(BONUS) Operational Blindness: What’s Costing Hospitals Millions

28:23When it's all on one person. And then we award that person, then the other person coming up after you says, I need to be a hero. but I don't know about you all I like to be a hero parent I don't want to be a hero at work I don't mind stretching the earth for my child my baby my boot day oh and my two sons but at work I shouldn't have to do that I want to operate in the system but we've been saying this for 20 years and now you carry this weight alone you can't admit it to the board you can't admit it to your peers you can't admit it to your team so you carry it alone and the more senior you get the more isolate the weight fields because if you do say that you have a problem as a VP, you think that that means that, hey, that means that I'm not fit for the job.

29:07So we patch it, we hide it, we patch it, we hide it, we patch it, we hide it, we patch it, we hide it. And before you know, we have a lot of an organization full of passwords with no system work. And the best way to build something is structure. So we talk about systems. Everyone has intelligence and everyone has technology and And all of a sudden, all of these 30 year old companies now the same systems and programs are now intelligent all of a sudden. New buzzword, new day is fine. But as an organization, you have to ask yourself it when there is no technology, how can we operate intelligently?

29:48when there is no technology or systems or structure how can we move in a way that allows for us to move according to ensuring that patients regardless of what type of surgery can get back home to their babies the same way that you want to so matters and we don't want you to carry this along because what happens is here's the cost that no one measures strain at home you're present but you're not present your spouse sees it your kids feel it you're at the dinner table but you're still at the hospital you're there but you're not there the loss of joy you got into health care to make a difference now you spend your days managing the aftermath of things that you never saw coming you hired a rock star and you thought that it would change and that rock star is not a rock star but you can't fire them so you just have to now create all these difficult ways to get them to quit but they won't quit we talk about the health cost blood pressure sleep weight the body keep score, you know the stress is taking years off of your life.

31:07The quiet fear, how long until this catches up to me? How long until there's a problem I can't recover from?

31:18And it's not your fault. That's what I want to tell you. It's not. The architecture of healthcare operations was never designed to give you the visibility that you need to lead at this level of complexity. It's not your fault. We just never had a system. And a system is just simply a series of programs that work succinctly together in order to produce an efficient outcome. And I'm sorry, the purpose of the lean belt system doesn't teach you how to restructure an organization from scratch. It teaches you how to make the current structure, assuming it is the most efficient structure efficient. So this is why you can have all the black belt lean on your team and still have mayhem.

32:11Because lean was created in a world, Toyota, that already had a flawless system and they just were making tweaks along the way. So what happens is you learn lean, you make it efficient and you make your workarounds efficient, but you don't deal with the symptom at hand. OR is underdeveloped or the SPD is underdeveloped. We have service techs or liaisons that have never been in SPD. The purpose of a liaison from SPD to OR is to have somebody that understands both worlds. And when you look at a pit crew, the most important person on the pit crew is the mechanic that worked the garage and also is great at working with the pit crew.

32:55That's a person that can liaison in between, communicate in between, talk in between. This is a systematic structure that are needed. So we did a study. As you can tell, I am a doctor, but I'm not a doctor. If you are sick, if you call me, you may end up dead. My doctor is in a business administration. So I like to tell people when your organization is sick, that's when you call me. I'm the person that makes your organization feel better. I'm not the person. That you come to for anything else, but if you want to change. And you're not alone. We actually measured it. Remember, I told you that we went and did a study with 185 leaders all over the country.

33:34Some of the larger hospital systems in the country we support. And even those leaders is absolutely scary. How many leaders would I talk to in confidence, told me the real truth that they feel like they couldn't tell their peers, their upline or their leaders? So we come with these fronts, with these masks on to conferences and talking to your peers. and imagine being in a space where you can't even be yourself and be honest about how much of a mess things are and how much of lack of a structure people have. So we did a study. Did you know that 99.5 % of the people that we did a study with scored at risk or operationally blind?

34:1399. 99%. And did you know these same 99 % actually had tracking systems? If tracking systems, how they currently stand actually worked, even in the hospitals, they have all the modules. Why are we still having the same issues that we had before the tracking system? It's not a tracking of instruments. If I lose my key at home and I keep losing my key, I'm not going to put a tracker on my key fob. I'm going to find a place and make it a routine and a behavior split in the same place every time. 50.8 percent lack early warning capability. Did you know that 50.8 percent feel like they can't see the problems that are coming and it just hits them like a like a ton of bricks every single time.

35:01Now imagine if you're a VP and every department feels that way. Just hide in your room and just get through the day and say there will always be a problem. 49.2 percent say solutions fail to fix persistent problems. Bring in a consultant. It works. They leave. It breaks. He brings back in the consultant. It works. They leave. It breaks. And we keep this cycle up. We keep the cycle up because the solution was never actually solved. And we've had a lot of hospitals because what most people didn't know with SIPs, when we do staff or we have staffed before, we actually built those leaders from scratch.

35:46Those technicians that we that we placed, a lot of them, we trained from scratch and got them certified. So they were a little different than when we placed them. The hospital, of course, says, hey, we want to cut costs. So we want the staff. We want the team. You get the team, you remove the system. Two years later, they call us back. Same team. I need an RFP. Cool. We do an RFP. They give our same team to another company. And that company, same team, same team, new company, overseeing it in the dumps. They bring us back. Same team. Our system, it works. Why? Because how we build an organization is all programmatic.

36:31When I'm hiring somebody from scratch, what is your program to take them from entry level to top performer in your organization? How do we decide the quality of a technician or nurse or surgeon? Is it just based on tenure?

36:49Man, the 10 years, man, I've seen it all. 10 years of interviews, you're a great interviewer. but when I ask your organization that you've come from what has happened you ran out of there when problems arise because you know there's a shortage all over the world and what I've learned about this consulting space is that when people underperform at their hospital they go work for a consultant company let it die down for a year or two pop back on the local hospital. This is just the structure. This is why fundamentally what we've done in the organization is it doesn't matter what your tenure is. Everyone gets assessed the same in giving some type of belt.

37:32We have a color-coded belt system. And based on how we assess you, I don't care if you're a 20-year vet, how you're assessed and you have to keep that belt status like karate. This is how we're able to progress throughout the organization. Why? Because building a system is a programmatic way, especially when humans are the main focus of the care or the delivery of the service. We don't assume what people know. And if you're offended that I test you because you've been in 10 years, you don't fit. Thank you, ma 'am. Thank you, sir. So you know what we did? I got it, brother. I know what you're thinking.

38:06We went to the healthcare system, the same one that I told you that we saved all this stuff. They wanted us to get a person that was a manager of 10 years. I said, no, we're not going to do it. They said, no, we want somebody of 20 years. I said, hey, see, sweet, remember? You told me you let us figure this out? This is already in Shalmers. Let us figure it out. We went and found a supervisor. There's never been a manager before. But they were 1 ,000 % committed to the system and development. You know what happened? They love her. They love her so much. They said, can we keep her? She said, oh, no, he can't keep me.

38:43because I don't have a system.

38:48Because the hospital thought, oh, it's the manager. But no, it's how we develop our leaders in our system. And when we saw this, I said, hey, man, come on. Come on, bud, let's come over here and let's do it. So we say here, 50 % of operations leaders are operating blind. The highest, this is the highest of any role that we assist. that operations leaders said, we have no clue what is going on anywhere. And we depend on reporting. Give me the dashboard. Give me the report. Give me the information. And it's crazy what happens when you sit with people one-on-one. You actually talk with them. They understand that you truly care about what's going on with them.

39:30You're not trying to sell them. It's crazy the type of truth that comes out. It's crazy what type of truth that comes out. And they say, Doc, I'm going to be honest with you. I know I go around and I say how well we're doing percentage wise, but. It's bad. And so I give the front, that's what one of them told me, I give the front that everything's great, the statistics are great. And I said, well, how are you measuring greatness with statistics? Well, I just measure where we where we come from. I said, well, where are you going? Well, we just want to keep incrementally getting better. I said, well, how do you know your organization is better?

40:04Yes, you're trending up and things are coming down. But at the end of the day, what is your metric that you're judging your organization against? He said, Dr. Jake, I never even thought about that. I just was proud to say that we've gotten better. And I said, there's nothing wrong with you getting better. But what are you getting better to? In comparison to whom? Based on what knowledge? We saw that. These stats are scary, you all.

40:3240.7 % said they're operating fully operationally blind. Metrics don't match reality. When they look at the dashboard, raise your hand if you looked at a dashboard and you said, but this doesn't feel like reality that I see. Especially with the vendors. I'm just going to be honest. We're vendors, so I can be, I can talk about the vendors. We give a dashboard. Wow, we want to stay. and you're looking at the dash like dude i just don't see it i just don't see it i don't see it why because the metrics aren't matching why because numbers do lie it just depends on how you want to tell the story so the great old additive that numbers don't lie put the facts the facts out there and they'll do that then i can ask them based on what you say man we cut down overtime.

41:21Well, let me see. If your organizational structure had not changed, you cut down overtime, but you increased in travelers. You're just moving the teams. It doesn't fundamentally work. So as an operations company, we look at the true structure of an organization. Forget all the fluff and all the names and certifications and all of this. So what we did when we first got on board, as we were building this, I'm a little bit of a radical transformations. But I'm not an idiot. So the first thing we did, we went and hired one of the best sterile processing vets on this side of heaven. Her name is Sharon Green-Golden.

42:03She's been the president of ISM, HSPA. She is a rock star. And she's a traditional SPD specialist. 40 years in the game. She's seen every evolution of sterile processing. She's on international boards. It's a rock star. Then I went and we hired an operations specialist that did sterile processing, but left to build his own business. And came back. Do y 'all know why I hired that person? Because that person had to learn how to build something from scratch. See, a lot of times when you grow up in a system and you've been programmed to be an operator, you don't know how to actually rebuild the structure or the program.

42:51You just kind of like make patchwork. You don't know how to reverse engineer and look at all the fail shoots and rebuild that structure from scratch. You just operate. So when I'm operating as an operator, I get promoted to director sometimes because of proximity. sometimes because they just like you or because you are a great clinician or a technician. You are really great at what you did. But fundamentally, being great at the job does not make you great as an operational leader. And we do that all the time. Man, this person is a great tech. I want to make you a manager. That's not how it works.

43:32So we looked at the structure. I said, OK, I'm going to get you. I'm going to get you and my team of ragtag crew the Y kids and we're going to deconstruct every theory myth methodology structure understanding any of that we're going to reconstruct that and we're going to actually build a system that's amazing we had a lot of fighting nights some wanted to quit including myself me calling Dunny saying this ain't worth it But every day coming back to the table, looking at what has historically worked for our company, looking at what hasn't worked with vendors come to organizations and what has worked, rebuilding that structure.

44:15And then turning around hospital systems moving forward. But when we look at this, this is why I say the metrics don't really match, because when we went to a hospital system, they had four vendors supporting one hospital. Yes, they were going through a third party. But anytime you have four staffing companies supporting your one company, each staffing company wants more staff. So they quite naturally do what? They sabotage each other. Because in their payroll, you get commissioned for upselling inside the organization. So now you say, man, we got a third party. They're doing all the work because we don't want to do it anymore.

44:57But then you're not asking the third party, how are they getting their staff? They just send emails to staffing companies to fill these gaps. So you're being filtered in from 10 different agencies and you're wondering why, because 10 different agencies have 10 different philosophies and 10 different methodologies and 10 different reasons why that they there. And you're wondering why you have help, but it feels like you have none. And now you can't go back to leadership and say you need more help because they finally gave you what you asked for. Now you're stuck again. And forty seven point six percent said we can't explain the root causes to execs.

45:35So we just kind of just. One of them literally said, Dr. Jake, we just dug it out. And I said, absolutely, it's crazy. So this is what we call operational blindness. I wrote a book entitled Operational Blindness. why healthcare leaders can't see what's costing them millions and how to finally fix it. Every one of you is going to get a free book, free copy. We'll send it to each and every one of you. I'm daring you to think about the way that we think. I'm challenging leaders to change the way you think. When I write books, historically, I've been doing it 10 years, 10 books, seven sectors, same result, change.

46:14You know, the reason I write books, not to make money, to invoke thought. Put this in your hands so that you can actually see it, understand it, maybe challenge some things that you're thinking about. So this guy right here that's making it really weird, he has a camera that's following me. He has, at the sales booth, he's going to find, he has a QR code, you can sign up for it, we're going to send you a free book, free copy, no cost, no hidden shipping fee or anything like that. I just want people to understand, operational blindness is when healthcare leaders are accountable for outcomes they cannot see, cannot govern or cannot influence in real time.

46:43Despite having data, despite having dashboards, despite having technology, it's not incompetence. It's not ignorance. It's not inevitability. The problem is systematic. Leaders have no knowledge or expertise, and it can be eliminated with the right architecture. So symptoms you may realize. This is how you know if you have are dealing with operational blindness. Reactive decision making. You're responding to problems after they've escalated rather than preventing them. Don't raise your hand. Just do it like this with Josh.

47:22Firefighting culture. This is how it's always been. You don't understand our... You don't understand how our hospital system is. Ours is different. That's fine. Culture different, people different, that's fine. But every hospital can't tell me the same thing.

47:44Morale injury. When you can't deliver outcomes you know are possible, it creates professional distress. Problems discovered too late. Issues surface. We were one of our health systems. And one of the people reported we have no Midas findings. findings. We said, well, that's a little scary. That means y 'all aren't reporting. Because I know that we've caught like 10 that should have been put on my list, but it wasn't. So if I look at the data as an executive and everything is moving fast, I say there are no findings. We are a perfect organization. And it's only because they just covered it up because if they actually tell you that they're underperforming, they're scared to lose their job because they know you're not going to give them the system or you're not going to defend them for the resource they need to rebuild the structure so that it can be able to help.

48:36So they just say, hey, hey, if something come up, then let me know. I'm going to fix it. Don't report it, though. Kind of like my culture growing up, they say, don't snitch. My daddy said, if you didn't do it, call the police immediately.

48:55It's very important. Here, leadership fatigue, constant firefighting depletes cognitive resources. You can't even think about being innovative because you're so busy putting out fires where you are. Leadership fatigue and executive burnout, high accountability, low visibility creates unstable environments. And it's kind of crazy. It's like this leadership paradox. We have more data than ever in less clarity.

49:26we have just so much information we get you data and just data board you and dashboard you you want to dash it up when you look at this thing you're going to be able to see everything that's happening but seeing everything that's happening doesn't help me like i you know i know we're sick like can you fix that so when you look at it's actually proven the more information you have without the tools and your tool belt to actually improve it, the more it bottles you up that you can't actually solve it. Now you get more anxiety because you have the information, but you don't have the skill set, the tools or the resources or the system that can actually bring about change.

50:08And this reminds me of IBM. Healthcare today is where IBM was in the 90s. Everybody remember IBM? Everybody remember IBM was about to go bankrupt? And everyone was scared. Everyone was terrified because this is America's company. If IBM dies, America dies. So they brought in a guy named Lou Gertzner. Never been in tech in his life. He's a Y kid like me. We went to the same school. The school of Y. and he came in asking simple questions why and what he realized was every or every department in the company was his own little business when i look at health care everything is siloed everything's apart everything's in pieces spd has its own system and technology that doesn't communicate with anything upstairs or has their own system in their own world and their own governance and their own leadership that doesn't talk with SPD.

51:09And if you do talk to SPD, you know, you kind of talk to SPD, but you really don't talk to SPD. You just make it a part of your rounding to talk to SPD, but it's not really SPD. And SPD doesn't want to talk to OR. Good OR is mean, but then they're not mean, because when I talk to OR, they want to be your friend. They just don't know how to be your friend. You know the guy that wants to be your friend and the guy that wants to be your friend? It's just weird for y 'all to get there. That's where it is. EVS, they've got their own metrics. And you know what everyone says? without us, nothing will work.

51:38I promise you, ask every department. They will mull you down that if we all boycott it right now, everything will be shut down. For some positions, it is true. For others, it is not. But the ones that it is not technically true, the reason why they are peacocking is because they haven't been included. From 1969 to 2013, you know how long that gap is from being even thought about being in a conversation of patient safety? And how many of those leaders that we have that were in leadership in a world with no true regulations that are directors of SPD, that are leaders of SPD?

52:23These are These are These are These are An organizational structure issue I want you to write this down If you're taking notes If you're taking blind notes Blinking And you just want to Close your eyes And blink to take a picture You can But it's not going to be on the board So I don't know how you're going to Blink and take a picture So just bring out your phone Take a note Write this down People Move Processes people move processes processes create systems systems create automation and automation influences scalability to through technology that's the order that's the order you can't bring in new gitchy gadgets in an infested world You have to rebuild, starting with the people.

53:18What is the fundamental development program that your people have that is innately in you? Like my mother, you remember I said about the skillet, cast iron skillet. My mother was taught to use a small cast iron skillet, not because she was told, but what she observed. That's the same way you develop organizational structure. And what we have here, the system level view. Who optimizes for this? If everyone is siloed in their own world, who ultimately is affected? The hospital business, the business of hospital, the business of health care. So this is not about working harder. If you ask everyone in health care, if you ask me, everybody in health care works hard.

54:05Everyone is on their feet. Everyone's back hurts. Everyone's brain hurts. So it's not about a matter of who works harder than the other. It's now the question is, how can we work in the most smart, the most efficient way possible so that when anomalies do come up, we have the brain with and the power and the energy to actually go and solve it? because it's my belief that when you actually structure a organization based on a real system that means people development process development not sops that sit in a binder that you say we have processes but if i ask five of your leaders the same question why do i get five different responses like i asked my auntie my mama my grandma about the cast iron skillet.

54:53So it's not about SOPs, but if I go and ask your person to show me what that SOP looks like, why do we ever want to do different things? And we wonder why that there is no structure. So we have to go from managing departments to governing systems. Say governing systems. Say governing systems. So we have to go from managing these departments to actually governing systems to predict, to have some type of predictive integrated structure. So we look at capabilities that eliminate blindness, real-time visibility. This is important. This is why technology is important. But getting technology without understanding how to properly use the tool is inefficient.

55:33So if you use any of these wonderful vendors out here, don't try to penny pinch. You're going to do it. Actually go about doing it. figure out how to actually make it work within your organization ensure that everyone has it because what training is not this is not considered training but historically you go to a conference like man we've been trained we have a vendor come in they teach you one hour for two hours you say my team has been trained that is not training training is the consistent recorrection of idei ideology and concepts over and over again practices and procedures over and over again to ensure that that person is great.

56:13Training is how you parent. Course correction every single day, frustrated or not, but the love that you have for your child will keep you up to continue to keep holding them accountable into the line. That is training. One of my favorite books, it says, if you train up a child in a way that they should go when they leave, they'll never depart from you. That is development. One of my favorite leaders of all time, they call him Jay. Before he sent the leader out, he worked with them for three years one-on-one he had 12 of them that went out and changed the world that's my big brother jay he's my mentor i love him so much but big brother jay spent time with his leaders he didn't train them one time do a miracle jump out a hallway and say go tell everybody he developed them he worked with them he curated them he had a development program for everyone and that's why he still has the greatest organization Jason all the time.

57:09He's the greatest leader ever. So predictive insight, know what's coming before it arrives. Intervene. We have something before we layer our technology into a company or in a hospital. We never layer our technology in a hospital until we have a manual process that mirrors what our technology does. Because if at any point the technology stops working, I want to make sure that the people in the organization can still operate with efficiency. If I allow for the technology to come over that and we don't develop the manual process and teaching them the why, then guess what? The technology is not beneficial to my organization.

57:46It handicaps us. So we fix the organization before we layer in the technology. So I said cool. Yes, it's cool. Does it have predictive stuff? Yes. Does it stop you from making mistakes when you have it? Yes. Because we built our technology not to track instruments, but to correct behaviors. you correct the behavior the instrument is going to be there if I if I check the instrument I know where it is but why is it there that's my question I know who did it did anybody stop who did it we can do that here architecture and intelligence equals visibility not just intelligence of technology architecture systems what is systems programmatic way of doing something over and over again from people development process development and you test and you assess over and over again what we did in our organization y 'all can take this down if you want within our built system we're able to work with hr got it approved that every time they they grew in a built that's when they got a raise so people can get raises without being managers because i told my team management shouldn't be the only way that you get paid more because everyone is not a manager.

58:56Some people are specialists, and I want to keep you there. So we run our organizations like Harry Potter. Put on a sword and hat, Gryffindor, Slytherin. Why? Because we want them to fit where they fit, and we don't want them to go into management not liking people. But they took the job because that was the only way they could get paid more. It's very crazy what happens when you actually start building structure. Now you have a new technician that sees value in their organization. Now you see a technician and we have the service techs too. So now you see the technician go from a tech to a service tech.

59:32They go from tech to materials. They go from tech to leadership, tech to OR liaison. And that leadership circle, we value it the same. Very important for us to understand this. So SIMS exists from operational blindness. We have our operational system. This is the people part. people in process then we have our technology that we layer on top this is the visual part and what what does this change it changes everything and we reframe we reframe uh the reframe that changes everything is the old belief is we're not executing well enough the new truth is your system just needs to evolve we're operating on a 20 year old system today in a totally different world can we agree that this world is totally different from before pandemic Can we agree?

1:00:19So that means that if we're operating in a whole new world, we need to actually create new systems that can support the new world.

1:00:30I lost two points. I know I'll get it back, bro. I'll get it back tonight when I party. I'll get it back. All right. So you are not failing. The system is failing. And I want you to understand this. Eliminating operational blindness is not a health is is how healthcare operations becomes predictable governable sustainable and all

1:01:00Since the age of 12 I've been about my father's business at the age of 30 he sent me to his