"Sensitivity to Operations" (High Reliability Organizations): John Collodora

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Episode Synopsis:

Welcome to Episode #9 of Habitual Excellence, presented by Value Capture.

Our guest is John Collodora, a Value Capture client advisor who brings deep and diverse experience to the Value Capture team, with 25 years in manufacturing, supply chain, and healthcare before joining the firm.

Paul and host Mark Graban discuss the second trait of High Reliability Organizations, "sensitivity to operations." What does this phrase mean? What's the context for why this is important, especially in healthcare? John also shares some examples of this trait in practice. You can also listen, in Episode #3, to Tony Millian talk about the first trait, "preoccupation with failure."

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Automated Transcript:

Intro (0s):
Hi want to tell you about a white paper that's been published by Value Capture, it's titled pursuing Habitual Excellence Sutter Health. So in the paper, ah, it talks about how Sutter Health designed to a new primary care process and encourages learning and experimentation and continuous improvement to download the free white paper, you can go to www.valuecapturellc.com/sutter that's S U T T E R Welcome to Habitual Excellence presented by Value Capture. This podcast and our firm is all about helping you and your organization achieve habitual excellence via one unifying focus, one value based structure and one performance system.

Intro (48s):
In other words, it's about helping you Capture dramatically more Value through achieving perfect care and perfect safety for patients and staff. To learn more about Value Capture and our services visit www.ValueCapture llc.com. Hi I'm Mark Graban and we are joined today by John Collodora. He is a client adviser with Value Capture John, how are you today? I am good. Thanks for having me. So we were talking about a topic and it was important to you and, you know, it's always good to start with the why. So I, you know, I guess first question is why is this idea of Sensitivity to Operations is such an important trait

Mark Graban (1m 32s):
for highly reliable, right?

John Collodora (1m 32s):
Will really in the pursuit of eliminating harm. This is such a key aspect of that we need, when you focus on operations, the care delivery process, the, the value added process that, that there's so much complexity within that. So to focus on that really is the key part of our journey to zero harm eliminating harm to patients. So eliminating eliminate in harm to our employees within the Operations themselves.

Mark Graban (2m 4s):
So in the end, those are important wise an important goals. So, so let's, let's start with maybe into the What. I mean, what does this phrase or this trait

John Collodora (2m 14s):
Sensitivity to Operations mean to you? John, you know, as I can think about this on it, it starts with the front line. I, it starts, you know, inherent in the Sensitivity to Operations are the people, and there's the processes, there's the equipment and the supply. So the unwavering support of the front line, there's the problem solving aspect. So, so as we start to see elements of harm, a situation that could lead to harm applying the scientific method in, within healthcare, the scientific method is a cornerstone of patient care, and it's really starting to take that and bring it into the environment of care, applying it to those systems within operations.

John Collodora (3m 3s):
And then also not a, not just a scientific method to solve the problems, but also sharing the best practices, sharing the learnings that, that are found within the process of problem solving. And then lastly concerned with the unexpected. So understanding what are those, what are those factors that lead to harm and how can we make those more visible, make those more top of minds so that we, we can see in it and start to predict the unexpected.

Mark Graban (3m 35s):
And, and, and so I'm curious here are your thoughts, you know, how, how do we operationalize this, this traits? I mean, they're like my, my first thoughts from what you've said, you know, I think of connections to lean management of the idea that leaders shouldn't stay isolated in their office, that they, they, they, they should be president at the front lines and have a respect for, for, like you said, the value added work, that care delivery in, instead of maybe viewing, ya know, the, the, the organization from a strictly financial perspective or viewing the, the, the organization as a, as an org chart or a strategy Operations is, is really critical.

Mark Graban (4m 18s):
How do, how do you see that?

John Collodora (4m 20s):
Mmm.

Mark Graban (4m 20s):
How do you say that on a, on a daily basis?

John Collodora (4m 25s):
Well, it, and that's such a great point, Marc, in the beauty of starting with safety, ah, one is that its unwavering, I mean, who can argue with not focusing on safety, who wants to be the, the person who says, well, we could, we can be good enough with safety versus eliminating harm. So the concept that, that you brought forward, have the leadership support too. This one is leaders create the space and the capacity to be able to focus on this because it is complex. And they do that by not just, not just talking about the current state as designed or as perceived, but as experienced in a, in as viewed by getting out and, and going to the frontline, going and going to Gamba and seeing what's actually happening today, what's actually happening on, on the shift today because there's so many different variables that, that the frontline team members have to deal with.

John Collodora (5m 24s):
There's so many decisions that, that they're trying to deal with. So understanding the complexity and helping them think through how do I address that and, and starting with a supportive standard work. So the ability to no, who does, what, when has it in the purest form of standard work and then starting to create some predictability of how do we do our work I'm in that is the law. That is the basis. That is the start of Improvement of having standards so that we can start to see where gaps to that standard exist, or what barriers exist to that? What, what decisions do we need to make to just follow a standard work and how can we reduce some of that complexity within the operations to be able to achieve it, or what problems do we need to solve to return to the predicted outcome of the standards?

John Collodora (6m 15s):
So, first and foremost, getting out of the office, getting out of the conference room and then being able to observe and support the standard work of the P of the people that care team members as their taking care of patients. So how do you, you mentioned standard work and we were talking about Lean concepts again, how, how does a standard work and in other practices like visual management or a visual controls help from the standpoint of understanding operations and what's actually happening, you know, that, that's a great question. And I really think of visual management as one of those key parts of being able to predict the unexpected, having, having the visibility to see what's going on.

John Collodora (7m 0s):
If you think about the, the world of care delivery or those support functions who are supporting the care team members, there's a lot going on and a lot of decisions that are being made, and it's easy to overlook some of the product problems that lead to harm some of the, some of the barriers in the day. So a visual management does a visual controls to help see abnormality, to be able to help see variation. And, and even if we making it visible, threw some of the run charts through some of the charts, feel to see what his, the level of variation, and then having a conscious response to that, knowing when do we react when we start to see that variation, it just helps to be able to put some processes and some visuals in place so that we don't have to be thinking about how do we care for the patient, but also are we getting into the right level where we need to react to something it becomes easy to see when, when we start to experience that.

John Collodora (8m 3s):
And then by having a problem solving process, the problem solving methodology, which follows the scientific method we can begin to address, what are the causes of those? So many times today, the a, a, a problem might be contained to a problem might be addressed, but we don't eliminate the cause of that problem, which means the, the, the individual continued to experience it over and over. So having the visual management system to be able to see having the process to be able to solve, and then lastly sharing that information of what problem did we experienced, maybe we can, if we share that we can, we can get it out to another team member, we could get it out too, a different department, or, or even in a different entity in that, in the hospitals system, so that they can address it on their site before they actually experience it, or whatever the solution two, the, to the cause was, they can implement that same solution before they experienced, you know, either the problem or the harm that, that it leads to you.

John Collodora (9m 6s):
And we are, and we've all learned from our friend, professor, Steve SPIR, who, who talks about I'm, you know, see salv and share it and see, see problem solve problems, share

Mark Graban (9m 19s):
What was done. And, and, and that seems to tie into the idea of, you know, Sensitivity to Operations and And recognizing that things could go wrong. We share what we've done with different parts of the organization to give them a, a, a heads up. And,

John Collodora (9m 35s):
You know, hopefully they can be proactive

Mark Graban (9m 39s):
In, you know, applying a lesson from an area where there was reactive problem solving and, and instead of hoping, or assuming things as well,

John Collodora (9m 49s):
Which is kind of go, go on,

Mark Graban (9m 51s):
Well, there's, there's connections here. It seems like between Sensitivity to Operations and preoccupation with failure, it seems like it goes hand in hand

John Collodora (9m 58s):
Very much, very much that's right. So if we can use some of the visual controls with individual management system to, to see a lot of problems before they lead to an unintended outcome, and then to be able to share that so that others can then either implement or, or build off of that approach before they experienced an unintended or unfortunate outcome. And so you mentioned problem-solving, maybe we can delve in to that a little bit at the beginning, you, you know, some people listening who might care about, you know, leaders are becoming more aware of what's happening on the front line and, and, and they're problem solving doesn't mean that the executive then has to solve all the problems.

John Collodora (10m 41s):
So how I can, can we talk about how that model of problem solving works and, and, and who's engaged in them? You know, probably the best way to think about this is that the leader has a coach. And in this case of problem solving coach, and as you mentioned, that doesn't mean that they take all the problems you solve. The problem is close to where the work is being done as possible. There may be some problems that they need, the leader needs to help resolve. They might be outside of the span of influence or a span of control, have a frontline team member, but many, many problems, especially as we talk about being proactive and solving causes of harm before they become an unintended consequence, those causes can be solved by, by the team member themselves.

John Collodora (11m 33s):
So the, so the leader has coach one is I can help them walk through the scientific method, help them to better articulate what the problem is, helping them think through what could be causing it. But another role as a leader can just be creating the space and the capacity of the frontline team member to be able to solve that problem can, they can create some time or it can, they help them with their thinking so that the solution is an overwhelming. If the solution can be something simple that they can implement within their daily routines and then share it across to other team members. So the leader as a coach, I think is a key part of this. And as you said, not the leader, just taking every problem and becoming overwhelmed.

John Collodora (12m 18s):
And are you talking about the leader as a coach? You know, that's a shift from, he goes John Tucson, or a friend dr. John Tucson calls, white coat leadership of leaders coming in, and a feeling pressure are thinking they have all of all the answers and feeling pressured too. You know, our, our other friend Kim Barnes is from, he would have been at feta kind of a really nice a book called beyond hero's. So I was wondering if, you know, if you can kind of talk about this shift away from heroic leadership to something or something that's perhaps better, and that's it, that's a fantastic point of leader's thinking that, that they need to have all of the answers.

John Collodora (13m 1s):
You know, Lead many leaders had been rewarded and have achieved their, or their position, ah, by being good problem solvers, but not thinking about it from the aspect of having all the answers to all the questions, but the process of problem solving. So shifting that mindset from, I need to know everything to what I really need to be good at is helping people think through on it and apply the scientific method, apply plan, do check act, or, or plan do study act. And then that's, that's different. That's a different way of thinking, but it's so powerful and it can be applied in all aspects. You don't have to be a subject matter expert.

John Collodora (13m 42s):
You don't have to be someone that's led a particular team for years and years two, to be able to help them. What you need to be able to do is help them with, with their thinking in their approach to problems solving. So you're absolutely right. Leaders is, as heroes is, is different in this case, too leaders as being able to bring forth and, and apply the thinking to problem solving. So maybe as a final thought, you know, it's, it, it's always been an unpredictable world and, and things have been a more unpredictable recently.

John Collodora (14m 23s):
But as the mind, if you can talk about, you know, methods or practices that can try to help create at least a, a greater level of predictability in an organization, you mentioned, you mentioned visual management before. And I think there's, there's a lot of aspects of visual management. We've talked about standard work, you know, having targets and an understanding what that target is. It could be level of supplies. It could be target equipment that's needed. And a target is only good as, as the situation and understanding why we weren't able to achieve the target, why or why the target needed to be different in a given situation.

John Collodora (15m 8s):
It is more important than the target itself. So you are, there may be a staffing level that we think we need, but as a surge comes in understanding what, what precipitated the surge one, and then how do we react to it? That's that thinking of why, why are we above and below? Our target is in this case with a surge, we were probably above our target and, and going through that reflection will help us to be able to predict, or to be able to see a similar situation coming in the air in the future where, or we might need to change our target for a given for a given application. And it might not be long term, but in a certain situation.

John Collodora (15m 51s):
And, and that helps us to be able to react to the ever changing world by reflecting, and then being able to apply that learning in a future scenario or situation.

Mark Graban (16m 4s):
Well, great. Well, John, thank you for, you know, sharing a lot of great thoughts here about safety leadership. I'm the Y's in the Watts have Sensitivity to Operations. I mean, is there any final thought that you might want to close things out with?

John Collodora (16m 24s):
My experience with Lean has been both in manufacturing and now health care and this notion of the pursuit of zero harm. It, it is so important. One is it is so respectful to our patients and our employees. No one comes to work too, to be injured. Certainly no one comes to the hospital to be injured. You come to the hospital to be healed. So this notion of zero harm is so important to our patients and our employees and, and the downstream benefits of pre the pursuit of zero harm is the quality improvements. The, the efficiency improvements, the engagement Improvement. So I can think of a better true North for an organization than zero harm.

Mark Graban (17m 11s):
Well said. So again, our, our guest today has been John Collodora. Who's a client advisor with Value Capture John. Thanks so much for being here today. I'm sure we'll be able to explore other topics in a future podcast.

John Collodora (17m 23s):
So hopefully Thank you. Mark

Mark Graban (17m 26s):
Thanks for listening to Habitual Excellence presented by Value Capture we hope you all subscribe to the podcast and please also rate and review it in your favorite podcast directory or ad to learn more about Value Capture and how we can help your organization on this journey to Habitual Excellence visit our website at www.ValueCapturellc.com.