Podcast | Systematizing Equity at Virginia Mason Franciscan Health

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Thank you for joining us for “Better Never Stops”, our podcast for healthcare leaders and everyone committed to transforming healthcare. We interview leaders from our clients and partners around the world, as well as leaders right here in Seattle who work to sustain a culture of continuous improvement at Virginia Mason, for instance, can help. In each episode we hope to explore a philosophy of go see, ask why and show respect. My name is Chris Backus and I’m the Executive partner for the Virginia Mason Institute. And I’ll be your host for this episode of Better never stops. Today I’ll be joined by two members of our Kaiser and promotion office at Virginia Mason Medical Center to discuss the topic of systematizing equity at Virginia Mason Franciscan health. Nate Higby oversees a number of quality improvement initiatives in his role in Cape EO and serves as the co-chair of proudly VM, the LGBTQIA plus affinity group inside Virginia Mason Franciscan health and outside of the organization, Nate shares the city’s LGBTQ plus commission. Monica Marie, also a VMPS specialist oversees many quality improvement initiatives for Virginia Mason Medical Center following her 35-year career as a physical therapist 24 of those years in Virginia Mason. Monica has led both inpatient and outpatient therapy teams prior to joining KPO. Monica is a member of proudly VM and the Virginia Mason Franciscan health systematizing equity implementation team. I’d like to welcome Dayton Monica. Thank you for joining our discussion on systematizing equity at Virginia Mason Franciscan health. I know that the Virginia Mason Institute hosted a webinar in 2020 to share a bit about how VMPS has evolved to include systematizing equity. But I think it would be helpful if we started out with a kind of a level set understanding of what we mean by systematizing equity. So, Nate, how about you start out and Monica, why don’t you go ahead and follow after Nate’s had a chance. Alright, um, Thanks, Chris. Thanks for having us. We’re super excited to be here to share our story and our work. So, when you say systematizing equity into Virginia Mason crescents can help and more specifically for Virginia Mason’s production system. What we mean by that is we are looking to embed an equity lens in all the work that we do. So when we first started this initiative, we understood that, given our management system was how we did our work, it was the tools in which we did our work, which includes process improvement and daily management. We believed that the best way to embed equity was through embedding equity into BMPs. And so what that looks like today, is our workshops consist of utilizing equity tools to draw attention to, and underrepresented team members or underserved patients, or bringing attention to when we’re missing people from the table. So that’s just kind of a high-level overview. And, Monique, I’m sure you have things to add. Thanks, Nate. Thanks, Chris, for having us. Yeah, I think, well, you’ve really covered the bases there. I feel like Nate, it’s just the idea of

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in our work in the hospital system and caring for patients, there’s been just a long history of leaving people out in a lot of ways, without understanding that we were doing that. So, the idea is just trying to collectively increase our understanding and support of each other, to be better at making sure all voices are heard, as Nate said, team and patients, patients, of course and community extending to our community as well.

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You know, when what when I think about it, I think about one of the basic most basic concepts of BMPs is that we try and make sure that the important things are included within the process within the standard work instead of an inspection step outside. So, this idea that we’re systematizing a consideration and respect for equity within the work that we’re engaging teams to improve so that it’s not something we have to think about and look for afterwards, but just that we bring it in the way we do our work just like our quality, our safety considerations, or respect for people considerations, making sure that whatever we do,

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doesn’t leave someone out to your point on

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Okay.

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Now, in our last podcast, we talked about daily management and how that’s been evolving. And Monica, I know that you’ve been involved lately with bringing equity into daily management. I wonder if you could talk a little bit more about that. Yes, certainly, I would like to tie this into a little bit to an RPI W we just did in November, which was a divisional one of our first divisional, our rapid process improvement workshops. And at the front end, we needed to do

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use that equity lens to create a process that didn’t have equity waste built in. And part of that was the daily management of the NEMO washy and preparing the all the teams that we were going to work with and having the conversations with them up front, in our daily management system as part of our huddles, and really working with the nursing leaders. It was around their work and and really supporting them to be asking those questions to their team, as we prepared for the workshop within that, blends of the daily management.

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And then we’re going to talk a little bit more too I think, in a bit about the concept of psychological safety. And so in, in the lens of, you know, within the lens of daily management, am I creating space? That’s one of the things we’re really working on with the leaders. Am I creating space for all the voices? Have I figured out the avenues to get the quiet people in the room? Or the people who feel intimidated? Am I having enough awareness of who might feel intimidated that aren’t speaking up and reaching them? So that’s a big a big way in which we’ve been working on it. And Nate, probably, I would hope, maybe touch on the equity huddle cards we’re working on?

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Yeah, so yeah. Actually, not to like to throw this conversation on, I do want to circle back to something Chris mentioned, I think it’s spot on. When we say systematize, it was a strategic move on our part to look at our existing tools and processes and embed the equity pieces there as opposed to create creating additional resources or additional toolkit makers, we found that.

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We found that there was risk associated with creating these additional toolkits, you’re basically creating an additional thing that a leader may or may not utilize in when they’re doing their process improvement work. So, it was a very deliberate effort on our part to look at what we currently use, and embed, and revolve those tools. So, I just wanted to touch on that. Because I think that was a important piece. When we think about systematizing lean dei into lean.

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One of the things that we have been looking at is, how do we take the really powerful conversations that we’re having in our workshops using equity pauses, which is one of the tools we talked about in our webinar? How do we bring that to operations? And so, one of the PSAs that we’ve been working on is this concept of equity huddle cards, where we have created topics, we create cards associated with a different topic, psychological safety being why now, I mean time is for leaders to define these terms. And then ask a question about what’s going well with our team and psychological safety, and what’s not going well. Either topics include health equity, or implicit biases. And the whole point is to create that quick pause during operations and draw people’s attention to where there might be inequity waste in their work. So that’s an effort that we’ve been looking at is betting those conversations into huddles, which is one of our six elements of daily management. Right. And, you know, that’s such a great example of the power of a shared management system across the organization. We don’t have to educate everyone on equity and expect them to be professionals at it, just because they go to a specialized training is like, we have a way of bringing it into the way we do our work. And you know, we constantly are learning what the best way to do our work is. And you know, now, just the topic of this podcast, making sure that we pause for equity, make sure we understand so we aren’t moving forward enthusiastically, and maybe even unintentionally leaving someone out. So that idea of we have huddles, so let’s give them a tool to use within the huddle to make sure that it comes in instead of one more thing to have to worry about because I think that’s a fear of so many people right now, of having too many one more thing to worry about on top of just you know some of the stresses of just running the day

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So have you just with, with the huddle card, the PDSA the Plan, Do Study Act of that, of that rollout has there been positive re measures or stories or just moments of just wow, this is really helpful. It’s working.

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So, before I get to that, I also want to touch on what you just said.

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So, I think when we talk about Dei, and you know, this idea of adding on equity, to the list of topics to talk about with a team, one of the ways that our team has actually found to be an effective way is by identifying what are already key strategic initiatives or priorities that these leaders have to work on and embedding equity into that those conversations. So, I think length of stay, for example of where we are, is a huge initiative across our organization. And instead of just trying to tack on equity in our operational huddles for the hospital, we look at where equity falls within our life to stay work. Given that’s already been agenda item, your question was regarding successes for the equity Hello cards, I’ll be back I have been hearing from leaders is it’s great, because it’s simplifying, something that’s already very complex, the more we can give our leaders the tools and the resources to be able to feel facilitate those conversations, the better off they’ll be. And by trying to keep the attention on the dynamics of the department and the patient, you have something that draws everybody into the conversation, meaning you have once invested in the patient’s experience. So, you have this, if you draft your focus on how we can improve health equity for our patients, you are naturally going to draw people in because of why people work in health care is for the patients. We know, it’s also it’s kind of interesting, this topic that we’re talking about right now is we’re really enabling our frontline managers for success. And we constantly learn more about what success and healthcare means. And right now, success, very importantly, is focusing on diversity, equity and inclusion. And so, rather than just have an expectation, how do we set them up to do their best work, and be their best selves as a leader on the front line by enabling their ability, instead of finding the one, you know, weeding people out? We’re actually enabling people in, really, and that that in itself is our learning about equity. Right? That is an equitable moment.

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I was wondering if I could add just to that, to that. So how some feedback that we’ve had, and a positive thing that the that came out of having the equity huddle cards themselves, is that

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leaders, we’re all kind of we’re all on different in different places on our awareness of equity and trying to systemize equity within our work in our lives. And so, some leaders communicated feeling a lot of discomfort about trying to start the conversation. And so, the equity cards, the equity huddle cards actually gave them an anchor. And it’s a process we’ve used in the past, through VMPS. With patience, you know, people having their

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I apologize, I don’t remember what they’re called exactly what they’re the Kaizen

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flip cards that we give people to talk about in huddles about different Kaizen concepts. So it’s, so it fits in with that concept for the, for the leaders. And the other thing is really working with them a lot on getting back to that basic VMPS concept of facilitation, that as a leader, they are facilitating, they don’t have to fix it, they don’t have to have all the answers, they just have to start the conversation and support it being available to everyone in the room. And so really, that’s a really good way in which we’ve just kind of brought it back to our basic VMPS concepts, and supporting them with facilitating this new kind of language for a lot of people.

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I would just add on to that think one of the learnings I’ve had around doing this work is there’s so many parallels between VMPS and de Dei, um, you know, Monica, touched on this idea of you don’t need to be the expert. And I think our senseis will say the same. You just do it, just get out there. Do the work, have the conversations? It’s incremental improvement, right. And so, I think there’s a lot of parallels. That’s something that I didn’t anticipate going into this work, but I’m starting to appreciate because now that we leverage our skill sets in this space

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In

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part two very important conversations that we need to have. Yeah, it’s interesting though the just the, there’s that just do it. But then there’s also that with something that people value so much the risk of making a mistake, the fear that Oh, I might say the wrong thing I might do the wrong thing

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almost prevents that just do it, barrier.

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Crossing over that just to a bear. I know, I’ve experienced that with some of my clients outside.

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But I think I think it’s important that we’ve talked quite a bit about how managers can, we’ve helped them with tools to engage their teams, but it’s also about having the whole team Pause and consider the patient experience as well equity in the patient experience.

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You know, one of the one of the things we had talked about just a few moments ago was the idea of, of reinforcing the tools we already have with equity. And so, we’ve evolved five ass. And so instead of five S’s now there’s six S’s, right? So, tell us a little bit more about that.

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So, this has been a really exciting journey for me, you know, just to kind of for background, the RPi W about Systemizing equity was before I joined the KP o team. And so, I’ve had quite the growth journey. With everyone. It’s been exciting. And one of the one of the later pieces was really honing in on this idea of

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an element of our

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the five s around safety, and I’ll kind of lay it out, but then I think Nate can probably fill in some blanks to have the historical background.

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Initially, their conversations about let’s talk about how we include these concepts of safety within each of the five S’s. So, there were some iterations and trials with that, and it was very clunky. And a lot of

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people who tried to tried to do the PSAs were confused, and it just didn’t feel smooth. So, what we landed on was the idea of having a six s that was for safety and had the language around.

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Kind of the three elements that we found. People landed on the most around safety one, the first was physical safety within the physical safety of the work. Then there was psychological safety, how do people feel within the work and working with each other and speaking up? And then inequities? Are we reaching all the right people?

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An example of that just recently was the RPi W did we did on the nursing career development pathway. The team identified nightshift, people, P nurse nurses with new babies, part time, nurses who never had any opportunity to participate in career pathway, thanks because of their, their work. So, they chose to use the inequities lens for their success. So, the way it’s worked, it works is the five s exists as it does. And then you have your sixth column. And as you do all of your observations and your preparation for your event and understand what waste is there, that guy that should guide the team to which safety s they want to use, and then they plug that in. So that’s how we’ve utilized it. Love to hear what they might add. I think it covered it spot on. I think the important thing to emphasize with this success is that this was probably one of our more radical innovative ideas that came out of the RPi W that we had looking at equity in our management system. And the reason why the team was able to get to that place was because we had permission, we were given support, and permission and agency from our leadership, who understood that, in order for us to truly systematize equity in a meaningful, effective way, we had to look at all of our tools and really ask ourselves, where are we not doing justice for our patients or for our team members. And the five s was one of those tools. The five s made an assumption that there was a readiness that the team had around change and sorting and sweeping. There, you think that they’re

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both pretty simple things, but for some people, there is an emotional connotation to those actions. And so anyways, I just given that permission to really look at those tools allow us to create, I think, some of the more innovative right

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turtles coming out at this workshop. Well, and you know, Monica, you use the term, a few minutes back Nemo, washy, that idea of readiness. And no Nemo washy comes from farming in that you never plant until the soil is ready. And so that, you know, it’s where respect meets equity, it’s like, let’s not assume a team is ready, let’s, let’s help them be ready. Let’s understand if they are ready or not. So it may never

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stop us from doing improvement. But it may help us actually do the preparatory work with the team in order to get the improvement. So that that idea of old terms really finding a home in the future with like Nemo, washy readiness and, and making sure our teams are ready. And adding I think a deeper lends to do we really know, our patients and who we’re serving? And maybe we know who we’re serving, but who aren’t we serving that extra layer? So I think that’s, that’s great.

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I’m gonna, I know, I know, we gave you some questions to prepare for. But I think it’s important for people listening, because we hear so much about equity and Nate, you’ve used dei diversity, equity inclusion, so those, there’s a lot of understanding, and I would say misunderstanding about those terms. But when you think about equity, what were some key learnings, when we started using the term and started really talking about equity at Virginia Mason or or just as you do your work? Where do you find the misunderstanding with equity?

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Yeah, so I think, given that we work in a healthcare setting, we have we really started doing this work, Neha Patel, who was one of the CO leaders of this workshop alongside with me, notice that people had this mental Valley around equity, in that it related to patient care. It was, how do we address healthcare disparities by their patients, which is, you know, a component of equity. And they right, they’d be right to think about that. But as we started to kind of dive into these conversations, we realized that equity applies to all facets of healthcare, from our corporate settings, our recruiting, supply chain of the device, the diversity of our vendors. So, as we started to

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lean into this work, and really start to spread these tools across the system, we started to recognize that equity applies to all facets

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of the organization. And I think that’s been one thing that’s been neat to see is our patient Financial Services team using these tools to help them understand where equity plays in their work, supply chain, and so on. So, I don’t know if Monica, do you have anything to add to that? This is anecdotal in spending so much time in the hospital. What I am aware of is how much more nimble the team is with us of this is just one example of the video interpreter. And there’s an immediate what I noticed, even in my observations recently is that there’s a more immediate

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retrieval of the video interpreter versus

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expecting a family member to do that work when they’re already burdened people understand. It’s not just this is the law, the why behind this is burdensome to that family member who’s in maybe in pain or has confusion or is worried about their family member, and they get just to be to the daughter, they don’t have to do that medical roll, maybe they’re not prepared for so under just seeing that all different layers of team members having the nimbleness of using that and getting an understanding it’s a tool that’s important for our for our patients, and having them understand and getting from them what they need as much as possible. So that’s been very cool to see. Ya know, it’s, um, as you were talking there, Monica, it made me think about, you know, we talk about Muda as waste, but we there’s the Moray Mora and Muda. And, you know, there’s that level of waste, about unreasonable expectations. And you know, really, you pair that understanding with the respect for people of walk in the shoes of others and you start and then you add that lens of equity and you start to see that is a burden on the family who already are. Our normal world is their abnormal experience. And so, it’s how incredibly insightful and

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respectful of the team to see that and response. And it’s and this is again, where the management system helps them. Because if we made it hard for them, they may default to old habits. But by making things

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available at point of views, they have what they need. And it takes no extra thought, it just becomes the way they do their work. And that’s just exciting to see the power of the management method,

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enabling a better understanding and use of equity in our care. And we all win. When we think about it that way. Yeah, absolutely. Yeah, that’s fair. That’s exciting. That’s exciting.

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So there, there have been a number of tools,

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trainings for different levels in the organization. I’m wondering, what are some of the outcomes that have come from this, so we’ve seen

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but better teaming, I’m thinking about one, you know, in my day, you know, 22 years ago, working in KPO, we were working on bedside rounds, they became interdisciplinary. Now multidisciplinary rounds, have you seen value, bringing equity into something like that and other things in the organization, one that I can think of right off is our multidisciplinary rounds. here locally at Virginia Mason

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didn’t include the bedside nurses, initially, for at least when I began hearing KPO, at some of our, the other VMFA hospitals, that was true, they didn’t, they did were present.

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And there’s been a variety of

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either absence of bedside nurses who are during the direct connection with that patient, consistent patient voice, or very provider centric. So that

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there was a lot of worry about psychological safety for the bedside nurses being able to speak. And so some of the preparatory work we’ve done to improve our MDRs has been around across the division, and our length of stay work is to work on the element of psychological safety, for all the people attending and making sure that everyone’s included, that should be there. And, and that idea of this is a safe space, and the patient is in the front, and in the center, the patient is in the center for us. And that’s why we’re here. So we’re going to support each other to get to that place. So that’s been very powerful. You know, it’s the

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playing on the equity concept. It’s the opposite, we can’t expect any one team member to know everything about the patient. But we all know something. And if we have that space to share together, the experience is much better for everyone, right? Yeah, exactly right. In the in the iterations of kaizen events at all the different locations, one of the key elements was a team agreement. And every team chose to include that you don’t have it’s okay, if you don’t know the answer. So, it’s great that you said that, because that was one of the things that people communicate about being afraid of, and they got that right up there that it’s okay. You’re going to do your best with what you know.

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Yeah, I think a lot of that also comes from the fact that when we one of the things that we’ve been able to do is incorporate these tools into your new hire orientation. So, when any employee starts here at Virginia Mason Medical Center, they are oriented to our inequity, waste wheel, and equity pauses. And we have seen improvements in our team members saying they know how to report disrespect when it occurs. And I think a lot of that is a cultural kind of shit. When you see that when you have those tools upfront, when you new employees join our organization, and I think it creates a venue for team members to speak up when there might not necessarily have been a venue in the past.

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We have been very good about teaching our team members to speak up when there’s waste and addressing waste, but we didn’t really have any mechanism in place for them to speak up about inequities or things that they saw were happening to employees of color or patients of color. And I think about the Super backs, which is our vaccine clinic that we had Amazon, Damon Nelson Pearson did a podcast on it. And definitely check it out. Even one of the in the planning for that

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because we had one

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Be pause. I mean, we were, we had a mechanism in which some of our leaders could speak up about patients who were not technical, not technically literate, or did not speak English. And so, I think that’s just like one, one way in which these tools have provided that outlet. Or that means for people to call attention to potential harm, you know, I’ve been following the improvement, you know, being part of the institute, we’re a bit outside of the organization. So, we have the cheap seats looking in. And as you know, kind of a former member of KBO, it’s just my heart proud to see people take the method and grow it instead of just stay static with it. But you know, there have been quite a, quite a few learnings about our, our commitment to diversity, equity and inclusion. And I remember someone saying that, you know, the most important thing is to keep the path simple for equity. So, your equity path keep it simple.

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that lines up nicely with how we coach people with daily management, start simple, you know, grow by doing learn, do improve. And then I think it’s also that sharing the information.

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You know, so if people to your point, Native people have a voice, and they know, they can use their voice and share the voice we all learn from everyone’s experience. And that’s the power of a system. You know, we are teams of teams learning together, right? Yeah, absolutely. I think this goes back to, again, do what you mentioned, just keeping it, keeping it simple. Try not to overcomplicate it.

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Again, you know, for many people, including myself are still learning. And the more we complicate it, I think the easier it is to kind of lean away from a middle, you know, shy away from actually leaning in. And so we have found, at least for me, my favorite tool, when it comes to this work has been the equity impact analysis questions that we have incorporated in our inequity, waste wheel toolkit. And a lot of these questions were drawn from the Center for racial justice and innovation race board. And what these questions do is they just allow us to say, who’s missing? And that’s the question, right? It’s who’s missing from the table? What adverse effects or unintended consequences could result in this? And we’ve just found that by drawing from these questions that our leaders are able to easily apply them to ongoing conversations, our president has been able to use this tool to do equity pauses in our all-leadership meetings, engaging the leadership in a conversation around something that might have equity implications. So that’s kind of how keeping it simple has allowed our leaders to incorporate more of useful more of these conversations into that work.

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Now, that goes back to that idea of the daily management, right reliability, what may help what’s helps them be reliable about it, if it’s something that’s easy, if it’s easily embedded, so that’s really been a big focus of our work, the visual, making a visual, having the inequity waist wheel, and it’s easy to put up and, you know, it’s right at the point of the huddle so they can reference it and, and the questions are pretty straightforward. And a lot of work intention went into choosing them to address things that we would that would come up in people’s work, to make it easy. So

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you know, just hitting on those other elements of daily management. Having that in mind, is a way we’re trying to embed it and have it be successful as it’s being embedded to while and I think that’s, that’s such a learning about the Virginia Mason production system is we never seek to invent something that’s already exists. But we use our management method to assure that it’s brought into the organization into the way we do our work in a way that is success oriented. You know, so, Nate, you cited, the organizations that are kind of the experts on equity, so we didn’t have to be the experts on equity, but we had to draw upon their knowledge and find a way to make it meaningful. Within the day at Virginia Mason and Virginia Mason, for instance, can help I think, something that people don’t actually know is that a lot of this work was actually inspired by the City of Seattle, the city of Seattle uses a Racial Equity Toolkit. And that is actually the one product that inspired this idea of looking at our management system. And that I think that is where the team that did the work during the RP

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Aw, was really able to create meaningful products

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was through the knees through using existing resources that are already out there. But just really redefining what it looks like in the context of process improvement, or BMPs. So

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taking what other people have done and just tried and true, but we get in our own? Well, that’s, we have such a history of that as an organization, you know, we think about, we can see an opportunity sometimes by the problem we encounter or the opportunity we hear about, but we don’t, we don’t have the way in which it can be part of our organization. And so, we use our process improvement methodology to bring it in. So, you know, you’ve referenced the rapid process improvement workshop on systematizing equity that really got the ball rolling. It’s how we worked to ensure flu shots for all staff, because it was the idea of a medical assistant who heard the scientific evidence. So, someone, I’m not sure who it was that, Nate, it might have been you. I’m not sure given your role with the city, but the bringing that toolkit, that awareness, but there is an opportunity for Virginia Mason, can we find a way for this to become

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a support and a transformational opportunity for the organization? Yes, I think you’re spot on there. And I think the key to success there was using are using what works for us when it comes to creating change. And that was our management system. So had we just looked at this toolkit and said, Alright, let’s just sit in a room or, you know, have worked sessions where we think about our management system and how it can be better, I don’t think we would have had the success that we had have now a

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large part of that, because we knew we were not the subject matter experts. And so, we brought together the subject matter experts in the context of an RPA W to do this work.

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That means that it became a very meta experience, because we were scrutinizing our RPO W process while we were in our pow.

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And so, for me the way we do improvement.

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Yeah, it’s a love was something that was I think one of the challenges was Neha and I planning for his event knew that we were engaging in inequity waste, to create this event, and may alter the outcomes of the event. And so that became a one of the unique challenges of we need this work. But I think the team really came together to figure it out. So, when we talk about, you know, the basics of the Virginia Mason production system, I think we all use the slide the quote from Taiichi Ohno without standards, there can be no improvement. I’m wondering, do you was it important to standardize the organization understanding of equity is, you know, when we talk about common words that we use every day, they’re often misunderstood or understood differently by different people. And just the power of something like an RPI W that can say this is equity. And here’s where we are. Do you feel that it was important to get that understanding across the organization about what equity really is? It’s an ongoing journey. You know, when we think about who we are as VMF, H. Virginia Mason Medical Center started a more robust process sooner than some of the other parts of our organization, trying to standardize it is part of the goal. Because that common language takes a motion, you know, part of what makes what standards are good about is they take emotion out of things in a way that feel scary to people or unknown or not, nor not usual. And so

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I want to good just go back to the tools, our standard operations tools.

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We embedded an infinity symbol to identify inequities.

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Well, that fits right in with the quality and safety, it doesn’t make it stand out as something that’s different. It’s part of just understanding that we were missing this piece. And on our observation forms, we added the column that says, are you noticing any inequities in this process? Are you hearing any communication? So, it just normalizes it in a way that helps I think people

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move forward fast. I’m hopeful, I think I think we’re on that path. You know, I would say one of the challenges that we had during the event, the rapid process improvement workshop, was that people have very different lived experiences and different understanding of what certain terms mean to them.

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And so there was a disagreement about anti racism

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with during the event. And so, what we have found to be

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the best way of creating shared language was really through the development of those inequity waste. And by leaving some room for interpretation, and this is where I think we have work to do is with our process of movement workshop, workshops is the leader who was opt in, going into this, going to the gamba, with the biggest waste in mind. And that, that their biases will determine the inequity wastes they see. And so, one of the things that we have to work on as an organization is how do we get our frontline team members to say, these are the inequity ways that aren’t we’re experiencing that means you don’t see as a leader, given your perspective, or, you know, the power dynamics and whatnot. So

41:06

I know that kind of going on a tangent here. But I think the waste wheel has been the tool to create that shared language. But we still have work to do around how do we how do we ensure that people’s biases or blind spots don’t prevent them from seeing other waste of other perspectives?

41:25

I love what you’re saying there, Nate, I think it lines up nicely with the spirit of kaizen or continuous improvement. You know, one of my coaching tips, whenever I get an organization started on the improvement is remember, this is just the beginning, anything we do this week is going to reveal what we need to do in next month. And so, I think it’s that same idea with equity, anything we put in place now to systematize equity, when systematize allows us to see where our next opportunity to become more equitable exists. So, I think it’s very much just coming back to the beginning, it wasn’t about doing something extra it was about making use of the method we have and bringing it into the methodology so that it becomes natural. And to your both of you talking about tools are there to help us. So a little infinity symbol just helps us remember, or a question

42:21

that, you know, have you seen something that, you know, it isn’t equitable? Or is there any concern you have just allows us to continue thinking about it? Right, because we all know when you look at a process the first time you only see the surface, when you go back more and more. And the more you have those cues, the more things you will you’ll look for.

42:41

We’re kind of nearing the end and I’d love to open it up a little bit more. I really I wish the group could see how enthusiastic you both are about this the smiles, just the energy.

42:56

But hopefully they’ll get that in your in your voice as well. But I’m wondering, you know, if you think back on the work at Virginia Mason Medical Center, Virginia, Mason, Franciscan Health, has there any, like any moment that has really stood out for either of you, in the journey you’ve been on? I’ve had a lot of them.

43:20

But I would say as a one of the most powerful ones for me,

43:25

was with my my leader that I was my first Kochi to go through her kaizen event after LLVM. So my very first person that I’m working with as my in my role as a as a specialist, and it worked, and they were working on a dynamic that included providers and

43:46

schedulers and Ma’s. What came out really early on was there was a reluctance and conversation to try things that when the leader said, Wait a minute, I probably should have done this earlier. I want to do an equity pause right here right now. And she understood that her team did not feel psychologically safe to say what their ideas were because they were afraid that the providers would just say, forget it. I’m not doing that. And it led to some really powerful conversations. And her sponsor came

44:23

and had a lot of enlightenment. And it allowed them to bring the whole team providers, all the team members together in a meeting in a shared space to have the conversations where everyone was, could feel safe and say what they needed to say. Really powerful. It was just that was very cool to me, and just

44:43

demonstrated the power of just the awareness that we’re all growing and learning to have. Nate, how about you? Yeah, no, I like Monica. There’s been a lot of highlights and I think my favorite

45:00

And this is a hard one to describe because it’s kind of intangible. But I felt like a kind of a cultural change shortly after this workshop. There, it was funny once we launched the tools, we actually had our lot of leaders running with grabbing these tools that were still in PDSA mode and bringing them to their teams and then involving them, and it became like we it just became too much, you know, our PDSA gone overboard and I think that really spoke to the demand and the interest that was in bringing these topics, either team members, and just seeing, I think that increased dialogue and awareness of these topics in their work has resulted in just this cultural change of this is the norm. This is part of how this is who we are, this is how we do our work. The tangible piece to that story is, every year, we do a survey for our Employee Resource Groups member. So, we have proudly Byam which is our LGBTQ

46:07

belonging group. And then we also have momentum, which is a employee resource group for employees of color. And we do a survey. And when we launched these tools of survey data followed that launch, couple of couple months later, many respondents said that they felt was the best accomplishment related to Dei, what’s the creation of these tools. So, we hear from our team members that they value, these tools, because it shows where we stand as an organization. So that was just just, it’s just really cool to be part of that effort. And to kind of know that, you know, we played a role in this change.

46:47

It’s so great deals are such good examples of, you know, we talk about the heart and spine of kaizen. And, you know, it’s sometimes it’s the clarity of the tools that spine, that brings the awareness and the learning the heart that feel like you said, Nate, it’s it, it’s hard to put into words, but things changed, you know, and it’s, our hearts got a little bigger, you know, the heart of kaizen really helps. So, I really want to thank you both for taking the time to share on such an important topic and healthcare.

47:22

Just in respect for equity, is there something that we should have talked about, that we hadn’t talked about yet today that you feel is important for people to know, for organizations that are interested, and wanting to really be more intentional about equity, and how equity plays a role in process improvement, looking to your team members looking to the frontline team, is going to be the best way to do it. Because they know they live these experiences they’ve seen they encounter these patients. So, leaning on them, help you design, what does equity look like? And process improvement is going to be your ingredient versus test?

48:02

Monica? Yeah, you know, that hits the nail on the head. For me, I feel like that’s one of the things that we work on with our leaders around VMPS is really, the heart of VMPS is supposed to be right. The people who do the work, may helping make the decisions and creating coming forward with the ideas and putting them to action. And they’re the team members who are closest to the patient the most of the time. And so, to really get the patient voice. I think that’s going to be our constant I hope is our constant front work and evolution is in that is in that regard. How much we can continue to involve our frontline team. Well, I want to thank you both for taking the time. And I look forward to people hearing this podcast, I think it’ll provide a great deal of inspiration for others who are just beginning their journey. So, thank you so much.

49:04

Thanks so much, Chris. Yeah, thanks for having us.

49:10

Thank you for joining our podcast today on the topic of systematizing equity in health care.

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