By Brian Lucas
Main Line Health is a shining star of agility in Southeastern Pennsylvania’s health care industry. In fact, it is one of the most progressive health care organizations in the country. Main Line Health is not a small enterprise; it is suburban Philadelphia’s most comprehensive healthcare resource, offering a full range of medical, surgical, obstetric, pediatric, psychiatric and emergency services. At the core of Main Line Health are four of the Southeastern Pennsylvania region’s most respected acute care hospitals—Lankenau, Bryn Mawr, Paoli and Riddle and one of the nation’s premier facilities for rehabilitative medicine, Bryn Mawr Rehab Hospital.
They are especially recognized for their cardiac, orthopedic, oncology, rehabilitation and women’s clinical services. More than 10,000 people are part of the Main Line Health family, making them one of the largest employers in Southeastern Pennsylvania. Main Line Health is an award winning organization. The American Nurses Credential Center has awarded three of Main Line Health’s acute care hospitals—Bryn Mawr, Lankenau and Paoli—“Magnet” status in recognition of their nurses’ skills, professionalism and commitment to superior patient care. A number of their physicians have earned superior national and international reputations as leaders in their specialized fields. Many have been recognized by local and national publications as well as their peers for being among the finest medical professionals in the Greater Philadelphia region.
These achievements speak volumes about Main Line Health’s enlightened management. David Francavilla, who is an incredibly natural agilist, is a Sr. Property Manager at Main Line Health – Property Management – 255 Lancaster Avenue, MOB 1, Suite 104A in Paoli, PA 19301.
LUCAS: Dave, have you ever had any formal training in agile?
LUCAS: In fact, agile as it is being used today as a methodology, is a new term for you?
FRANCAVILLA: Absolutely, my educational background is in Business Management, with a degree is in Business Administration. Of course I was aware of the concept of business agility. However, the true depth of the adaptability of an enterprise to change and the empowerment of teams and individuals to accomplish mission critical initiatives was not something I was exposed to formally in any way.
LUCAS: Tell us a bit more about how you think and how this evolved in you.
FRANCAVILLA: Over the years, I found that I had a natural ability to perceive things, systems, and processes as they really are in their most fundamental sense. I can identify changes or adaptations to make them faster, more efficient and improve the quality of the results with reduced labor. Processes are, in themselves, very unimportant; its SUCCESSFUL results that count. In my career, I was able to take the spirit of what I had learned in my education and go far beyond it to effectively adapt to circumstances that were radically different from what I studied. The key is that I always thought about what I was doing while I was doing it.
LUCAS: How far back does that thinking go in your life?
FRANCAVILLA: Interestingly enough, for me this goes back long before school, to when I was growing up. I was always looking for a better way to do something, not through elaborate efforts, but simple ideas implemented in little short term experiments. Adaptation has always been a part of my physic makeup. For example, I have had extensive martial arts training in very formal schools where the kata was ritualistically taught. However, in most altercations off the mat you have to make considerable adjustments to your form in order to avoid being hit and hurt and, of course, end the confrontation as soon as possible.
When I went into business I carried that mentality with me. It is something that was always with me since I was a kid. I understood that you had to have the basic facts and a fundamental understanding of something, but I often noticed that many people didn’t know what facts were important or were able to really look at something in terms of the goal they were trying to achieve.
LUCAS: So your natural adaptability is something that was with you since you were a child. You said something here that was really important. You just didn’t do and adapt – you constantly THOUGHT about what you were doing in terms of additional knowledge you were gaining as you were working. You also focused in on the goal being important – not the process.
FRANCAVILLA: In reality, as long as there are no ethical violations, it’s the ends that justify the means – not the other way around. Too many people blindly follow a process and won’t speak up, even when they know it isn’t working, because they are afraid of being remonstrated or putting their job in jeopardy. What they don’t realize, is that the anonymity they practice is putting the enterprise in a precarious position since actions that don’t achieve a desired “profitable” result are not sustainable for a company.
It is interesting, but it is really only recently, in hearing you speak about agile at a business exchange meeting, that I have really reflected back on my career and contemplated this adaptability that has enabled me to be successful in different parts of my career. Since that meeting, we have had some very interesting conversations. You have made me think and look at things differently. You have enabled me to consciously realize things that were previously only subliminal for me.
LUCAS: I appreciate that. It is really serendipitous how we think alike in some areas. It makes it easy for me to understand what you are saying and thinking. For example, we both don’t take things on face value.
FRANCAVILLA: Exactly! I remember when we talked about the Internet revolution. I was a young and fairly inexperienced president of a real-estate company in New York at the time. I had leasing directors coming to me with deals for Internet start-ups that looked lucrative on paper because of the amount of money they were prepared to pay for space. It occurred to me however, that contrary to all the boom thinking that was going on, having a stable company in a location for a 10 year lease at a regular rate was more profitable than having a mercurial one paying a higher rate go bust after a year or two. As it turned out, whenever the directors listened to me the results were positive. Where we accepted the so called flash-in-the-pan clients; the expenses of having to recondition and refit the areas after a year or two and getting new clients, were far greater than the higher rents they were paying. We later found software that we were able to use to make these kind of projections and it bore out exactly what I thought.
LUCAS: It seems that a large part of your adaptability is based on a visualization of your goal and predictive analysis. Though your initial understanding is not something that you are married to; and you constantly find ways of revisiting your understanding and assumptions and verifying your facts. I remember you relating how your father would tell you to do something. You always did it in a different way in half the time. For example, I remember you telling me your father did carpentry work and would always tell you to bring out a tool and put it back right away. You however, would always bring out all the tools for the job ahead of time and then put them back one at a time when there was no more use for it. That saved a lot of time running back and forth. You were bucking-the-system, as it were, even at that time. How old were you?
FRANCAVILLA: As early as nine years old, and when I really came into my own as far as agile reasoning was concerned was 12 or 13. I remember playing sports like football. We would strategize ahead of time about a team that had a particularly big or good player. We would put two kids on that player, but if he wasn’t performing well that day. I would suggest we move our coverage back to a man-on-man profile or double cover someone else if they were hot that day. This was always plainly evident to me, but it was hard for me to get the rest of the team to understand; after all we were just kids.
LUCAS: It really doesn’t sound as if agile was something that developed in you. It appears to be something that you were born with. You seem to naturally be able to observe phenomena. You look at the bigger picture and are not confined to what is in the immediate space around you. You see things relative to their interaction with other elements. While you emphasize speed, you never seem to sacrifice quality in whatever you are doing. The time you are saving actually enables you to put greater quality into your effort. A lot of people mistakenly think of agile in terms of quick and dirty, but that’s not true for you.
FRANCAVILLA: Absolutely, when I was a kid and throughout all my adult life, doing the best possible job and having the most productive and satisfying outcome was always foremost in my mind. I think most people build task lists for accomplishing something one task at a time. They start out with the first task they need to do and then the next in a very sequential order. I visualize the end goal and then reason backwards from it to where I am now. I find it enables me to understand the target better by focusing my mind on what is to be rather than where I currently am. It often enables me to skip a couple of the preliminary steps and expend more quality effort on the more critical ones.
Once you have a vision in place, working together in harmony is most important. So very often I have seen situations where people were assigned to a project or initiative and only a few were totally focused on a goal. Maybe as little as one in three persons were dedicated to the successful accomplishment of the goal. Others added no value to the effort and worst still there were those who were actually hindering any progress. In order to work well together, you have to be able to pass information around effectively and efficiently. I have never known of an effort that required collaboration that succeeded without good communications. Motivation is probably the key to both of these. If those involved don’t share a common motivating factor like basic survival or job retention or shared financial success they usually won’t try to work together or communicate with each other.
LUCAS: You introduced a lot of subjects there; motivation or shareholder stake, good communications and teamwork. These are all basic critical success factors for agile. Your experience in the personal securities industry which you related in an earlier conversation, demonstrates when a person’s basic survival is at stake, and they know it, that they are more likely to hone these agile skills successfully. When the threat is greatest – a person’s situational awareness is greatest. That is similar to the concept of tachypsychia.
FRANCAVILLA: And sometimes being agile or adaptive is about getting back to basics – if that is the need. Often people don’t really focus on the right need or goal. For example, it is not important that you cover yourself with a paper trail; because no paper trail will ever produce a satisfying result or achieve an end goal of customer satisfaction. The most important thing; is to accomplish what you set out to do. THAT is what will lead to customer satisfaction.
I remember years ago, I a friend in New York came to me with a business problem. He ran a security service business. He was such a good salesman, that he had reached a point, where his business could not keep up with the work demand. He was starting to have failure rates and it was taking months to train new employees. He knew if he started to turn customers down that it would be disastrous. So I analyzed his entire business processes. From how he got his leads, to who sets up his meetings, to how the results of a meeting are communicated with others, to how the office sets up an account for the new client, to how all the supplies are ordered to service this new client.
What I discovered was that he spent so much time on marketing, and he was such a great marketer; that no one had spent time on the operational end of the business. He was not taking advantage of automation or leveraging computers to his advantage. His fulfillment process was long and meandering. No two people understood the flow in the same way. Also his business was fraught with turnover in a few areas that seemed trivial, but were actually critical to smooth business operations.
So I worked with him to streamline his processes and establish a basic and very simple documentation set on how the business operated. They were actually able to reduce their throughput time so much that their fulfillment issues, even with increased business, disappeared.
Here is a simple example of the kind of improvement I am talking about. Suppose you open mail one piece at a time, and then date stamp it, and then file it. You could do the same work in half the time by opening all the mail, then date stamping it all in one pass, then sorting it into categories for filing it and finally filing it. This very simple change could allow your mail room to shift from being a hold up in the process to being ahead of the demand.
LUCAS: Just to recap, throughout your entire life – you have applied your agile thinking in whatever you have done – whether it was business or personal life. In fact, it seems as if you have a burning need to reinvent whatever surrounds you or whatever situation you are in – using your agile method. I am sure that you have run into considerable resistance in the past, but I am curious as to how things are working out for you at Main Line Health.
FRANCAVILLA: I started at Main Line about three years ago. When I first came into the company, I focused on absorbing what their processes were and what was actually happening. I did not want to come in as a bull in the china shop and change everything right away until I understood what was really going on, the reasons for it and perceived a real need for change. So in the first year I asked a lot of questions, listened very intently and observed very carefully.
The traditional process of office or facility management in the health care arena, we work in, goes like this. A doctor comes in looking for an office or is looking to revamp his current office. We then go out and hire an architect or engineer or both and have them evaluate the current space to see what it needs to meet the tenant’s requirements. They create a set of documentation which we then go out and price. A contract is then negotiated between us and the doctor to see who is paying for what. We will then build the space to specifications and hand it over to the doctor.
In the past our focus was in keeping the upfront expense, like those of architectural and engineering fees, to a minimum for previously occupied spaces. Our thinking was that if the space was good enough for the previous tenant; it was in rentable condition. Well architects and engineers are not going to say no to a lower fee, but they will not do much due diligence if their fee is capped. For example, they will generally only see the facility one time briefly. When I came on board I was handing keys to doctors for office spaces that were freshly painted, newly carpeted and lamped to a doctor. He was initially happy because he was able to move in and start his practice. Later I would get a call from them at two o’clock in the afternoon on a hot summer day saying they were dying because the air conditioning was insufficient. When it was winter I’d get a call in the morning saying it was freezing in the offices.
LUCAS: In this instance being agile actually meant to adopt a strategy of more upfront planning. I know that will sound contradictory to some agile purists, but adapting to the needs successfully is the most important agile principle.
FRANCAVILLA: That’s right, getting complaint calls from clients is a serious problem. What I did was go to the call system and mine it for the information about complaints made from previous tenants. Sure enough I found patterns of HVAC, plumbing, electrical and lighting insufficiency that were addressed tactically, but never dealt with in a strategic sense by reengineering the system. Every time we had to address these complaints it cost us time and money usually at a high rate. The onsite technicians knew of these problems, but did not communicate them with the people who marketed the space. In turn, the people marketing the space did not call the onsite people to see how satisfied the previous tenants were with the space.
The fact is that maintenance of these utilities is very difficult, inconvenient and costly to perform when a tenant is occupying the space. It is far easier and less costly to perform between rentals. So I prepared documentation showing that this was a problem and that in order to stop having the problem we would have to institute a policy change in our upfront refurbishing costs. I proposed that a team be formed of an architect, an engineer, a property manager and an onsite technician as well as the space marketing people to review a facility and its history after a tenant announced they were leaving. I developed a spreadsheet checklist that covered all the historical problems that were reported for the facility and see what was necessary to address them strategically. Our records showed that it was far less expensive for us to correct these issue once-and-for-all during a tenant transition than to fix them temporarily on the fly. Furthermore, our tenants would be much happier when they occupied the space and were able to focus on their business, not facility issues.
LUCAS: What was your management’s reaction to the proposal?
FRANCAVILLA: Management at Main Line Health was progressive enough to recognize this. Their intent had been to actually save the doctor or tenant money, but it turned out that the policy did not have a positive effect. When I presented my case, they recognized the facts immediately. They very quickly adopted a new policy and supported me fully in formulating this change. What surprised me the most, was how receptive Main Line Health’s management was to accepting recommendations early on and how quickly they responded to them.
Since I came in as a senior manager, I was invited to the leadership assemblies. All the senior management would come. There would be hundreds of us. The CEO and the Chairman would tell us about the business plan for the year. They would always present these plans in a clear and direct fashion. Their style was open and friendly and they put great emphasis on presenting to us, not just giving a presentation; their communication skills were superb. Quite frankly their attitude was refreshing and amazingly agile, which I have found to be rare in a company of this size.
LUCAS: I agree with you that it can unfortunately be rare in larger organizations. You just drove home two important agile points again; great communication and open to new ideas. It sounds like these come straight from the top at Main Line Health.
FRANCAVILLA: Jack Lynch, the chairman takes the time throughout the year to send out very well thought out emails. They covered subjects like health care reform, clearly articulating the challenges that Main Line Health faces and even issues that affected the industry in general. He then sets the vision, goal and strategy on how Main Line Health will deal with these challenges. It shows an amazing focus on proactivity and solid strategic planning – balanced with responsiveness to change. He also reports on progress very much in an inverted pyramid fashion where he makes us feel as if his number one goal is to enable us to do our best.
He tells us how we currently rank in the industry. For example, every one of our hospitals is ranked in the top 100, but that we need to do better and what specifically our goal is. He always identifies what our focus should be and these always revolve around quality first and profitability second. He will talk about the importance of infection control for the clinical people and identify key specifics about the process that we need to concentrate on.
LUCAS: What is your relationship like with your immediate management?
FRANCAVILLA: I report to two phenomenal managers; Lisbeth Grossman, the System Director for Real Estate and JoAnne Magnatta, the Head of Real Estate Facilities Design and Construction. They are both very accomplished individuals. Often when you work for people who have achieved as much as they have, there is little room for self-expression or outside ideas. You do things their way and that’s it. These two people made it very clear up front that they expended a great deal of effort in the positions that they fill – looking for people who can think for themselves and bring new strengths to the enterprise.
What really took me by surprise however, is that not only did they listen to me on matters relating to facilities management, but they also embraced ideas I had that were generally not the purview of a property manager. For instance, way finding on a hospital campus; I noticed when I started work that people were having trouble finding their way to the office where they had an appointment. They were fumbling along, sometimes they were exasperated or having physical difficulty with mobility. I started to investigate what we had in terms of signage and way finding and found it to be less than adequate. The signage had grown in an organic fashion without a thought to overall traffic navigational needs.
LUCAS: How did you go about solving the problem?
FRANCAVILLA: I sat down and thought about how I could get a handle on this issue. Direct observation seemed to me to be the best answer. I stood in the lobby from 7 to 11 in the morning with my employee badge clearly displayed that says I am the property manager. If anyone appeared to look inquisitive or lost I would ask if I could help them. It was amazing what I learned. First off, there was a tremendous variance in the information people possessed when they were trying to find their doctor’s office or other destination. Some had everything including a script, a business card and appointment instructions; others only knew the doctor’s last name. Some could not even remember the actual doctor’s name, but knew his specialty.
It became evident that an overall solution had to be devised. It needed to help all types of people; from those who knew exactly what their destination was; to those who possessed minimal information. I knew instinctively that we needed commonality to make this easy to use by various types of people through various entrance and exit points. This meant we needed an orientation map that was ubiquitous and color coded. To make this work, we needed to take the color scheme and follow it throughout the facility. To be economical, we needed something simple like a backdrop on all the signs with a reveal that carried the color theme. This would give us the best of both worlds; continuity in color coding making it easy for patients even on a subliminal level to navigate by color, and freedom for the facility to maintain and remodel areas based upon esthetics that were pleasing to our clients and their customers as well. Lastly, it needed to be implementable in a very simple fashion like using 8 1/2” by 11” holders with plastic sheaves so that they could be easily updated without going to an expensive sign shop.
I very quickly put together a concept and I went to Lisbeth Grossman my immediate manager. I presented to her and asked what she thought. Her reaction was superlative. She didn’t reject it and she didn’t rubber stamp it. She asked very intelligent questions. Then she was good enough to take the time out of her busy schedule to come out and stand with me in the lobby to see the situation first hand. She didn’t delay her decision or action either. When we got back to her office she was immediately planning on how to implement this new signage program. This is now fully in place at the facility I work at and we have received very positive feedback both from our tenants and their customers about the ease of finding offices. People have even gone so far as to inquire when we would implement this at all Main Line Health facilities and now we are starting to do that.
LUCAS: That’s a nice example of enlightened management. Is it common throughout the organization?
FRANCAVILLA: Main Line Health has a term we commonly use which is to guide all our actions. It’s called “The Superior Patient Experience”. It’s a mantra that helps rally and bring everyone in the entire enterprise to a common focus.
LUCAS: That’s a beautiful articulation.
FRANCAVILLA: It’s our code of conduct. Everything is about the patient and we are only as good as our last patient feels we were. For example, if you did a great job within the building, but as the patient is leaving, he has a bad parking lot exit experience, that a problem. Main Line Health not only encourages improvement, but acts quickly to free up funding and fully supports these types of initiatives. That goes right up to the CEO and the board of directors. They are approachable.
If you can demonstrate you have an idea that advances the concept of “Superior Patient Experience”; they are very agile in getting a program off the ground and implementing it. Every month we have a leadership meeting at each one of the hospitals and the hospital president runs this meeting. They present all the financial and operational information and its net effect on the enterprise. Furthermore, they encourage us to share this information with those who don’t attend these meetings. They have a very strong concept of transparency and open communications. It’s really refreshing to know that senior management is working as diligently, or more so, than anyone else in the company and that they are flexible in recognizing that the environment is always changing and that they need to be a step ahead.
Once in a meeting I attended at Bryn Mawr hospital – the room was strewn with hospital gowns, bandages, bed sheets, etc. – just all over the place. The president took over the meeting and said I am sure you are wondering what is going on around you with all the hospital supplies lying about. Well we stock each room to the brim with supplies without consideration as to what the specific patient who will occupy the room needs will be. We did a study and found out that these are the supplies we are throwing away each day, because when a patient leaves a room whether you used the supplies or not they all have to be removed and thrown out. We need to get to the point where we are not wasting supplies like this. It is money down the drain for us and our patients. It was a great to make the point. Paoli hospital has become one of the top ten hospitals and has been asked by the medical community to communicate how they have accomplished this in various conferences. This in turn has led to tremendous financial success.
LUCAS: Well Dave we have come full circle. You started with success being important not processes and ended with that. It really sounds as if a natural agilist has found a home at Main Line Health because they have a “Healthy” attitude towards agile. The health care industry should look to companies like Main Line Health to see how to adapt to the new health legislation, the changing nature of the patient base and the new economy in which we are now fully immersed.
Note: At the time of publication the author never worked for nor had any financial interest in Main Line Health.
Tachypsychia is a neurological condition that alters the perception of time, usually induced by physical exertion or a traumatic event. It is sometimes incorrectly referred to by martial arts instructors and self-defense experts as the Tachy Psyche effect. For someone affected by tachypsychia, time perceived by the individual either lengthens, making events appear to slow down. It is believed that tachypsychiais induced by a combination of high levels of dopamine and norepinephrine. Upon being stimulated by fear or anger, the adrenal medulla automatically produces the hormone epinephrine released directly into the blood stream. This has various effects on bodily systems, including increased heart rate and blood pressure. It is common for a tachypsychia subject’s pulse to rise to between 200 and 300 beats per minute. Dilation of the bronchial passages also occurs, permitting higher absorption of oxygen. Pupils dilate allowing more light to enter, and visual exclusion, or tunnel vision, occurs allowing greater focus. Glucose is released into the bloodstream, generating extra energy by raising the blood sugar level. It is common for an individual to experience auditory exclusion or sensitivity. It is also common for individuals to experience an increased pain tolerance.
Wow! What an inspirational story! Very expressively written! I am an operations manager at a Fortune 500 company that is DEFINITELY NOT progressive or agile in the manner that this article describes. I must admit I am also not a natural agilist, but I see the advantage of this type of thought process and would like to operate in this way. I also read the introductory post to this interview and it implies that there will be more interviews of this nature. Please do so! The more examples you post the more evidence and examples I will have to use and help move my organization and management team (particularly the C level) to a more progressive structure. Right now upper management makes all the decisions and the workforce carries them out. When we get creative people with ideas in like Mr. Francavilla they are criticized for making suggestions. They are subsequently forced out or laterally transferred. It has become politik to keep your mouth shut and not make waves. If I was in the health care line I’d put in an application at MainLine Health! (name withheld by request)
I realize it is always difficult when you are in senior management, as you are, to admit that the organization you work for is wanting. It is especially painful if it is lacking in fundamental ways as you are describing. One of the most deadly diseases an enterprise can suffer from is the intolerance of new ideas. No matter how good or strong the business originally is; that sickness will eventually kill it. I commend you for having the perception to recognize the situation at your organization honestly and having the courage to voice it in your reply. I can tell you that Mr. Francavilla is a very exceptional person and ANY company would be very fortunate to have him. Although I have not personally met his CEO Jack Lynch, from Dave’s description he must be a remarkably progressive visionary. Having met with Dave several times I can tell you that he is not a person easily impressed. I have two additional interviews I have already conducted, that I have not posted yet. I just have to find the time. I will try to get to them as soon as possible. Good luck with your mission and keep me posted. You can email me if you are more comfortable. -Brian
I am not sure it is possible for any employee even those in trusted C Level positions to change the shape of the company structure. Only the CEO has the authority to do so and that seldom works out even when they try it. In order to change everyone has to want to change and that will is more times than naught lacking.
This is a great interview and a very novel idea to boot. Personally I am sick and tired of reading interviews with celebrity eggheads that blather on about theories and have left a trail of dead bodies behind them. So many nice ideas and theories don’t work in the real world. It is refreshing to see someone actually show real life examples. I hope there are more to follow!!!!!!!
Thanks Ryan! I enjoy talking to real people who are making it happen and not just the theorists. I also like to see examples that actually work and not just hear a CEO brag about their efforts and misrepresent them as successful when they are far from it. I can assure you that Dave was very factual and down to earth in all his claims. In fact he understated them. -Brian
Amen Ryan, I have worked for several companies that were the casualty of a high flying CEO that wasn’t worth a lousy dime.
I could read a book about this without finding such real-world approaches!
I am a professional consultant with over 38 years of experience in Information Systems. I am very impressed with David Francavilla’s interview. I want to add my voice to others that have embraced the idea of hearing from people who have successfully applied agile in their life and careers. I have only begun to work with agile efforts over the last 18 months. I have heard so much propaganda about successful agile software projects. In my experience the failure rate is 50%. This post is a breath of fresh air. It is a little long, but I assume that is the author’s intent. Tracing a person’s life from its beginning to the present and seeing the impact of agile thinking. Despite it being long the interview flowed smoothly which made it easy to read. To say the least it puts David Francavilla in a positive light and makes Main Line Health look like a model organization. This is the kind of positive advertising that a company usually pays for one way or another. At this point I have to ask the question. There is no disclosure statement on the interview so I am assuming that the author has not worked for Main Line Health. I believe you should declare that explicitly. Having offered that bit of criticism I want to complement this post. It has changed my attitude about agile. David appears to be quite a good story teller and the author was also wise enough to keep his questions and comments to a minimum. Many others would have given into the temptation to show us how clever and smart they were by constantly interjecting. I find that very annoying. I really see that agile is a return to the solid systems analysis practices I learned when I got into this business and the focus was always on efficiency. The only real difference is that it is incremental which is something I can readily get behind. Keep posting and let me know if you have done any webinars.
Ken – Thank you for your comment. It always means a lot to an author to receive acceptance from someone in their field that has as much experience as you have. I will add disclosure statements to all my interviews, but to answer your question I have never worked for Main Line Health. I first met Mr. Francavilla at a local business exchange meeting at which I was making a presentation on agile and human capital management. Your observation that Dave is a good story teller is insightful. He is, in fact, a great conversationalist and a pleasure to interview. -Brian
Since I have chosen the health care industry as the place I want to work in, it is reassuring to know that there are organizations like Main Line Health that have their act together. The introduction tells how successful the organization is and is what you see in press releases and on billboards. There real story is about Mr. Francavilla and how he was accepted at the company and his view, which sounds very genuine, about how positive of a work environment Main Line Health has. Great Story!
Thanks Trisha! You are right the real story is about Mr. Francavilla who is an incrediby active an prolific agile thinker. Main Line Health scored big when they hired him. That in no way detracts from the truth the Main Line Health is an organization with a very progressive and enlightened CEO in Jack Lynch.
Brian you too are a remarkable thinker as well. Those who are truly brightest are not afraid to shine the spotlight on others.
Of all the interviews (and I like them all) this is my favorite. Because it involves both life and work aspects of the thought process that Brian is trying to teach us all. I have never followed a blog that I found more interesting or made me want to comment more in a positive fashion than yours Brian. I will add my (voice) to the others here who are calling for Dave to participate more. And if his managers are as enlightened as he feels they are (and I have no reason to doubt him) I am sure we all would like to hear from them as well. It only took me 3 minutes to type this after all surely they have 5 minutes to invest.
Thank you for the comments.
As the pressure to perform in our business roles increases, it unfortunately does not leave the time we would like for participating in this blog in a timely fashion. I will now check the blog on a more regular basis. When Brian first asked me to do the interview, I was not sure who would be out there listening. Now I can see that there are very many people who share the same concerns and thirst for Agile knowledge.
Agile is really a simple concept. However, since most of us work for an employer, the magic is in conveying this concept to the employer and obtaiing “Buy In”. If the employer is not willing to recognize the need to adjust business plans, business targets as well as methods & procedures; then you will simply be banging your head on the wall. And, you may put yourself in harms way as you try to push this thinking on others. In some cases, the search for an Agile organization may lead to changing employers. Brian and I have been tossing around the idea of doing another interview, or perhaps a joint “white paper” that deals with manageing your own career. That will be an interesting endeavor to show how we allign our personal goals with an employer. In many cases today, the economy has made it necessary for people to re-invent themselves in new careers. All of this needs to be discussed.
I appreciate David’s effort at responding here, but I think he is dancing around the subject. I for one would like to see a bit more proof of the enlightened management claim made here though further examples or anecdotal evidence. The experience of most of us with organizations of this size is that they are vast bureaucracies fraught with inertia and rife with management self protection. If this organization is agile people are not being overworked as David seems to be implying. The ‘too busy’ comment is often used when someone is not in a position to offer an honest reply due to job concerns.
I am going to disagree with you here Brian and side with Tim who very gently reminds us just how bright you really are. We all realize that and appreciate your modesty.
Thank you Trisha. My background is Corporate Real Estate and Facilities. Actually, I was looking for a company like Main Line Health. One that would be financially stable, predictive and progressive enough to chart an intelligent course around our turbulant economy. MLH fit the description of a company that would meet my needs. The trick was watching their website and other job boards to see if an appropriate position would open up. Fortunately for me, it did. I would love to do another interview on “Managing Your Own Career Path…During Turbulent Times”. Perhaps Brian would be interested in doing this?
The ball is in David’s court on this one. When he is ready I will interview him.
This is the most original approach to explaining agile I have ever seen. Mr. Lucas is very creative and by far an away one of the most interesting writers I have read. This tells such a great story about Main Line Health I am surprised they aren’t advertising this everywhere. I wonder if Main Line realizes just what a gem they have in Mr. Francavilla. For that matter I wonder if the company that Mr. Lucas works for recognizes his writing talent. Quite frankly he seems to have appeared on the agile scene out of nowhere. Impressive work but your blog could use a bit of graphics flair. Keep posting you have a great talent for it. Please post more often. I would read your blog every day. Respectfully Barry Walters
Barry – Thank you so much for your generous and supporting words. I have tried hard to bring originality to this blog in exploring natural agilists and agile in history. I honestly believe that Main Line Health recognizes the wealth of Mr. Francavilla’s contribution. Jack Lynch the CEO is obviously a dynamic and charismatic leader with superb communication skills. He is an astute and knowledgeable executive as well as a progressive thinker. I will try to post more. It is just a matter of finding time. -Brian
Original says it Barry. That is what I like most about this blog, it has original content based on original thinking. Brian has done us all a service by injecting a fresh approach to agile as a way of thinking and not just a method of software development. What we have to do is get him post more. Unfortunately his time is apparently limited based on some of the comments he has left.
My CIO forwarded your blog to me with a glowing account. I first scanned it quickly, and then took the time to really read it. I have been the CEO of my own company for almost 30 years. During that time, we have grown from a handful of people to an organization of almost 5,000. There have been many challenges we have faced. Our hard work has rewarded us however; and we have been successful. We have beaten our competition through tight management and better value. Your blog has made me realize that this success is not enough. The prevailing thought from my generation was always to be better than your competition. While we are not in the health care business, this article of your interview of Mr. Francavilla has truly impressed upon me the fallacy of that thinking. I have read all the interviews and they are all conducted with skill and each provides both an education and a moral. But it was this interview, Mr. Francavilla’s thinking and his description of his CEO’s approach not to just beat the competition, but in always challenging themselves to improve proactively that impressed me the most. Yes this was a long article and we are all too busy today to do more than quickly scan articles of this nature. What a mistake! Mr. Francavilla is the type of person who would enrich ANY organization as the examples in his interview show. His intellect, his logical approach to problems, his positive company attitude and most importantly, his embodiment of always looking to improve and never accepting the status quo; make him a very precious asset. This interview is so powerful and positive I am surprised it has not been promoted more. I had my executive assistant look on Main Line Health’s site for more on their agile philosophy and we could not find any additional references. That was a disappointment. If I admire the subject of this verbal portrait; I must also pay tribute to the artist. Mr. Lucas has a talent for understanding and expression that I have rarely seen and deserves much recognition for his work. I have read a number of his posts now and notice that he has never marketed his company. So many blogs make shameless self-serving statements that make you discount them immediately. Mr. Lucas stands above this with an integrity seldom seen. This article has made a difference for me and will make a difference for my company and our people. The message that it sends is being heeded by us.
Thank you for the comments.
I believe that “Good Enough” is never good enough. In my 35 years of working in large businesses, I have come to realize that the best organizations are on a relentless pursuit of perfection. Each year problems are identified, and each year the process is modified in an attempt to do things better. This does not have to be an endeavor that puts undue pressure on the employees. Simply put, it must be an attitude that is promoted and supported by management. Once you have that model in place, the ideas will flow easily. You will also know who your Agile thinkers are very quickly. In my mind, this is a healty way to run a business. Too often we see the exact opposite model where new ideas and change are suppressed. At the end of the day, the suppression model leads to dissatisfied employees and a disappointing bottom line.
I am sorry I have not commented on Dave’s interview before. It is a very fine piece of work and Dave sounds like a very interesting person. I find it very interesting how you and Dave interacted during this interview. Since I read it after Wayne’s interview I now realize some things that weren’t apparent before. You are very skillful at guiding an interview without seeming to overtly do so. I suspect that as sharp as Wayne and Dave are you are still a page ahead of everyone. I always find myself gaining another nugget of knowledge each time I reread one of your posts. That’s a true sign of incredibly great writing. -Jack
Brian is simply Brilliant! With that said, he has an amazing ability to conduct and pace an interview. He recognizes what each person has as valuable knowledge and can somehow keep them on task and extract the best out of them. Yet, Brian does this with great integrity. It would be easy for him to put words in someone’s mouth, but he does not do that. He is amazingly able to extract the knowledge the person he interviews has, and can capture and pass it on to others.
I just had to get in on the act here and make a comment. I liked Wayne’s interview which has most of the staff here gaga, but I found Dave’s interview more interesting since it traced his thinking from early on in his childhood. They both sound like very capable persons and I hope they are really appreciated where they work. It sounds like Dave could and should teach agile thinking at MLH. With the sign issue, I am surprised no one noticed the problem before. I guess Dave has not worked there very long although the interview does not make it clear. I want to say Brian that I don’t think you are getting enough credit for these interviews. They are smooth and readable because you are making them so. Well that is my comment I hope you post more!
You are correct, I have been at Main Line Health for three years. You are also correct in recognizing that Brian Lucas is an excellent interviewer. He can easily pull out of you exactly what he wants you to cover. Brian is also very ethical, he will guide the conversation to cover the items he believes are important, but he will only capture what you truly mean to say. Although Brian has many years of Agile business thinking under his belt, he will not put words in the mouth of the person being interviewed. Once again, I’m not sure how we get someone qualified to interview Brian.
Dave you should be teaching your way of thinking to everyone at your hospital and presenting it at every event MLH attends. This is too good not to promote. It could benefit so many people. Please let us know if you decide to do so. It would be great if you posted some background on how you met Brian and your interview. When is someone going to interview Brian? That would be very interesting!!!!!!
I want to join the others here who have said that this was such a great post. I enjoyed reading about Dave’s agile thinking during his life experience. It sounds like it is worth a biography. I learned a lot about agile thinking. From your profile here you also have a very interesting story to tell as well. I looked for you on Facebook and the internet and could not find you at all. I think you should consider telling your life’s story and how you always were or became agile.
Brian after reading the other serious and detailed comments you have received on so many posts throughout your blog, I felt guilty about the short and simple comments I made previously. I will try to make up for it here. I guess we all got caught up in the buzz of Wayne’s interview and the positive way he viewed his service to hospital staff and medical practitioners. I was easy to do so because you are both eloquent speakers and the interview was easy to follow. I will admit to reading Wayne’s interview more than once. When I read this interview with Dave Francavilla I was struck by the span of time it encompassed. Wayne’s interview was about his job. Dave’s interview was about his life. It is amazing to me how smoothly you drew this information from Dave. I know I have had to interview potential hires and found it a difficult process. You made this look easy. The other point that struck me is your lack of self-serving statements. Even when Dave was paying you a complement about your speaking at a meeting he attended, you simply acknowledged it and turned the conversation back to how Dave thought. In fact, nowhere in any of your posts have I found any evidence of your bragging. This quite frankly makes me as well as others I work with curious as to what makes you tick. This interview was long and I know that there will be some people who won’t read it or read all of it because of its length. That is very foolish because they are missing a beautifully crafted portrait of a person’s lifelong approach to thinking. I am going to join the others in calling for more background on these interviews as well as more interviews. I also believe that both Wayne and Dave should write a sample piece for your blog. I am sure they have a lot to contribute. Most importantly, I would really like to see someone interview you. Do you work with an editor? Could Dave or Wayne interview you? That would be fascinating! Well the was my attempt at a more substantial comment I hope you felt it was worthwhile.
Leigh, don’t feel guilty. Your comment here is a beautiful perspective. Yes Dave talked about his life which is a fascinating tale, while Wayne confined his comments to his current job. As far as making self-serving statements is concerned, there is an old saying, “he who toots his own horn plays in a one man band.” (Please forgive the use of the masculine pronoun here.) As far as what makes me tick, we are all the sum of our experiences and our dreams. It is the tension and balance between the two that makes life interesting. From an interview perspective, I am reluctant to show the hubris and allow myself to be interviewed, however, I am considering starting a thread where readers can ask questions and I will answer them.
This is a remarkable story of a person who has made a difference whatever he did and wherever he worked. I understand this story for it brings back bittersweet memories to me. It has been my remarkably good fortune to have worked with in my long career several persons like Mr. Francavilla. It was my misfortune to be foolish enough not to take advantage of all their knowledge and capabilities. The first time I came up against a person who had this level of capability I was jealous and would not listen to all they had to teach; so I wasted years of effort in my career. The second time, I was an executive, and too proud and fearful to listen to someone smarter than myself. The third time as a business owner, I was mature and wise enough to cherish a resource that had so much to give. This profited me and my company greatly. It was a sad day when this person, who had become a great friend as well as an employee, passed away. In my experience people like Dave and my friend Richard have complex personalities. They can be both coldly logical in analyzing incredibly complex situations and emotionally angry at seeing missed opportunity or frustrated with those of us with less intellect. When they cannot make themselves understood especially when they see the subject of their explanation as simple they often withdraw. They find solutions with a rapidity we find insulting and are always not just a page ahead, but sometimes chapters and even books. It is our loss that we don’t take more advantage of people like this; if we did it would be a better world. As I am in the twilight of my life now, I am glad that I can say I found the emotional maturity to do so once in my life. As a very old man, I offer Jack this piece of advice. Cherish Dave, listen to him, meet with him regularly, place no limits upon him that are not fiscal in nature, forgive him his unintentional abrasiveness and protect him from the jealousy of others. You will be rewarded a thousand fold.
Tim, thank you for the kind comments. It is interesting that you picked right up on the fact that Agile business thinking is not immediately accepted in the general corporate environment. It has taken me 30 years to be able to get my thoughts across without putting myself in harms way. The fact that our economy is in such turmoil, actually helped me in this area. When Owners and CEO’s are faced with providing immediate answers/solutions, all of a sudden they are looking for the person who thinks outside the box. Still, depending on the environment, you have to pace yourself for introducing new ideas. Each organization has it’s own timeline on which the senior staff become ready to accept new Agile ideas. That lesson came hard for me. I have been working in business for 35 years (since age 15 at AIG in NYC), and along the way found myself being dismissed from my position when I pushed too hard. I am looking forward to doing another interview with Brian to discuss “Managing Your Career”. This will cover choosing the right organization, and how to be Agile and still survive. Thanks again.
Mr. O’Donnel, you are a person I would have loved to meet during your working career. Your words are well chosen and filled with considerable wisdom. You speak with an honesty we are unaccustomed to hearing from people nowadays. Your advice to Jack is profound, heartfelt and gently given. I hope he takes it! I am proud to have met you even in this limited way through this blog. I hope you will continue to correspond!
Dave when are going to give us a post? We are all waiting! And when is someone going to turn the tables on Brian and interview him? Not enough posting going on here.
Brian is so masterful at these interviews. I’m not sure if any of us could do him justice at interviewing him! But, I have to tell you, he has a great amount of Agile Business expertise. Perhaps the Master can offer a suggestion on how and who could interview him and make it worth while.
Well Mr. Francavilla, we are still waiting for this much anticipated turn the tables interview as you put it. When is it going to happen? I think that a group interview would be a really interesting concept. Rather a novel idea, at least for blogs I have read. That is assuming that you can overcome any scheduling difficulties. I recall the days of my doctoral thesis and having to defend it in a room of questioners. Some were aggressive, some were supportive, but all were fair. I was the better for the experience. Christopher P. Thackery, Phd.
Does Dave teach his method of thinking at MLH as Haley suggests? If not why not? It seems to me that when a company has someone like Dave and a progressive CEO educating the organization to new ways of thinking should be a priority. I am curious how they do it and if not why not. Any answers? — Lordes
My postion here at Main Line Health is that of a very busy Senior Property Manager. Although I do not personally teach Agile at Main Line Health, our Corporate Trainers offer various courses to our employees that promote similar thinking. By example, being a hospital, we often have situations where a Nurse (or other clinical person) observes a doctor doing something that seems odd or wrong. Previously, they may not challenge the doctor based on the common hierarchal theme. MLH has come up with a class called “Crucial Conversations”. This class promotes the braking down of “Classes”, and encourages all employees to challenge each other when a situation arises that could possibly lead to a poor result. Well, it definitly works. We now have what we call “Great Catch Awards”, where individuals are recognized and rewarded for catching errors, bringing them to the attention of others and challenging the original order giver. In many cases, lives have been saved. I suppose that you could say that on the strict business and financial end of things, the message is just as important.
Dave what is it going to take to get you to reply here? Come on we are all waiting for you to be agile! lol
Brian and Dave I have never read a more wonderful interview on the subject of agile business thinking nor seen more intelligent and even emotional comments. This story is reaching out and resonating with many different people in diverse situations and at different points in this life. You both should continue the thread and keep it active and by all means do another interview or joint article. I found Tim’s advice to Jack one of the most poignant things I ever read in a blog and very good advice. I hope Jack takes note of it.
It will be interesting to see where this thread goes from here. I would really like to hear Dave and Brian do a free format talk show.
Dave and Brian still waiting for the promised post and Brian’s interview. Come on guys let’s get going we are all breathlessly anxious!!! Why don’t you all interview Brian at the same time I am sure he could handle it?
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This really is a great interview that is a tribute to the interviewer’s skill. I really enjoyed the nuance of how he returned to the beginning of the interview in his summation and chose the title for the article. As I said, masterful interview and Dave is obviously a smart person, but I am not sure that the organization Dave works for is as agile as he says it is.
Did not mean to attack John or put Brian in a difficult position, Leigh. I just wanted to draw some attention to this thread. I won’t retract what I said about the other mangia followers though if there are a 1000 of the only seeing two respond is lame in the words of lady Jane.
Haley you posted this comment to the wrong thread. Oops! It belongs as I am sure you realize in the Interviews with a Natural Agilist: A Natural Agilist Makes Mangia a Marvelous Experience. I appreciate your passion in responding.
Really Haley you should pay more attention when you are trashing someone and get it in the right thread. I told you not to keep multiple windows up! Just teasin you girl! And though it might upset Brian I agree…
Hey Dave don’t forget about us….
This link got so much play at our company I just had to finally read it………………………………..Now I know why everyone here was caught up in it. I thought it was very educational and supremely well done. Brian and Dave are like two peas in a pod the way they communicate! I enjoyed reading the comments as well, they were facinating. If Main Line Health ever holds events that Dave and Brian speak at I would like to attend.
This is good post on agile thinking. I much enjoy. Many more must be post.
What a shame this stream died out and Dave did not follow up on some of his ideas for future posts. It was quite interesting. I would have like to have seen how all the interviewees turned the tables on Brian and interviewed him. I suspect that would have been epic!
Nice interview Dave very lucid and expressive. I find your frankness refreshing. I hope you follow up on your intentions to post more about being responsible for your own career management.
Since Mr. Harrington broke ranks with the strong stream of kudos for this post which are surprisingly present throughout this blog, I’ll follow suit. I have to compliment the moderator here if it is not Mr. Lucas for letting it post. After reading Timothy O’Donnel’s comment this takes a bit of courage to do. Mr. O’Donnel has the kind of personal honesty and self-reflection that we all should have and seldom do. I cannot testify to the fact that Mr. Harrington read Mr. O’Donnel’s comment of course. To start let me say, I do ‘like’ the interview it is well written. These are obviously two highly intelligent individuals. On the other hand, I also think that there is somewhat of a lack of novel thought here, if not agile thinking as the title implies. Everything that Mr.Francavilla talks about here is pretty simple from how you sort mail to what he calls ‘signage’. It does not seem entirely consistent that the problem with this signage should have arisen if the managers that Mr. Francavilla reports to who run the buildings are as phenomenal and accomplished as he claims. Don’t they ever walk through the building themselves? Shouldn’t they have noticed this problem. I am not a facilities expert, but I would have and obviously this was frustrating people and patients for some time before it was addressed. That has me wondering. I realize that in any interview unless it is intentionally adversarial, there is a certain amount of a promotional aspect. That being the case here, if Mr. Francavilla is going to tout his direct management he needs to give better examples of why they should be so admired. He did start to go in that direction when he talked about the CEO Mr. Lynch and his creative use of graphic examples of waste at a management meeting. That was interesting and informative. I am also a bit surprised there were no comments from others at the facility. Perhaps for some reason it did not get good press or coverage there. Still I would have to say that this interview for whatever unanswered questions it leaves in my mind was a worthwhile post.
I believe the recent questions would be better answered in a chat session either online or in a webcast. It seems that there is enough interest in this post to justify that approach. Brian and Dave do you agree?
I think some of the criticism leveled at Dave was not right. What do you expect him to do complain about his bosses in an interview? I know I worked for some real nasties. His might not be perfect, but they listen to him obviously.
Quite a powerful endorsement of this hospital and it’s executive leadership. I wonder if Main Line is typical of American hospitals or is it more unique?
Good example of how a manager should listen to someone that works for them and how a progressive attitude starts at the very top. Nice insight into what the interviewer calls agile thinking. Its a bit surprising that with all the comments on this interview that none of them came from anyone else at Main Line Health. I wonder if there was some prohibition on them commenting?
I believe there is a bit too much analysis of this interview by readers. We should acept it and Dave’s interpretation of his management team on face value and move on. What did you expect him to do complain about them?
It is very surprising and disappointing there was no followup from Mainline health management on this interview. A missed golden opportunity on their part! This could have represented a very positive stream for communicating to the public in a less marketing oriented fashion. It makes me question just how progressive they really are.
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