Podcast, The Lens – 24. How Children’s Mercy Hospital activates problem-solving Capability with Their Tiered Huddles

Posted on by CATALYSIS
Paul Kempinski, President and Chief Executive Officer at Children’s Mercy Kansas City; a member of the Catalysis Healthcare Value Network, shares how Children’s Mercy now has a network of over 300 tiered huddles that occur throughout their organization each day and activating their over 8000 employees as improvement specialists.

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Peter Mariahazy: Welcome back to the lens I'm your host Peter Mariahazy. Today, I'm joined by Paul Kempinski the President and Chief Executive Officer at Children's Mercy Kansas City, a member of the Catalysis Healthcare Value Network. Children's Mercy now has a system of over 300 tiered huddles that occur throughout the organization each and every day and activating their over 8000 employees as improvement specialists. Paul, thank you for joining me today. Paul Kempinski: It's my pleasure Peter. It's great to be with you. Peter Mariahazy: You know, why don't, let's get started, please tell our listeners a bit about yourself and Children's Mercy. Paul Kempinski: Sure, well I've been at Children's Mercy for just a little bit over two years. I came from Nemours Children's Health System. I was President of the Alfred I. Dupont Hospital for Children, which is the flagship hospital of Nemours, located in Wilmington, Delaware. Nemours has operations in both the Delaware Valley and Florida, so I was there for 15 years. Fantastic organization, great people. You know, my aspirations were to lead an independent children's health system, and you know, I had several great opportunities, and when I set foot in the Kansas City community and Children's Mercy, I saw what I routinely described as perhaps the greatest story never told. Nothing has disappointed me. This is a fabulous organization in a great community. And it's just great leading one of the only 30 independent children's health systems in the country. Prior to coming to Children's Mercy and being at Nemours, I spent the rest of my career in the adult healthcare world. I started my career at Rush University Medical Center in Chicago where I was for about 10 years. I was in Pittsburgh, Pennsylvania, at something called Jefferson Regional Health System, which was called Southfield Health System at the time and then went up to Rochester and worked at an organization which is now called the Greater Rochester Healthcare System. So spent the first half or so in the adult world. I entered the children's health space and, as my friends and colleagues said, once you get into pediatric care you'll never turn back and I can't imagine turning back from this incredible mission that we live out every single day. Peter Mariahazy: I just I can't imagine the day to day, where you can see the joys and the smiles and I have to tell you, on a personal note, I was born at Rush in Chicago. Paul Kempinski: You were, ah, that’s fantastic. Peter Mariahazy: Yeah, that was interesting and for our listeners, we're recording this shortly after the super bowl, so my condolences. Paul Kempinski: They had a great run. We could do a whole podcast on that event. Peter Mariahazy: We can do that, we can do that. So you know coming back to the management system what elements of the lean management system, do you focus on?   Paul Kempinski: Well, you know from my perspective, first of all, when I came to Children's Mercy, one of the things that attracted me here was the fact that Children's Mercy was committed to lean. As their philosophy and cultural underpinning of improvement and happened to use the same philosophy and consultants, as we did at Nemours when I was there, and I was the executive sponsor for our Delaware Valley journey into lean. So, this was familiar to me it resonated with me and when I came to Children's Mercy, the one thing I told the masses was everything's negotiable with me. We'll have a conversation about how we evolved this great organization, but one thing is not negotiable with me, and that is our commitment to lean as that cultural underpinning for improvement. So, from my perspective, I want to ensure that we have a robust daily management system and those 300 plus tiered huddles exemplify that. But we also create a culture where all of our 8,500 employees feel that it's both safe and they are compelled to surface and escalate the barriers and obstacles to safety and the service experience for our patients and families and to really have that culture. And that we also evolve into strategy deployment, which is ensuring that we are cascading our strategies and our True North goals using our lean system and aligning all of our organizational resources, including our most important, our people, all the way down to the front line so that's been the goal. And of course, role modeling leader standard work and those behaviors that are associated with lean principles and lean culture. Peter Mariahazy: Boy Paul, it sounds like when you came to Mercy Children's it was almost like coming home, you know, you just had an environment you fit right into good for you. So, you talked about the 300 tiered huddles, how do you handle escalations out of those huddles so that, so that those things can be addressed, you know, effectively? Paul Kempinski: Yah well, I think the first principle, Peter, that we want to ensure we're focusing on is ensuring that we are solving problems most closely aligned where, where the work is done. So we want to make sure that and, as you pointed out in the introduction, we want to activate all of our employees as improvement specialists. In fact, my goal is to have that title on everybody's ID badge so that they are constantly reminded, and reminding their peers and colleagues, and patients and family members. That that is one of their most important jobs, in addition to being a registered nurse. We want to problem solve as close to where the work is being done as possible, but when those barriers cannot be broken down or circumvented or the countermeasures cannot be implemented effectively then escalation occurs, using the tiered model structure. With a big caveat that if the issue is a safety related issue, or a service recovery related issue, we want those topics to be escalated all the way to the highest level of those tiered huddle structures, which is our executive huddle that occurs every day. Now that doesn't mean we are going to solve the problems at that level, but we want to ensure broad awareness on the part of leadership as to what the barriers and obstacles are to creating the most, the safest environment that we can for our patients and our own staff as well. So that awareness gives us a sense of the trends and patterns that we need to be mindful of as leaders in order to protect and continue to improve those outcomes. Peter Mariahazy: That's a good point. So, what have you done to define and implement accountability for problem solving by the tiers? I mean the escalation is process is available, but how do you, how do you get them to own it? Paul Kempinski: You know, that is a challenge and that's part of the journey, to be very honest with you, Peter, so we first want to ensure that there is an acknowledgement of the accountability responsibility that goes along with being somebody on the front lines of where care is delivered and supported, but we also have to create the capacity for improvement to occur, and that is realistically a challenge when you have busy employees, who are working on the front lines of care, carving out that time to be able to map a process or do a situation target proposal methodology is hard work. So that's what we're trying to ensure we have configured in our structure and in our culture to protect the time for improvement and to ensure that the frontline staff understands where they can go to seek the support and the resourcing, from what we call the feeder lines. Whether it's facilities, information technology. Whatever those areas are that can support the improvement efforts. And as leaders, our job as we go to gemba and we visit the place where the work is being done, we can teach, we can coach, and we can mentor. We don't do the work for those frontline staff. But we help to guide them and perhaps point out opportunities, where improvement efforts can be rejuvenated, or focused, and ensure that those resources are available to those folks to help break down those barriers and reinvent those processes and conduct the experiments. Peter Mariahazy: You know what, Paul, as I was watching a few of the of the things you shared with us, that we've been able to do virtually, you talk about the, and I what came to me was the personal interactions as well, which seems to very much help and make it conducive for that type of sharing and that type of accountability, where it's not seen as an attack, but it's seen as “you're here to help me, let's figure this out.” Paul Kempinski: Yeah, such an important point, Peter and, in fact, you know the method that we try to utilize when we go to gemba is not to start to probe on what's wrong or why that occurred, but it's to ask curious questions. It's to use an appreciative inquiry, you know it's, “hey, I noticed that we have a gap in your target performance here. Tell me about that what have you learned about that.” You know, what are you working to improve upon and so forth. So we want to create, again, that culture where all the frontline staff, including their direct managers, know that it's a safe place to speak transparently about those problems and barriers and what's being done to pursue that target condition that everyone is searching for. And we also want to ensure that the improvement efforts on the front lines are aligned with our organizational goals, our true North goals, our strategic goals. So, creating that alignment is another part of the coaching conversation when we go to gemba, as leaders. Peter Mariahazy: Fantastic. So what are some of the strategies being implemented into the lean management system? As you continue to evolve and grow and, quite frankly, what challenges have you come up with? Paul Kempinski: Well, I think you know that the challenge is what I alluded to earlier, where we want to make sure that we are robustly surfacing and escalating those problems, and barriers, related to safety in the service experience. So, one of the things that we do, we've implemented a kata approach after our executive huddles. Where we debrief and reconvene and we talked about how we can improve the huddle structure, both the methods and the mindset, if you will, of our huddles to create that safe space, and to nurture, you know, those escalations on the quality and safety side. We've also tried to create more visibility on our huddle boards to the quick hits and the complex issues and the projects that people are surfacing and escalating that are related to all of our quality, safety, process, people, stewardship categories and so forth. You know before I came here, sometimes our quick hits and complex problems were on little 8.5 x 11 sheets of paper. And they became secondary to the daily readiness conversation. Daily readiness is critically important, but we want to balance the conversation and make sure that we're spending a great deal of time asking the questions. What are our safety and service issues today? What are our process issues today? So that's been a big part of the work and, as I mentioned earlier, we are migrating now into strategy deployment, which essentially is a tier five huddle, above our executive huddle level, and that is a new experiment for us but we're making good progress in that regard. Peter Mariahazy: Sounds exciting, I look forward to hearing about that as you progress and continue to implement that. So, obviously, it's clear that you know, you've taken a very personal ownership in this. How are you coaching your direct reports? Do you have some tricks and examples we can share with the listener? Paul Kempinski: Yeah, I don't know if I have tricks, but let me tell you, I'll go back a little bit. You know I've been here for just a little bit over two years. And you know we've been through this sort of three-phase roadmap to the future. And that first phase, we called it foundational, which was modernizing our Organizational Structure, putting our team together. And that team is comprised of some of the great leaders that have been at Children's Mercy, for a long time, and some amazing leaders that we brought in from around the country. As I've recruited leaders, as I've promoted leaders in the organization, one of the questions I always ask is, “Are you committed to immersing yourself in this lean journey?” We don't expect people to be experts coming in, but we do expect the commitment and the immersion into becoming a lean leader. Now I've been doing this for a decade, I still consider myself a novice. I learn every day. I make mistakes every day and I need feedback every day. And that's what we expect of our leaders. So first of all, it's setting expectations and then it's doing those elements, of leader standard work. Like doing joint gemba rounds. We round routinely in a dyad mode, as well as individually so that we can learn and coach one another.  And then, of course, we rely on our performance improvement team, our own lean specialist to coach us, as well, and give us feedback in gemba in the moment where we're at. And we always want to go back and audit, and debrief, and look at how we can improve and evolve the daily management system and the way our frontline employees are experiencing our coaching and teaching along the way. Peter Mariahazy: It sounds like you're very much encouraging and embedding with everyone the learning and personal improvement philosophy that I can be better, and I can continue to learn and expand. Paul Kempinski: We are, and you know, COVID has really been, has enabled us to really propel and accelerate this journey and it's become more important than ever. You know what the phrase I was using as we were going through the heat of COVID was? Social distancing should not mean leadership isolation. So, from my perspective, it was more important than ever that leaders were visible, we wanted to do that safely and effectively, but we were visible, we were accessible, and we were still engaged in going to gemba and using our teaching and coaching skills. Peter Mariahazy: So what, what are some of the opportunities you've identified?  And again, continuing to develop your direct reports, you mentioned building the team, and as you look at bringing people in or promoting people within the organization, what are some opportunities you've seen and really helping them along that path from on a one-on-one basis or as groups? Paul Kempinski: Well, you know, first of all it's always part of our conversations in our one-on-one meetings and our team meeting so, it's just enculturated in the organization. As we talk about our strategic plan, our true North goals, the enabling initiatives that go along with that, we are always talking about using our lean principles and methods to advance the work of our strategies even our strategic plan. It may buck conventional wisdom, in the minds of some, but we can use our lean methods and principles to help execute the various initiatives that are aligned with our strategic goals. And the other thing that we are doing is we are evolving an Integrated Project Management Office, here at Children's Mercy, that will be completely aligned with our performance improvement specialists, those that are part of the Children's Mercy lean system so that we are using lean principles in project management. And our team are really seeing that there are assembled resources, that are skilled in project management, but using our lean system as part of the management and execution of our various initiatives and projects. Peter Mariahazy: Oh, that's exciting! That's very exciting. So Paul, you know you've talked a lot about leadership. How about you personally, do you have time to reflect? To when, and how, and just kind of you know, for yourself and your own development? Paul Kempinski: You know what, it's um, it's one of the hardest things as leaders, and especially at the CEO level, that we have to carve out time to do. And I probably do it at the strangest times, you know, I may not do it necessarily in the heart and the heat of the day, but I, I do it as I'm driving. I do it when I'm home, and I do it when I’m exercising. Sometimes I even do it on the golf course, which explains why my golf game is so lousy. But you know what, we have to do that, we have to carve out the time and one of the things that's helpful to me in that, in just doing the thinking time is, I have a personal coach and all of my members of the Executive Team also have coaches as well. They are coaches of their choosing, and they were all external coaches. But sometimes it's good for us to take off the blinders and appreciate the perspective of those that know us well and are helping us to be better leaders. And sometimes that perspective can come from the outside, as well as the inside, and helps us to be thinking and contemplating and helping to evolve the organization and our own leadership effectiveness. Peter Mariahazy: Good for you, Paul. You know, kind of in closing. Any final thoughts, you want to share with the listeners that perhaps we didn't touch on, or a unique thing of sharing? Paul Kempinski: I think the only thing I would say, Peter, is that you know our lean system and all of the folks out there that are, you know, using adaptations of, in our case, the Toyota management system or whatever they're using. I think COVID, and the last year, has done nothing but amplify, affirm and confirm the importance of a culture and a philosophy of constant improvement, and you know, there's another aspect of this. We are on a journey right now to rejuvenate joy in the workplace, that has been something that has been challenged as a result of COVID, and we all hear about provider burnout and the things that were occurring before COVID. When you look at the concept of joy, and I've done some studying of the Institute for Healthcare Improvement, the IHI framework associated with joy. One of the key elements of it is constant improvement and reflection. And to me, when I saw that, that just struck me as affirming the importance of our lean journey and cultures in our organization. So, to me, the future is bright. I'm so optimistic about our continued maturation and evolution of our commitment to lean and it's just such an important part of the journey and the beneficiaries, of course, are the children and the families that we serve every day. Peter Mariahazy: Paul, thank you so much for, especially for that closing message. That really brings it home and we really appreciate you taking time today and sharing about your lean management system and the tiering. Paul Kempinski: Well thanks, Peter, I enjoyed it very much and thanks for the opportunity to join you today. Peter Mariahazy: And for our listeners, visit to find more information about the Catalysis Healthcare Value Network, and other ways, you can get involved with the Catalysis learning community. Stay tuned for more episodes designed to help healthcare leaders support their organizations on a journey to organizational excellence.

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