Why Healthcare Leaders Only See the Tip of the Iceberg

Why This Episode Matters

Healthcare organizations often know they have problems with flow, safety, delays, frustration, and waste, but they may not actually see the work clearly enough to solve them. In this conversation, Maria Mentzer explains how See to Solve helps organizations surface hidden problems, involve the people closest to the work, and build practical problem-solving capability through simple, repeatable behaviors rather than heavy improvement infrastructure or abstract training.

Key Ideas Explored

• Why leaders often see only the tip of the iceberg of organizational problems 
• How See to Solve helps teams make work visible before jumping to solutions 
• The role of process and relationship mapping in creating shared understanding 
• Why leadership support is essential for sustaining improvement behavior 
• How small, rapid experiments help teams generate learning instead of just implementing fixes 

Takeaways for Quality Leaders

• Start with a narrow slice of real work rather than trying to solve the whole system at once. 
• Involve the people who actually do the work; they see barriers leaders often cannot. 
• Treat mapping as a way to create insight, connection, and energy for change. 
• Make leadership participation visible, practical, and sustained beyond the first workshop. 
• Build internal coaching capacity so improvement becomes part of daily work, not a consultant-dependent event. 

Continue the Conversation

Maria Mentzer on LinkedIn

Resources & Frameworks Referenced

• See to Solve
• Decoding the DNA of the Toyota Production System
• The High-Velocity Edge
•  Iceberg of Ignorance (Sidney Yoshida)

Disclosure: This episode is not sponsored. Jason has no financial or commercial relationship with See to Solve. The conversation reflects his editorial interest in the work and in Steven Spear’s contributions to improvement science.

Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.

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Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.

Help us build this podcast  community from the ground up: share your top insight from this episode and where you’re seeing it in your own work. I read every response and will share what we’re learning over time in future episodes and other ways.

New episodes published every other Thursday at 7AM Eastern Time.

Credits:

Host, Writer, and Executive Producer
Jason Meadows, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic

Transcript

The Hidden Problems Iceberg

SPEAKER_00 0:00

The executives at the top of the organization, they only have visibility to about four percent of the problems in their organization. The first product that C2Solve developed was a software product called Alert. Just tap tap with a phone in your pocket, and we automatically route it. We map it in the back end so the nurse can continue to focus on her patient while she knows that this problem is going to go to the right person.

Meet Maria Mencer And C2Solve

SPEAKER_02 0:29

Welcome to Leading Quality, the podcast spotlighting the people moving healthcare forward from the front lines to the C suite. I'm your host, Jason Meadows. Maria Menzer is the Chief Marketing Officer at C2Solve, a small company founded by Dr. Steven Speer out of MIT. But as Maria explains in this conversation, in a small organization, titles only tell part of the story. Much of her work is as a coach for high-velocity learning, continuous improvement, and problem-solving culture, helping organizations implement Spears' frameworks in a practical, visible, and repeatable way. This episode is about what it really means to help people see problems so they can solve problems. See toSolve began with the idea that organizations need better ways to surface problems early, route them to the right people, and create the conditions for learning before those problems grow, combine, and become harder to manage. We discuss a deeper issue, which is that many healthcare organizations believe they already see their problems. Leaders know about patient flow, falls, safety events, delays, and hospital-acquired infections. But Maria pushes us to ask a harder question. Are we seeing the actual work clearly enough? And are we involving the people closest to the work in a disciplined way? In this conversation, I ask Maria to walk us through what her work actually looks like in the room. Leaders being prepared, teams mapping their own processes, breakpoints becoming visible, rapid experiments beginning, and people discovering connections in the work that they had never seen before. Before we get into this conversation, I'll just note that I don't have any financial or commercial relationship with C2Solve. I invited Maria because I'm genuinely interested in the work and because Steven Spears' writing has shaped a lot of how I think about improvement. I hope you enjoy this conversation as much as I did. Maria Mencer, welcome to the show.

SPEAKER_00 2:38

Thank you so much, Jason. It's great to be here.

SPEAKER_02 2:42

Great to have you. Uh been looking forward to our conversation, and uh we had a great encounter meeting up for the first time at IHI, even I think it was just this past year. And yeah, wanted to get you here and to have a conversation about what you do. And I wonder if you could start us off by just introducing yourself and and your role with Sea2Solve and just the work you do.

SPEAKER_00 3:06

Yeah, absolutely. I'm happy to. Um, so my name is Maria Mencer, and uh I work in a small company called C2Solve. I'm um officially chief marketing officer, but we're small, so we do everything. And uh the thing I love doing is being a coach um for high velocity learning or continuous improvement or problem-solving culture, whatever you want to call it. The cool thing with Sea2Solve is we were founded by Dr. Steven Speer out of MIT. And I think hopefully many of you know that he's a thought leader in the space of operational excellence. So I get to help uh organizations implement his frameworks. Um, and that's really why I joined C2Solve and and uh why I love working with C2Solve.

SPEAKER_02 3:59

Yeah, and I think many listeners will be familiar with with Steven Spears' work. Certainly all its PhD thesis is famous in the uh in the field and and the books um in recent years have really been impactful on me, I know, and I think a lot of people. So how did your connection with Steven begin? And and what kind of got you bought into doing this work?

SPEAKER_00 4:22

Yeah, my connection with Steven began. I think the first time I've heard of him, I was working in manufacturing. I mean, this is a long time ago, 25, maybe even 30 years ago, at Intel Corporation. And um we were doing a lean transformation, the first lean transformation at Intel at the time and decoding the DNA of the Toyota production system. Uh, Steve's article and that he wrote with Ken Bowen. That was the first article and reading that we did. And so that's when I first heard of Steve Speer. And um, and we used his principles back then to um to do our lean uh transformation in that um in that uh plant. And then a few years later, I joined um the MIT Leaders for Manufacturing. It was called then. Now it's called Leaders for Global Operations, um, dual degree program. And Steve was our summer professor for the class to teach us lean and six sigma methodologies. So then I was extremely happy to actually get to, I was kind of starstruck, right? I'm like, oh my gosh, you know, Steve Spears teaching the class. This is amazing. So I had him as my professor over at MIT. And then after MIT and the experience that I had, you know, in in the plant at Intel, once you've seen this stuff work and once you've experienced it, you I at least I cannot stop. So I always, you know, wherever I worked, wherever I went, would be implementing and trying to implement continuous improvement culture. And sometimes I would bring in Steve or give him a ring and give him a call. And so we continued to stay in touch through the years. And I continued to bring him in as help. And then eventually three years ago, I uh finally it was time for me to do this as a full-time job and not just as a side gig. And I called him up and I said, Hey, Steve, you know, I really want to focus on just helping organizations do what you and I have been doing over at Intel. And um, and that's how we figured out how I could join C2Solve. So that's my connection with Steve. So now he's my colleague. So he's been my professor, he's been my consultant, and now he's my colleague.

SPEAKER_02 7:01

That's great. And tell me a little more about what C2Solve is. I like how that rolls off the tongue. Um, and I know that there's like a rich, deep kind of simplicity, but an elegant simplicity behind that. So tell me a little more about that.

SPEAKER_00 7:14

Yeah,

Software That Flags Problems Fast

SPEAKER_00 7:15

absolutely. I mean, just like the name says, see to solve, we're all about helping uh organizations see problems so that they can solve problems. Um, and it goes back to uh Steve's frameworks, and and he's so good at breaking down continuous improvement work into simple capabilities and behaviors that people can practice. Um, and that's really why I think he's so successful taking his frameworks across industries and across any business function and and you know, prove that it it works anywhere if you focus on the behaviors. So just as the name tells you the behaviors that we're looking to help people do, seeing problems and then helping them solve those problems more, faster, better than they did before. See to solve itself, Steve founded it, I think, back in 2017, more as an experiment. He was working with a client and they were lacking software to help them amplify problems or kind of, you know, pull the and on cord. So the first uh product that C2Solve developed was a software product called Alert. And um it's still in use today with clients. Um, and it is a super easy way to call out problems and then automatically get it routed to the person who is equipped to help. Um, and it's really focused on making it easy for the person who encounters the problem uh rather than making it easy, you know. A lot, there's a lot of systems out there that make it easy for the person who's responding to track and filter and all that stuff, but it it's usually pretty cumbersome for the person who's who's actually seeing the problem. So we're really targeting that kind of forgotten user group. And so that's how C2Solve started. Started as a software company, and then, you know, there's other software tools that's been developed since then, but um, we're also kind of in the middle of a pivot that I can touch on a little bit as well.

SPEAKER_02 9:25

Yeah, absolutely. We can, I'm sure we'll get into it as we go. I think that there's probably people among our listeners who will already kind of see where you're going with teaching people how to see so they can solve. But I wonder if you can expand on that just a little more because I think there's also a population of people in healthcare who think they already see the problems and already have their own ways of trying to fix them. So why is it why is the seeing part necessary and and where do you start helping people trying to see?

SPEAKER_00 10:03

Yeah,

Seeing Work Through Frontline Eyes

SPEAKER_00 10:04

I mean, the the seeing part is all about getting every single person, their eyes and ears, to help you expose problems. Um in in many organizations, actually in all of especially in large organizations, we have uh we have a visual we call it's the the uh uh iceberg of hidden problems. And it's uh it's not it's not something we came up with, but it's it's kind of proven that at the top of the organization, the executives at the top of the organization, they only have visibility to about 4% of the problems in their organization. And then the next layer has visibility to, I think, like 9%. And, you know, not until you get to every single person do you actually have visibility to every single problem that every single person is encountering. And uh the problems are there, whether you, you know, act on them or report them or not, they're just gonna stick around and fester. And so the the whole idea of seeing problems and calling them out quickly is about being able to take care of these issues while they're actually small and manageable. Um, because if you wait, they're gonna not only themselves kind of fester and get worse, but they're gonna combine with other problems. And then you may have, you know, riskier, more costly problems to take care of. And then, of course, you know, in healthcare, you got the risk of harm, patient harm, which would be the ultimate catastrophe, right? But it it's the same in any organization. Whatever, whatever problems you have, if you don't, if you don't address them when they're small and easy to take care of, they're not going away. They're just gonna continue to linger around and get more difficult and harder to take care of. So that's that's why we really focus on, you know, what Steve Speer calls capability one in his um high velocity edge book is flag problems early, as early as you can, so that you have a chance to address them.

SPEAKER_02 12:14

Yeah, absolutely. And now's a good time as any to to mention that I will link to any of the uh the resources and publications that we mentioned during the conversation. Um, really good stuff out there. I don't have any financial stake in any of this, uh any of the published work, but um, but it is good.

SPEAKER_00 12:28

I think it was Sydney Ashida who did the iceberg of hidden problems, if I remember correctly, but yeah.

SPEAKER_02 12:35

Yeah.

SPEAKER_00 12:35

I want to make sure I give credit to the right person.

SPEAKER_02 12:38

Absolutely. Yeah, well, uh good good giving credit where it's due. You know, I've seen the iceberg metaphor before. I think maybe others among our listeners will have have seen it too. I don't know that I I fully internalized this idea that you just said, which was the leadership having visibility into that very tip, but that the unlock for seeing the whole rest of the iceberg was to include people. I think that's uh such a powerful argument in favor of including uh people at all levels of the organization, if you could actually see all the all the important problems.

SPEAKER_00 13:17

Yeah. I mean, and I think especially in a healthcare setting, the the healthcare organizations that we work with, they are even included. I mean, they obviously you have all the eyes and ears of your staff and your your team members who are walking around and seeing things all the time. So making it extremely easy for them to call out issues and and not have to worry about who do I call if I have this issue, who do I call if I have that issue, but like just tap tap, you know, with a phone in your pocket, and we automatically route it. We map it in the back end so the nurse can continue to focus on her patient while she knows that this problem is going to go to the right person. That is one thing. But we also have all the patients and their family members and their eyes and ears. So we're engaging their eyes and ears to also help see more problems. And that's very powerful. Plus, it also, of course, means that your, you know, your family members and your patients feel heard. Like they they feel, you know, listened to, which is which is really important.

SPEAKER_02 14:29

I wanted

Share Your Experience With Us

SPEAKER_02 14:30

to pause for a moment to invite you into something I'm starting with this podcast. If something from this episode connected with your own experience, where you've seen it work or not work, I'd love to hear about it. There's a short link in the show notes where you can share what you're seeing in your own work. It takes about a minute. I read every response, and over time I'll be sharing what we're learning together in future episodes and in other ways, and giving shout-outs during future episodes to people in the community who share ideas that really move the conversation forward. If you're up for it, I'd really value your perspective. Thanks.

Day One Mapping Breakpoints Together

SPEAKER_02 15:11

What I've understood from our conversations here and and previously is that the training part, the workshop part of C2Solve is maybe a lighter weight, more accessible version of some of the other types of lean and other quality improvement training that people have had. I want to make this kind of concrete for our audience and hoping you can explain when you're starting to work with a team, and we'll try to limit ourselves to healthcare examples if possible. Um, what does the the first day or the first few hours actually look like?

SPEAKER_00 15:51

Yeah, I'm just gonna step back a little bit because so here's the here's what we've been able to do. Like I'd said before, right? Steve is really good at distilling down the DNA, right? What is it that makes these organizations who separate themselves from the pack, who who win in whatever industry they're in? What is it that makes them able to do that? And it is things like amplifying problems, it's things like setting the conditions for your people to actually slow down to look at their work, to improve and and and experiment to discover the solutions for those problems. And um, and it's methods like simplification, things like that. Um, and it's also sharing the learning across the organizations and it's leaders who who take the responsibility for making sure that their people can do that. So it's about really spreading those capabilities amongst every single person. And that's what makes these organizations outlearn or out-innovate others who are not doing this. So that in itself is a message that resonates with pretty much any leader. If you say, Hey, would it, would you like to outlearn your competitors or would you like to, you know, innovate faster, better, more? Would you like to learn faster, better ways of doing work, you know, to create more value? People would say, Yeah, sign me up, right? Where a lot of these transformations get stuck is in the complexity of perhaps the language, the lean language itself, um, can be kind of scary if you're not familiar with Japanese terms or you don't know like you don't know what they mean. And from trial and error on my part with trying to implement lean, Six Sigma, and other improvement methodologies, I learned through the years that using a simple language, hey, four behavioral capabilities, seeing problems, swarming and solving them, spreading the learnings and leadership. That resonates with most leaders. And that is the most important part. So when I work with a team, the first thing we do is qualify the leader. Because without leadership support, it is going to fizzle out. We may get bubbles, like we may have, there's always some people in an organization and some leaders who get it already. They're like, yes, you know, I've seen it done. Like I was, it was, I did it at my other hospital or I did it here and it works and I want to do it and they're gung-ho. But they can only create a large enough bubble, you know, around their own sphere of influence, and then it'll fizzle, you know, they won't be able to get other people on board unless they then have the next level of leadership support. So we always kind of have to qualify that the leader is in it for the right reasons and that they understand it. And sometimes we have to put the leader through what we call an immersion event so that they really get to feel it and what it is. And when we say having leaders that create the conditions, what do we mean by that? So that's like the first thing. Is the leader actually, does the leader get it? Do they understand their responsibility and the success? So let's just assume we have one of those leaders because they're out there. Then what we do with a team is typically get them immediately into a session where they just need to show up. We do some pre-work to you know, pick the right team, pick the right, you know, area, focus, et cetera. But we get them into a room and they begin immediately mapping. And we use process mapping as a way to get teams to see the work collectively, collaboratively. So we get the people who are actually doing the work to map their work, not some sort of Six Sigma person, not someone else, the people doing the work, because they're the ones that know everything that gets in their way every day, and all the frustrations and all the little things that is just invisible, like the iceberg, right? So we got to get the people who actually can and know and have the knowledge of where things can and should improve. And these people don't have to have any prior understanding knowledge of lean or six sigma or continuous improvement or process improvement or quality improvement methodologies, none. I have done it with hundreds of teams, and it always works with the right facilitation. So we get them in a room, there's they start um doing some simple templates on the wall, kind of scoping their work, making sure that it's it's a small enough sliver of their work that we actually can map it out to the level of detail that's gonna be useful. So there's, you know, there's some of that facilitation where I come in and I kind of adjust, make sure that they're they're not trying to bite off too much. That's usually the issue that try to kind of map the whole entire universe. And it's like, no, you gotta kind of start with a sliver. And then they map on the wall, very simple way of process mapping that Steve he calls it relationship mapping, but it's it's really kind of who is doing the work, what are they doing, when are they doing it? Who do they depend on? What are the handoffs between people? And and kind of map out all those steps and the flow of work and the flow of information between people and across time. And then we start to have them add like, where are the breakpoints? Where are the pain points here in this process? So then they they they basically, you know, after about the the morning part of the session, they have a map. Of their work and where the pain is. And that's powerful just in itself. I mean, the conversations that happen when the team is mapping, that's the that's where they the aha moments go. Oh, I didn't know you had to do that. Ooh, tell me more. Why are you doing like what makes you have to do that? And then usually there's these conversations between people and they're so powerful. And I get my goosebumps every time I hear these conversations. And the people go, hang on, what did you say you do? And then they someone will explain, right? And and the and the person goes, hang on, I can help you with that. I actually have that data that you're looking for, but right. And so they start to make these connections that they never made before. And these are people who might walk walk by each other in the hallways every single day. And they just didn't know how they were connected through the work that they're doing. So it's extremely powerful to have them do that in the room where they can hear each other's pain and also feel like I can help you, right? So it builds this energy for change, meaning that I don't need to call in like a change management specialist because I already have this energy in the room from these revelations and these conversations that are happening. So that's the first thing we do. Then we also bring in all the leaders and stakeholders that are part of this, like that that this team either depends on or that are supporting this team, and we do a map walk with them so that they get to understand what these people actually have to go through to get their work done. So we we lower the water of the iceberg, right? So now the leaders go, oh, I had no idea. And then we do a little coaching too, before, hey, leader, you know, when you show up to this map walk, make sure that you, you know, have a curious mindset. Make sure that you are you're here to help them. You're here. Ask, how can I help? What barriers can I remove? So that when the team goes, hey, we want to, you know, work on these problems and we want to experiment here, the leader goes, okay, great. I can, you're, you're good. Go ahead. I can call those people up, make sure they know you're coming tomorrow. So after the map, the team will have a list of problem statements of those breakpoints and hypotheses that they want to test. They will have shared it all with their leaders and stakeholders, and they have a plan for what they're going to experiment with the next day. So they're using the scientific method right there in the room, whether they know it or not, they are. And when I work with healthcare organizations, I try to use language that makes sense. Like I try to switch my language around. So in healthcare, I could say, hey, you know, think of the process as your patient, and now you're diagnosing the ailments of the patient. And now we're coming up with a treatment plan, and now we're gonna test it, and then we're

Day Two Experiments And Sharing

SPEAKER_00 25:02

gonna, you know. So I'm not a medical professional, but I try to kind of weave in the language that maybe resonates. You just never know what's gonna resonate. The second date, all they do is go out and actually run small rapid experiments to test their hypotheses. So you know, they go out on the floor with their notebooks and like run their experiments and help each other, and then they come back into the room and then they write down on a template what they discovered, what did they learn? And the experiments are all about generating learning, right? It's not all about like, hey, we got to fix it right away. There it there is learning there because the problem is there because it was either ignored or we were ignorant about how to solve it. And and we can't assume that we're gonna get you know knowledgeable about it just by looking at it. We have to go out and test and see what happens. So just scientific method again, just experimentation, rapid experimentation. So then they come back and then they share their learnings and then they think about who else in either my hospital or in our hospital system, my colleagues, could benefit from the knowledge that we just gained. And then they put up and write down a sharing plan. Like, how are we gonna share it? We're gonna share it in our huddle, or are we gonna share it in our you know, all hands, or we're gonna go talk to our colleagues, right? Are we gonna update a standard or something like that to help share and spread the knowledge? So just and then there's another leader math walk and kind of session. So that's the the workshop in itself. And it was it was designed to lower the hurdle of starting to practice, and that's by design because this change is behavior change, and behavior change, after you have a basic understanding of the core concepts, it's all about practicing and and repeating until you develop the skill, until you've changed your behavior. And that takes discipline. And if you leave someone to do it on their own, it's really easy for that discipline to go somewhere else, to dissipate. But if you have a coach who sets up the session and you just need to show up and your teammates are there and your leader is there, the the hurdle for practice is lowered. And in the beginning, that is super important, which is why we do these workshops because it lowers the hurdle. They have all the coaching and they have all the support needed, they've already, you know, carved out the time. And then after the first workshop, it's all about getting them to practice, like continue to do it. And usually we do that through like weekly check-ins, and then we have another session a month later where they come back in the room, the same team, and to do it again. And usually, with the right leadership, after about three months, they have done this enough, enough repetition, that they kind of can do it on their own, so long as they have leadership support. And it's a very simple, simple, simple formula. That doesn't mean it's easy. My gym coach always says simple doesn't mean easy, but it is repeatable. And so with the right leadership and the right coaching, this is a way to kind of get the flywheel to start. And we always start very small because you have to have that strong leadership support, and then we spread from there. So the whole point is like creating, and there's so much more I can talk about, but that's kind of in essence, like how I start working with a team, qualify the leader. If the leader needs help, we we put them through an executive immersion event with Steve, get them, you know, to understand it and feel it. And then we start these, we call them model lines, basically slivers of the the team underneath that leader working on solving problems in their in their work. That was kind of long.

SPEAKER_02 29:13

No, that was the that was the perfect level of detail. I like making it concrete because I feel like even when I go to a conference sometimes or have conversations or read publications in you know peer-reviewed journals, there's there's always this question lingering in my mind of like, yeah, but how did you actually do it? Yeah, I think that's exactly where I wanted this conversation to go. So I no, I think that's that's really helpful to me anyway, and hopefully to others. You mentioned that the conversations change once the team starts to see the work more clearly and see the work more clearly together. Can you think of an example?

SPEAKER_00 29:52

Yeah, yes, I can. Oh

A Room Turnaround Breakthrough

SPEAKER_00 29:57

my gosh. Um a couple of months ago, maybe six months now, I did a I did a session like this, a mapping session. We had three teams in the room mapping their processes. And the team I was kind of helping to coach was a team of uh environmental services team members. I don't think I'm supposed to say housekeepers, but they called themselves housekeepers.

SPEAKER_02 30:27

Yeah, there's a variety of terms I've heard, but yeah.

SPEAKER_00 30:30

Yeah, they were mapping their room turnaround work, workflow. And these they had never even thought about process improvement process mapping. Like they had no idea what why they were in the room and what they were, they just knew that they were gonna improve their work. And they were fabulous. Um, this team was able to map their process of room turnaround, and they identified. I mean, there was there was a I'm trying to remember the exact details, but there was a uh there was a checklist that was not visible to to others. So they wanted to run an experiment to have the checklist kind of on the door and have it, have it kind of be something they could flip and like say, hey, the room is ready, and here's who's done it, and here's the sign-off, and they just flipped it in screen, and then everyone knows rather than like waiting for it to go into the system because the system something like that. It was it was it was kind of signal that the room had been ready and it's signed off and the checklist was there, so make it easier for them. And um, and the cool thing was that the team wasn't sure how to do this, but there was another person that was mapping in the in the other team next door that were working on patient false. And she goes, Hey, I love this experiment. Like, I want to help you, right? And so this person came from the patient false process mapping team and like joined the environmental services room turnaround team because they like because of the sharing and the math block and said, Hey, tomorrow when you guys do this experiment, I can help you because I I I know where the printer is, I know where to do, like I, you know, and so they the convert that was just a simple example of someone who is not doing the work, but is depending on the work, and who who, because of this experience, um was able to come in and say, Hey, let me help you out. So they, you know, there was a whole team of people that went around with with the EBS team to implement this checklist and like test it and turn it and talk to people about it, which is just amazing, right? That that wouldn't that connection would have never happened if we didn't have them in the room mapping together.

SPEAKER_02 33:02

Yeah, I mean, what a I would have loved to be in the room at that moment. What a cool experience that must have been.

SPEAKER_00 33:07

Yeah.

SPEAKER_02 33:07

Yeah. You know, this work really applies across industries. And at the same time, we in healthcare think of ourselves as unique. And sometimes we're, I think we're right about that. But I'm curious from your perspective, what has felt unique about healthcare and maybe what's more universal than we realize?

SPEAKER_00 33:31

Mm-hmm.

What Makes Healthcare Harder

SPEAKER_00 33:33

Yeah, it's a fascinating question because I think I was surprised even myself when I started to take these concepts outside of you know, Intel corporation where I kind of spent a few decades. Even though I knew that they worked in in all the different business functions that I had helped use these four capabilities, it worked. Um, and I, you know, going from what manufacturing to marketing to finance to human resources to product design to supply chain, I mean, like across the board. So I I was pretty confident, right? And then of course Steve has tested these methods across industries. But I still, I'm still, I think even today, I every time I use it, I get surprised that I'm it still works, right? It actually works. And I know the reason is because we're we don't focus on solutions at all. Like a lot of change efforts have a solution that they say, hey, this is how you solve this problem. And so they come in and with a solution, and the solution may not actually be transferable, but the behavior that generated that solution for the first time in some organization, that behavior is transferable. So healthcare is not different in that sense, in in the sense that if you can transfer the behaviors that lead to these groundbreaking solutions, then you will come up with the groundbreaking solutions with your own flavor that works for you and that works better for you. Um, rather than just copying solutions. And plus, of course, we all know, right, when when people are engaged and they come up with an idea, they're so much more motivated to make it happen as well. So it's not just that you're copying someone else's solution, but you're actually learning the behaviors to be empowered and generate your own answers and discoveries. So the behavior part is huge. I think I think what's been difficult for me working in healthcare is I find it hard to get leaders from the top to show up with their teams. Even the leaders who have the right intentions and say all the right things, for some reason, it's a little bit more of a hurdle to get them to show up to these math blocks or to get them to participate in our like leadership immersions. And I don't know if it's just because they're even busier than other executives are in other organizations or or what it is. That's probably a question for Steve when you have him on. Um, but I think that's the biggest hurdle. And then the other thing I think with healthcare is I mean, there's so much like pain in terms of just, I mean, nurse turnaround, like turnover, and and everyone's so busy. And there's a lot of initiatives also kind of being pushed on people with all the different technology changes and implementations and this and that, right? And it's an ever, I mean, it's there's so much entropy in a healthcare environment. I mean, things are just going to kind of like, I mean, if you're not on top of things, stuff is gonna go, can go bad pretty quickly, right? And you're responsible for people's lives. So the stakes are extremely high, the pace is very fast, and there's enormous pressure. But that we see in other organizations as well. So at any time, I think maybe it's that there's that leadership structure is maybe a little different that makes it a little trickier for us to really get that leader engagement. Um, I don't know, yeah. I'll let you know when to figure it out.

SPEAKER_02 37:56

Yeah, it's okay for some things to be uh a bit of an open question still, but I appreciate your insights there. And so when you're, you know, you you kind of alluded there to some of the challenges when you're jumping in with a new team uh in terms of having, you know, making sure that leaders are are fully engaged and are present for kind of all the sessions with their frontline teams. At this

Pitfalls To Avoid When Scaling

SPEAKER_02 38:18

point, you've done uh a lot of these sessions with uh teams in and out of healthcare. What kind of, you know, from that process, those first couple of days that you described, what are some of the the pitfalls that you're anticipating, the things you have to guard against, warn them against?

SPEAKER_00 38:35

Um I already touched on the first one, which is make sure that you have leadership support all the way up the chain. I talked about how we pick these very narrow, we call them model lines, but you know, sometimes people get kind of confused by the word model lines. So I mean it's it's literally a group of people who have full support all the way up their leadership chain because without that's the first pitfall. Without full support, they're not gonna get the time to do this work. And like I said, it it's it's uh simple, but it doesn't make it easy. You do have to devote time to it. You do have to actually practice. I mean, it's like it's like anything that you want to get good at. In the beginning, it it's it's an uphill. You're you're going up the hill, and not until as a team, this has become a habit for you to see problems and maybe map something out real quick and swarm it, solve it, run an experiment. Like it takes a while before teams get to where this is just part of how we do our work every day. That's the goal. The goal is always to get it not in a workshop, but like you want to do the workshop as a practice session so that you can then just do it on the spot. And it's just something that we do, that it becomes part of the culture, right? How we do things around here. So the first pitfall is all, and this is the most important one, and it is so important. And we're still trying to figure out how do we really crack this nut about having that leadership support because it's night and day. We we see it when we have that leader, especially the leader at the top, that is like, this is how we're gonna do things. I'm fully committed. I believe in these principles, I believe in this work, I want more from my people. You know, I know my people are smart and capable, and I want to make sure that they can, you know, we can grow and we can do all the things, serve our community with the people that we have, right? Those leaders are gonna be successful. And then it's just about, you know, figuring out how do we take these slibbers under them. So the first one is the leadership, make sure that they're qualified. Then we, before we even set, you know, foot in the room with a team, we do some scoping sessions and making sure that we pick the right team, the right team members. We pick a problem that is important to them as well as to others, because sharing early wins, even though other teams may not be doing this work yet, just having them know about this is going on and then being able to share early uh wins is important. And so we do that planning. The other thing, so there's a pitfall. If we don't do that well and we don't follow like our formula, the teams can come in and we might not have the right team members in the room, or we may not have, you know, we might not have all the experts in the room. We may not, we may be trying to bite off too much. That's usually like a big pitfall is the scoping in the in the early people think, oh, we're gonna have this session, we're gonna solve all our problems. Like, no, this is just the first session. You're gonna continue to have many sessions, and eventually you will have solved all your problems, but we have to start small. Um, so those are the some of the pitfalls we work through teams with. Um, and then um after they've had this amazing experience, usually they have some amazing results too from the just the two days. I mean, we see teams, you know, come away with like, oh, we improved this metric, you know, by 20%, 30%, 40%. Like they just after that, those first two days, they will they will go, oh my gosh, like this is amazing. Then it is about having those weekly check-ins and the leaders carving out time for the team to continue because some of the they won't be able to address all of their experiments in two days. The whole point is that now they have a list of things that they can do on their own from the process map, and they can experiment. They have a plan for what to experiment with. Now it's just about them doing that. And that takes also someone who can lower the barrier and lower the hurdle for them, which takes a leader. We see this when we have a strong leader who meets with the team every week to talk about the experiments and offer help and figure out what's getting where they're getting stuck, those teams are successful and they practice. And then the other pitfall is uh not coming back into the room thinking that, oh, we did it once and now we know how to do it. So the team is just gonna be able to do it on their own. And so we've learned that even under the best leader, it takes at least three sessions, like for the team to practice this. So it's like a three-month thing. And we and like we haven't really been strong enough in like pushing this with our clients before. And we kind of notice that they're like, oh, we can't meet again, and we're like, okay, whatever. And then we it fizzles out. It just does. Um, so sticking with it for three months, at that point, the team has done the face to face is three times. They've been practicing in between sessions, like they are now fully equipped to continue to do this work on their own with less hand holding. So that's another picture. Is like not sticking with the same team for like at least three months. And then another pitfall that we sometimes see is um not training up internal coaches. Our goal is to get an organization to be self-sufficient. Like we really are not consultants, like we're actually a software company, but we realize that these organizations are not gonna even be able to take, you know, get value from our software if they're not practicing. I mean it's like you know, trying to sell someone Microsoft Word and they don't know how to write yet. Like you gotta teach them to appreciate writing, and then they'll appreciate Microsoft Word. So this is the same thing. It's like, look, you may think that software is gonna help solve your problems, and we're happy to sell it to you, but you also like you need to do the work and practice the behaviors, and then you will get you know amplified benefit from the software. So the reason I say that is because um one of the pitfalls is not training up enough internal coaches to keep uh to get to something that we call self-sufficiency. And that means that you have a rule of thumb, one coach for every 10 team members. And we say coach here is someone who typically you can notice in the first session or two, like there's these people who are just like, oh, I love this work, like I want to do more of it. Those are really good people to be trained up as coaches. And the training is gradual, and we'll take them through the training to become a coach. It is not there's no belts, there's no, you know, Six Sigma. There's there's not a, you know, it's not have it's mainly practicing how to ask the right questions of your team, some of those kind of um kind of brain-based conversation skills, like you know, productive inquiry and facilitation skills. So if your team, you see your team struggling with a problem, you can go, hey, I'll book a room, we'll map it out. And the coach kind of makes that easy for the team to do when they're on their own. So we like to help the organization train up enough of those internal coaches that sit with their teams. They're part of their team and they help their teams practice and they help, you know, the both their leaders and their teams continue to practice after the three months. So not training up their own internal coaches is another pitfall. I think I could go on and on. I mean, there's like eventually you will need to have some sort of a program office to like help just manage the engine of spreading. Because you start with like one team and then you, you know, you get another leader who's like, I want to do it with my team, and then you, you know, go with them and then you train up coaches as you go. So we have a formula for that. But without like a kind of like a program management office, someone has to own it so that they can plan out well, who's the next team to go, like and and just make that easy and make that engine work. And eventually that program management office team and the leaders need to sit down and look at probably their HR policies and their HR guidelines. Like they become, they they start to build what everyone talks about the system. They start to build it gradually as it as it grows. But we don't start with like creating the system. We start with the behaviors. And then the system evolves to support and provide the structure and the wiring, sort of to use Steve Spears' language, to make sure that people can continue to practice these behaviors. So whatever might be needed from like a system, I mean I say system, it's not like computer system, right? It's it's the whole system around it. Like, how do we lower the friction for people to make sure that this is how we do things around here? And sometimes it's things like promotion criteria should include these behaviors, or hiring should, you know, like should include it, or communication, um, messaging, things like that that helps kind of get keep the engine real and training, of course, and and setting up you know these workshops, etc. So those are some of the pitfalls. There's more, but we can have another podcast on just the pitfalls.

SPEAKER_02 48:29

Exactly.

Spreading Capability Over Time

SPEAKER_02 48:31

I wanted to to shift gears a little bit and look towards the future of this work. You've already answered a few of my questions on that front, really, with um, you know, kind of how you're building and and how you see organizations uh maturing through through the coaches, through the spread of learning, through the the four capabilities that you mentioned from uh from the high velocity edge. I'm curious what you have learned about how organizations build this capability over time.

SPEAKER_00 49:05

I think I already touched on some of it. Like we always say, I always say start small because we're doing behavior change, and because you don't have the resources to handhold teams closely in the beginning if you do a big bang kind of um rollout. So starting small in model lines, making sure that those people are supported and you get like you gradually run more and more of these model lines and get more and more people to practice. So that spreading through the model line approach and through leaders who are role modeling themselves with their teams in the model lines is how it grows in an organization. The the program management aspect that surrounds it is just to make sure that that spread can go as quick and and and as far reaching as is needed. So it's it's looking at it can be things like boots underground and going into people's staff meetings or all hands meetings and explaining what this is, even though it may not have spread to that organization yet. We always find it very useful when the top leader communicates that, hey, we're doing whatever you call it, a transformation, continuous improvement, transform, problem-solving culture, whatever the whatever the leader decides to call this work. But we're doing it, it's coming to you, but we're starting small with these few teams, and then it's gonna spread. Eventually it will get to you. Get ready. And here's why it's important spreading that broad message so people know it's gonna come and it's happening is important. And I see that done a little different in different organizations, and that's is really just depended on the leader. But the successful organizations have a strong leader like that that will stipulate, right? Like this is why we're doing it. It's important, it's to empower you, it's to make sure that you know we can grow with the people that we already have and that we're using our people's brains, right, to the full potential. Those things, like those, those people values, I think are really important for the leader to to communicate. It looks a little different, like how, like how an organization decides to like run the program office and like train their coaches, and it can, you know, and and their messaging and their you know, their their communication, it needs to be their language and it needs to fit with with their their kind of company. So um we we typically don't try to, I guess, put too many rules there, just but just make sure that it resonates and it's pretty simple language. And then we're we're there to support these organizations as they roll it out. So hopefully that answered your question. I don't know if you're looking for something different.

SPEAKER_02 52:09

No, no, I think it does. And you know, as you were talking about scale and you're talking about spread within an organization, starting small, getting bigger, um, continuing to practice these capabilities, um, you mentioned uh a few times now how important it was for these really engaged leaders to be there to support uh all the way to the top. Is part of this work scaling, you know, nationally, internationally, is part of this also that senior leaders at, you know, the most motivated senior leaders at organizations that find success with these methods, are they gonna have to be kind of the coaches or the part of a network of other senior leaders to make this change? Truly successfully.

SPEAKER_00 52:58

We're actually testing some of those, like we're we're actually struggling sometimes, like finding the right leaders who actually value the work that we do with organizations. And we've been talking a lot lately about like where are they and like how can we qualify them so that we don't waste our time on leaders who don't actually get it and are not going to value what we do. And I think it's the type of leader who is always looking themselves to grow and who are like the leaders that are seeking out peer networks for feedback or to like who are not afraid to be humble and who are not afraid to say, you know, I don't have the answer. Um, but I am, you know, and I'm curious, right? Like, how have you done this? How you know, those types of leaders are the ones that have potential for this type of work. And yeah, so like if finding the ones that are have that openness and willingness to to frankly improve their own leadership is kind of the key for us. And they're there.

SPEAKER_02 54:11

They're definitely there. Um and I'm glad you found you know so many of them today's.

SPEAKER_00 54:16

We can we can use a few more for sure.

The Five-Year Vision For Care

SPEAKER_02 54:21

I'm wondering as you look forward, if you know, this work achieves its highest five-year aspirations, what does that look like?

SPEAKER_00 54:31

Oh gosh. I mean, at the end of the day, it looks like not only improvements in like in the workplace itself and and in the people's lives at work, in terms of you know, coming in, badging in and knowing that that you um you are valued and that your brain is valued, first of all. So it it looks like more engaged people, more engaged leaders. And then the results come after or come from there. And in the beginning, it could just be results in the things that you know that you that you're that matter most or the biggest pain points, like usually in healthcare, it's like patient flow, right? It's it's it's um some sort of safety. Like we worked a lot in in one hospital with patient falls, or you know those those those metrics will just improve. But at the end of the day, it's the ability to better serve your community, right? Like it's the ability to to do what you were trained to do and have more time and energy to devote to the profession that you spend so many years training for. And that is universal no matter what organization you're in. It is removing the other distractions that that take you away. And it's the leader's responsibility to create the conditions for the people to be able to remove those distractions, but because they're the only ones who know what they are. So you get to like, you know, the five, 10 years after doing this, you get to a point where not only are you a leader in your like industry, so healthcare, better able to serve the community around you and heal more people and and you know, help more people, but you're also you know, able to most likely retain a workforce that feels valued and is is is more able to really use their brain for for what it was intended or where they intended to, what they intended to do, their profession, right?

SPEAKER_02 56:47

Yeah, yeah, it would be an inspiring vision for sure to uh to have all of things those things come true. I'm glad to have you working so hard on that. And I love it. Really grateful for our time in the conversation today.

How To Connect With Maria

SPEAKER_02 57:01

For listeners who'd like to follow your work or connect, what's the best place for them to do that?

SPEAKER_00 57:06

They can um look me up on LinkedIn. And uh I have even a book a time with me button there. So, you know, you just I would love to talk about this stuff. I I have many conversations with people who um just, you know, we just talk about improvement work or the challenges or leaders, the challenges that they're facing. And so yeah, just just reach out, ping me on LinkedIn, um, set up a time with me. I'd love to get to know you and the work that you do and maybe the challenges that you're faced with. And I can connect you with Steve.

SPEAKER_02 57:45

Um and we'll well thanks for that. We'll um we'll link to uh to any resources that have been we mentioned in the conversation, as as I mentioned earlier. Maria, thanks so much for for taking this really important work, you know, bringing it to the front lines, taking complexity and distilling it down to its most simple, not always easy, but but really uh simple and elegant form. Thanks so much for for our conversation today. I hope we have another one.

SPEAKER_00 58:10

Yeah, me too. Thank you so much, Jason. I really enjoyed it.

SPEAKER_02 58:15

Thanks

Subscribe And Share The Show

SPEAKER_02 58:16

so much for listening to today's episode of Leading Quality. If you enjoyed the show, please take a moment to like, subscribe, and share it with someone who might find it useful. You can find all our episodes at leadingquality.budsprout.com or in your favorite podcast app. The show is written and hosted by me, Jason Meadows, edited by Milan Milostavievich, and produced by Thrive Healthcare Improvement. See you next time.