The power of our origin story
PROFILE – Earlier this month, our editor visited the US and sat down with the CEO of a community health center near Boston. His humility and honesty about his lean leadership are striking.
Profile on: Kiame Mahaniah, CEO, Lynn Community Health Center – Lynn, Massachusetts
Words: Roberto Priolo, Managing Editor, Planet Lean
As part of my job, I get to travel the world and meet lean leaders doing the most amazing things. (I am lucky, I know.) The senior executives I typically interview tend to be very impressive individuals, which is hardly surprising given the fact that it takes a certain type of person to embrace lean principles and live by them every day. Of all the leaders I have had the privilege to meet, however, few were as inspiring as Kiame Mahaniah.
Kiame is the CEO of Lynn Community Health Center, a federally qualified institution providing care to some 40,000 people in Lynn, Massachusetts. I first met him in March, when he told me about the lean transformation of the health center, and I remember finding him to be very kind, well-spoken and approachable. More importantly, I thought he had a very clear idea of what it means to be a lean leader (he will probably disagree with me on this one). What I had yet to learn was how humble Kiame is, which I discovered when I visited him in Lynn together with Alice Lee, his coach from the Lean Enterprise Institute.
Kiame took over as CEO of LCHC less than a year ago, after holding the role of Chief Medical Officer for two years. So, when Alice and I sat across from him in his office, I started by asking him about his first year in the job. His answer was striking, the first of many.
“I feel like I have accomplished almost nothing so far,” he said. “I feel like I have only been CEO for a few weeks, because the first 12 months of my tenure were spent learning basic skills and handling personality conflicts. Conflict at a personal level is something that the lean literature currently doesn’t provide much help with. At the moment, the idea is that if you handle things well, there won’t be any personality conflicts or that they will be contained in a constructive framework. But it is not that simple.”
The past year has certainly been eventful for the health center, and conflict has played a major role in this delicate phase of transition to a new leadership. First, a number of senior executives decided to leave the organization, with the “decision-making void” that comes with it.
Then came a budget crisis, as State Government cuts to several funding streams over two years amounted to $4 million, which correspond to 5% of the LCHC budget – “something almost unimaginable” for an organization that is normally happy when it is .2 to .4% in the black. Lynn reacted to the cuts by building on the lean work that had already been done: faced with the need to see more patients each hour, the organization leveraged the reporting system it had in place to tell teams how they were doing on a daily basis, as well as the sense of responsibility that staff already felt for the community. Kiame explained: “We told the teams that the template would be going from three to four patients an hour, but that the team leaders would get to decide under what circumstances those extra slots get opened or not and how to use them, given the parameters they have to achieve.”
Despite this, the backlash was fierce at first. “People felt personally offended. I was even told I wasn’t a ‘real physician’ if I thought like that,” he continued. I suddenly understood why he had put so much emphasis on personality conflicts just a few minutes earlier. Indeed, the fact that front-line people were given the authority to decide how to use that fourth hourly slot contributed to the feeling of unease that caused further disaffection amongst the senior leadership. Needless to say, relying on until now unattainable productivity numbers as the model around which to build the budget made the financial team quite uncomfortable.
Over time, however, people realized Kiame was serious about the front line controlling the slots and became comfortable with the idea that, with a few checks in place, the new system could work. So far, the numbers are saying it was a good call. “I am still holding my breath,” he said, “but if we can maintain this as a standard and continue knocking down barriers for the clinical teams, it means we will have a cadre of middle managers used to the idea of encouraging the front line to take the lead, while using a number of tools to check work that happens in their teams. I feel these are small steps that are preparing us for the next changes.”
If the departure of 40% of the leadership team and a budget crisis weren’t enough, The Joint Commission (a US accreditation body for healthcare organizations) showed up back in July. They had visited several times before, with LCHC passing with flying colors. This latest visit didn’t go well and LCHC was put on probation. The Commission’s report highlighted several problems, which ranged from not asking for patients’ IDs to not being able to open a bathroom door from the outside in the event of a patient collapsing.
It was a “big blow” for the organization, but Kiame was determined to see the positive side of the situation: a few weeks after the visit, while reading Getting the Right Things Done, he suddenly realized that 90% of the findings fell under one value stream – people development and coaching. Currently, the organization doesn’t have a structured approach to interviewing, recruiting, onboarding and developing people’s capabilities, and the link between this and the poor results in the report was clear. Kiame said: “When you have that many problems, it feels like whack-a-mole. Being able to visualize most of the findings within one value stream meant that as you put duck-tape here and there as a temporary fix you can use what you learn from the fire-fighting to plan for the stabilization of the process. I believe that The Joint Commission gave us a huge gift, because now we have something concrete to focus on. I have yet to convince my people that probation is a gift!”
KNOWING WHERE WE COME FROM
Kiame talks a lot about his “origin story” and how it influences the person and leader he is today (I would, too, if my background were half as interesting as his). Having grown up in a completely dysfunctional society – the Congo – as a kid and moved to an extremely functional one – Switzerland – as a teenager gave him an appreciation for the difference between what works and what doesn’t, and the curiosity to think about how to go about transforming societies. His parents also instilled in him the idea that as a privileged person he had the moral duty to do all he could to impact the lives of those around him – one of the reasons he ended up working in social justice institutions right after graduation.
His origin story got even more interesting after he moved to the United States to attend Haverford College, a Quaker liberal arts college outside Philadelphia. As an Italian, I am not too familiar with the Quakers and, as if reading my mind, Kiame promptly explained: “The Quakers make all important decisions by consensus, which is very close to the lean idea of respecting the front line. Everybody participates in decision making and everybody has an equal voice. This might seem like a less-than-efficient way of making decisions, but the Quakers were the first major religious institution in the USA to go against slavery – which shows there is power in forcing people to be individually responsible.”
Seeking consensus (or at least enough consensus to get the improvement work started or sustained) and getting people to feel “individually responsible” is a challenge for every lean leader, but not every lean leader decides to rise to it the way Kiame does – being humble and showing vulnerability. In my mind, that’s what it truly means to be a lean leader. Kiame is not afraid to admit he doesn’t have the answer to a problem, nor to show his vision for the future of the organization.
Not that that is easy, as he rushes to explain to me. “I have a clear vision of an ideal future, but it’s hard to find the right language, tone and moment to talk about it when people are still suffering from daily dysfunction. It’s critical to strike a balance between giving people a common goal and being conscious of the daily problems that occur. The other difficult part is that when you reveal your vision, you are much more vulnerable because people can use it to harm you,” he said.
I asked him to expand on the idea of feeling vulnerable, because it’s not something I am used to hearing from a CEO. He answered: “Being willing to admit there are problems you don’t have an answer for gives people a way to question your leadership. Asking questions rather than providing answers makes you vulnerable, but I still think it is necessary.”
Necessary indeed, and impactful, as interim COO Kim Eng confirmed: “There have been a few key moments in which Kiame has opened up to the organization about how he felt about things, and those moments have taken us through months because it’s when people got the sense that he is there for them. Once they got to know him as their CEO, things started to shift. The calming vision he shares has started to build stability.”
I couldn’t help but wonder what contribution lean thinking has given to the making of this great leader who believes in respect, honesty and humility. His answer to my question couldn’t have been more articulate: “Lean has helped me to move past some of the beliefs I had interiorized over the years because of my origin story. For example, it has made me comfortable with my position as a leader and with the status that comes with it, despite my natural distrust of power – a result of my growing up in a military dictatorship. In fact, one of the reasons I am so enthusiastic about lean is that, to me, it is a bridge between my discomfort with being a manager and my desire to help our community.”
Alice Lee of the Lean Enterprise Institute is Kiame’s coach. She commented: “Kiame lives and breathes the idea that ‘with power comes responsibility’. He is committed to contributing to a more just world and believes embracing lean thinking provides a means to address the social injustices that LCHC’s patients, families and staff face daily.”
AN ENDLESS BATTLE?
Intrigued by his story and by his willingness to discuss it, I asked Kiame about some of the biggest changes he has experienced in his daily life so far as a result of lean. He told me that the philosophy has drastically changed the way he organizes his job, down to his daily schedule and habits. For one, there is no podcast or music playing in his car during his morning commute anymore, as that time is now used to think about what’s coming that day and what he can do to help. He also reads and journals more than ever before. But the biggest change of all is perhaps the fact that he used to think of gemba as isolated time, whereas now he is in a “permanent gemba mode”, constantly observing, listening and asking questions wherever he goes.
When I asked him to elaborate more on his view of a personal lean transformation, he said: “We are used to seeing a leader’s personal transformation as some kind of an epiphany – you are something one moment and then, after a flash of light, you are something else. The real revelation for me was that the pain of a transformation keeps happening every day, and that it is just as hard on day 100 as it is on day 1.”
What, then, keeps him going despite these difficulties and the fact they probably feel unsurmountable at times? Kiame was quick at admitting that he is often afraid (once again, his candor and honesty surprised and moved me) and told me that his secret to fight fear is focusing on what he wants to achieve, which happens to be very clear to him – fighting disparity, achieving social justice in the community, being a good boss and creating a good jobs institution.
“Working in a social justice institution is an advantage. It’s a lot of pressure, because if we fail our patients have nowhere to go, but it’s also a lot of encouragement, because if we get it right 600 families in Lynn will immediately benefit from our work. And that’s what keeps me going.” he concluded, smiling.