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Two Years in Tanzania and a Whole New Understanding of Purpose

by Michael Grogan
January 13, 2015

Two Years in Tanzania and a Whole New Understanding of Purpose

by Michael Grogan
January 13, 2015 | Comments (6)

After months of anxiety, my work life had finally come to a climax. I'd arrived at the point of no return. I finally told my boss “I quit.”

I was walking away from my comfort zone in corporate America to coach lean thinking in a hospital in one of the poorest, but most interesting countries in the world, Tanzania. I knew I would rather go and fail than stay and never know. Two years have passed since that day. I offer my reflections on these two years so that you might reflect on the comfort zones in your life that you possibly need to break free from.

When I quit my job in the US, I had already been to Tanzania three times. On my second trip I fell in love – not with the woman of my dreams (this is still pending!) – but with a particular healthcare organization – CCBRT (Comprehensive Community Based Rehabilitation in Tanzania) in Dar Es Salaam. For 20 years, CCBRT has transformed lives through disability and maternal healthcare services. I was the organization’s sole lean coach with the responsibility of initiating a lean transformation. No easy task as this is a 450 person organization. A lot of the credit for me being there goes to CCBRT’s CEO Erwin Telemans. He was the one who invited me and had the courage to experiment with this “lean thing”. In Tanzania, Lean in healthcare was unheard of, but he saw the potential. So we started to dream big.

Getting to Work

We first initiated classroom training focused on problem solving – certifying staff as “yellow belts” for those who completed the curriculum (four days of training and two improvement projects). Most senior leaders welcomed me on board. This "lean thing" was looking a lot like "structured common sense." There was also natural skepticism. Is lean thinking really applicable in healthcare? Will it work here? If you asked my team members to describe me in those early days, they probably would say passionate, over enthusiastic, and “talks way too fast.” I had many lessons to learn, but the CEO and I were determined to keep moving forward.

The satisfaction I got from observing those “a-ha” moments when people started the process of thinking differently was probably my greatest joy. We were making real improvements, visible and invisible. Seeing staff apply simple concepts (go to the work, observe the work, show respect to the people who do the work) enabled them to achieve amazing results. One team significantly improved the safety risk of staff getting hurt in the disposal of hospital waste. Another reduced the cycle time of a donor reporting process by 70%, saving 30+ days a year on non-value added work. When I started doing gemba walks with leaders, more and more of these moments happened.

Seeing wonderful people – doctors, nurses, and managers – pick up new tools, behaviors, and mindsets reminded me of the privilege of my position. I was lucky to work with people who were willing try something new. At the same time I was fighting a personal battle. One time I witnessed of one my favorite doctors teach lean thinking to her own team. This should have been one of my proudest days: when the student becomes the teacher. For a moment, it was. But later, alone in my room, I felt isolated. I had been struggling with how to manage being on my own for a year. This was the first time in my life that I had so much time to think. This pain would enable me to discover more about myself in two years than I had in the 30 years before I moved to Tanzania. While my team members were learning new ways of thinking about work, I was beginning to think differently about my own purpose.

What I've Learned

Getting out of my comfort zone allowed me to discover who I was and what I am here to do. This is one of many life lessons that this work in Tanzania has taught me. As a result, for the first time I now practice daily gratitude. This habit alone has had the biggest single impact on the quality of my life. From a lean perspective, my experience CCBRT has reaffirmed my belief in the importance of focusing on leadership. Everything rises and falls with leadership. Leadership excellence, including willingness to experiment, precedes operational excellence. Where there was pull, I gave CCBRT's leaders as much one-on-one time as I could. In retrospect, I wish I gave them more time.

My biggest mistake? Spreading myself too wide and thin. The Yellow Belt program was a great idea, however, taking 94 staff into the curriculum on the first year with only one coach resource was ridiculous. I got carried away. I let them down as I could not give them the required time in the gemba that was needed. Learning from this lesson allowed more focus on working directly with leaders in creating model cells. With model cells we can show people what good looks like. I believe this philosophy of “going slow to go fast” is one of the most effective approaches in making change contagious and lasting.

I’m grateful as well for the support we have from the lean community. Five lean coaches have volunteered their time with us and more are expected. John Toussaint from the ThedaCare Center for Healthcare Value spent a week with us CCBRT and later hosted four of our senior leaders in the US where they attended the CEO Site Visit and “Creating a Lean Management System” programs. To quote CCBRT’s CFO Elly Festo: “Visiting ThedaCare has forever changed the way I think about work.” This support from the global lean community has been critical for CCBRT’s lean journey.

The Opportunity Now

In a part of the world with such limited resources, it’s heartbreaking to see the suffering caused by inadequate healthcare and resources. I’ve seen far too much needless suffering. Knowing and seeing firsthand that CCBRT is doing something about it – whether allowing dignity to be restored to a disabled child or ensuring a mother doesn’t die from childbirth – makes me extraordinarily proud. Imagine combining the mission of CCBRT with the power of lean thinking. Millions of lives can be transformed. This is one way to make poverty history. As a lean community, we have the capability to truly change the world by working with others to share what we know.

As for what’s next, I’m working on stepping out of my comfort zone again. In March, with a heavy heart, I will have said goodbye to Tanzania and have moved to the Philippines. There I will continue my work sharing lean thinking, engaging organizations with powerful missions like that of CCBRT. I offer this story of my experience not because I expect people to do what I did. “Stepping out of one’s comfort zone” will be something different for everybody. But one thing I know for sure is that life really does begin when you try to leave your comfort zone. Thinking back to when I quit my job two years ago, my decision to leave turned out to be the best decision of my life. I’ve never grown so much. I’d love to hear if and how this relates to you. I’ve been blessed by so many people who have helped me on my personal and professional journey, and in that spirit, if there is any way I can help, do get in touch. 

The views expressed in this post do not necessarily represent the views or policies of The Lean Enterprise Institute.
Keywords:  global,  healthcare,  learning
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6 Comments | Post a Comment
Jess Reyes January 13, 2015
5 People AGREE with this comment

What an inspiring article Michael! The greatest frontier for Lean is in life saving non-profit organizations like the one you helped support. And the greatest barrier to entry is ourselves! The Lean Expert! It is difficult pulling away from traditional lean jobs in private industry. It is difficult for profit oriented lean consultants to justify the time and revenue potential to provide lean science to these masses. For me holding lean from them would be like holding back a new drug we know would save lives.

My new year’s resolution for 2015 is to begin a non-profit organization that will help close this lean gap for life saving non-profit organization involved in 3rd world healthcare, food care and emergency response.   But my greatest barrier is pulling away from where I am at today as it was for you. So for me the next two years will be my transition. I hope folks like you will continue to help build this lean flywheel momentum for these non-profit organizations.



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Silas Dickie January 13, 2015
2 People AGREE with this comment

Michael! Thank you for sharing your story with us! I agree with you on the importance of leadership. That was my biggest first-hand lesson from my visit to CCBRT last November. I now have an interest in looking for leaders everywhere I go. As a new lean thinker, I'm grateful for your leadership in particular. I know you'll do great things in the Phillipines, but also learn a whole lot, so please keep sharing your story! Transparency is the way we do things. Thank you, Michael!



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Andrew Parris January 16, 2015
1 Person AGREES with this comment

Thank you Michael for sharing your moving story. It was great to see you and the evidence of your work at CCBRT in Dar es Salaam - both in things I could see in the Gemba and in the people I met.

Thank you for teaching Lean Daily Management to World Vision's East African Process Improvement Leads and Champions. Training from outside Lean professionals such as yourself has been of great value to us.

We have seen how Lean helps NGOs do more with less - and this is of great value to the poor and needy whom we serve. I wish you great Lean impact in the Philippines and other parts of Asia.



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Lester Sutherland January 23, 2015

Michael,

I saw your post in Linked-In and came here to read the story.  It sounds like you are doing really great and needed work.  I am wondering who this "woman of your dreams " is who is allowing Tanzania and now the Philippines.... It must be a great adventure.

 

Carry on with the good work.

Les



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Linn Asbury March 14, 2015

Well done, Michael!  Trying to do the same in my own very tiny way in remote Kenya.  I have a feeling our paths will cross some day.  The guys (Jim and Dwayne) are still rapid about using lean in mission work so we stay in touch frequently.'

Blessings to you.  Linn



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Anita Vogelius March 28, 2015

Ever since I started with Lean I felt transformed, as if something was happening differently in my head from that moment. thanks God, I am not alone! And I am extremely happy to have joined the Lean people.

It made me look at the traditional leadership with totally different view, but at the same time I find it extremely difficult fitting in my organisation based on traditional leadership values. 

Anyway, I have found out that my values had always been a close fit with Lean values, and I am happy to have found it out and if I can bring this message further and if it will benefit others I will be extremely happy.



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Search Posts:
Integrating Visual Management
Joe Murli & Mark Hamel
Value-Stream Mapping for Healthcare
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By John Toussaint, MD and Roger Gerard
Potent Medicine
By John Toussaint, MD
"Too Busy to Walk the Gemba"