Lean: "The more you talk, the less they learn" (transcript)

Michael Grogan

PEX Network Editor, Diana Davis, speaks to Michael Grogan, Lean Missionary, and Leadership and Management Development consultant about applying Lean principles to the vital work of improving healthcare in impoverished Tanzania. You can also listen to the full podcast here.

PEX Network: You're a Lean practitioner from Ireland, and you’ve lived and worked for many years in the United States. How did you end up working in healthcare in Tanzania?

Michael Grogan: It’s quite a long story but I’ll try to keep it brief. I came to Tanzania as a tourist back in 2010 for two weeks. It was a very unique time, but that trip, unlike any other vacation I’ve taken, had a lasting impact on me.

It was my first time outside of Europe and North America and it significantly changed my perspective on life because it was the first time I ever really saw poverty. Seeing women and children in this situation had a significant impact on me and my perspective about what was important in life. It started me on this journey of trying to find my own purpose in life and got me thinking about how I was could add value to society.

Since that visit in 2010 I came been back twice before finally relocating. Once in 2011 and once in 2012, on short-term voluntary assignments. I was very fortunate, I’m a man of faith and I believe it was fate that through a friend of a friend I got connected to the CEO of an amazing organization here in Dar es Salaam in East Africa that provides healthcare to one of the most vulnerable populations in the country. I got a chance to volunteer twice with them and finally I had enough of short-term assignment volunteering and I moved here fulltime in 2013 where I am today. There have been some scary times and some dark times but I look back on the decision as one of the best decisions I've ever made in my career.

PEX Network: What would you say are some of the big issues then facing healthcare in Tanzania today? Paint a picture of the situation for us.

Michael Grogan: The true definition of poverty is not necessarily the absence of wealth but the answer to this question: ‘what happens to you when you're sick?

Seeing is vastly different to being told. Prior to 2010 I’d never really seen and could never really grasp what it was like to live in poverty. Since then I've seen things I never thought I would see in terms of the level of human suffering, It’s heartbreaking, it really is.

I’ve seen a child suffering for days with diarrhea, woman unnecessarily dying during childbirth, men, woman and children unnecessary being crippled with a disability. They’re all so unnecessary, all so preventable. It really highlighted to me, first of all, the horrors… the consequences of living in poverty and reflecting on my own fortunate life that I had. It gave me clarity and perspective.

If I had to like put it on the context of all the global problems that we have in the world right now, I would put the African healthcare system, on which Tanzania is a parallel, as probably one of the greatest humanitarian crises facing us today and the human race.

PEX Network: And how is your work then with Lean helping to address some of these issues?

Michael Grogan: I consider myself extraordinarily lucky that I've been exposed to Lean thinking, others put different labels on it but essentially it’s all about continuous improvement principles, I passionately believe that this philosophy, this system is the best way we have to adapt to a changing society and to strive for a better quality of life. You could say my work in coaching Lean here is a drop in the ocean but, to quote Mother Theresa, the ocean needs that drop.

"I consider myself extraordinarily lucky that I've been exposed to Lean thinking, others put different labels on it but essentially it’s all about continuous improvement principles."

The organization I work for is relatively small, it's a not-for-profit and has about 470 folks, my focus is exclusively on leadership and management development of the senior leaders in the organization. My role involved helping them solve problems using scientific methods, helping them manage systems and people, helping them lead others and lead themselves, and of course helping them become more productive. I use the title Lean Coach but it's so much more than that, it's about space management and leadership development. I really believe that in order to make a significant sustainable difference, the biggest leverage we have is in leadership thinking.

PEX Network: Perhaps to bring some of these principles to life then, can you give me an example of some of the work that you've done in Tanzania and what it has achieved?

Michael Grogan: Actually I could spend an hour giving you example after example of how we've made improvements here - reduced waste out of the system, reduced steps, etc., provided better quality or better… reduced the safety risks for staff - but, before I jump into that, I could categorize my activities into four things. I do the classic classroom training - death by PowerPoint, as I sometimes joke. I do facilitation of workshops, whether that’s problem-solving workshops or strategic planning. I also do a lot of development in mono-cell management systems. So, I try and work with managers one-on-one, helping them develop a mature management system that has the right people to look at the right information to solve the right problems faster.

Working one-on-one with the manager in his area, I help him to understand the process, understand how to know if the process is working and ultimately to help improve the process. There are the various activities I've been doing as, I guess, the only Lean coach in the organization. And I could spend PowerPoint after PowerPoint on some of the improvements we've done but they would be all in terms of what I would categorize the physical impact of Lean, whether that be reducing safety risk, improving productivity, reducing waste out of the system, which we have many examples across the 30 steps using Lean concepts, reduce that to half the amount.

This is nothing new to the audience who listen to this but I really passionately believe that the goal or the true impact of this exposure to Lean has been in the invisible part of Lean and what I mean by the invisible part is that ‘go see’ mindset, it’s asking the right questions, it’s that act of self-reflection, of team reflection, the act of challenging one's assumptions, asking questions of what's most important and the act of respect for people and action taken that reflect that.

Essentially I believe those are the invisible changes in thinking that are my best opportunity in influencing the people I'm working with to ultimately develop these new habits and I really, really believe that my success here or any success in the transformation program is if it doesn't establish new habits, make things better, you're not going to get to see any results. My ultimate goal is to establish these habits. Some would say habit excellence around a particular act is a routine and to get the leaders doing those routines and forming habits is ultimately the impact I want to make with the Lean transformation program I'm trying here.

PEX Network: So, it's not just about the specific projects or initiatives, it's very much about changing the habits and the mindset?

Michael Grogan: Yes, and from my own reflections of eight years of being exposed to Lean, I've seen so many… I don't like to use the word failures but in terms of disappointing results I think that part of the root cause… There are many root causes but a project approach to Lean is highly recommended, not to look at the project alone or look at the tools alone.

PEX Network: What are some of the key successes that you've had along the way?

Michael Grogan: My honest answer would be the change in leaders' thinking. Leaders seeing something differently for the first time, whether that be the matron or that be some of the doctors that lead the Maternal Division. I remember going to the maternal hospital with one of our doctors here, Dr. Brenda Dmello, one of my absolute heroes, the most passionate woman I've ever met, and she's been in so many labor wards and the first thing, when she brought me into the labor ward and she turns to me and goes, Michael, what do you think, I turned to her and the first question I asked her was, Brenda, what's the standard.

"I've got so many highlights but one of my proudest moments is when you see a leader develop, when one of your students become the teacher, when they pass that on."

Why I'm sharing that story is because I’ve noticed how Brenda is thinking and speaking more critically, how she's seeing the gaps more clearly, both in her own thinking and how she's managing and leading and that for me gives me extraordinary joy, when the staff see the value in the questions I'm asking, they, in turn, start to try and answer those questions and pass on that knowledge to their colleagues.

I've got so many highlights but one of my proudest moments is when you see a leader develop, when one of your students become the teacher, when they pass that on. Whether that be in the classroom setting or one-on-one on the shop floor, when they pass that knowledge on to their other colleagues, it gives you an extraordinary sense of satisfaction, that they've really taken this knowledge not just in their hand, not just in their mind but in their hearts.

PEX Network: You mentioned right at the beginning of this interview that there were both the high points but also, I think you called them, the dark times as well. What have been some of the big challenges that you've encountered along the way?

Michael Grogan: That's a great question and I think a few years ago I would have answered this question differently but maybe it's my own journey in life and maybe there's a philosophical approach but I think the biggest challenge isn’t external, it’s internal, it’s me. For a long time in my career I looked outwards rather than inwards and I really… I paraphrase a well know quote when I say, ‘I have found the enemy and it is I’. I think the best moment, the greatest turning point in my career was when I looked in and realized this.

I'd taken full responsibility for my career, whether it be good or bad and essentially I deeply, deeply care about the people I work with, I really do, so the dark days of the past are when I know I've let them down, but I really believe my philosophy and it's what my own sense of self has taught me, there's no such thing as a bad student, only a bad teacher.

So when I say that these people are my heroes, I really believe it, and it is absolutely my honor to serve them and to help them realize their own potential. But for me to have the biggest impact on that, I need to continuously invest in myself, continuously reflect on what went well, what could have gone better, continue to get people throughout the continuous improvement world to come and give us feedback on how we can do better. It's through those experiences and self-reflection that I've seen the biggest challenge has been me.

The first person you should look at in Lean transformation is yourself, regardless of the circumstances. When I'm surrounded by a lack of resources and folks who did not get the same educational opportunities as me, it's very easy for me to point at those reasons but the true biggest challenge, the biggest obstacle that's in my control is me and that's something I'm trying to strive to continually get better at every day.

PEX Network: I'd be curious too to get your thoughts on how different applying Lean to healthcare has been to manufacturing, given your background in that industry?

Michael Grogan: Actually I've worked in other not-for-profits before in healthcare and education, and in many ways the principles of Lean are independent of any industry. I've even done some work in churches, and it's really for that organization to define its own customers, to make clear how they define value and waste in terms of their customers. I could never be a frontline healthcare worker like those heroes but I think all the work I do behind the scenes within the management/leadership space does make a difference. It allows the healthcare provider to provide better value to that patient and that feeling is just one of the greatest feelings I've ever had in my professional career.

"The best advice I ever got in my career was from an amazing man, who worked in Merck and he told me, Michael, the more you talk, the less they learn, and that advice has been the most valuable advice I've ever received."

PEX Network: It has been wonderful to speak to you, Michael, my final question then is what advice would you give to other practitioners who are really trying to make a difference with Lean in healthcare environments or maybe even extend that to other humanitarian, not-for-profit types of environments?

Michael Grogan: I thank you so much again for giving me the opportunity to share my story, and as it's my last question, so I'm going to end with an impassioned plea, if you will. But the best advice I ever got in my career was from an amazing man, who worked in Merck and he told me, Michael, the more you talk, the less they learn, and that advice has been the most valuable advice I've ever received. What it means, and I hope the intent behind it, was the power of listening is far more valuable than impressing your own opinions and values on the needs of other people.

In my early career, especially in coaching, I loved the sound of my own voice. I love going to PowerPoint, love talking and I didn't do enough listening. So, I can't stress enough how important is it for potential teachers to also be good listeners, especially those who want to implement Lean thinking. People don't care how much you know until they know how much you care, so really create those opportunities for empathetic listening, as you can begin to understand the pain and suffering and the frustrations that they're going through. That's my biggest professional tip to anyone, the more you talk, the less they learn.

In terms of general advice, whether in healthcare or not-for-profit or anyone who wants to do some good work in terms of contributing back to society, I'd quote Robin S. Sharma here and I'd say, "investing in yourself is the best investment you will ever make." So, invest in yourself.

I think the greatest day in my life was when I took full responsibility for my own career and I stopped blaming my lack of opportunities and growth on other people. I just started reflecting back on myself. I would really encourage people to become a fanatic learner of their own development and their own personal growth.

The second and I guess the last piece of advice would be,… Well, I think one of the greatest human tragedies in life is when people go through their life casually and incidentally. Maybe some readers see themselves in positions of leadership later in life, but perhaps don’t like to take risks or don’t reflect on their own development and situation. I'd really encourage those people, and maybe this is my spiritual dimension, but I’d really encourage them to take the time on their own to ask themselves questions.

What is my purpose in life? What do I want to grow to become? Where do I want to go in life and what do I want to leave behind after I die? These are really powerful questions. Put pen to paper and begin your own process of self-discovery. You're never going to get those answers overnight but I really believe this is beginning of that journey of self-discovery and what you're here for, what your purpose is and what you're here to achieve will begin to clarify in your own mind, and that will give you one of the greatest joys in life.