DARRYL GREENE: Full Interview

FULL INTERVIEW TRANSCRIPT

The transcript has been lightly edited for clarity…

Jake Stiles: Hi, I’m Jake Stiles, CEO of Stiles Associates. Joining me is Darryl Greene. Most recently, Darryl was the Executive Director of Continuous Improvement at the Cleveland Clinic, one of the top-5 hospitals in the country. He has recently written this book, Experiencing Improvement, which talks about the Lean transformation he underwent at the Cleveland Clinic. Darryl, thanks for joining me this morning.

Darryl Greene: Thanks for having me.

JS: Tell me why you wrote this book.

DG: The book was really written to recognize and thank the caregivers we collaborated with. They embarked upon a journey for change and Lean transformation, and we wanted to highlight those successes and efforts – the book is a tribute to them. Additionally, we framed this book from two perspectives: What they experienced through the transformation and the other was our perspectives coming from different industries into healthcare. That’s the reason for the title.

JS: When you look at your background, you’ve led this transformation in a number of different industries, including discrete manufacturing; financial services; and the last eight years with the Cleveland Clinic. I’m curious what you saw as the major differences and what else you learned along the way.

DG: First I say it’s been fun; it’s been a nice ride. There’s a fundamental question people are always asking and it’s, “Can you take a proven Lean transformation approach from manufacturing and apply it to an environment like financial services and healthcare?” I think the answer to that is yes. You truly can get an ROI and a cultural impact is the first thing I would say.

The second thing I would say is leadership is absolutely critical, and the reality is leaders need to lead and sponsor all the way from the beginning when they start to as it’s getting going to all the way in terms of ongoing visibility that leader has to provide in order for it to sustain itself.

Perhaps another is the fact that it’s hard. The thing about transformation is it’s changing from the status quo. I don’t know about you, but whenever I’m asked to change, I struggle. The reality is it’s hard, so if you can put it into a strategy of implementation and how to navigate it, it can be done.

JS: We’ve both been involved in assisting Lean transformations in one form or another for a lot of years, and the key component always seems to be leadership engagement. How did you inspire leaders to get engaged across any industry, and what were some of the challenges associated with that?

DG: In terms of the importance of the leader and inspiring them, it starts with first connecting with them and meeting them where they are. You can’t walk in and tell them what needs to be done; that’s just not going to work. Time must be spent with the leader, listening and understanding what they really need and then trying to meet them where they are. In the case of healthcare, I actually started going on the nursing floors and rounding with the physicians and nurses just so I can understand what their environment was. All I did was listen; I did not suggest at first, so I think some of the inspiration came from the fact that I wasn’t trying to do something to them, I was trying to understand and collaborate with what they need then work alongside them to move it forward.

Inspiration comes with you allowing them to see some success. Whatever you’re focusing on, you got to get the results. You know this, Jake. If you’re not getting the results, if you’re not impacting what their interests are, there is no inspiration. That was another piece – whatever we locked in on and collaborated on together, that we made sure success happened on the back end.

JS: Based on your experience across multiple industries and those reporting structures – clearly there is a far more dynamic fluid reporting structure within healthcare – where physicians have far more influence and autonomy than other executives do in other industries. What challenges did that cause and how did you approach that?

DG: The hierarchy and the span of control was probably one of the hardest elements to understand and think about how to manage and maneuver within. If you think about financial services and manufacturing, they have good incentives with bonus structures and other mechanisms in which you can be involved. I remember GE; 40 percent of income was tied to transformation. That rallies the troops pretty quickly. Financial services is similar. You can get some kind of bonus structure and incentive; usually some multiplicative factor of your base. Those are some good reasons for people to be engaged and involved. As you point out, once you get to healthcare, those incentives don’t exist that way, and the ability for a top-down edict is important, but harder.

What we found is you literally have to go to each physician. Each physician has been trained, practiced and rewarded for their specialty and knowledge. That has to be acknowledged when you’re doing the Lean transformation, and you have to spend the time understanding and match what’s in it for them. If you can build that relationship then you can start to inject some of what you need. As an example, if their interest is access to patients, then great. You can start bringing in other things and say I brought in the access, now imagine what we can do if we start looking at turnover, or other things perhaps you’re facing. It’s doable, just an acknowledgement the hierarchy and the incentives don’t create the spread as quickly in healthcare because there isn’t that same structure. You have to spend time with each physician leader.

JS: It’s a cell by cell.

DG: It’s a cell by cell. Whether you want to say s-e-l-l or c-e-l-l from a standpoint of an organism, it is a cell by cell.

JS: Let’s talk about the value proposition for a minute. We experienced that when we were supporting the clinic with the work we’re doing, the value proposition of getting people to change industries and come to healthcare was very apparent. It was clear the first day as soon as they walked into the clinic, they felt differently about the work they were doing because they were affecting people’s lives. Talk about the value proposition from your perspective and how do you use that to your benefit?

DG: For me, in terms of the value proposition, I see the most galvanizing effect is linked to patients. Anytime you’re struggling through a problem or trying to frame an opportunity, typically if you can get it in the context of talking about patients – it truly is the heart of why they’re there; it’s part of the DNA. I’ll give you an example. If I came to a particular leader and said I can improve your equipment utilization, they’d look at me saying what are you talking about? I can get more patients through your existing equipment, which is going to allow you to see more patients and allow you to affect more lives. That’s a different discussion. You have to tailor it toward what’s it to them, and I think the patient is a very valuable value proposition.

The other thing that’s going on now is I think there’s a new value proposition that’s here. Years ago, if we mentioned cost, we would’ve faced a lot of pain. Mentioning cost in financial services and manufacturing is second nature, but in healthcare talking about cost was a challenge in that there’s a true belief that whatever is required to save a life you do that. Cost is not what’s going on in someone’s head. Part of what we spend some time doing – and I really applaud leadership for this – is they started talking about the reasons why cost is relevant. The reason cost is relevant is ultimately it means if I can reduce my cost I have more margin and capital. If I have more capital, I can re-invest; if I can re-invest I give you more equipment; I can give you more resources and the buildings that are needed; I can give you more OR rooms; supplies and so forth. That re-investment actually became a very powerful …

JS: Like a train …

DG: That’s exactly right. And now of course there’s healthcare reform. That’s a very good value proposition. As you know, everyone is talking about value in the context of quality over cost, and that quality can range all the way from services to thinking about safety to the actual clinic outcomes – and dollarizing all of that is truly in reason. People are starting to understand the importance of the cost of the services as well as the outcomes of the services.

JS: You mentioned dollarizing in your last statement. How important is it to dollarize ROI on an ongoing basis as you’re driving these transformations?

DG: There’s sort of this [notion of] culture or results; there’s an interesting discussion that tends to happen. Do you worry about impacting the culture and the results come, or do you start with results then soon the culture will come? At the end of the day, these are all businesses. Whether I’m in financial services, manufacturing or healthcare – they’re still businesses. They exist because they have some type of return that is allowing them to do so through the promises they made in terms of quality they offer, but also managing their financial discipline responsibility. So, dollarizing what we do is critical for the survival of the business.

Your question about the importance of sustainability – whether we’re at JP Morgan Chase or the Cleveland Clinic – seeing 2-3x investment, which for us meant that for whatever we cost, we had to achieve at least 2-3x that cost in either revenue or cost reduction. Seeing that year after year in that fashion shows something has happened in the culture in order for that type of return to happen year after year. When you talk about dollars, you can’t just think of a single year, but you have to show it over multiple years and let that be a measure of having some sustainability and impact on culture.

JS: Absolutely. Particularly, you start dollarizing that ROI outside of your own team. I know you’re looking at 2-3x in ROI, but as you really start to train people – it’s one of those reasons suggestion programs are so powerful. They start to come up with their own improvement ideas, and give you them the tools and support to garner that type of thinking. That’s really where it starts to pay back.

DG: I agree with you. If you think of either industry – financial services or healthcare – we never said our team earned this. We said in collaboration with the caregivers or frontline, these savings were earned.

Going back to what I would do differently, you have to start owning the transformation. You got to make sure that your group isn’t getting looked upon as “the ones.” You truly are engaging the others to, in turn, do additional work. Your hope is once they experience it, now they’ll start to actually embody it, use it and apply it, so they can see more issues freely and address those issues. That to me is one of the challenges, is making sure you don’t have one group or individual own it.

JS: Let’s talk about that for a minute. You’ve been involved with driving these transformations at GE, Hoover, Maytag, JP Morgan and the Cleveland Clinic. Vastly different industries – what did you learn along the way that changed your model or affected how you thought about those transformations?

DG: Don’t jump industries every other year (laughs). Actually, I consider myself very fortunate to be able to go from industry to industry because of the transformation work. My ability to go between them was truly driven by an interest level and the opportunity to utilize something that was working in one place [and delivering it] to another industry. To answer your question about what was learned … that value proposition is so important in selecting what it is the sustainability of that value proposition. For instance, healthcare is so busy – it’s a very busy place in terms of trying to deliver patient care. So, for you to assume I can just deliver for this year and rest on the success of that is very dangerous. Sustaining the value proposition year over year is one thing that’s critical for all these transformations.

Leadership – I have got to tell you, I know people read about it, think about it – but that determines success or failure. No matter how many books you read, it always comes back to the leadership at multiple levels. You have executive leadership, but you also have to think about leadership at other levels. The reason leadership is so important, is because at the end of the day – and you know it as the CEO of Stiles Associates – people are going to pursue what you show is important, and you highlight and reinforce that over and over again. How do you get your folks to deliver on the goals you set collaboratively?

JS: Having a clear set of goals and supporting them along the way.

DG: Right, and you’re very visible. I think it’s exactly the same thing. We had great success at the Clinic, where you can see the leadership was active and consistently there. We also had pockets where we had some challenges, and you can relate that back to leadership. The other thing I’d say is important too is back to getting results. If you can get that you can continue to show that what you’re doing is worth doing.

JS: A good change agent needs to understand both change hearts and minds and get the results consistently.

DG: One of the things I definitely learned looking across my experiences, is that we have to spend time with the leadership. In hindsight, if I had to do it over again, I’m convinced that if I had spent more time with the executive leadership, some of the impacts and outcomes would have been even greater. Once you lose site of the leadership, shame on you. That’s my responsibility to do that, and that’s what I’m there for. I think that’s one of the things I’d tell everybody who’s doing this change and Lean transformation, is that’s where the largest portion of your time should be spent because they affect everything.

JS: Well don’t be too hard on yourself. One hundred and five million dollars in cost reduction in five years at the Cleveland Clinic really speaks to a lot of the things we’ve been talking about in terms of culture engagement and the actual changes process.

DG: I appreciate that, but again, that’s continuous improvement, right (laughs)? I’m always trying to figure out how to do it better.

JS: Let’s talk about the pace of change. Clearly the pace of change in different industries you’ve served has been different. Talk to me about those experiences and how you managed that.

DG: In healthcare, the pace of change for a given initiative tends to be slower, but for a multitude of initiatives it’s perhaps quite fast. I’ve never seen an industry that has had to have focus on so much at the same time. It’s not simple enough to only worry about patient access, value relative to cost reduction or another 30 million people will have the opportunity to have healthcare. It’s not practical to pick one, so you’ve got to pick all of them, and managing that scope of portfolio is really one of the greatest challenges. The multitude of what needs to be done affects that pace. The other that affects the pace is the place is busy, so when you’re busy and have many things in the air at the same time [you’re constantly changing your focus].

In healthcare, because the energy is so much on the patient, I think part of the challenge is getting the time with the leaders to actually do the work. In some of the industries, doing it right there in the context of the work is more doable. I’m not saying you can’t do it, but that’s a challenge healthcare faces.

JS: Understanding the dynamics in any industry or business before you really start to ask the tough questions is really critical. Healthcare is full of dynamics with multiple focus areas.

DG: In financial services, if I’m doing something in the back office in terms of check processing or something like that, I can pull people away for a multi-day event. I can’t go into healthcare and say I want you all to stop doing surgeries and so on and we’re going to multi-day. If you schedule it appropriately, that’s kind of the dynamics I think you’re talking about. It’s not that it’s not doable, it’s just you need to be in tune and understand your environment in order to take what you know works and apply it in a way that fits this environment and matches what the caregiver needs with collaboration to make this better.

JS: You know it’s interesting, in the work we’ve done across multiple industries there’s always a learning curve. In healthcare, we always give advice to take time – even six months if you have to – to understand the dynamics and develop relationships before you even attempt to really drive change.

DG: There’s a level of support you get when you spend time understanding and acknowledging the frontline – it’s almost a statement of respect. I respect what you’re doing. I respect how you do it. I want to figure out how I can help you in some way, form or fashion. To start off by talking is not usually a good idea.

The other thing that’s interesting with that too is at what point do you get individuals who have internally learned it enough to become leaders and help move that transformation forward? You’d like to pass it along, so folks are doing that work. Early on, we were thoughtful about when to pull physicians into sections. Then we started to think about can we get into their training. The Clinic provided some physician leadership training, and we got into that curriculum. So, within the context of that curriculum we would say how many of you are here because you’ve heard about this or are anxious to get out of here and start to apply. We would look out for the ones who would come up to us during or after class and say they’re interested.

The ultimate step that was impactful identified time for those physicians to do this work. They would say 10 or 20 percent of their time is going to be spent helping lead the continuous improvement effort and Lean Transformation. That’s a very powerful message to the organization, and seeing the leadership occur from the physician’s vantage point obviously had a big impact in terms of garnering the interest of other physicians.

JS: You think about the burning platform concept that in many cases is required to ignite this transformation. It’s going to be different from system to system – you’ve got different pressures and different dynamics. Even in the same system, you might have had institutes at the Cleveland Clinic that had a need, so as a result they were pulling on you a lot harder than other institutes. In your efforts to really drive this message and this work across all institutes, how did you create that platform when it wasn’t there?

DG: This gets back to what we discussed before, which was understanding what’s in it for me? And I don’t mean that selfishly at all – you just got to connect. We spent a lot of time in relationship-building, and the reason why was it was a source of information as well as the ambassadorship it provided. We were constantly trying to figure out how to align with what we had to offer with what the organization needed strategically. To me that burning platform is you got to get to the strategy, even if it’s at a local level, there’s still a strategy someone is trying to do, but ultimately you want to get to the executive-level strategy.

In the case of manufacturing, typically efficiency and cost were a significant burning platform, which was part of the strategic priorities of that industry. In the case of financial services, it had very much to do with what the customers wanted because we were in check processing, and anything from depositing money you knew as soon as you possible you had those funds to make sure you got your statements on a timely basis. It was very much a customer-centric focus, but also understanding how efficient and fast it was. For healthcare, a lot of what we talked about was managing the busyness and the flow because the experience the patients were dealing with was a big deal. All the way from when I make the official call, to when I get there, to when I do and don’t do surgery, to how soon I can go home, to how to include my family in this process – that was where we started.

What I love is now that the Affordable Care Act is truly active, to me that has created a burning platform for healthcare. You see the concerted efforts, whether you’re a payer-provider, employer or patient – everybody is now actively involved with trying to figure out how to make healthcare better. You can argue all you want about many of the aspects of it, at the end of the day you’d be hard pressed to say you didn’t have all parties figure out how to make things better.

JS: To that point, you think about the visibility in healthcare right now in terms of patients being able to go online and look at the outcome records, and being able to make a decision based on that and the cost – and how that affects any number of organizations.

DG: Transparency. You know this well: If I have a metric; I understand how to perform; I have the ability to see the good or bad or opportunity or improvement; and I’m going to pursue what’ll be best for me. It’s all about getting people the information to make better decisions.

JS: And competition makes us better.

DG: And competition makes us better. I can say that right now, I think Lean transformation has a foundation now in healthcare unlike it ever had before. This is the time. This is the moment in my mind. I don’t mean it in the sense of it sounding as short as a moment can be. This moment is probably the best five to 10 years at a minimum. This is the time to take a lot of what we’ve learned in other places and collaborate with the physicians and payer providers and create something that’ll improve healthcare for patients and families.

JS: How impactful is it to have functional leaders who actually understand Lean and support it because they have a sense of what it can do for a patient?

DG: I would love it if I could have individuals who both understood the technical aspects of the business of care delivery and also understood the practices and principles of Lean and other improvement work. If you bring those two together, you have a different awareness and ability to see waste and address some of that. Standardized work can have an impact. I think it is absolutely a goal. There are realities you have to work with, which is not every physician is going to become an expert in Lean – it’s not realistic. To educate; run alongside; experience through practice; coach; and make meaning of it for them so they understand its principles and its purpose and direction. They are going to start to impact other people around them: their physician peers, other caregivers; staff; nursing; and mid-level providers. “If my leader is doing it then there must be something about it.” I think it has its opportunities, but it has its challenges you have to manage through.

JS: What it boils down to is you’re trying to create that a-ha moment in as many individuals as you can because that’s where the spread is.

DG: It’s funny you mention the a-ha moment. The book is really about that a-ha moment, whether you’re senior, middle or front line. When you start to clearly see what their issue is, and you have the ability to address it and see the improvement, I don’t know anyone who hasn’t gone through an “Oh my. I get it.” That’s really where you want to impact that. If I get them to that moment then I have the opportunity to start talking about that spread. How do I make sure they have the tools, support, the mechanisms to now do it again then do it again. From there, we go from being reactive to that proactive stance, where they’re constantly surveying for opportunities.

JS: Talk about the strategy you’ve used regardless of industry to create the spread.

DG: I think about all the organizations – the GEs, Maytags, JP Morgan Chases and now the Clinic – very large and complex organizations. We spend a lot of time talking about the breadth – the basic tools and practices you can give the organizations so they can understand how they’re performing and make small improvements. Depth strategy is in a given area, division, line or institute; how do you impact the folks through the a-ha moment and start embodying that every single day?

A lot of energy was spent putting in those basic things. The breadth and depth for GE happened much faster because of that incentive. The depth was everyone pulling together their teams and organizations the training and applications, and putting that into the strategy and making sure the cascading deployment occurs in all the energies around that was really what was happening in those spaces. That’s more of the manufacturing.

Financial services was an interesting deployment because truly, we started with the front line. We really believed if we can get visual management in every major area within the check processing operations, independent site, that was going to be a very powerful tool for the front line to have an opportunity to see what they were doing and what the issues were. Common measures and helping them solve their problems. How do I translate that? How do I take a site that’s in Detroit and translate that to a site that’s in Indianapolis?

That was the spread, and yet I can go into a given area and spend more time at a given site and really go deep. The Clinic was a different animal. I didn’t have the opportunity to say we’ll put visual management everywhere. The beauty of the Clinic was there were other support groups that were doing business intelligence and a lot of scorecarding. We partnered with these folks and were like hey you’re doing scorecards, we’re all about a balanced scorecard – how do we get that across the organization so everyone looks at measures that come from the executive leadership? That’s the spread.

A lot was spent bringing people together to have reviews and dialogue around how they’re performing, and because I had similar metrics across sites, I had the opportunity to do an apples-to-apples comparison. Now when I start seeing I got the issues because I’ve cascaded the best I can those common measures, how do we start to solve the problems?

That was some of the breadth, then the depth, we tried something a little different. We deployed and embedded resources to given areas, and I’ve got to tell you and thank you again, Stiles Associates. You were part of my thought leadership, and I really appreciated the advice you and your brother Ted had provided when we met on a regular basis around, “How do I get a resource into an area so I can truly go deep and really have that resource beyond point working in collaboration with that leadership?” Becoming part of that leadership team and helping to see all the opportunities to integrate it. That to me was a big game changer.

JS: Thank you for the compliment on the thought leadership piece – we’ve certainly enjoyed supporting your effort at the clinic for eight years. You know it’s interesting from a thought leadership standpoint, having been in this business for 20 years assisting all sorts of companies through transformations, we’ve all become students. We know what works; we know what doesn’t; and we know what the structure should look like at any organization, so a lot of our conversations over the eight years we’ve worked together as I recall were work-structure related. What lessons could we take from other industries that can be effective here, because what it boils down to a lot of those approaches were very simple. The embedding approach we used in the institutes; that’s not necessarily different from a manufacturing plant having a Lean leader in it.

In watching and studying those transformations, looking at the rate of success was very important to us. Whether you asked for it or not when you hired us, this comes with the territory – it’s in our DNA now and we feel it’s part of the value add that we bring to all our clients.

DG: I would agree there are some common elements of success. The power of thought leadership is your lens looking outward; you have my lens that looks inward; and putting those together to try and understand what’s needed in my space and being innovative about what’s happening out there, and trying to figure out how to bring that together and make it successful is what’s neat about the relationship we had.

JS: Those conversations are critical because without them, we would not have been able to support you. When we think about the type of people who are going to be successful at the Clinic, we had many discussions around what does that person look like.

DG: I went into it thinking about individuals who are going to be successful in helping the transformation, I was pondering their fit into the culture; their willingness to listen; their expertise; their willingness to influence in a way that’s respectful and encouraging; and helping people make meaning of tools and practices. That’s one of the top things: Helping people make meaning of the tools and practices in their environments. Our discussions around who are these people and finding them were paramount. I think we were very successful in the way we collaborated.

Thinking about this partnership is partnerships in general. One thing I’m sure of is in any transformation – in its significant size and complexity – you can’t do it by yourself. You need internal and external partners because there’s no one person who has the solutions. You got change management in there; tools and practices of Lean transformation; learning and development that has to happen on a consistent basis; and all the infrastructure that needs to happen to bring data and information process and act upon that.

I just don’t know anybody who can go in and try to pursue something where they don’t start to connect to some of the other folks.

JS: Going back to how impactful it is to have functional leaders who support Lean. With all the clients we supported over the years, it’s been real interesting to watch the spread that occurs as these companies in a variety of industries start to see the power of what they’re trying to get their hands on. We have built our business and been pulled by our clients into a lot of different functional areas because of the need to have that type of support in finance, supply chain, engineering, manufacturing, etc. – you need that team.

Whether or not you bring them in from the outside or train your internal people, it works but the focus needs to be on giving front-line and executive leadership the tools and training so they can start to live and breath it to what they’re driving their organization to do every day. That’s where we’ve seen major transformations occur, and it doesn’t have to occur in a short period of time. If you get that piece right – going back to ROI – it just starts to multiply every quarter. Then it becomes unstoppable.

DG: One of the things that was big for me in lessons learned and the impact was the thought leadership piece. The partnership we had with you and your brother Ted was very impactful. I don’t know if you recall, but for the most part the things that were happening in my space I wasn’t sharing. I was very much focused on what we were doing and how we were doing it, and over time, the deepening of our relationship in terms of you all sharing with me what was going on out there. What were other people doing not only in healthcare, but in financial services and manufacturing?

It was a very powerful transition for me to have that thought leadership and start to incorporate it in some of the planning I was having in my team on where we’re going, how we’re going to do this and what’s the next big step for us. I just really want to thank you at Stiles for that thought leadership – it was amazing.

JS: You’re welcome and it was a very enjoyable experience. I’m convinced we would have not been able to really understand your needs unless we had those conversations on an ongoing basis – and allow us to predict what your needs were.

DG: I remember the phone calls just to share where we’re headed. What I learned from that was within the organization, how do I better leverage and partner with folks internally and start to include other support groups. Even sharing the perspective of leadership to my own team, and so it had a significant impact.

JS: Based on your experience in a number of different industries, I’m curious where you see Lean going next.

DG: We’re always thinking about what’s next – it’s sort of in our DNA. I would first say, honestly, there’s so much still here. I look at the opportunities to apply improvement work and transformation with manufacturing, financial services and healthcare – we haven’t even finished. Particularly in healthcare; healthcare just starting. Financial services likewise still has a long way to go, and I don’t know anybody who’s still not plugging away in manufacturing looking to do it better.

From my vantage point what’s next – I’d encourage the continued focus and application in these existing industries whether it’s been there for a long time or just starting out. Beyond that, I start pondering what are other areas that require attention? Academia is one if you think about it. Think about how often we hear about the cost of going to college, and forget post-secondary, you can go all the way to elementary. The opportunities to figure out how to make teaching and education more efficient is a pretty sizable challenge. I can see some possible applications associated with that for Lean and other improvement work in that space.

JS: As a parent with a long way from having to pay those tuitions, I’m hoping the competition between universities and community colleges is going to drive costs down and make education more affordable.

DG: Well, I’m facing it right now; I don’t have the time you have (laughs). The faster we can get there the better. I’d love your thoughts even beyond that. Sometimes I ponder those possibilities. We tend to apply this in for-profit; I always wonder about the continued application in not-for-profit. Obviously, healthcare is the beginning of some of that. I don’t know any nonprofit that wouldn’t be looking out to have a greater impact on the service they provide to help others, and do that in a way as efficient as possible. Then I also think about third-world countries and the possibilities associated with them there.

JS: The possibilities are endless. In the spirit of continuous improvement, I would second your earlier comment about getting beyond the tip of the iceberg with the industries we’re active in now: manufacturing, healthcare, financial services, government and nonprofit. We need to dig deep and focus on what’s going to improve those businesses and how do we do it.

DG: Your “tip of the iceberg” comment is the perfect term for it. We’ve all seen the picture of the true iceberg below, and I think that’s true for its depth and breadth in terms of what can be done there. Pure opportunity.

JS: Agreed. Well Darryl, thank you for your time today; it was a great discussion.

DG: It’s been a pleasure.

JS: Again, Experiencing Improvement is the book Darryl has co-authored that talks about the continuous improvement efforts at The Cleveland Clinic, which is a great read regardless of what industry you’re in. It’s got a lot of great lessons.