Ever since meeting Shawn Callahan at a meetup group, and then having him run a session at LAST conference, I’ve been  following Anecdotes’s blog posts. Recently, Kevin from Anecdote posted about the above animation. It’s in the style of the RSA animations, one of the most well known being Dan Pink’s Drive video.

Related to this, I’ve previously mentioned both Jurgen Appelo’s How to Change the World, and Fearless Change, and I recently did a short talk summarizing Appelo’s treatise, at a recent Agile Business Analysts meet up. In that text, he says:

The hardest part of continuous improvement in organizations is changing the behaviour of other people.

I’m not very familiar with Dr. Robert Cialdini’s work, but fascinated about the subject matter. This video, as Kevin says is well worth spending 12 minutes watching.

Change and improvement

This podcast episode of the architecture and design show 99% Invisible from radio KALW in San Francisco appeared in my Twitter stream today via @kjscotland (Karl Scotland).

99% Invisible-30- The Blue Yarn by Roman Mars

I probably don’t have to tell you that the lean concept in software development is adapted from the automobile manufacturing industry. In this podcast episode, a really interesting case study is shown where continuous improvement by reducing “waste” was achieved at a cancer centre in Seattle by adapting the Toyota Production System to healthcare.

Here were some salient points that I thought were notable in this:

Change is hard

“When Dr Kaplan told his staff they were changing the whole way they operate…the response was not pretty…There was a lot of anger…led by the doctors of course”

Change is hard. The improvement at The Virginia Mason hospital was a multi-year project. The driver of all the improvements was the needs of the cancer patients (as well as the need to save money). However this butted against the desires of some of the doctors e.g taking away offices with good views. Changing from a doctor driven experience to more patient driven experience is hard.

A different angle

“We couldn’t conceive of it intellectually until we saw it visually”.

People think they are dealing with an issue intellectually but until they see the situation represented in a different way…using a blue ball of string and a map of the hospital in this example, they might not be able to see where improvements can be made.

Using a different approach identified that waste existed in the form of patients having to wait a lot but until a different approach was…no one identified this. It was just the way things had always been done.

Sometimes people need a kick start. In general, people don’t really like being told what to do, although IMO there are times when this needs to happen but that’s the subject of another post. Helping see issues for themselves allows them to then work with you and their colleagues to solve them.


“If you’re anything like me when you hear the phrase ‘management system’ part of your brain begins to shut down. Another part of your brain prepares itself for hearing either a load of complete nonsense or common sense tarted up with unnecessary jargon”

In many walks of life, issues can be over complicated by the use of  jargon. Speaking in plain language is preferable; be careful about introducing terms like “sensei” or “Scrum Master” for example. Providing some terms as a framework can be useful but you have to be careful about them getting in the way.

Effort = Results

Putting in the effort to change yields results, despite the difficulties. In this example, it saved money by making the hospital safer and by eliminating waste and (presumably) helped the cancer sufferers themselves, improving the clinical experience by considering their needs as a priority. User Experience design for healthcare.

Further reading

There is a book about the Virginia Mason experience called Transforming Health Care: Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience

Amazon page

Publisher page

Here is a review of the first 3 chapters over at The Lean Blog

Lean Blog review

I haven’t read the book but it’s definitely on my “To Read” list.

The 99% Invisible podcast seems pretty good. I’ve subscribed on iTunes and it’s also available on Soundcloud.