PAPod 515 - Engaging Insights from the Santa Fe Workshop Q&A Session

Show Transcript

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Hey everybody, Todd from the future. How do I sound, future-y?

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So this is a part two. If you haven't heard part one, it was last week's, but it hardly matters.

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Although if you get a chance, it might be good because I do give kind of a brief

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description of what this is about that I probably will not give this time.

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Either way, enjoy the pod! We'll be right back.

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Music.

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Hey everybody, welcome to the Pre-Accident Investigation Podcast.

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I'm Todd, your host, Todd Conklin, just in case you don't know who I am.

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And this is part two of the outbrief of the 2024 Santa Fe Workshop open question

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and answers that we use for the ending.

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So the first one went great. You loved it. Lots of feedback telling me so.

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So this is kind of the rest of it. And I think you'll enjoy this.

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Well, I'm figuring just about as much, if not more. So it's a big weekend for me.

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So I am currently at the Winfield Bluegrass Festival listening to,

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I probably am, even as we speak, discovering new music that I didn't know before,

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which is always kind of a, I don't know, when you find a new band,

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even at my ripe old age it's kind

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of exciting because two things happen one

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is you've discovered a new band which is always super cool

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but two you're like i wonder where were they were why didn't

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i know about these people where were they what's going on that's kind of the

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excitement so that'll be fun and then i'm zooming off to you know do some stuff

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and then i'll be nestled in my house enjoying fall as it appears around me in

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new mexico hope you're doing good how are things going,

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getting back into the swing of things and doing great work, good work done well

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for the right reasons, if you know what I mean.

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I'm hoping so. So what else about the conference in Santa Fe?

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Well, the other thing I would share with you, because it's worth sharing, is we've over, because.

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Because I'm connected with a t-shirt artisan, Steve Thomas, the t-shirt artisan,

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we have created some t-shirts that we give out at the workshops.

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And I was especially pleased with what t-shirt artisan Steve Thomas did on this

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one because it's a sugar skull.

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And if you don't know what that is, that would be something to look up.

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It's a thing from Dia de los Muertos in Mexico, and it's a skull.

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So it's kind of creepy because skulls are kind of fundamentally creepy,

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but they're normally made out of sugar, and they're a treat, a dulce, a little candy.

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But we took that same design, and on a t-shirt, we put Dia Sin Muertos en Los

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Trabajos, so Day Without Death at Work.

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And it came out great. People loved it. That was exciting too.

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So that was kind of a hit and fun to wear.

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So if you wear t-shirts, that would be the one to wear. I don't know if they're available.

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That's a really good question that I don't know.

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We'll have to see if we can find that out. If so, and you want one,

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maybe we can hook you up with one.

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We can probably do that. That's probably doable.

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I hadn't thought about it, but they're kind of cool looking.

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You'll think they're fun.

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That was a fun part of it as well. So let's pick up right kind of where we left

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off with Mike Peters and Martha Acosta and Jennifer Long and Bob and Andrea, oh, Bob Edwards,

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I should say that, and Andrea Baker and myself listening to some questions,

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some interesting questions that were we're sort of tossed out to the crowd.

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So without any further ado, let's jump into the pod.

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Sound familiar? This will save you time. They said it used to take me 30 minutes.

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Now it takes me three hours a day.

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So we actually didn't listen to them. We didn't ask them. We did this to them, not with them.

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And because of that, now we put more time pressure on them.

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If you ask people who get work done, what is in your way that doesn't help your

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operations? I've done learning teams on this.

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Supervisors, what gets in your way? They thought they'd get one or two things.

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They got a flip chart page of things that is absolute waste of their time.

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So in over a couple of months with a leadership sponsor, those supervisors were

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able to say, this doesn't help, that doesn't help. Let's automate this. Let's get rid of this.

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And in about a two to three month time, they gained back six to eight hours

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each per week. Would you like that?

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Yeah. So I came Came back to that site. I said, how'd it go?

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And the sponsor said, really well,

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I couldn't believe all the crap we have them do that brings no value.

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And he said, we have really freed up a lot of their time. And he looked at me

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with all seriousness and said, Bob, what should we fill the gap with?

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I said, you don't have a gap. Leave them alone. Let them go supervise.

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The problem was is we were doing things to them, not with them.

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People resist change. Why? Because we do it to them, not with them.

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When we did this change with them, they showed us where the wasted time was.

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And if you can get a supervisor closer to work on a regular basis,

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that's actually what supervising is supposed to be.

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So where did that all come from though? A leader willing to listen to the people

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actually get the work done.

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So yeah, I think we can alleviate some of this time pressure because I think

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we're doing a lot of stuff that there's a waste of time.

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Yeah. Yeah. So Bob makes me want to add.

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So actually, Bob and I worked the same company and they came out and we did

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pretty deep dive learning in the supervisors and they were spending two full

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days, 16 hours a week in timekeeping.

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So I had to do the board of directors, senior leaders meeting.

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And I said, I can buy you two additional days of supervision in the field.

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And of course, everybody's ears perk up.

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And I said, hire somebody to track your time, right?

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Because there's whole companies that are willing to come and do timekeeping, right?

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And it was the most interesting meeting because, and you know this guy too,

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the CFO of the company said, I've heard that shit for years.

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That's what he said. And the big boss, the big, big boss, like the board of

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directors boss said, and today we'll listen. Yikes-o automatic.

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I'm going to say one last comment on this.

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I think too, because I work with a lot of the senior teams, when it's a growth

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issue and you've got the time pressures,

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some of them aren't doing good strategy where they're really looking at what

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are the aligned actions and what are we doing over the next 12 to 18 months

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to actually solve whatever it is, especially if we're not really prioritizing well.

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Because I think if they're not there aligned or

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something that's that's going to help prioritize you're

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left with the pressure of try to get it all done it sounded

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like i don't know it sounded like you use small pockets of success to influence

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and spend your time at that level and and it just started to perpetuate and expand to probably a

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point where it caught the executive's attention to go,

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I want to understand more of this rather than expel all that energy at the front,

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trying to convince a bunch of executives.

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And plus you got engagement from the floor up behind you, right? Yeah.

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Yeah. As far as I can tell, anyone chime in, just from all of the organizations

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and the different examples that we've been able to see, there seem to be.

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Two more prevalent ways that this tends to happen in an organization.

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The first is what you just explained, meaning that there's folks that are somewhere

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within the organization, usually somewhere in middle management.

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They hear something about this topic. They really think it's a good idea.

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They don't have a lot of influence in the organization, and so they spend time building influence.

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They do pilots. They influence the people around them. They make small change

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until something catches someone else's eye, and they have a meeting with someone,

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and then they're able to actually bring that to someone else in the organization

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that has more influence.

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That's one model. And then the other model, which I'm sure Todd can talk more

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to, is something bad happens that has caught somebody's attention,

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and they're looking for an answer, and the answer comes in the form of Todd

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Conklin, usually, right? I said the answer.

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And that's usually in those organizations, change starts from the top of the organization.

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Is that a fair summary of what seems to be true?

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Yeah. But I actually think that Andy's first example is more sustainable and

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between us chickens, a million billion times healthier.

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Because after something bad happens, like a fatality, multiple fatalities,

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I just did a decapitation that really took this company, just surprised them.

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Well, so first of all, of course it surprised you. If you have a leadership

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team that says, well, we're expecting a decapitation soon, that's a pretty scary leadership team.

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The challenge is, and I think this is really the big part of what we deal with,

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is the realization at some level that leaders need to be curious.

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And so the only thing I can say, because I don't know how to fix leaders that

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aren't curious, that are already leaders, they're kind of a problem.

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But I will tell you, when you're hiring people that work for you,

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when you're building the next generation of leaders that are going to come and

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take your job, and if they're really good, maybe they're going to take the job

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above you, hire people that are genuinely curious.

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Because curiosity is really important.

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And always reinforce the message that it's way sexier to not know than it is to know.

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If you already think you know the answer, right, which we deal with all the

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time, you can name the boss that fits that category.

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Then when they go to the field, what they're going to do is look for ways to

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reinforce what they know, right?

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So there's even a name for that in psychology.

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So, and that bias is really strong. What you want is a boss that is genuinely

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comfortable with not knowing, which we've talked a lot about him.

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But one of the things about your boss, Scott, is he was completely comfortable

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at every level with the opportunity to learn. In fact, I think it's fair.

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I think he found that the best part of his job.

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That's what he liked to do was to learn. So that's key. I hope that helps because

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that's a really good question.

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So one thing that really kind of sticks out with me is the phrase,

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what's happening when nothing is happening? Not a great question.

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It's a very proactive phase.

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So I see such huge value in going out and doing the field engagements and things like that.

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What would be, I guess, your, as a panel, what would be your,

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I guess, thoughts on how do we sell that proactive stage when we're actually very reactive?

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We generally wait for something to happen to get ahead of something.

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There are so many soft signals that are out there.

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So I guess that would be my question is how do we get that proactive or reactive

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or from a reactive to that proactive phase?

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One thing is that weak signals are by definition weak, right?

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So weak signals are hard to hear because they're weak. Loud signals,

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super easy to hear because they're big fat accidents, right? Right.

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And so part of what we want to do is kind of change the attenuation of our organization

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so that we're actually identifying problems before they become catastrophic or consequential.

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And really what we're talking about is resilience and recoverability.

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So you'll always have to prevent.

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In fact, let me just take this moment to say, don't stop any prevention strategies.

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They're really good. keeping people from getting hurt and managing hazards aggressively.

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That's a really important thing. In the tree world, fall protection seems pretty

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vital to me. Don't stop that, right?

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The problem is, is it's not enough. And so it's the idea of building a case

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for resilience, which then causes the conversation to change.

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But let me give you just a quick hint. Instead of having your leadership go

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out and identify where risk is high, have them go out and identify where control is low.

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Now, you may say, actually, you guys won't say it because we've been hanging

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out a long time, but other people in your organization may say, what's the difference?

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That seems like the same question. And yet, your very question is encapsulated in that shift.

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When we ask people to look for where risk is high, which is a pretty good exercise,

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they're going to go out and tell you what the most dangerous crap we do.

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Except in your industry, where near as I can tell, everything's kind of dangerous.

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I mean, it's a dangerous work, right?

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If you go out and ask them where control is low, you're really tuning your ear,

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or better yet, tuning the organization's ear to listen to smaller signals early

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because they're going to tell you which part of the system is most brittle before it fails,

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not waiting till it fails.

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So I would guess that the answer to that question is highly dependent upon where

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somebody sits in an organization, right?

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If you have the ear of senior leaders and you can have that discussion up front,

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you could have an intellectual discussion where they're willing to try something new. That's one thing.

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There's many in this room that are lucky enough to have that position in an

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organization, and there's many that we don't have that much influence in an organization.

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So if you're in a space where you don't have the ear, right,

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you can't use you can't use a very cohesive and logical explanation to help

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somebody see something differently.

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What you end up having to do is sort of is prove it and prove it in small ways that add up.

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So the ways that I can picture where we tried to bring attention to looking

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at things proactively, I actually started reactively because that is the only

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thing that we paid attention to.

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But what I mean by that is I would take an event that we had already done some

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sort of investigation for.

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And I would do some type of operational learning to understand what people were still facing.

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And then I would take those conditions and label which of them haven't existed for a really long time.

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And I would do that after events, even after we had done sort of our traditional

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investigation to show that, hey, these elements, they've existed for a long time.

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And so we probably had an opportunity to look at them ahead of time.

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And then I would do the same thing with our audit. So we actually already have

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fairly proactive engagements.

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We just don't necessarily use the face-to-face interaction well.

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We could do something more with the time. So anything that was proactive that

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already existed, I did my very best to hijack.

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And I hijacked it at a site level because that's what I had control over at first, right?

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So we had requirements for observations, we had requirements for audits,

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and I would turn those into mini operational learning discussions.

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And then I tried to find a metric that I could show that there was value in

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doing that. And in my world, we had something called concern reports.

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And concern reports were considered good things, right? Meaning an employee

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was bringing up an issue, a difficulty, and it was being reported.

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And the more concern reports in my world, the better you looked as a plant.

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Well, I took all that information and shoved it into our concern reporting system.

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So suddenly we had hundreds more concerns than anyone else had because we were proactively learning.

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And then people started to ask questions. And when they started to ask questions,

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then there was a door for a conversation.

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Yeah, my question is almost identical to Pat. Him and I are on the fire department

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together, so we think alike.

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So in and around that, I want to know more about how to expose the dark corners,

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you know, the weak signals, specifically for the supervisors that we can take

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back and have conversations.

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We're both operations folks, spend a lot of time in the field, not as much as we'd like.

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And we have those conversations with crews, but they're so, I think,

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normalized by slight deviations, right? And we're performing at a pretty high

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level, but there's the things that creep up that you'd say, man, I never saw that coming.

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And that's why I was looking for, like, if you were to ask three questions of

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a crew or whatever it might be from a supervisor level, what would that be?

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What would that really look like?

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Because we always talk, you can really hone in. And I like what Todd said about the low control.

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I do like that. So anyways, I just didn't know if you could expound on what Pat was asking earlier.

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So if you have to have three questions, I'll give them to you because they're

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out there and there's really cool work being done around this.

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So there's tons of data and it's kind of exciting and it's all part of this

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story. I mean, it's a part of people that you hung out with.

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But before we go there, one of the things that's really important about these

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weak signals is that they're not indicative of failure.

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So mostly systems rattle and creak and buzz and fart and burp and don't fail.

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And so what we're really talking about when we talk about weak signals is trying to predict the future.

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And we really have a high need as human beings to sort of understand and predict

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the future. I'll just break it to you as gently as possible.

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Generally, we suck at it because you're you're in this room,

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we're not on your yacht, you didn't buy Apple when it was 50 cents a share.

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I mean, we're not good at it.

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But there are ways to sort of predictively think about uncertainty,

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and it means that you have to move from if-thinking to when-thinking, which is expensive.

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It's resource-intensive, and it's a much different conversation.

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Instead of saying, there's a probability of 70% this will fail.

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So we're going to manage this with 70% protection, which we've done for years.

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We have to say when this system fails, right?

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Not if, when the system fails, do we have robust controls in place to manage the recoverability?

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So two things have to happen. One is your organization has to be really comfortable

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understanding that failure Failure is normal.

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So we could talk about zero, but we already have.

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The one that actually bugs me more than zero is all accidents are preventable.

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So the problem with all accidents are preventable is that it really sets up

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this sort of false dichotomy that the accident happened because we failed to prevent it.

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So I guess that's true in retrospect. All accidents are preventable.

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But I'll also suggest that all winning lottery numbers are knowable after they've been selected.

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Like we're really good at playing the lottery after they pick the numbers.

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The three questions are kind of what is now being known as the sticky suite.

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Are you guys familiar with sticky? We talked about it a little earlier on the

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first day. Stuff that kills you.

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Although nobody I know in the whole industry calls it stuff.

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You can sort of fill in what they call it.

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So what'll kill you, when it happens, what keeps you safe, and is that sufficient?

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That suite of questions will do more for your organization on a continuous basis

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around catastrophic and significant failure, like fatalities,

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than probably anything else you do.

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So it's a really powerful set of questions. Want to add to it, anybody?

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I think if Mark Yaston was able to be here today, I think probably what he would

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echo is that for sure we're not great at predicting, but we are really good

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at learning what is happening and what has happened.

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And so he talks to post-job brief, right?

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So if you're going out into the field, rather than trying to get people to predict

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what's going to happen, it is a lot lot easier for them to teach you what did

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happen that surprised them.

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And oftentimes that gives you an insight into places where things were surprising.

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Usually it worked out, right? Because it was creaking. What did you say, Todd?

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It was creaking, groaning, squeaking, and burping and farting.

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So it was doing all of those things.

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It was doing all of those things. People could hear it because it's already

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happened and then and learning from what has happened, but faster,

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right? So we're not waiting for the bad thing.

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We're waiting for just what happened today. Like what happened today that surprised

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you? Anyone remember some of the questions he suggests on his post-job brief?

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You remember it off the top of your head?

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What happened today that surprised you? Anyone else?

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Well, multiple brains are smarter than one brain. Multiple brains are smarter than one brain.

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What are we missing? What worked well and what didn't work well?

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I think there's one more that I can't remember.

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What would you recommend? I think we have it on hophub.org. We've got his list

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of questions as well, and he has all the slides up there. So that might be helpful.

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And in honor of Mark Yesen, who's not here with us this week,

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unfortunately, but he is amazing and normally is with us.

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He also tells a story of where they put cameras on rescue helicopters to analyze

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the rescue. Did I tell you this?

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Did I tell you this one already? No? I did?

307
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Yeah. Yeah. Okay. So, so I'm old.

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So yeah. So that, that whole notion of, of watching stuff to learn,

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right. That's the, that's right. We didn't talk about like football games, right?

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So people that are listening to this podcast may not have heard this,

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but the, the landing the helicopter and then that, that video going to the boss

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and the boss critiquing it was not helpful. It was scary.

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And they became more concerned about the video camera capturing what they were doing.

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But when they, when they told them about their leader was good enough to realize

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he was doing something they didn't mean to do.

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So now when they land, it gets sent to them and they can analyze their own rescue,

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right? So this is going to be on a podcast, right?

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So anybody on the podcast, if you haven't listened to or talked to Mark Yesen,

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man, reach out to that guy.

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He's got some great stories about post-work, post-rescue. They would do rescue

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after rescue, sometimes multiple per day in the Grand Canyon.

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And every time they would have that moment of what you'd call like a hot wash.

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What did we just deal with? Can we learn from it? Because we probably can.

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So from the best that I can tell, monitoring the health of the organization

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and understanding like how well we are with Hop and where we are in the journey

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is probably best measured by maybe culture surveys and the quality of the stories

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that are coming out of the learning teams.

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Is there anything else that maybe we should be looking at to say this is a good,

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you know, indicator of health in the system?

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Because, you know, we said Chevron may be one of the best.

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What are they doing or how are we measuring that best?

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Well, Diane Chadwick-Jones, who is a friend of ours, who was the sort of the safety guru at BP,

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she did safety culture surveys a gazillion times.

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And she has two papers that she's written where she analyzed that data,

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and she found that the one thing that matters in your safety culture survey is trust.

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That's it. So if you're looking at your organizational health,

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what you need to be able to look at is try to understand what level of trust

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do people have with their supervisors?

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What level of trust do they have with each other? If you think about all of

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the things that Andy and Bob and everyone has shared that you need to do,

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Jenny has shared around accountability,

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it just doesn't work well if you're not actively building trust.

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No i just there's there are culture surveys

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that look for trust specifically in psychological safety specifically and you

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can do it team by team and so start

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talking about it start looking at it and don't let it become so measured because

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i know the gallup survey has become oh we know what those questions are and

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we know what we have to do what how based on how we answer them so we're We're

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going to answer them in a way that we don't have to do those follow-up sessions.

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So think about there's new tools out there and they're not that expensive.

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And that learning ritual and I think just even the self-reflection rituals of

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how is this going and being able to talk about it.

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You may not need to have to pay to have somebody else tell you what they're really thinking.

354
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Don't leave. Don't leave. Don't leave. Don't do it. Yeah, because I want to talk to you too.

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So here's what I'd say. My population has so much survey fatigue and safety

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culture surveys are so stinking bad that I would never – I couldn't sleep at

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night if I told you to do more surveys because it's just mean.

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But what I would tell you, and I'd be curious to what you guys think about this,

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because this is just my opinion.

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I would tell you that I would probably have focus groups, and I would monitor

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the outcomes that you're hoping to achieve.

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So build your metrics around what it is you want to get out of this.

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So if you want to have increased trust, then create monitoring systems that

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actually help you understand trust.

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And then you'll have to sort of creatively figure out how to look at that.

366
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And that's why I would toss it to you guys. And you can disagree with me.

367
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It's fine. But I just find.

368
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No, I agree. I think surveys are. That's why they're game and gallop now.

369
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When they're kind of malpractice. Yeah.

370
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Yeah. No, I think Diane would agree with you.

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I mean, she is like having done safety culture surveys for these long organizations,

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you know, these huge organizations for a long time. She just doesn't see that.

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And I think really the way to measure these things isn't by people sort of reporting

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stuff as much, but actually actively maintaining these things.

375
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So instead of looking at culture as an outcome or a performance or safety as

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an outcome or a performance,

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those things call looking at things as performance calls you to look at these

378
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measures that are reactive, to use that word.

379
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But if you are aware of the elements that need to exist in your organization,

380
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like trust, like psychological safety, other things like that,

381
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then you just spend some time with your leadership and your people.

382
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And when people connect and and communicate, you look for signals that those things are there.

383
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And don't wait for the end-of-the-year safety culture survey because,

384
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just like Jenny said, everybody knows how to answer that stuff right, the right answer.

385
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How many leaders do you think, when HR calls them up and say,

386
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we're really concerned, this particular measure has gone down in your culture survey,

387
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you need to be working on that, do you think that they're really kind of spending

388
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time reflecting on themselves and their leadership?

389
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No, they're going to their team and saying, why the hell did you score me low in this?

390
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And that's not going to help you create the kind of environment that's going

391
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to help people make better decisions.

392
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I had something really funny happen. I worked in GE and our system that read

393
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all those surveys didn't work.

394
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So I got to load them in manually, 2,000 of them.

395
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You know what was interesting about that? It was actually really valuable because

396
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I saw a whole bunch of them.

397
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It's a Likert scale, one to five, a whole bunch of them, all ones.

398
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All threes, all fives, zigzag, it's the news down the side.

399
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It was just patterns, right? And easily 25% of them, total garbage.

400
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And yet we were taking those things and saying, what's our top three and our

401
00:28:08,898 --> 00:28:12,618
bottom three and our biggest three deltas between management and, and it was garbage data.

402
00:28:12,938 --> 00:28:17,378
But the privilege I had of doing all those manually is I got to see the zigzag

403
00:28:17,378 --> 00:28:20,878
patterns of people that are just tired of filling out surveys.

404
00:28:21,018 --> 00:28:21,778
Filling out surveys, yeah.

405
00:28:21,958 --> 00:28:25,738
And, and we know, we know when we trust and we know when we don't.

406
00:28:25,738 --> 00:28:28,618
And we have to just start talking about it.

407
00:28:28,858 --> 00:28:32,738
And it's as straightforward as that. And what are the rituals where you have these conversations?

408
00:28:33,778 --> 00:28:36,558
I would like to respond in two parts. Is that okay?

409
00:28:37,278 --> 00:28:40,298
So the first part in your question, you had said, hey, you know,

410
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we've said that Chevron is really good at this. How would you know?

411
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And I feel like that's probably different than the measurement question.

412
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The reason I feel like we can say that confidently is we get to talk to folks

413
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from the organization a lot.

414
00:28:51,858 --> 00:28:54,898
You can have a random group of people from pieces of the organization.

415
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Give them a scenario, ask them how they would handle it.

416
00:28:57,738 --> 00:29:00,698
And their responses are very much aligned with this thought process, right?

417
00:29:00,758 --> 00:29:05,198
So that's how we can say that and be like, yeah, they really understand these

418
00:29:05,198 --> 00:29:07,438
concepts. In terms of measurement.

419
00:29:08,792 --> 00:29:12,452
I mean, organizations don't function well without them and leaders demand them.

420
00:29:12,572 --> 00:29:19,392
And so the way that I personally had to try to figure out how to measure it

421
00:29:19,392 --> 00:29:25,092
was looking for artifacts of culture change. So if, which I think Todd,

422
00:29:25,152 --> 00:29:27,472
you taught me the words of that because I didn't really know what that meant.

423
00:29:27,512 --> 00:29:33,352
So for example, I'll tell you some of the early metrics that I used.

424
00:29:33,432 --> 00:29:39,632
My thought was if we taught this subject well, then the actual investigation

425
00:29:39,632 --> 00:29:41,372
paperwork would look different.

426
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Different. So in order to measure that, all I did, like I had access to that

427
00:29:46,512 --> 00:29:49,992
area, like I had access to all of it, I would just go area by area.

428
00:29:50,052 --> 00:29:52,672
At this point, I was regional, right? So I had a bunch of different businesses.

429
00:29:52,952 --> 00:29:56,152
And I would just read through them and put them in two different categories.

430
00:29:56,432 --> 00:30:00,692
The first category was, oh, this sounds like everything we've always done for 20 years.

431
00:30:00,832 --> 00:30:06,612
That was on one side. Oh, this actually has a lot of very specific contextual information.

432
00:30:08,032 --> 00:30:11,452
And I then I would look at whether or not that was changing over time.

433
00:30:11,592 --> 00:30:15,432
I never published it as a metric, as a requirement, but that gave me some sense

434
00:30:15,432 --> 00:30:17,872
of, is this translating into something that I could see?

435
00:30:18,572 --> 00:30:22,292
Another thing that we'd look at is we were required to do bowtie analysis.

436
00:30:22,732 --> 00:30:25,712
And my thought process was, well, if we truly understand these concepts,

437
00:30:25,832 --> 00:30:32,032
we're going to see more stuff in mitigation and we'll have better defined losses of control.

438
00:30:32,612 --> 00:30:35,252
So that's all I would look at, right? I'd look at it and I'd say,

439
00:30:35,312 --> 00:30:38,212
well, this looks like how we've always done it. There's a whole bunch of stuff

440
00:30:38,212 --> 00:30:39,792
in prevention and nothing over here in mitigation.

441
00:30:40,172 --> 00:30:42,972
And I would just put them in two different categories. And I would track it over time.

442
00:30:43,152 --> 00:30:46,732
And actually, because it was by business, I could look at, are we moving in

443
00:30:46,732 --> 00:30:48,732
one of these directions in each of the businesses?

444
00:30:48,972 --> 00:30:52,512
And if we weren't, then I would go and it allowed me to ask questions.

445
00:30:52,532 --> 00:30:53,752
So I could go ask questions, go

446
00:30:53,752 --> 00:30:57,232
learn, go see if any of it was translating and see if there was a place.

447
00:30:57,312 --> 00:31:00,112
But each of that would be specific to an organization.

448
00:31:00,352 --> 00:31:03,252
So if you're going to make this change, then your your thought processes,

449
00:31:03,392 --> 00:31:08,092
what that we can see, touch, smell, monitor would change.

450
00:31:08,892 --> 00:31:13,212
And let me see if it does. And then you learn from it. And then you provide

451
00:31:13,212 --> 00:31:15,572
another measure. It has to change all the time. It can't be just one overall.

452
00:31:16,840 --> 00:31:20,640
Real quickly, we used to do like every month an injury call. Sound familiar?

453
00:31:21,120 --> 00:31:24,120
Go through all your injuries. Every site had to call in. Safety manager,

454
00:31:24,420 --> 00:31:25,820
plant manager, go through every injury.

455
00:31:26,700 --> 00:31:29,840
They're brutal. They're like a bloodbath. So on our journey,

456
00:31:30,000 --> 00:31:32,380
we were one of the few hot sites in all of GE.

457
00:31:32,680 --> 00:31:35,480
So when it was our turn, we said, hey, for our five minutes,

458
00:31:36,100 --> 00:31:37,440
we're not going to go through every injury.

459
00:31:37,520 --> 00:31:39,800
We're going to tell you a couple we really learned a lot about,

460
00:31:39,900 --> 00:31:40,860
and one of them was a near miss.

461
00:31:41,440 --> 00:31:46,160
They're like, okay. And we would, Todd remembers this, it wouldn't be the safety guy.

462
00:31:46,160 --> 00:31:49,120
It'd be off people saying hey we had this near miss

463
00:31:49,120 --> 00:31:52,040
with this this press dropped this whole top

464
00:31:52,040 --> 00:31:55,320
plate the magnetic died i mean the magnetic clamp let

465
00:31:55,320 --> 00:31:58,520
go and it could have killed somebody but it didn't and we just so we turned

466
00:31:58,520 --> 00:32:03,180
our portion into it it ended up being so popular that the other sites were like

467
00:32:03,180 --> 00:32:06,760
what are you guys doing how do you get to talk about all this rich stuff and

468
00:32:06,760 --> 00:32:10,460
we go through every injury instead so we changed it to the learn and leverage

469
00:32:10,460 --> 00:32:14,760
which was still that ritual every month, except now it's not go through every injury.

470
00:32:14,980 --> 00:32:18,960
It's bring the stuff forward, like Andy said, that we've actually learned something from.

471
00:32:19,340 --> 00:32:22,820
And I can tell you how I know it works because when it was my turn to sponsor

472
00:32:22,820 --> 00:32:26,080
it, I looked through this. You can literally look in your system where you had

473
00:32:26,080 --> 00:32:27,240
this whole GenSuite thing.

474
00:32:27,400 --> 00:32:29,960
And there were these ones you could tell they did great operational learning

475
00:32:29,960 --> 00:32:33,500
on. I would just send a message. Hey, would you like to talk about that one? It looks like a good one.

476
00:32:33,840 --> 00:32:37,080
And when I sent out the list, one of my sites sent a message back like,

477
00:32:37,140 --> 00:32:38,280
what's the matter, Bob? You don't like ours?

478
00:32:38,840 --> 00:32:42,260
I'm like, what are you talking about? They said, look at case number 22605,

479
00:32:42,340 --> 00:32:45,120
whatever. We did a lot of really good learning and you don't want to hear about

480
00:32:45,120 --> 00:32:46,440
it? I'm like, sorry, my bad.

481
00:32:46,900 --> 00:32:51,340
I have never, ever had somebody asked to be on an injury call.

482
00:32:51,540 --> 00:32:53,820
Matter of fact, if they miss one of your cases, what would you say?

483
00:32:54,580 --> 00:32:58,140
Right? So we have, that's an indication. There's an artifact, right?

484
00:32:58,260 --> 00:33:01,380
Or there's a, it's that injury call, which now is called still to this day called

485
00:33:01,380 --> 00:33:05,460
the learning leverage, where people get to bring forward the things that they've actually learned from.

486
00:33:05,880 --> 00:33:09,160
So it's hard to put a a number on that, but boy, it's not hard to recognize.

487
00:33:10,512 --> 00:33:13,432
I just remembered my favorite metric. And I have to tell you,

488
00:33:13,432 --> 00:33:16,012
because actually it probably saved a little bit of my sanity.

489
00:33:16,552 --> 00:33:22,252
I measured the number of angry emails that I got from people after a senior

490
00:33:22,252 --> 00:33:26,312
leader would send out a global communication that wasn't aligned with this thought process.

491
00:33:26,572 --> 00:33:30,352
So when we first started off, there'd be a global communication that would have

492
00:33:30,352 --> 00:33:34,692
a lot of blame, a lot of retrospective discussion in it, a lot of root cause

493
00:33:34,692 --> 00:33:37,272
discussion, a lot of this is just what we need to do, discussion,

494
00:33:37,472 --> 00:33:40,772
and nobody seems to notice. It was just very normal.

495
00:33:41,092 --> 00:33:44,872
Then the more people were exposed to the concepts, then people would send me,

496
00:33:45,012 --> 00:33:47,912
hey, have you seen this email? It doesn't seem like it's aligned with this.

497
00:33:48,072 --> 00:33:52,232
And then we did more, and then I would get 200 emails, and then I'd get 1,000 emails.

498
00:33:52,392 --> 00:33:56,652
And I measured the number of angry emails when somebody didn't align with the thought process.

499
00:33:56,992 --> 00:34:00,332
Good. Are we good? All right. Can we wrap up with one?

500
00:34:00,732 --> 00:34:03,072
Yes, sir. You got another one? All right. Right.

501
00:34:03,572 --> 00:34:06,372
And then I got one last thing to share with you. I think you'll like it.

502
00:34:06,852 --> 00:34:10,532
So, yeah, this is this is actually just a question regarding the hop journey.

503
00:34:10,732 --> 00:34:16,652
So I would ask what warnings or cautions you might offer for a new practitioner

504
00:34:16,652 --> 00:34:18,972
or potentially what encouragement you might offer.

505
00:34:20,752 --> 00:34:25,892
So every organization ebbs and flows. So you'll have great moments of progress

506
00:34:25,892 --> 00:34:28,572
and then you'll just backslide like crazy.

507
00:34:28,972 --> 00:34:32,552
And then you'll have great moments of progress and then you'll move backwards.

508
00:34:32,992 --> 00:34:40,552
And so understand that the organization is this dynamic, and it's not fixed

509
00:34:40,552 --> 00:34:43,352
in time, fixed in space, or fixed in culture.

510
00:34:43,512 --> 00:34:49,172
And what you're doing is you're really trying to look at and leverage really,

511
00:34:49,252 --> 00:34:54,192
as simple as this sounds, the vocabulary your organization uses.

512
00:34:54,892 --> 00:35:01,232
So one of the artifacts, one of the things you can use to monitor is do you hear people say,

513
00:35:01,932 --> 00:35:06,112
that's an air-likely condition, or this system's really brittle,

514
00:35:06,292 --> 00:35:12,152
or we've got a single-point failure here, or we need to know that mistakes are

515
00:35:12,152 --> 00:35:14,472
going to happen and we need to be ready for them.

516
00:35:14,932 --> 00:35:18,032
And one of the things I learned, again, this comes from Bob's organization,

517
00:35:18,292 --> 00:35:21,692
is we spend a lot of time, and Martha can talk about it in Los Alamos,

518
00:35:21,752 --> 00:35:23,412
kind of dumbing the language down.

519
00:35:23,872 --> 00:35:28,772
And we thought that would be easier and it would diffuse better within the organization.

520
00:35:29,412 --> 00:35:34,052
With Bob's organization, we didn't dumb anything down. We used the terms and

521
00:35:34,052 --> 00:35:39,712
they stuck so much better than sort of the dumbed down version.

522
00:35:39,912 --> 00:35:44,772
So be really cognizant that what you're really doing is building a vocabulary

523
00:35:44,772 --> 00:35:49,732
because how we talk really reflects how we're thinking.

524
00:35:50,232 --> 00:35:53,632
And so it's a pretty good way to do it. It makes a big difference.

525
00:35:53,852 --> 00:35:56,792
And the crazy cool thing is, is you'll

526
00:35:56,792 --> 00:36:01,932
hear the language, this sort of new enlightened language used a lot.

527
00:36:02,272 --> 00:36:06,052
I mean, once they get it, they get it. I just have one last piece of advice on this.

528
00:36:06,920 --> 00:36:10,160
You're always one new CEO away from starting again.

529
00:36:15,520 --> 00:36:19,740
And there you have it. Oh, wait. Oh, I'm way over my 30-minute limit.

530
00:36:19,980 --> 00:36:23,280
Sorry. Oh, yeah, eight minutes. I hope you enjoyed that. That was really fun.

531
00:36:23,480 --> 00:36:25,660
And it was a good chance to get together and talk to people.

532
00:36:25,820 --> 00:36:27,260
I'm sure we'll do another one.

533
00:36:27,440 --> 00:36:30,700
If you want to come again, you're more than welcome. Until then,

534
00:36:30,800 --> 00:36:32,720
be good to each other. Be kind to each other.

535
00:36:32,780 --> 00:36:36,100
Learn something new every single day. Have as much fun as you possibly can.

536
00:36:36,920 --> 00:36:42,140
Check in on one another. It still matters, I think. And for goodness sakes, you guys, be safe.

537
00:36:43,600 --> 00:36:53,804
Music.