement culture. We also talked about valuable insights on monitoring data fluctuations, creating effective visual charts, and using control charts to monitor processes. This episode is a must-watch for anyone looking to drive sustainable improvements in healthcare.

  • 00:20 Journey into Lean and Process Improvement
  • 02:16 Impact of COVID on Healthcare Processes
  • 05:19 Lean vs. Six Sigma in Quality Improvement
  • 07:42 Challenges and Successes in Process Improvement
  • 15:39 Building Trust and Managing Change
  • 21:56 Building Trust in Conversations
  • 22:36 Mistakes in the Clinical Laboratory
  • 23:32 Addressing Shame and Fear in Healthcare
  • 26:36 Proactive Risk Mitigation
  • 32:33 The Importance of Small Improvements
  • 36:31 Reacting to Data Fluctuations
  • 38:49 Visualizing Process Improvements
  • 39:48 Conclusion and Contact Information

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Transcript

Note: We’re using a new AI transcription service built into our video/audio editing software, which does a decent job, but doesn’t do punctuation and sentence breaks very well. Hopefully it’s good enough to be helpful.

Brion Hurley: How are you doing? Thanks for joining me. Finally got connected and I wanted to have you on the podcast. We met virtually and we’re based in Portland. We never met in person yet, but Hopefully someday. I want to hear a little bit more about your background on process improvement and healthcare, government work

Sarah Cook: yeah, so hello everybody. My name is Sarah Cook and I’m a Lean Six Sigma Black Belt. Currently I’m a consultant, but it took a long road to get here. So I started out in the clinical laboratory setting at the VA medical center in Portland, Oregon. And I worked in the microbiology and molecular science department for almost nine years.

And my family and I just out of nowhere decide we moved to South Dakota, where we had some friends so we moved to Rapid City. But I had a great opportunity and I started working specifically in quality and safety in the clinical laboratory that was there. And that’s around the time I was introduced to lean and process improvement.

And eventually I started doing that work full time as a performance engineer for the healthcare system there. So we stayed in South Dakota for about seven years. We always wanted to come back to Portland. We had lived here previously. And I decided I’d get into consulting for a variety of reasons.

So I am now a consultant at Pepper Foster Consulting in Portland, Oregon.

Brion Hurley: Okay, very cool. So did you always have a interest in science? Going down the microbiology route.

Sarah Cook: It’s crazy to end up here. I thought for sure I’d be in testing laboratories for the rest of my life or doing microbiology, molecular science for the rest of my life.

And I really enjoyed that work. I definitely apply that scientific thinking and mindset to the work that I do now. But I was in healthcare and around the time COVID happened, I was pretty sure I wanted to break into something different and pivot my career a little bit. And I really did.

Brion Hurley: Did you get involved with a lot of stuff around COVID? Was that at the end of that, or were you doing something?

Sarah Cook: Yeah, so because the health care, all health care systems, I should say, we’re developing new processes. So new everything really.

And COVID was hot. We were creating new processes to, Get people vaccinated, get test results drive through testing, all kinds of things. And all of that was starting from scratch based on the urgency and expediency to get test results. And so it was, It was a great time to have people, that new process improvement, and it also broke down a lot of silos, which was, it was probably my favorite part out of all of it.

It was a lot of urgency and sometimes chaos, but all those departments working together and synchronizing was pretty incredible to watch. I

Brion Hurley: think that’s something else that was really cool was, wow, we can actually get things done pretty quick when everyone’s.

Motivated to change suddenly.

Things that would have taken years to get done.

So yeah, that’s encouraging that change doesn’t have to take a lot. Just really a priority and a focus and urgency around it.

Sarah Cook: Absolutely.

Brion Hurley: And I think that lowering the barrier is oh, we got to, triple check this first versus we don’t have time.

We have to get something up and running. I think hopefully broke down some barriers going forward with other changes people want to make.

I don’t know what exactly got you started? Was it a class you went to or was it part of an event or something you seeked out?

Sarah Cook: Yeah, I think one of the great things about lean is that I think a lot of us are practicing lean, but we don’t realize it and so I, when I was doing quality and safety in my role in the clinical laboratory, I was interested in all of the cause and effects of all the processes that were happening in our little bubble of the laboratory.

And I think. When I started to get exposed to, talking with people and just talking through processes that weren’t working and they weren’t serving the people doing them, someone mentioned lean. And I was like, what is this thing? And then when I learned about it, it was like the clouds parted.

And I was like, this all makes sense. And so then I was like, hit the ground running, learning everything I could. And trying to apply as much as I could to my role. And then that drove me into my. This, the role next after the quality and safety part of doing that process improvement performance engineer work, and then that also open the gates of being exposed to all the different parts of health care, like billing, surgery, patient experience, and all the things.

And I was able to practice out there and learn how to apply it in those different environments and different people and departments.

Brion Hurley: So did you get tied in with Lean first or did you get some Six Sigma with the quality background? Because usually that’s, most people in quality start Six Sigma route, including myself.

Sarah Cook: Yeah I think that probably would have made more sense. But I think when industries are just starting out with process improvement, Lean is, easier to apply than Six Sigma. In some cases, Six Sigma would be great, but maybe those teams aren’t collecting data. Maybe they’re not collecting the right data.

They’re just collecting the data that they’ve always collected, but they’re not sure what they’re going to do with it. So in those cases, it’s building blocks. So I like to start out with lean and that’s what I did. With my science background, Six Sigma was definitely more appealing to some extent, but starting out with lean and those principles and those building blocks, I felt like that was an easier introduction for people than Six Sigma was.

I think I learned about Lean and Six Sigma in parallel. And while I was actually applying Lean, I was, teaching myself Six Sigma, taking the classes, doing all the things, and then, moving up with different belts and certifications and stopped at Lean Six Sigma, Six Sigma Black Belt.

But I always found it that it made more sense for me to apply mostly lean tools and techniques than it did Six Sigma in many of the different projects and efforts that I was involved in.

Brion Hurley: I’d agree. I think that’s A lot easier to learn those lean methods first, and then build up experience of process improvement and change, and then get to the point where you start doing a little bit more analytics.

Maybe you, there’s a lot of low hanging fruit. Use that phrase as well. So you can clear out some of that stability, get some visuals, understanding what’s going on and then bring in a little more complexity. Once you got to clear out some of the easy stuff. There’s always side projects that happen.

People go through a six Sigma training and they need to do a project and they work on something, but. The organization maybe is not ready for that, but an individual can be in their department, but yeah, I think that’s a good way to do it.

Sarah Cook: Yeah, and I think that working with teams to make process changes, which that’s what you’re doing, right?

You’re looking at it from a process improvement. perspective, but it’s a change. That’s how it’s going to be viewed, at least initially. So when you have data that a team is collecting, it’s amazing. And it’s so helpful because you’re not coming in to say, Hey, your process isn’t going that great. That’s why I’m here.

It’s you’re showing the data and you’re being as objective as you possibly can. And you’re just presenting the data. The data isn’t bias. Hopefully it’s not bias, but you’re, it’s an objective perspective to say this is what’s happening, good or bad, but this kind of shows us where we can start.

Brion Hurley: You’re right. Take some of the emotion out. Bring some Visibility to problems that maybe they feel or don’t realize sometimes it confirms what they know. Sometimes it shows them something they don’t realize or hadn’t noticed before. And then I think the key thing is just there’s feedback on whether things are working better because we have the data to compare.

Sometimes I see there’s a lot of actions to improve, not a lot of verifying that it worked. And not that we have to verify every single thing we do, but after a while it’s like, is all this actually making a difference? Are we getting faster times? Are we seeing better quality? Are we reducing harm?

If it’s not, then we’re doing a lot of stuff and it’s not getting So that’s we need that data. Absolutely.

Sarah Cook: Absolutely. And it needs to be a combination of perspective and data to some extent, because I’ll see great numbers. The team will see great numbers, but they’re trying to continue a process that isn’t sustainable for them.

They’re working extra hours. They’re doing far more than they were doing before, and it’s not efficient for them to take breaks and things like that. So the data is coming out amazing, right? Turnaround times look amazing. All of that. The numbers look great, but it isn’t sustainable. It’s not going to last.

So we need to adjust our expectations and what’s people are doing this work. So we have to go back to that. What’s actually achievable.

Brion Hurley: No, that’s a good point. And that’s even when you see the improvement like that, if you don’t notice the overexertion and the fact that they’ve dropped everything else to get the results.

And now everything else is. It’s no turnaround time. And now you’re just like whack a mole because it’s not fixing the real issue or taking the waste out. Yeah, caution for people that initial positive data results. Doesn’t mean that’s. up in the long run.

Sarah Cook: I would agree with that.

Brion Hurley: You mentioned the work in health care, some clinical and also non clinical getting into some of the office process, back end processes.

Any examples or things you remember or want to share with the audience? Projects that you felt were interesting either side of it.

Sarah Cook: Yeah, definitely. One of the benefits of having a role that Functioned across an entire health care system was that I was in a variety of different departments and areas And working with a lot of different people so I would do a lot of little projects bigger efforts but so these are just the ones that You I feel like I’m probably most proud of.

One project that I worked on was to decrease surgical site infection rates for certain surgical procedures. And that was amazing. I love that work a lot. Also a very small team and I created a grassroots lean training so that we could bring, we’re going to these different teams and we’re introducing lean principles and tools.

Wouldn’t it be helpful to bring people in and say, hey, would you want to learn about some of this? So that you can help sustain these efforts that we’re working on And you can drive some of these things. We don’t necessarily need to come in You’ll have that mindset and the tools that you can sustain what you know We’ve come in to do and so I was really proud of that we had great turnouts we had leaders.

We had frontline workers We had a great variety coming in that wanted to learn those different things. So that was amazing You mentioned earlier, the COVID vaccination and test procedures. That was awesome. The healthcare system that I was at, they implemented daily tiered huddles while I was there.

And that was a great collaborative process and a lot of great outcomes came out of that. Also, a lot of opportunities for improvement and putting. Eyes on different areas of the health care system that may not have been getting noticed as much before and being able to bring them up to the front and listen to what they’re dealing with So that was awesome.

One of the first process improvements that I did was a lead management board and That was probably one of my favorite efforts because I fell flat on my face

Speaker 3: and

Sarah Cook: made You All kinds of mistakes, but I learned a lot just in that one effort that I’m so glad I was able to learn it as early on in my lean career because.

I would have struggled so much and I have my challenges. I still do, but I was very grateful to learn as much as I did just in that effort. And I kept it within the clinical laboratory that I was in. I had a lot of people around me that I was working with at the time that gave me a lot of feedback and support which was great.

And then Gemba walks, of course. Love Gemba walks and just hanging out with leaders who are trying to be great leaders.

Brion Hurley: What was the idea around the Lean Management Board? Did you envision what that would look like?

Sarah Cook: I, I read all the books. And I thought I knew so much. I had been reading about Lean.

I knew all the things, right? I thought I could come in and, get signed off by the leaders and say, hey, this is what I think might help. It was my idea. And I felt so ready. So I was like doing this timeline, this is what we’re going to do. This is what it’s going to look like, the structure.

And then when it went live, No one cared.

It’s not that they didn’t care. It’s that they weren’t, I didn’t bring them into this. I didn’t involve them. I was doing it to them. I was trying to create all the processes. I didn’t get their feedback. I didn’t loop around with them and say, hey, does this work?

Does this make sense? I created a schedule. I decided on the metrics with leadership that failed really quickly. And I learned a lot.

Brion Hurley: Yeah. I think that’s something we all have to go through because Yeah, it is tempting. And it feels like I can, I think I understand this. Let me just put it together.

It’s quicker. I don’t have to bother them. I think there’s good intent behind this but then you learn like it’s a waste of time if you’re not pulling them into that discussion. It’s going to go nowhere. It’s going to be harder. And it’s going to be wrong because you really don’t know what they need or what their challenges are, what they’re dealing with, or how to get them ready to brace something like that.

You get the knowledge and you’re excited. I can do this better. I know how to set this up. Yes, that’s true. Your answer would probably would have worked if they. Bought into it, but why would they buy into it?

They don’t know what you’re talking about

Sarah Cook: it’s so true and I think it’s not just coming back and saying okay. I made these mistakes It’s that I didn’t realize that I had lost the trust of the people doing the work and I thought I could just bounce right back And say okay, let me set up these meetings with everyone and figure this out No, I had to earn their trust back and that takes time, but if you go from there and you build trust, things will go much, much smoother if you actually care about working with them and not doing anything to them.

Brion Hurley: I think that’s the hard part too, is feeling like I want to bring value, I want to solve problems, I want to fix something, save money. But I have to do it in a way that they come along with me and I don’t ruin that trust and I go at the pace they’re ready for and those conflict, and it’s hard to say let’s just skip to the end or let me just do this and put it in and if you just follow it, it’ll be fine.

I think that’s a constant conflict we have to battle and that’s where you learn like. It’s pointless to skip over this. I just have to let it take a little bit of longer time because I know it’s going to be easier and better.

Sarah Cook: Yeah, and you’re on the outside. You have the “blind eyes” is what we call it

you don’t know anything about anything. You don’t know the history. You don’t know any of those things. You might see these opportunities right out of the gate, right? You’re like what about this and what about this and you have to take your time. You can’t interrogate people, but I would just come out with all these questions and i’m just like Chill out, this is a lot for them.

So have some respect because a lot of times you’re dealing with processes that have been happening for a long time, right? Maybe you’re talking with someone who created that process from nothing, right? You have to back up and have respect for the people doing the work. And that has to lead you through all of it.

Brion Hurley: Yeah. And that’s a good point. Like this person could have. taken a terrible, nonexistent process, and built a process up that is still inefficient, but to them, it was like, you shoulda seen it three years ago. This is a beautiful process compared to what it used to be, and you see it as, this is so wasteful still.

when you don’t see that background, it’s hard to.

Sarah Cook: I’ve come in with an easel pad and post its and , one of the people that was in the room had created that process from nothing, and it was exactly like you said they came in and they took the time out of their job. They were doing their regular duties, and they were trying to make something out of nothing.

And they just cried the entire time we were process mapping and I’m like, do you want to stop? And they’re like, just keep going, and just, it’s just some of those things that kind of takes me back a minute, but then I’m like they, this is theirs, they created this. I have to have respect for that.

Exactly.

Brion Hurley: What are some other ways to. tackle the change management part of what have you found that works?

Speaker 3: Yeah,

Brion Hurley: what you try to look for? Just things you consider or what you found helpful.

Sarah Cook: Yeah, I think when you’re, before you start any type of lean events, I think it’s really important to meet with the people that are involved in the process first and ask them questions about what’s what are your pain points?

What are things that you struggle with? And if you’re really, you’re noting all those things, but your real, the real purpose is to build their trust, because at the end of the day, if people can feel safe with you and build up that psychological safety with you you’re not really going to be able to find that root cause.

You could ask all the five, ten questions you want, but at the end of the day, you need to build their trust. I would have, I do an event, do some process mapping, and then while I was taking everything down, that’s when people would come in and say, hey, just so you know, When this happens, and I’m just like, yeah, totally, and you do what you got to do to get that trust going.

And I think another approach is when you start those different events is to frame it in a way, how did the process fail you? Instead of what are all the things that go wrong here, you say how did the process fail you? Because, the last thing you want to do is tell someone when you made a mistake at your job.

In healthcare, especially I felt a lot of shame when I make mistakes because you’re, you could be impacting patient care. It’s a horrible feeling. You don’t want to tell anyone. You don’t want to shine a light on anything that you’re doing wrong. You just want to fix it. And so asking the questions about how the process fails, you take some of the burden off of that expert and moves it over to the process where it belongs.

And again, until you get to that point where you can build up that psychological safety, it’s a lot harder to find the root cause.

Brion Hurley: No, I like that question. I think that’s a great way to deflect it away from the person, because that’s not what we want. Assuming 99 percent of the time people are trying to do a good job.

We hope that they just want to perform well. And so the process is to blame. You said something else, psychological safety, when they’re talking about an issue, they can tell you everything, or they can tell you some of the things. And if they don’t have that trust. They’re going to give you a surface answer or gloss over some of the details, or they could say to be honest I don’t know what I’m doing, or to be honest, I’m just trying to figure this out.

I didn’t get trained or I dropped the ball. I was supposed to check this. I’m so busy. There’s so many other things I’m not doing and that’s hard for them to speak up and say that, but. That’s how we can actually solve it is we can’t get to the real issue, the root cause, it just seems like it takes us offline in this different direction.

We waste a bunch of time. We can’t have those truthful honest conversations. And you’re right. Why would they divulge that if they don’t know what you’re going to do with this information. They don’t know you, we have to build that trust and not ruin it. And so that’s hard too, to want to tell other people about the problems that you heard, and then they ruin that trust by sharing it with the wrong person.

Who takes that knowledge and does something badly with I heard this person doesn’t know what they’re doing. It’s like now this is all falling apart.

Sarah Cook: It’s so true. I think one of the mistakes that I made in the clinical laboratory is people would have similar, two patients would specimens will come in at the same time.

And they both have the same first name, they’d have a similar last name, but the only difference would be their social. Okay. And I, that was one of the first mistakes that I made. And I just sat there while I was working with the specimen. And I was like, Oh my gosh, and I second guessed myself and I was worried and I’m just thinking to myself, has anyone else made the same mistake?

What do they do? But I, it’s not something I’d say, Hey, everyone, look over here. I made a mistake and I’m trying to, what do you guys do? Everything is quiet, like just fix it, move on, we’ve all done it, right? And then everyone’s telling you like, Oh, we’ve all done that, we’re trying to just fix it.

This is how you can do that. And, but there’s a lot of shame around it. You don’t want anyone to know.

Brion Hurley: Yeah. And that’s, it doesn’t, especially healthcare, where it feels like you’re, they have someone’s life in your hands and yeah, but I see that, a factory job, something that would be less.

critical that’s still the same fear or shame comes up too. And it’s, I don’t want to get in trouble. I don’t want to get yelled at or I don’t want to lose my job or get written up or whatever consequences they fear or suspect that’s going to change how you act. And it’s gets into a protective approach or a cover up thing.

And then now we don’t see the data, don’t get to the root cause. And it’s just, it’s. Makes it so much more challenging,

Sarah Cook: right? And the data that you’re seeing you’re believing, right? right We can’t go on thinking all processes are perfect 100 percent of the time We have to acknowledge that things are maybe breaking down.

So when you’re getting all the data and you love it and it looks great How much do you trust it? Because maybe you just haven’t built that trust with the team so you can have great data you also have to take it with a grain of salt if you’re not hearing all the things sometimes.

Brion Hurley: Yeah, I had a recent experience where someone said if I know I’m not going to meet my numbers, I’m not going to try that hard. I’m going to slack off. At first someone might be like, oh my gosh, this person’s admitting that they’re being lazy during the day.

And I was like, this is a good sign. I was actually very encouraged to hear that, but they felt comfortable sharing like. Hey, this is honestly, how I act. When things are so broken in the process, I’m not motivated. And they’re honest about it. And I was like, I can work with this that honesty and that truthfulness about it.

I can build on that when it’s like, Oh, I tried my best. And then we’re never really getting to the heart of the issue again. So I was so encouraged to hear them admit that I’m not trying because I’m really demotivated right now. Okay. This is why we need to fix these problems. So you’re not demotivated as much.

And so it was really, I think, shocking for others to hear, but I was like, this is a good sign. Yeah. This is actually really positive.

Sarah Cook: Yes. And I think it’s great to take that information and react that way, because I think it gives people other, they’re able to see, Hey, this person’s not taking this information and compromising my job, right?

They’re saying, okay, this is somewhere we can actually start from. Okay. Let’s go from here. And we don’t dwell on it. We’re not saying did you not get enough sleep that night? Do you always do this, right? You’re not blaming the person. It’s not the person, it’s the process. What’s going wrong in this process that, that brings you to this point, that happens here.

So I think that’s, trust is everything when you’re doing process improvement.

Brion Hurley: In healthcare, are you seeing applications of risk mitigation or proactive work? I know that’s a big challenge is we can fix. First, can we get the organization to fix their current problems and see the problems, but to get them to step back and then be more proactive.

That’s a whole nother level of difficulty. And I don’t know if you’ve had much luck or success in doing that. doing some more proactive or risk mitigation type activities ?

Sarah Cook: Yeah, I think when I was doing work with surgical site infection rates there was an effort to do some proactive activities.

I think, looking for something early on in the process that might create dominoes right for the rest of the processes that follow one might be doing that surgical timeout right and looking to make sure that these different processes are happening and when they’re not happening. How is that rolling and trickling down to the rest of the process?

So I think we’re always looking at looking at the process from the very beginning and looking to see if each of those steps are happening. And if those steps didn’t happen, what was the impact of that? So the first thing that came to mind was the timeout, because we would see a pattern where if a timeout was very expedited, or maybe a timeout had Not been checked that it happened.

And in healthcare, if you didn’t document it, it didn’t happen. So you have to make the assumption that it didn’t actually occur. So you’re going through and just looking to see if those steps, you’re viewing them as being proactive for the remainder. ’cause what you’re really looking at is, did that patient.

Did they get a surgical site infection or not? So you’re looking at all the things that haven’t before, something like that.

Brion Hurley: How to get that woven into the process, it’s challenging. We can fix problems, but it’s like trying to coordinate a team to talk through stuff and say, what can we do to avoid this from happening? You don’t have time for that. But we’ll have a meeting to talk about what did go wrong.

It’s a part of Six Sigma. It’s not as strong of a part of lean, but I think, the standard work elements. There’s things in mistake proofing and things that are there to stop issues. But as far as like proactive stuff, the huddles, the engagement systems and huddles are good talking through what can go wrong.

Here’s our plan today, we’re short staffed. What do we need to do to make sure we have as good a day as possible, given that we’re overwhelmed or we have too much demand or, the network’s down, systems aren’t working. We still want to provide good care, what do we need to do?

Sarah Cook: Right. And in some of these cases, the patients have been waiting four to six weeks, to get a procedure.

And all of these procedures are stacked up against each other. So you want to take care of them. You take the time to do a timeout, to walk through everything about that patient in the beginning, do that standard work, but you also only have that room for so long before you have to go over to another procedure and then go to, right?

So if that one goes over, all the other ones go over. There’s a lot of pressure, I think, especially during or after COVID and we brought back elective procedures again, those had all been stacked up for a long time. Patients are waiting, right? And so you’re trying to get patients in and you’re trying to meet that demand, but you’re also trying to make sure that you.

You follow the processes because what we’ve seen is that when you skip any of these processes from the very beginning that sometimes they do have a domino effect to all the other things that happen after that. So sometimes I think a process like a timeout can be dismissed, but it’s critical and it’s part of standard work and it’s there for a reason.

So you have to make sure that people know the value in that.

Brion Hurley: And I can imagine that the. The culture and the psychological safety is critical for that to work.

Sarah Cook: Because let’s say you start a procedure, right? And the surgeons, they’re about to go and there hasn’t been a timeout. And there’s someone in the room that’s Hey, did anyone notice?

Do you want to put your hand up and say, Hey, everyone stop what you’re doing? We didn’t have a timeout. That takes a lot of courage, right? To say, Hey, stop. But, that’s what we ask of these caregivers to do those things and advocate for the patient and the process. But that’s it’s hard work to do something like that.

It takes a lot,

Brion Hurley: right? Especially if you have concerns that the reaction’s not going to be very positive. We don’t have that safety. It’s really courageous at that point.

Sarah Cook: Exactly.

Brion Hurley: So all these things all tie together. Yeah, that’s true. Really critical. It’s proactive change management and psychological safety.

Those aren’t necessarily value stream mapping tools and kanbans and stuff, but That’s like the outer edges of the process that have to be there to make those. tools work the way they’re supposed to with the people who are engaged in that process.

Sarah Cook: Yeah, absolutely.

Brion Hurley: I think everyone goes through this, right?

It’s to learn tools and the tools are pretty cool. And then you realize, oh, the tools are a part of it, but all this other stuff is actually the most critical things and that’s the more difficult things, developing the leadership, changing the leadership, getting them on board creating that safety, that’s not easy.

Sarah Cook: No, and even, I think you can never underestimate what’s viewed as a small improvement, right? Like quick wins those can really mean they can be challenging for someone that’s just trying to get through their job every day, but it could also mean that someone gets a lunch break when they typically don’t, right?

So it’s important. to understand that even something small that feels really insignificant and you’re thinking, I don’t want to bother with these small improvements. I want to do the big things, right? I want to do, patient experience for three departments and all these things, but don’t minimize or dismiss smaller efforts because that could be also a really great way to get people on board and really see what Lean can do.

Brion Hurley: Yeah. And I think your Lean training that you talked about was a great way that you’ll never forget. understand the improvements that came out of that. There’s lots of small things,

I can leave 15 minutes early today. I can get home a little earlier than normal. I can not be frustrated today.

They could have made some improvement just from basic training and support like that, that’s , Not going to get written up or documented

Sarah Cook: All of our team I think at one point or another we would just think Let’s work ourselves out of a job we can come in and we can help with these process improvements But the end game was always to have people identify those in their areas themselves And start looking for those ways that they can make those improvements and identify those ways and add value It means a lot to set people up that way And be able to watch a statement because they invested the time to be able to learn all those things.

So it’s pretty incredible.

Brion Hurley: Anything else around employee engagement that you’ve seen work well? You’ve said the huddles, you talked about some basic training. , Encourage, , small improvements, anything else?

Sarah Cook: My job is just to encourage people to come to me and tell me what they’re comfortable sharing and using that information in a way that I think helps them instead of scares them, right?

In some cases, like we mentioned earlier, you’re bringing really sensitive things to the surface that maybe everyone knew and knows but no one would want to share publicly, right? So just, I think, understanding that you’re asking people to take a big leap of faith with you, and so your job really is to create that environment where they can be safe.

Like you said earlier, where someone said, if I know I’m not going to meet my goal, I’m not going to try as hard. Now you have somewhere to start from now what your current status and what you’re looking at without that kind of information. You’re guessing.

Brion Hurley: Yeah.

Sarah Cook: Right.

Brion Hurley: One, I think even just understanding the opportunity that’s there says you can just take some of these problems away. Off their plate, not frustrate them so much. We can get much better productivity and they’re gonna be happier. And that’s really what we’re trying to do.

Sarah Cook: Yeah.

They’re gonna get their lunch

Brion Hurley: break .

Sarah Cook: I had someone pull me aside and they’re like, look, I don’t know what you’re doing. Okay. I’m not sure if I’m on board with this process improvement or not. Can you please make sure that out of all of this I can get my lunch break? And I’m like, okay, let’s go, let’s try and make it happen, you have to bring in that trust and create that environment to do it.

Brion Hurley: Oh, and just listening for what, what’s important to them and not asking for, I need this automated or to made it so easy for me. I just want to focus on what I’m here for and take away this frustration and things that keep me from doing the work.

I like the work, but I can’t get to the work because of all this process problems.

Sarah Cook: And if you are collecting data, understand that data fluctuates. It’s normal. It happens. Try your best not to react. If, something goes up half a percentage because, numbers do that. They move around.

Things change every day. Something could have happened. Mark Graban, he’s done a lot of writing, about, when to react to data, when not to, or try not to. And I think that’s something too, when, when you’re looking at data, you want to put all your faith and look at it and think that’s exactly what’s happening.

Something is out of range because it didn’t meet your standard or it didn’t stay in the green. It could have been anything that people didn’t necessarily do anything wrong. A process didn’t break down. The process just moves and fluctuates in different ways. So don’t panic. It happens.

Brion Hurley: The number is always going to go up or down, right?

It’s not going to stay the same. So the question is, does it move in a way that’s unusually large or unusually different than what it used to? That’s what we want to really get worried about.

Sarah Cook: Teams would do turnaround times and length of stay and as soon as something turned red, it was like, hey, what happened here, and if I were working , in those departments and someone’s Hey, I need to know what happened here.

I’m going to be like, Whoa I don’t know. I don’t know. The day seemed like any other day, right? And so you just have to calculate those ranges that you’re willing to say, all right, this is how much we’re going to fluctuate and try and work with that before reacting.

Brion Hurley: Yeah, I think that is something that is really helpful on the Six Sigma side is being able to not react to noise and the fluctuations of data, looking at the process behavior charts or control charts and

SPC

to, say don’t worry about that one.

It’s actually going to fluctuate a certain amount. I think if you talk to people in that process, they would probably back it up without seeing the data. They would say, this seems like every other day. I don’t know what’s so unusual or special about this situation. What are we reacting or freaking out about?

Sarah Cook: Yeah. And I think meeting people where they are with the data, I’ve met with different teams, clients where they had really intricate, standard deviations and all the things and all this stuff for printed out from Minitab

you can just draw some lines, make it easy for people to interpret at a glance and so that as I’m walking by, I should know exactly what happened with that data today.

It doesn’t need to be super intricate, just what’s going on with it. And so don’t think that people need the lots of special things. They just want to be able to interpret something on a board. We did a process improvement. Is it working? I don’t know.

Brion Hurley: It gets to the, visual part of it is, how do I know how we’re doing?

Getting some kind of visual chart on their huddle boards or In their area somehow to get feedback.

Sarah Cook: Yeah, for sure.

Brion Hurley: Cool. This has been great. Anything else you want to add? Yeah,

Sarah Cook: I love it. I love talking about this stuff. And so thanks for hanging out on a Friday afternoon.

Brion Hurley: Talking about process improvement.

Sarah Cook: Woohoo.

Brion Hurley: How can people get ahold of you? You want to connect, reach out more about what you’re doing.

Sarah Cook: Yeah just find me on LinkedIn and then message me and we can chat. Lean, data, Six Sigma, I’m all about it.

Brion Hurley: Are there multiple Sarah Cooks?

Sarah Cook: There probably is.

So it should be just Lean Six Sigma Black Belt is

Brion Hurley: we’ll

have the link in the notes.

Sarah Cook: And the red hair,

Brion Hurley: Okay. That’ll be easy.

Cool. Thanks, Sarah. Appreciate having you on. Thank you so much.

Let’s stay in touch.

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