INTERVIEW – “Dr Fred” is an amazing leader, who led one of the most successful lean healthcare transformations this magazine has come across. In this Q&A, he talks to Planet Lean about his new book, which is result of over 15 years of lean learning.

Interviewee: Dr Carlos Frederico Pinto

Planet Lean: Dr Fred, what motivated you to write this book?

Carlos Frederico Pinto: The Manifesto is a new, adapted and expanded version of what we called the “Leader’s Manual” at Instituto de Oncologia do Vale. We’ve been using this since 2015 to develop our leadership using standard practices and a learning roadmap. We also shared the manual with other organizations, which, after adopting it, experienced the same benefits we did in improving how to train leaders at the gemba. The manual had a companion “Action Guide” that we used to go to the gemba. It focused on mentoring leaders and apprentices with several templates for gemba discussions and respectful leadership behavior. I decided to publish only the first part of the manual as a manifesto, but an “Action Guide” will soon be available, too.  

PL: What is the purpose of this book?

CFP: I created the manual nine years ago to develop our leadership in a fast-growing environment. We needed to disseminate our values and principles to new team members and prepare our leaders for the new opportunities that arose between 2016 and 2018, when – following a merger – we had a chance to bring our management system to an organization twice as big. At the same time, IOV started collaborating with the local public healthcare system to help them reduce waiting times and address their care delivery problems. During the pandemic, the practices contained in the manual were critical to sustaining our management system in a deeply challenging context. In fact, most of our success navigating the pandemic crisis can be attributed to them. At that time, both IOV and a number of public hospitals in our town were using the Manual to provide leaders with the tools and practices they needed to face up to the emergency. With the book, I am hoping to bring these important lessons to our wider audience.  

PL: In your opinion, what is the contribution of the Manifesto?

CFP: The Manifesto is based on Dr. Deming’s System of Profound Knowledge (SoPK) and how to use it daily. Obviously, other ideas from several other authors are introduced to better illustrate how SoPK works and how it can impact an organization. So, one important contribution of the Manifesto is that it will help organizations understand why several simultaneous initiatives don’t work, why leadership behavior is more important than one might think, and why organizational change will not work if it is not addressed to leaders first. If you look at this from perspective of the Lean Transformation Framework (which we use in the Action Guide), you’ll find that the content of the Manifesto is related to the foundations of the house: mindset, basic thinking and assumptions (we also discuss how to revise your assumptions, by the way), and leadership behaviors (which are deeply connected with the basic thinking). The Manifesto will help lean practitioners strengthen the understanding of their assumptions and basic thinking and identify those that are required to lead a successful transformation.

PL: Is this book better suited for mature lean organizations or does it also apply to companies in the early stages of their journey?

CFP: The book is for leaders involved in change management at any level of the organization or at any stage of maturity. The idea of a transformation architect suggests the importance of applying Lean Thinking to our organization with a clear understanding of what the problem is – in other words, what the organization needs to succeed. After all, it is an architect’s job to build a house in a way that takes into account what is important for you, what your values are, what your interests and plans for the house are (if you’ll invite friends to dine in your patio, if you like TV or games, if you like to cook or paint, and so on). I guess you could say that the architect builds a house that you can then turn into a home, that is uniquely yours. The same is true for a transformation.

PL: Lean companies will have established practices like daily meetings, huddles, stand-up meetings, visual management, and so on. What is unique about the approach you introduce in the book?

CFP: It’s all about behavior and understanding how people think and behave when they face certain challenges. Most of the time we are talking about how to create a psychologically safe environment. It’s important to have the tools and practices in place, but it’s equally important to understand that Lean is a socio-technical system... And that the “people side” of change can’t be overlooked. Indeed, a psychologically safe environment is vital to succeed, and it’s critical to realize that, sometimes, even minimal, almost imperceptible attitudes can erode that safety. The Manifesto will also help leaders in their self-reflection, helping them to understand how their behaviors can drive a team in the right direction (or, well, the wrong one). Leaders must accept their fallibility and adopt more humble attitudes towards daily challenges. A few minutes of extra reflection can prevent huge headaches down the line, and this typically works better when it is shared with the team.

PL: What obstacles have you encountered in the dissemination of these practices?

CFP: The major obstacle is a poor understanding of how systems work – specifically complex systems – and how we are supposed to deal with them. Organizations are used to studying their markets, using large amounts of Excel-plotted data and SWOT analysis, but are often unaware of, and are therefore not capable of dealing with, the complexity that exists within their boundaries. As a result (as my experience in healthcare taught me), their response to complexity is often to introduce more complexity. This seems like a paradox, given that our brains are attracted to patterns and simplicity. The Manifesto will help you see how every system follows a pattern, often the simplest possible pattern that is best suited for the way people think.

_{The e-book of System's Architect Manifesto is available for purchase here.}

_{THE INTERVIEWEE}