So what do you do for a living?

It’s a scenario I know you’re familiar with: you meet someone for the first time, you exchange pleasantries, you perhaps comment on the weather or some common ground. Then the question gets asked “so what do you do for a living?” Now you have a choice. I don’t know if you know it but you have a powerful opportunity here to leave an impact on someone that they may never forget.

The vast majority of people (and I’m including myself in this) when asked this question “so what do you do for a living?” begin to describe their position in the organization they work for. Depending on who I’m talking to,here are some of the answers that I would give to this question today: I am a leadership development coach, I am a management and leadership trainer, I am a continuous improvement coach, I am a lean mentor.

Team picture of CCBRT staff after 3 days of hands on problem solving using Lean Thinking

When I reflect on it deeply I almost never describe the purpose of the organization that I contribute to. So if I were answer with that in mind I would say “I contribute to a Tanzania where people have access toquality disability services as well as safe maternal and newborn healthcare – I do this by teaching my colleagues on the most powerful continuous improvement methodology every discovered by man”.

But maybe there is a better question – rather than “What do you do for a living?” instead ask “what do you want to do for a living?” Now that’s a powerful question. Think of how many people who don’t even allow themselves to answer or even ask that question. However with all my heart I know this question is deeply important to everyone. It’s a question in my opinion that in part justifies why our soul / our spirit exists. It’s a question that makes us uniquely human.

There are millions of different answers to the question “what do you want to do for a living?” I’m going to make an assumption here, but I pretty sure your answer would relate to your vision of living a life that would leave a legacy. You vision of living a life of greatness. However greatness is never achieved by copying others.  I would do you a disservice and insult you if I simply asked you to follow me. After all, what do I know about you and what your purpose is in life? My opinions should have no influence on the truth of your purpose in Life. But I deeply believe that both you and I have a purpose, that greatness is something that is not started by transforming things around us, but greatness is started from transformation of self, where your purpose is discovered, grown and released from within.

The outcomes of all our work in CCBRT are felt by our patients - how can we keep these infants safe from harm?

Within me I have a strong burning feeling the coming to Africa and spreading Lean Thinking into Healthcare is part of my purpose. The feeling I get from this work gives me satisfaction, it gives me contribution to something bigger than self, it gives me meaning, it gives me significance. However, I don’t want this letter to be about me. I want this to be about you. I sincerely do want you to find your Truth. To find your Purpose. So my challenge to you as I finish this letter. Do not focus on me or how you’re going to answer the question “What do you do for a living?” but instead focus on asking yourself a better question “What do I want to do for a living?” Warning: The answer will take time. Warning: The answer will CHANGE your life.

Podcast with Mark Graban from the LeanBlog

After much background work I am delighted to share the link to our Podcast interview with one of my favorite people in the world of Lean - Mark Graban, please check it out
http://www.leanblog.org/2013/07/podcast-182-michael-grogan-dr-brenda-dmallo-lean-healthcare-in-africa/

How do you want to be remembered?

Dr. Brenda has been on the frontlines of Maternal Healthcare in Tanzania for the last 22 years. I first met her on my 3^rd trip to Tanzania in Nov 2012. At the time my 1.5year long internal discussion to quit the US and move to Africa was reaching its conclusion. I remember Dr. Brenda sharing with me a story of one of her attempted interventions in maternal and newborn healthcare in Dar es Salaam, the largest city in Tanzania. She talked about of how she saw the massive gaps in the management and leadership of the maternal hospitals in the city, the blame game & unchallenged assumptions were the norm, with a total absence of knowledge of the current situation on the ground. Mothers and babies were dying at a rate that was getting worse. She told me how she reached out to an industry that was booming in Tanzania – the tourism industry; she asked a manager of a successful hotel chain if he would consider helping the situation by training these public health managers. His answer was brutal. “It’s impossible, this is public health in Africa, it will never work”. Dr. Brenda told me she refused to believe his perspective. She proclaims with all her heart “There is a way to prevent these deaths, I’m convinced of that, we just haven’t found it yet”. In Lean thinking she has found the answer.

Dr. Brenda and Michael coaching at one of the local maternal hospitals 

Since then I moved to Tanzania full time in Feb 2013. When I reflect on the time I have spent working with Dr. Brenda, I am amazed at the similarities between my previous experience working as an Lean Practitioner in the manufacturing industry in the US and Europe.  The root causes of our problems and our management and leadership behaviors follow similar patterns. Waste is universal in every organization. Lean is the enemy of waste and the most effective & efficient method “invented” in human history to attack waste and thus increase value to humanity.  From errors in the procurement of hospital supplies to a mothers labor records not being correctly filled out, the same themes appear –Lack of communication, no standard in place, the standard not being followed or the standard being incorrect! There are no new battles. Lean can work in every organization in the world. Today we are proving that Lean Thinking is one of the greatest interventions we can make in what is one of the world’s greatest humanitarian crisis – The African Healthcare System.

My job description here can be summarized in two words – Developing People. The joy I get of seeing those “ah-ha” moments in a leader that I am working with as they begin to develop habits that will transform how they manage and lead their organizations, ultimately increasing the value to patients. My proudest moments are those times at the GEMBA (the place where the work happens) when I observe the student, like Dr. Brenda, becoming the teacher to her colleagues. In the context of this humanitarian crisis nothing that I have ever done in North America or Europe can compare with the meaning and sense of purpose I get from this work. Nothing can compare to this feeling of significance and contribution. We are currently working with 3 of the largest Maternal Hospitals in the city. In 2012 these 3 hospitals reported a total of 56,622 Deliveries with - 1,594 Still Births (2.8%), 800 Neonatal Deaths (1.4%) and 115 Maternal Deaths (0.2%). This thing we call “lean” is already starting to make a difference on preventing more unnecessary deaths.

 Dr. Brenda and Michael coaching  problem solving to maternal healthcare leaders 

In my recent trip back to visit my family in Ireland, I had many of my friends speak privately to me about their admiration of the work I am doing here and their wish they could do something similar. When I encourage them that they can – so starts the “yeah but” conversations. So that gets me to ask myself the question “who am I writing this for?”.  99.99% of people who read this won’t do anything, 99.99% of people I engage with won’t do anything. But it’s the 0.01% that will, that keep me motivated. There is a desperate need to convert great intentions into action – action in the form of

1. Boots on the ground (if only for 2 weeks)
2. Helping to fund our program  
3. Helping to spread the word of what we are doing here. 

This is an opportunity for the 0.01% to make history, to leave a legacy after the short time we have on this planet. Join me, join us, help them. In the words of Dr. Brenda “22 years I have been in Maternal Healthcare in Tanzania, if you gave me the choice of teaching clinical skills or lean thinking – I would pick lean thinking all the time”. So my message to the 0.01% - what are you going to do? How do you want to be remembered?

A visit from President Bush and Laura

My workplace was taken over by US Secret Service this week as we had VIP visitors stop by.
http://www.ccbrt.or.tz/news/list-ccbrt-news/details-ccbrt-news/?tx_ttnews%5Btt_news%5D=229&cHash=8b054b8f2c429a4965aea3d3c791f1aa

My interview with Melissa from CreateValue.org

http://gembawalkabout.com/2013/06/28/lean-in-the-developing-world/

My thanks to Melissa for giving me the opportunity to promote our work here in the hope that others will get involved. The human need is desperate.

My first 79 days

My first 79 days

Background:

My name is Michael, 30 years of age who moved 79 days ago to Tanzania, Africa from my comfortable life in the US, to work as a Leadership Development Coach (Lean consultant) for not for profit healthcare provider CCBRT on a 2 year contract.  I will attempt to summarize my experiences & thoughts on what has been the most challenging change in my life. 

Work related Summary:

I have got an engaged senior leadership team at CCBRT, what more can I ask for - this is every consultants dream. For a lean transformation to happen it must begin with the leaders - the one-one's with the CEO and his deputy and the 3 day workshop I co-facilitated with the entire senior management team has convinced me that they have the capacity to make the changes needed in their own thinking. A lean transformation to my knowledge has never been done in healthcare in Africa. For those folks that don't know what a lean transformation is my best and latest definition is that we are trying to create a continuous improvement culture with the organization focused on patient value. It's a journey that never ends, it will be new way of thinking, it will be tough, it will be difficult, it is necessary and it will be worth it. They will make history here.

Members of the CCBRT Senior Leadership Team 

Non-work related summary:

My priorities when I arrived. Find a house, find friends, find a football team and find a church (I'm not sure in what order that is). The house I live in - in honesty is ridiculous. I live in luxury. I share guilt when saying this but also honesty, I am content with the choice I made. I live in a western style compound of 8 houses with a swimming pool and high rise fence and 24-hour security. I am neighbours with UNESCO and the Russian, Swiss and French Embassy. I feel safe here. The house is a 4 bedroom castle and a good place for me to escape from the intensity of the city. I’ve travelled outside of the city to the island of Zanzibar and 2 local cities. I want to develop the routine of once per month escaping the city. I have now opportunities to play football (soccer) 4 times a week if I choose, swimming and playing football are my means of physical exercise so I'm relieved to have both easy accessible. There has been many (too many?) party weekends. 

High Point (work):

Senior Leaders beginning to Change their thinking: I got to teach a 3 day problem solving class to 16 Senior Public Maternal Health Administrators and workers. I co facilitated the class with my hero Dr. Brenda.

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Helping Healthcare Leaders think differently about the root causes of their problems

I will struggle to give you data to measure the impact this had on them but I saw enough evidence to say that this could be the greatest teaching moment I've ever had - they were so determined to changing their own ways. The goal of the 3 days was for them to reflect on the flaws of their current thinking so they stop blaming and start going to the maternal hospitals, observing the work and talking to the people who do the work. To be managers that supports their front line workers by being with them and deeply understanding the problems. 

Working with Team members on reflecting on how we do continuous improvement

Dr. Brenda has been in the maternal wards with them since and has in her own words observed a transformational shift in their thinking. The exciting part is that it is only the beginning of the journey for these managers as we (Dr. Brenda & I) have committed to give them more follow up mentoring and training. With all my heart I believe that this investment will make a difference in the maternal and infant death rates.

Teaching a 3 day Problem Solving Class to Public Health Workers

Low Point (work):

Tragedy at Temake: Temake Maternal hospital has statistics the no hospital in the world would envy (For the first 3 months of 2013: 4896 births; 13 maternal deaths; 169 stillbirths and 80 neonatal deaths). It was time for me to go see with my own eyes. The day will live with me for the rest of my life. To see a still birth being delivered and then two premature twin babies being left to the side to die was truly heart-breaking. When I looked at the patient records with Dr. Brenda & Dr. Yoni it revealed the greatest tragedy of all - the loss of life was preventable. As for me the images of blood on the floor, the unsanitary conditions, 3 women per bed, women lying on a floor, women screaming in pain, women in agony in silence, over worked staff, the broken management system they were working in and the image of the dead and dying infants has pierced my heart to the core. It's the greatest inspiration I have had in my life to continue with the work here. The human need is so great the suffering so needless. We can do something about it.

High Point (Personal)

Community: there are so many good people here, I have had the pleasure of meeting so many heroes’, so many people to be inspired by. I really feel lucky with both the house I live in and the people I share it with, we've become a family of sorts - cooking for each other, socializing together and being a community. I feel that too with the church I started to go to, it is so important to have people you can begin to call friends or at least begin the journey to friendship. I have been fortunate to meet fellow ex-pats willing to share their experience and knowledge with me so to better equip me to adapting to life here.

With my friend and Swahili teacher Fulgence

Low Point (Personal)

Loneliness. I must be honest here, however my pride would prefer to hide it. There have been many moments and days in a city of 5 million people I have never felt so disconnect from people. There is a disconnect with ex-pats and locals that is hard to explain but is a reality. Within the ex-pat community deep meaningful relations seem hard to find. I'm not saying it is impossible but it really is challenging. It has yet been a great lesson for me - that I have tested myself and know myself better. I am now spending more time in meditation and prayer reconnecting with myself and my creator, the solutions to my own personal struggles are not my external environment but lie within me. My personal pain is getting better but I feel it important to recognize it, appreciate it and grow from it. That's what I choose to do. 

In the community observing peoples struggles of a life in poverty

Mob Violence. Tanzania is one of the most beautiful places in the word with people that can no doubt teach westerns about the real meaning of life. However it would be naive of me to exclude an ugly side. I could tell you about how much widespread dishonesty is in the population as so many people including police and government officials are every day I feel out to rip me off. It can piss you off at times but with patience and experience I can see myself managing this with a smile. Witnessing Mob justice sickened me to the core. The thief (or should I say what looked like a 12 year old boy) along with the mob that were holding him only passed me by for a few seconds. What I learned was that he was caught trying to steal a mobile phone. When I asked what were they going to do with him, I almost got sick. They were going to beat him to the brink of death and then burn him alive. This punishment was the mobs way of dealing with crime in the absence of effective policing. How can this happen to this child. I am not here to analysis all these problems but I share this with you the reader. There is no simple solution. Wherever there is poverty there is injustice. The choice for the west is to act or not act.

What you can do:

Part of me wishes I could give you a very specific action that would make a meaningful contribution to this cause. Signing up to become a mentor in the Mentors for Africa program for example is one way to involve people who can't necessarily travel and be on the ground and is one of many ways you can help. Another part of me wants to give you a powerful quote that will inspire you. But instead ask yourself why are you reading this? What are you hoping to get from this, information, entertainment, inspiration? What change you want to make in your life? Decide to do nothing or do something. Whatever you do - do not procrastinate, you’re wasting your own time. 

Personal Message

Passion is the pain you are willing to endure to follow through on something that you believe in. Even though these first 79 days have not been without their challenges I believe that my purpose here is 100% intact. As I write this I fly home to be with my family in Ireland for 2weeks. It's the break I needed, however I can't wait to return to Tanzania fully charged to continue my work here. I alone am not a saviour of the issues here, my approach has got its flaws and I mess up and sometimes do more bad than good. Many more are serving far more effectively.  The human need is overwhelming and we don't have enough people, I will commit to making the best with the limited resources we have,  I will continually seek to improve, I want to get better, the better I can be as a person the better I can serve the women and children. They are my ultimate inspiration.

Mentors for Africa collaborates with Center for Palliative Care, Nigeria and Association for Reproductive and Family Health Nigeria

In spite of the very short planning period, approximately one month, the first pro-bono "Fundamentals of Lean Thinking and Lean Management" training was held at the Association for Reproductive and Family Health (ARFH) offices in Ibadan, Oyo State Nigeria, 9 – 11 April 2013. The training was collaboration between Mentors for Africa, Center for Palliative Care, Nigeria (CPCN) and ARFH.

I arrived in Ibadan on Monday and was able to visit the offices of the CPCN for a “Go See” prior to the training, I met the very lovely and dedicated staff and was extremely moved by the conversation I had with the President, Prof. Olaitan Soyannwo. We discussed their current process and I am happy to report that they do have the beginnings of a Tier process, i.e. they meet daily to discuss the plan for the day, but we were going to have to work on visual metrics.

The next day was training day, I arrived bright and early, not entirely sure of the make-up of the participants, I knew we had participants for the CPCN, ARFH and the local teaching hospital, University College Hospital (UCH), but that was about as much I knew. I was pleasantly surprised to see a packed room, approximately 30 participants from 20 different organizations – NGOs, Hospitals, Nigerian Academy of Sciences... to name a few.
We started with an “Opening ceremony”, different for me but the intent was noble... this was a big deal. We had the CEO of the State’s Broadcasting Corporation give opening remarks and declare the training “Open”.

The next 3 days went in a flash, Participants were great, completely involved and asking all the right questions. One of their biggest concerns was around Good sponsorship, so I included some Change Management at the end of the lean training.

Overall, this was for me an overwhelming success. I truly believe that each participant left with something worthwhile and something they can pass on, and that makes it all worthwhile. I urged the participants to move themselves up the “Change Curve”, from “Contact” to “Institutionalize” by practicing and reaching out to M4A for mentorship.

I will certainly do this again; I know I got much more out of it than they did. It is I who should be grateful for the opportunity to share my knowledge and pay it forward.

Meeting CPCN Folks

Day 1 - Picture with all Participants

Day 1 - News Crew

Day 3 - Almost done with training (Bitter / Sweet)