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Wednesday, June 22, 2016

#HCSummit16 final thoughts

Well, only in Lake Wobegon are all things above average all of the time. My #HCSummit16 experience was a bit of a disappointment, to be candid (and it had nothing to do with the Summit content). My long inbound flight delay out of SFO put me at MIA so late that I was running on fumes on Day 1 of the Summit, after only about 4 hours' sleep. The in-your-face asphyxiating heat/humidity combination (90F + 100% humidity, episodic T-storms) didn't help; I'd get out of my rental car and my glasses would immediately fog over. The oppressive heat also meant that the AC at the venue would typically be walk-in freezer cold. I was wishing I'd brought a jacket or sweater.

I was so tired by Wednesday afternoon there was no way I'd stay up late enough to attend John Toussaint's jazz band performance, as I did last year. I got back to my hotel (I was staying offsite) and promptly crashed out. Hated to miss that.

Then there was the limiting liability of attending solo, which meant that I'd not get to see most of the concurrent AM and PM learning sessions. Back when I was with HealthInsight during the REC days we typically had at least four or five people tag-teaming events such as HIMSS so we could compare notes and max out our individual and collective experience.

I'd said at the HCSummit16 outset I'd be particularly interested in "Leadership" presentations, and anything detailing the effective integration of Health IT into Lean initiatives.

Notwithstanding repeated tweets, I got no takers, and there was nothing in the presentations I did attend expressly addressing the HIT-Lean topic. Neither did casual talk with other attendees during lunch and intermissions yield any engagement.

It remains a priority issue of importance for me. It should be obvious just why, given that health care delivery remains an irreducibly high-cognitive-burden, fast-paced endeavor, one where data acquisition and evaluation are critical. BTW, see my May post "Technology, particularly the technology of knowledge, shapes our thought."

apropos of workflow, I'd brought up one aspect of this last year:

Most recently, I again brought this up during my recent HIMSS16 coverage.

Whatever. Continuing missed opportunity here.

The "Leadership" stuff was again fine, both as expressed in the Keynotes and Mark Graban's excellent CEO panel.

Speaking of Keynotes, I was delighted by Dr. Patrick Conway's CMS presentation.

The CMS budget comprises about a quarter of federal spending. Effectively Leaning up cannot but have significantly beneficial effects. We'll see. The federal government suffers from what I call "Policy ADHD" roughly correlated with election cycles, and Lean is not a Gartner Hype Cycle management fad.


I didn't attend Dr. Bahri's session.

They handed out comp copies of his book. Very good.
Walking into a dental practice in Jacksonville, FL one would hardly expect to find a learning laboratory for lean practices or a relentless lean pioneer. But that’s exactly what I found when I first visited the offices of Dr. Sami Bahri in 2007. I had already heard about the “lean dentist” from lean thought leaders like Jim Womack and John Shook, and respected lean practitioners like Jerry Bussell from Medtronic. They all said the same thing, “You've got to see this guy … He actually gets it!”

So what does it mean to “get it” when you’re the leader of an organization, whether it’s a dental practice with a dozen employees or a Fortune 500 company? Let’s remember that the “it” we’re talking about is real lean that strives to consistently deliver only value-creating services to the customer. The Lean Enterprise Institute (LEI) has chosen to share Sami Bahri’s story because he has proven that he understands what a lean transformation requires of a leader:

  • A deep understanding of how your customers define “value”and a willingness to build your organization around that definition
  • Getting your hands dirty in the real work of your organization to understand where the value is flowing … and where it’s not 
  • Treating your organization as a system rather than a collection of disconnected operations
  • A commitment to changing your own behavior while understanding what it takes to help others change
  • A passion for learning—about your customer, your process and all of its problems, and about creative countermeasures based on constant experimentation
  • An honest belief in the power of Plan-Do-Check-Act (PDCA) and a commitment to completing the improvement cycle every time
  • Becoming the teacher who models lean thinking, participates in lean experiments, and learns/teaches by asking the right questions, rather than providing the right answers
  • Humility to admit that knowledge is everywhere in the organization and that every improvement is temporary
Perhaps the most amazing part of this story is that Dr. Bahri is completely self-taught. Since opening his practice in Jacksonville in 1990, he has read virtually everything in the field of organizational improvement, from Deming’s Out of the Crisis, to Womack and Jones’ Lean Thinking, to Csíkszentmihályi’s Flow: The Psychology of Optimal Experience. Even more importantly, he began experimenting with his staff to convert his new knowledge from theory to practice. So in the process of understanding what it means to be lean, he became the teacher for everyone on his staff (including fellow dentists), the scientific observer for his lean business experiments, and the leader of a lean enterprise.

Dr. Bahri has a profound understanding of the essence of lean. He got this understanding in much the same way as the original developers of the Toyota Production System. He pursued it because of an unshakable belief that there had to be a better way and through his own hands-on PDCA experiments.

It’s been my great pleasure to get to know Sami well while bringing Follow the Learner to the market. The major challenge in the project has been to capture the deep understanding of lean that he has developed over his almost 30-year lean learning journey, while also preserving his gift for “keeping it simple.” In the process, he’s defined an equally “simple”—and very challenging—model of leadership. Butthese are the fundamentals, not the basics of lean leadership. If we’ve done our job, the book will help you to look at the fundamentals of your own lean implementation and the vital role that you must play in it as a leader within your organization.

To provide you with additional information about Dr. Bahri’s lean journey we have created a dedicated web page for this book at the LEI web site:
It's a quick, accessible read. I fired up my Dragon and read in the conclusion.
I am including here a handful of lessons I have learned along the way to keep our lean efforts focused. These lessons have worked well for us and I welcome you to use them, but please also improve upon them and create your own.

Improve the process flow before you eliminate waste from individual operations. Start improvements close to the customer and spread the improvements backward toward the beginning of the value stream. Some operations can be totally eliminated, meaning you may never have to work on them.
Run your value–adding operations in a series and the support functions in parallel. While your value–added operations (e.g., crown or filling in our case) are running, your support functions (e.g., writing notes in the chart) can happen in parallel, at the same time. In practice, we try to keep the patient in the office only for the duration needed to perform the value–added treatment.
Start as small as you can when making improvements within your organization. Mistakes will only have a minor impact.
Change is most effective when it grows naturally.  Grows like an embryo, change needs to start small, drawing upon as few resources as possible, before it can spread outward to encompass the entire organization. Because we tend to think only in batch–and–queue terms even when implementing change, which tends to make a small change somewhere, and as soon as we see good results, we try to spread it over the entire organization. I found that policy to generate early resistance that could halt any change efforts.
We need to fight the desire to spread change on a large scale until we have implemented it as deep as necessary in a small area of the organization. In other words, go 1 inch wide and 1 mile deep, not the opposite.
Use small–scale experiments to prove to your coworkers that the changes you are proposing are actually improvements. Providing proof changes minds, establishes trust, and reduces resistance to change.
Shorten the lead time to make your processes more flexible and more responsive, so you can respond faster to market changes. Look for flexibility in your people's attitude, the flexibility to learn and to help whenever and wherever they are needed. This is the best way to constantly increase capacity in your organization.
Put the decision-makers together rather than in separate locations. To facilitate one–piece flow, we like people who need to make decisions and who owned different pieces of the puzzle to be located in one space around the patient.
Communication and decision–making will improve dramatically. For example, our treatment plan coordinator, Candace had an office that she kept even after she became flow manager. One day she was sitting across the table, discussing the schedule with me. I was holding a color printed schedule that showed me more details than the black and white printed schedule that she held. Because of that difference, she could not understand everything I described about the schedule. Frustrated, she came to sit next to me. As soon as we looked at the same paper, we had no more communication problems.

"If it is so difficult to communicate while across the table from each other," she reflected, "it must be even more difficult for the assistance to communicate with me when I am in my office and they are in the treatment room."

She decided to abandon the office that she had used for over 10 years. The next morning, she moved to a desk right behind the hygienists and dentists. From her new location she could hear the hissing of the cleaning machine, and when it stopped; she did not need anybody to tell her that the cleaning was finished. If anyone needed help with an insurance or scheduling question, they did not need to call her anymore because she was right there and could hear the discussion.

Most importantly, learn. However you can, learn. Even when I was teaching dentistry, I have found that learning was more fun than teaching. When I began learning lean management, I explored a new knowledge first with an interested individual and then with everyone on the staff. Today, I'm always adding to my network of fellow leaned learners from around the world, so that I can learn more and more creative lean applications. My only plan is to keep learning. My wish is that every leader becomes a lifelong lean the learner and teacher.

But start implementing lean today. Do not wait until you have learned "all about lien," including the leadership principles I've written about here. In the end, practices the only thing that will enable you to find your way by learning your own way. These personal lessons will determine the kind of leader that you will become. (Pages 87 – 90)
I went to Amazon to see whether it was offered there. No, but I did find this.

Okeee dokeee now... LOL.

"The Lean Dentist" is available here.

There is no shortage of worthy QI books to study. Four of my cut-to-the-chase favs:

Count me Old School Deming, for one thing.

I have a couple of technical recommendations. First, the lighting. Of all the conferences I attend every year, the Lean Healthcare Summit is by far the weakest in terms of presentation venue stage lighting. It's like one continuous sleepy Happy Hour ambience. Two sparse light trees at the back of the ballroom, outfitted with about four or five poorly aimed white spots each (the left side podium was literally in the dark), no backlighting, no floods.

The Health 2.0 conferences are the best in this regard. Pro A/V. We should learn from them.

Second, I lost track of the overloaded, impossible-to-assimilate slides, e.g.,

This syndrome is by no means unique to the Summit. We've all been to myriad presentations wherein the speakers drone on ad nauseum reading through their text-heavy slides (and, to be fair, I have not always uniformly walked my own talk -- pdf). Some of the Summit16 presentations were manic, with speakers plowing intensely through too much visual material.

I already know how to read.

Again, Health 2.0 conference presentations are -- well -- leaner, and consequently more effective in terms of information delivery. Attend. See for yourself. I'll be there again this fall.

One of John Shook's closing Keynote slides.

OK, I also recommend, to the extent practicable, application of the principles embodied here:

Performance in three acts
The Presentation Secrets of Steve Jobs is structured like one of Jobs’s favorite presentation metaphors: a three-act play. In fact, a Steve Jobs presentation is very much like a dramatic play—a finely crafted and well-rehearsed performance that informs, entertains, and inspires. When Jobs introduced the video iPod on October 12, 2005, he chose the California Theatre in San Jose as his stage. It was an appropriate setting as Steve divided the product introductions into three acts, “like every classic story.” In act 1, he introduced the new iMac G5 with built-in video camera. Act 2 kicked off the release of the fifth-generation iPod, which played video content for the first time. In act 3, he talked about iTunes 6, with the news that ABC would make television shows available for iTunes and the new video iPod. Jobs even introduced jazz legend Wynton Marsalis as an encore.

In keeping with Jobs’s metaphor of a presentation as a classic story, The Presentation Secrets of Steve Jobs is divided into three acts:

  • Act 1: Create the Story. The seven chapters—or scenes—in this section will give you practical tools to craft an exciting story behind your brand. A strong story will give you the confidence and ability to win over your audience. 
  • Act 2: Deliver the Experience. In these six scenes, you will learn practical tips to turn your presentations into visually appealing and “must-have” experiences.
  • Act 3: Refine and Rehearse. The remaining five scenes will tackle topics such as body language, verbal delivery, and making “scripted” presentations sound natural and conversational. Even your choice of wardrobe will be addressed. You will learn why mock turtlenecks, jeans, and running shoes are suitable for Jobs but could mean the end of your career.
Short intermissions divide the acts. These intermissions contain nuggets of great information culled from the latest findings in cognitive research and presentation design. These findings will help you take your presentations to an entirely new level.

Gallo, Carmine (2009-09-11). The Presentation Secrets of Steve Jobs: How to Be Insanely Great in Front of Any Audience (Location 178). McGraw-Hill. Kindle Edition.

Create the Story

Creating the story, the plot, is the first step to selling your ideas with power, persuasion, and charisma. Succeeding at this step separates mediocre communicators from extraordinary ones. Most people fail to think through their story. Effective communicators plan effectively, develop compelling messages and headlines, make it easy for their listeners to follow the narrative, and introduce a common enemy to build the drama. The seven chapters—or scenes—in Act 1 will help set the foundation for presentation success. Each scene will be followed by a short summary of specific and tangible lessons you can easily apply today. Let’s review the scenes here:

  • SCENE 1: “Plan in Analog.” In this chapter, you will learn how truly great presenters such as Steve Jobs visualize, plan, and create ideas well before they open the presentation software.
  • SCENE 2: “Answer the One Question That Matters Most.” Your listeners are asking themselves one question and one question only: “Why should I care?” Disregard this question, and your audience will dismiss you.
  • SCENE 3: “Develop a Messianic Sense of Purpose.” Steve Jobs was worth more than $100 million by the time he was twenty-five, and it didn’t matter to him. Understanding this one fact will help you unlock the secret behind Jobs’s extraordinary charisma.
  • SCENE 4: “Create Twitter-Like Headlines.” The social networking site has changed the way we communicate. Developing headlines that fit into 140-character sentences will help you sell your ideas more persuasively.
  • SCENE 5: “Draw a Road Map.” Steve Jobs makes his argument easy to follow by adopting one of the most powerful principles of persuasion: the rule of three.
  • SCENE 6: “Introduce the Antagonist.” Every great Steve Jobs presentation introduces a common villain that the audience can turn against. Once he introduces an enemy, the stage is set for the next scene.
  • SCENE 7: “Reveal the Conquering Hero.” Every great Steve Jobs presentation introduces a hero the audience can rally around. The hero offers a better way of doing something, breaks from the status quo, and inspires people to embrace innovation (ibid, pp. 1-2)
Deliver the Experience

Steve Jobs does not deliver a presentation. He offers an experience. Imagine visiting New York City to watch an award-winning play on Broadway. You would expect to see multiple characters, elaborate stage props, stunning visual backgrounds, and one glorious moment when you knew that the money you spent on the ticket was well worth it. In Act 2, you will discover that a Steve Jobs presentation contains each of these elements, helping Jobs create a strong emotional connection between himself and his audience.

Just as in Act 1, each scene will be followed by a summary of specific and tangible lessons you can easily apply today. Following is a short description of each scene in this act:

  • SCENE 8: “Channel Their Inner Zen.” Simplification is a key feature in all of Apple’s designs. Jobs applies the same approach to the way he creates his slides. Every slide is simple, visual, and engaging.
  • SCENE 9: “Dress Up Your Numbers.” Data is meaningless without context. Jobs makes statistics come alive and, most important, discusses numbers in a context that is relevant to his audience.
  • SCENE 10: “Use ‘Amazingly Zippy’ Words.” The “mere mortals” who experience an “unbelievable” Steve Jobs presentation find it “cool,” “amazing,” and “awesome.” These are just some of the zippy words Jobs uses frequently. Find out why Jobs uses the words he does and why they work.
  • SCENE 11: “Share the Stage.” Apple is a rare company whose fortunes are closely tied to its cofounder. Despite the fact that Apple has a deep bench of brilliant leaders, many observers say Apple is a one-man show. Perhaps. But Jobs treats presentations as a symphony.
  • SCENE 12: “Stage Your Presentation with Props.” Demonstrations play a very important supporting role in every Jobs presentation. Learn how to deliver demos with pizzazz.
  • SCENE 13: “Reveal a ‘Holy Shit’ Moment.” From his earliest presentations, Jobs had a flair for the dramatic. Just when you think you have seen all there is to see or heard all there is to hear, Jobs springs a surprise. The moment is planned and scripted for maximum impact. (ibid, pp. 85-86)
Refine and Rehearse

 So far, we’ve learned how Steve Jobs plans his presentations. We’ve talked about how he supports the narrative through his words and slides. We’ve discussed how he assembles the cast, creates demos, and wows his audience with one dynamic moment that leaves everyone in awe. Finally, you’ll learn how Jobs refines and rehearses his presentation to make an emotional connection with the audience. This final step is essential for anyone who wants to talk, walk, and look like a leader. Let’s preview the scenes in this act:

  • SCENE 14: “Master Stage Presence.” How you say something is as important as what you say, if not more so. Body language and verbal delivery account for 63 to 90 percent of the impression you leave on your audience, depending upon which study you cite. Steve Jobs’s delivery matches the power of his words.
  • SCENE 15: “Make It Look Effortless.” Few speakers rehearse more than Steve Jobs. His preparation time is legendary among the people closest to him. Researchers have discovered exactly how many hours of practice it takes to achieve mastery in a given skill. In this chapter, you’ll learn how Jobs confirms these theories and how you can apply them to improve your own presentation skills.
  • SCENE 16: “Wear the Appropriate Costume.” Jobs has the easiest wardrobe selection in the world: it’s the same for all of his presentations. His attire is so well known that even “Saturday Night Live” and “30 Rock” poked some good-natured fun at him. Learn why it’s OK for Jobs to dress the way he does but it could mean career suicide if you follow his lead.
  • SCENE 17: “Toss the Script.” Jobs talks to the audience, not to his slides. He makes strong eye contact because he has practiced effectively. This chapter will teach you how to practice the right way so you, too, can toss the script.
  • SCENE 18: “Have Fun.” Despite the extensive preparation that goes into a Steve Jobs presentation, things don’t always go according to plan. Nothing rattles Jobs, because his first goal is to have fun! (ibid, pp. 165-166)
Again, "to the extent practicable." Technical content presentations differ materially from short marketing content delivery. But, are we jamming too much in?

I also study the delivery approach contained in TED Talks. e.g.,


More to come...

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