Dr. Greg Jacobson: Juggling Life and Being Both an Emergency Physician and a Startup CEO

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Joining me for Episode #31 of “the My Favorite Mistake” podcast is Dr. Greg Jacobson, an emergency medicine physician and the CEO/co-founder of KaiNexus, a technology and software company. In the interest of full disclosure, I will mention that I have worked with KaiNexus, in various capacities, since 2011 and I have an ownership stake in the company.

That said, Greg is one of the most interesting people you'll ever meet. Many startup CEOs launch their company at night while working their day job. Greg started KaiNexus during the days while working some nights as an E.R. doc.

In today's episode, Greg (always the overachiever) shares FIVE favorite mistakes from his career:

1. Not reading more
2. Not figuring out work/life balance
3. Struggling with the diffusion of CEO attention as the company grows
4. Not being appreciative enough
5. Not doing his own due diligence

We'll talk about all of that, the importance of creating a culture of continuous improvement in a company, and much more. I think you'll enjoy the conversation, as I did.

You can listen to or watch the episode below. A transcript also follows lower on this page.

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Automated Transcript (May Contain Mistakes)

Mark Graban (0s):
Episode 31, Dr. Greg Jacobson, CEO of KaiNexus.

Greg Jacobson, MD (7s):
Maybe one of the mistakes I had was trying to pick a one of my favorite mistakes.

Mark Graban (17s):
I'm Mark Graban. This is My Favorite Mistake. In this podcast, you'll hear business leaders and other really interesting people talking about their favorite mistakes, because we all make mistakes, but what matters is learning from our mistakes instead of repeating them over and over again. So this is the place for honest reflection and conversation, personal growth and professional success. Visit our website myfavoritemistakepodcast.com. It would be a mistake to not enter, to win a free “My Favorite Mistake” coffee mug, go to Markgrabancom/mistake 1. And now on with the show.

Mark Graban (58s):
Hi, welcome to My Favorite Mistake. I'm Mark Graban, and we're joined today by Dr. Greg Jacobson. He is an emergency medicine physician. He's also the co-founder and the CEO of the technology company. KaiNexus. Greg, thanks for joining us. How are you?

Greg Jacobson, MD (1m 16s):
I'm great, Mark. Thanks for having me on as someone, you know, that I wouldn't say loves identifying my mistakes, but certainly doesn't have a problem identifying my mistakes. And I'm also glad you gave you about a month to prepare. So I could really think about all the different mistakes that maybe people could learn from.

Mark Graban (1m 35s):
Sure. I mean, that's, I mean, that's one of the themes of the podcast here is, you know, for one, we all make mistakes, but secondly, hopefully we've learned from those mistakes. And, and so, you know, with that, and there's a lot of other things we can explore afterwards, Greg. I mean, what would you say is your favorite mistake?

Greg Jacobson, MD (1m 55s):
That was maybe one of the mistakes I had, which we did, which was trying to pick a one of my favorite mistakes. So I love the number five and in kind of thinking through and identifying, I thought mistakes that were applicable to more people. Cause I think there's some mistakes that are going to be so unique to your personal situation, that while hopefully you learn from them, they're probably not beneficial for other people and really we're doing this so other different number from these. So I broke it down to five and perhaps they are in an order. So mistake number one is not reading more.

Greg Jacobson, MD (2m 37s):
I used to be someone that really disliked reading. I didn't read very much in elementary school, middle school, high school, obviously you had to excel in academia. Otherwise you can't get the medical school, but it felt like more of a chore. And what's interesting is that, well, before I say before, I say, if someone would have told me, I'll just kind of go through the entire arc, the, there, there was a semester in college where I went and lived in Costa Rica and there, I ended up reading for some reason, I really got into a whole bunch of John Irving books and was reading a lot of, a lot of his novels and someone even commented to me that, well, your, your writing on your emails has improved so much.

Greg Jacobson, MD (3m 25s):
So to me, there was this disconnect between reading and all of the other benefits that reading does for you. I always thought reading was just a singular, beneficial aspect of, well, you're just reading for information. I never, never ended up realizing that. Well, the more you read, the faster you read, the more you comprehend, what you're reading. And ultimately the more translates into writing. What's interesting is that if someone would have pulled me back in middle school to the single most valuable thing you can do in your life is to read because it will make you smarter and more efficient, a better communicator.

Greg Jacobson, MD (4m 5s):
What I probably wouldn't have believed them, but too, I feel like I would have had such a, a leap ahead in so many areas that I've struggled in, in, in, in the past. And, and then I'll just pause it to get your, your insight in this after as time has gone on. And as I've realized, the benefit of reading audio books have become much more popular. And while I think it's probably better to read, I find that that I'm able to consume so much more with, with podcasts and audio books. And then in this year we declared I kind nexus and that this is going to be the year reading.

Greg Jacobson, MD (4m 51s):
And I'm realizing now we're eight months into it, Mark, and it's not going to be the year of reading. It's just that we are going to have a culture of reading. And so we've done a number of different books in a book club format that, that we're all getting benefited from. So reading more in short.

Mark Graban (5m 9s):
So, I mean, let's explore that a little bit. I recently had the chance to interview Tom Peters, kind of legendary author of In Search of Excellence and other books. And I don't think he was just saying this because he's an author, he's, he's saying that the biggest fault of a corporate CEO is that they don't read enough. And he really puts a huge emphasis on that of basically the curiosity and the continued learning. In addition to the benefits that, that you described. So as a follow-up to that, I mean, I guess how, how, and when did you realize, I mean, you sort of talked about how you, you got into reading, but when, when was it that you realized that it had been a mistake to not be reading as much in the past?

Mark Graban (5m 55s):
How did you, how did you come to that?

Greg Jacobson, MD (6m 1s):
Certainly when my good friend responded, I mean, this would have been in '96 that I was in Costa Rica. So email was new-ish and he responded to the email and said, I can, I can tell you've been reading a lot better because I can actually understand what you're writing. And then, and then if there's one way to make someone really hate reading, it's to send them to medical school because you just have to read so much. And so between medical school and residency, my pleasure reading just really dropped off. And then it really came back with the founding of KaiNexus and, and realizing I didn't have a formal business education.

Greg Jacobson, MD (6m 40s):
And so starting to, to read about startups and general business books, you know, probably read 50 over the last 15 years, and now I've had people tell me, Oh, well, you don't need to do an MBA because you've already read all of the major texts that you would review in an MBA. Anyway. So the, really the, the switch has been getting extremely interested in and spreading continuous improvement connections, which I know we'll talk about at the end. And so, but one other tip that I found really interesting that it just started doing with the book club, because we're, we're not picking random books, right. We're picking books that we really think are beneficial.

Greg Jacobson, MD (7m 21s):
So I've ended up listening to them on audio book, and then I've ended up purchasing the physical copy and really listening to it on audio book while I'm physically reading the text. And I have just had a huge, deeper appreciation as low as extraction of information by doing that. So certainly worth an experiment for someone if they find themselves not being engaged or spacing out when they're either doing the audio book or the physical book, just combine them. It's really hard to think about anything else when you're that engaged in someone's words.

Mark Graban (7m 59s):
Yeah. So you talked about the mistake of not reading enough as, as a discovery. Thanks. Thanks to your friend. What were some of the other favorite mistakes that had occurred?

Greg Jacobson, MD (8m 10s):
Yeah, so, so number two, number two was not figuring out a good work-life balance. And so I am a consummate workaholic, as I'm sure many people that are listening to this podcast are, and really once, once medical school was going, I, there was a period of time where I didn't think I wanted to be a doctor. I didn't enjoy the, the academic part of medical school at all. It was in my opinion, completely devoid of intellect. It was just a process of how much can you possibly memorize and stick in your head? And so I got involved in real estate on the side because my parents were a entrepreneurial family and my father has been in real estate for 50 plus years.

Greg Jacobson, MD (8m 60s):
And so while I got more interested in medicine, when we started doing clinicals and seeing patients, my love of real estate never went away. So in the background, I've been investing in real estate over the last 20 plus years. And so that added a group of work. And then I had the brilliant idea of, well, how hard could it be start with a software company. So I've been doing that as well as maintaining a clinical emergency medicine practice, although that's pretty tiny now, but in, in 2015, my, my wife sent me an email and she said, if ever, there's a time you could work less, please do so, because I feel like we are just co inhabiting now versus having a meaningful relationship.

Greg Jacobson, MD (9m 53s):
And I'm summarizing a much longer, yeah. A much longer email, but that email was really, it was amazing for me to get, and it's one of those emails. I actually just returned to my inbox every 90 days. And I reread because the only way to establish work-life balance is to make tiny little choices where you're deciding, well, if I was someone that had a good work-life balance, what's the decision I would make right now, would I unplug and can go be with family? Would I pick up the guitar? Would I do projects around it, whatever it is that's not working. And so it's something that I struggle with constantly. It's something that I've gotten better at over the last five years.

Greg Jacobson, MD (10m 34s):
Cause I, I will ask her maybe once a year, how am I doing? But it's something that I think that it's not intuitive, but you actually do better work when you're working, when you do have a good work-life balance. And so sometimes just putting more time, effort and energy to something, it almost slows you down in a weird, bizarre way.

Mark Graban (10m 58s):
Well, there's some like a lot of entrepreneurs and even CEOs in large corporations kind of perpetuate this idea that you can just effort your way out of anything, you know, kind of the, the, the culture of, of bragging about how many hours you work every week or the executive profile of, well, so-and-so wakes up at 4:00 AM every morning and they're in the gym by four 15. And that that's, that's, that's not the only way to really drive effectiveness. Right?

Greg Jacobson, MD (11m 35s):
Yeah. I think I would hate to jump to the conclusion that someone that said, oh, I wake up every morning at 4:00 AM and I'm in the gym by 4:15 to say that they don't have a good work-life balance. But I think a person only really knows themselves if they, if they truly are aware and, and meaningfully introspective at whether or not they are achieving a work-life balance. Hopefully that process includes asking all the people that are most meaningful to them. Hey, am I meeting your needs in this relationship, in my present and my, you know, watching life pass by.

Greg Jacobson, MD (12m 17s):
But at the end of the day, it's just going to take looking at yourself in the mirror and figuring that out.

Mark Graban (12m 26s):
Yeah. So you said you had three other mistakes.

Greg Jacobson, MD (12m 29s):
Okay. Three other. All right. So one of the things that happens in a startup and it happened to us perfectly is that, and it's something that I actually read. I wish I remember I read a blog post on it and I was like, oh, that's that fits us about 90%. You get to a certain point in a startup where the founder passion becomes diffused through so much interaction that you can't drive culture through just being passionate about solving the problem.

Greg Jacobson, MD (13m 10s):
So what do I mean? So we have two founders at KaiNexus, Matt and I. And if we have our first two employees really got a ton of our attention. They were interacting with us, you know, certainly on a daily basis, but many times, you know, for many, many, many hours a day, as you go from two employees to five employees, to 10 to 15, you can, you can start to understand the exponential growth aspect of that. And you start realizing well, so now you have a hundred percent of my time. Now this person might have 80% of my time. And this person, you get to a point where people are really getting a very small percent of your direct one-on-one and so their, their needs.

Greg Jacobson, MD (13m 54s):
And it seems like 20 people is what the blog was. I was reading. I wish I could attribute it to the right person, but it seems like 20 seemed to be a good number to realize that you need to start managing the company a little bit differently. And you need to go from kind of flying by the seat of your pants, shooting from the hip, to being more intentional about the type of people you want to be, or, you know, people use the term culture. And so I have a recurring item on my to do that. That reminds me that, that I should be spending about 20% of my time working on I'm going to call them soft things.

Greg Jacobson, MD (14m 39s):
But that's not to say that that, that they're less important than hard things. You know, it's like the soft sciences are, you know, potentially more valuable than the hard sciences to us, but, but I'm, I'm labeling them as soft because you sometimes don't see a direct effect from them to the bottom line. For instance, like you would closing a deal or signing a renewal or expanding a customer, but both they directly affect. People's the amount of joy they have at work. It's going to affect your retention.

Greg Jacobson, MD (15m 21s):
We had a incredibly high retention level at KaiNexus and the first person that just left was right about the 20 person mark. And, and sometimes people leave because they decide they no longer want to do that job and want to change careers. And sometimes they leave for other companies, but if you don't take the opportunity to say, well, what could I have done differently to make that person, you know, not want to make that decision, then, you know, shame on you for not using the opportunity. So focusing on culture, and then this next point is it's, it's maybe not the end of the end, but it's just, it flows right off the tongue, right after the focusing on, on culture is, is focusing on, on appreciation and growing up in an emergency medicine framework, you don't have really direct connection to your medical director all the time.

Greg Jacobson, MD (16m 20s):
And so you're kind of a solo person that a lot of people don't really see what you're doing on the front line with a patient and this. So I never really appreciated how important appreciation is from your, your boss or your, the person that you report to. I mean, the, the, the emails that say, Oh, it's it's doctor appreciation day, or there's balloons, or they give you a gift. You know, those are great, but that's not the type of appreciation that we're talking about. We're talking about just meaningful. Hey Mark. Thanks for doing such a great job with the webinars series that kind of as us, thank you for, you know, really adding value to kind nexus over the last nine years and giving you examples, I think is, is something that I'm learning I'm trying to get better at.

Greg Jacobson, MD (17m 12s):
And I think that is hugely important in, in a company, especially when you kind of get past that 20 employee Mark.

Mark Graban (17m 17s):
So before you talk about the fifth, I've got to ask you maybe to, to paraphrase it back was learning, not learning soon enough, how to be more scalable as the CEO, how to influence larger company. And then you said that not being appreciative enough, is there a pattern you said your first two were sort of the eye-opener was an email from somebody…

Greg Jacobson, MD (17m 47s):
Oh, interesting.

Mark Graban (17m 48s):
Mistakes sort of come to light because of feedback, whether it was an email or thank you. Yes.

Greg Jacobson, MD (17m 53s):
I'm glad you brought that up. So we, we realized a couple of years ago when, when we started to focus on a culture in a more meaningful way. So what does it mean to focus on culture? So it means to be more intentional about doing one-on-ones with people, it means to stop and, and, and really realize that people are people and they have home lives and showing an interest, a genuine interest, not like a superficial interest about people's passions and about, you know, what makes them tick outside of work. And there's many other ones, but I'll just jump to the one where we got the feedback that I realized that I could probably be better at telling people, Oh, that was really great work.

Greg Jacobson, MD (18m 40s):
Thanks for doing that. So we started a reverse evaluation process in the summer of 2019 was the first time we did it. We realized we had done regular, I guess, forward evaluations, just typical performance evaluation. Yeah. Typical performance evaluations in, we usually do it around January of every year, kind of talking about the prior to theater and things of that nature, but we never gave an opportunity for employees to evaluate the people they report to. So we did a bunch of research on how to do that. And we came up with a process where it's anonymous and I'm very big on anonymity or big on not being anonymous when you're engaging in improvement work.

Greg Jacobson, MD (19m 25s):
And that's probably a topic for a different podcast, but we felt like doing it in a way where people could get feedback where they didn't fear any repercussions from that. And so it gets sent to someone outside of KaiNexus and that person kind of removes personalizations without trying to make it too diluted and kinda gives it back to us. And in, in, in both both evaluations in 2019 and 2020, it was a theme that people feel like they don't get appreciated. And so appreciation has to be from the perspective of the person that is receiving it, because that's why you're giving it for them.

Greg Jacobson, MD (20m 10s):
So I can say, well, I feel like I get people appreciation all the time, but if people don't feel like they're appreciated, it doesn't really matter what I feel in that, in that situation. So, so it was, it was through the written word. Yeah.

Mark Graban (20m 23s):
Well, and I, you know, when you talk about giving that direct, specific individualized feedback and recognition being powerful, that makes me think of, you know, one of my favorite business leaders, the late Paul O'Neill, who said, you know, in, in, in an excellent organization, people would be able to answer yes to three questions every day. And that third question is, have I received recognition? And here's the important part. I think you'll get a kick out of this, you know, have I received recognition from somebody whose opinion matters to me, which I think is an interesting thing plaques on, and I'm not saying that people aren't respecting that it doesn't matter that they're getting feedback from you, but I think that's, that's an interesting dimension to think about where I think that generic, I, it makes me think of that generic of like, Oh, it's nurses appreciation week and we're throwing a pizza party.

Mark Graban (21m 23s):
Does that really count as recognition? And if that chief nursing officer who maybe you've never seen all year suddenly shows up and has some platitudes, does that really, does that really prove it?

Greg Jacobson, MD (21m 35s):
Yeah, I'm sure it moves the needle, but it's not moving the needle, I think, in a meaningful way that people think it's moving the needle, it would just mean so much more when the chief nurse nursing officer walks down on a busy ER shift and just says, Hey, thanks so much. We got three pizzas coming later, you know, that I think is more meaningful than the, Oh, it's whatever the nursing appreciation or the backer appreciation they happens to be on the calendar

Mark Graban (22m 3s):
Recognition can also mean acknowledgement of, you know, I'm, I'm here and I'm not just dropping off the pizzas, but I've got some time if you want to tell me how things are going here and what could we be doing better? Those are conversations that you, and kind of ex-US, and, and the customers are always talking about improvement.

Greg Jacobson, MD (22m 21s):
Yeah. Yeah. And I recognition, or maybe I'm just using the word. And I didn't mean to say that you should drop off pizzas. It really, I think that 90% of the benefit they're just coming down and looking at someone in the, in the eyes and say, dude, I get it. Like, this is, you know, this is where the real work is happening and we really appreciate it. And I know it can get overwhelming sometimes. So, but pizzas are always great too.

Mark Graban (22m 45s):
And my point was, if that's, if that chief nursing officer only shows up once a year in that ceremonial, Hey, it's nurse's week that they might not, that that person's opinion or recognition might not matter. They don't know that person, they don't have a relationship with them. That's what you're saying in a company of 20 people or less, even though that's evolved, as you described, people can have more of a relationship with you as the CEO, then they could be with hundreds or thousands of nurses in an organization.

Greg Jacobson, MD (23m 20s):
Yeah. So I've always thinking about scaling this, obviously when we have 40 people that are part of the kind of access team and then a hundred and so on and so forth, there's going to come a time where I won't be part of the hiring process. I may have never worked with someone directly on something. So I would need to think of some process where, you know, I'm getting feedback or I'm hearing about things that are happening several levels different from me. Or I can call someone out with some, you know, specific example. And obviously if there's a thousand phone, we'll be able to do that to everybody. But if I could do that to, you know, 20 peoples throughout the year, and then I'm showing that as modeling behavior, then presumably everyone's going to get, get some appreciation or love from, from their bosses.

Greg Jacobson, MD (24m 14s):
And I think that probably that doesn't feel like a very difficult process to, to develop. It just feels like you need to have the desire to do that because a quick three-line email. I mean, what does it take you a couple of minutes to write? So,

Mark Graban (24m 33s):
Okay. And then what was the fifth of your top five?

Greg Jacobson, MD (24m 38s):
So, so this is an interesting one, and then maybe it's slipping at a little bit on your head or the question on its head, but I've made a mistakes in the past and sorry for the extra noise. We're all working from home. So I I've made mistakes in the past on… I'll use real estate, for example, cause that's just an easy one to kind of, I made some investments in real estate without doing my proper due diligence because I made the assumption, Oh, well, this person is investing in that. And, and they have a good track record and they're a smart person. So by proxy I don't need to do as much due diligence.

Greg Jacobson, MD (25m 21s):
And, and if you look back at all of the investments I've made that have not done as well, fortunately I have more that I've done well and the not, but if you look back at that, that's a recurring theme that happens. And so I think that the teaching point for me is that I don't make the assumption that other people know more than you or know better than you. That doesn't mean you should always make the assumption that you're right and they're wrong, but don't go in with that default assumption. And so I think that's the real tricky part is how do you know when to listen to yourself or want to listen to someone else? And if everyone did that, then we'd always make the right decisions because then we'd just ask around and know, Oh, that's the right thing to do.

Greg Jacobson, MD (26m 4s):
But I think you get my point that don't, don't do a little bit of your own research. Don't just don't aimlessly follow, if that makes sense.

Mark Graban (26m 13s):
So let's talk and thank you for, for sharing all of that. And, and, and for those reflections, well, let's talk a little bit about kind XIS and maybe have you describe, you know, what the company's mission is and what the products and services are, but then, you know, also, you know, it would be curious to know as CEO, how do you work at building a culture where people aren't afraid to admit mistakes and the P how do you create a culture where people are learning from mistakes? Because again, mistakes happen. So

Greg Jacobson, MD (26m 48s):
I'll touch on those two things. But before I touched on those two things, I want to add one thing that has gotten kind of access to where it is today. And so when we're thinking about mistakes, I are really decisions because we're talking about decisions, we made her actions. We did, that's really what the mistake is. It's probably not just a pure thought experiment that would determine a mistake. Is that in reality, if you look back at the arc of KaiNexus the five years kind of pre company formation, where w I was thinking about the concepts and working on a prototype software, and then the 10 years now of being in the company arena, there might be only five or 10 real decisions that would have completely impacted the company to the point of failure.

Greg Jacobson, MD (27m 49s):
The, the other probably participating in a dozen or two dozen decisions a day, depending on how important you're talking about it. It might be that a person is making hundreds of decisions a day down to if we're talking about like, well, what are you going to have for breakfast? But the vast majority of decisions that you make in a day, or in a business really, aren't going to change the bottom line in a meaningful way. You just have to get like 80% of them, right? So the real thing is, is, is knowing, is this a decision that could have the potential to kill the company, versus is this a decision that doesn't have that potential?

Greg Jacobson, MD (28m 37s):
So the risk of failure is one mitigated because the impact isn't necessarily detrimental, but two is going to be also impacted in a positive way, because you're going to be observant about the failure and you're going to improve from it. And so, as I'm thinking about, you know, delegating decisions to people that crosses my mind, you know, if, if Mark makes this decision and he's wrong, how detrimental is it? And so, so it kind of, as we're thinking through decisions and mistakes, there's, there's probably maybe one or two a year that are the really big ones.

Greg Jacobson, MD (29m 18s):
And then there's, you know, 99% of the other ones, you need to get most of them, right? You just don't need to get all of them, right. Obviously, if you're, if a hundred percent of the decisions you make your mistakes, you're going to run a company like Brown or organization on the ground. So I wanted to say that, and it dovetails nicely that we are a startup that is still around. And so I would argue that we have not made any fatal mistakes and that we, for the most part made more correct answers then, and then incorrect answers. And so we're, we're a software company.

Greg Jacobson, MD (29m 58s):
We, we help organizations spread a culture of continuous improvement. And so most people that are listening to this know, you are a, I'll call you a “lean guru.” And so most of our customers are coming from, I know you're, you're smirking, that's a mistake using that word. But most people that know you wouldn't, wouldn't find it. You're working with a software company that is implementing continuous improvement, lean, and Kaizen concepts, or at least helping organizations implement those. And so that's what we do. We have companies that come to us and say, we are totally disorganized. We have no way to understand impact.

Greg Jacobson, MD (30m 37s):
We have no way to engage our employees. We're using Excel word. We're using these project management platforms that, that aren't based on lean and Kaizen concepts. We need to accelerate how many ideas we get. So those are the kinds of things that people come to us. And we provide a platform to help people manage their top-down work, like large scale lean projects that might have 10 to 20 people involved in them that might last for months. And people sometimes call them value stream maps, or large PDSAs, or strategic A3s, or kind of give it a bunch of different names. We also help people manage their top, their bottom Upwork.

Greg Jacobson, MD (31m 24s):
That's, you know, employee frontline ideas, opportunities for improvement, frustrations, identifications of defects, or, or, or mistakes or patient errors, something that's, that's driven from, from the frontline. And then it gets routed kind of up through we, we help people visualize their KPIs, and hopefully if they're measuring the right KPIs and they're doing good improvement work, then, then those key performance indicators will be improving. And, and so, and then finally, as we will evolve, because we really started initially with just bottom up and then we added the top down, and then we, we added the KPIs, but we realized people were coming to us and saying, this is all great, but what we need a way to align it all.

Greg Jacobson, MD (32m 8s):
And so we've added in a functionality into the platform that helps people with their or strategy deployment or their Hoshin work, so they can see how, how did the KPIs, how did the big initiatives and had all the small initiatives kind of fit together? I guess I should have probably gone vertical there instead of horizontal. So, but that's a little bit about kind of access. So if, if you are trying to develop a culture of continuous improvement and you're struggling and you realize you're probably not using the right technologies, then that you would be a good person to reach out to us and see if we can help with those things.

Greg Jacobson, MD (32m 49s):
Yeah.

Mark Graban (32m 49s):
And the website, there is kainexus.com, KaiNexus.com. Boy, I made a mistake and stumbled through the spelling of that kainnexus.com. Yeah.

Greg Jacobson, MD (32m 57s):
I'm glad you, I think you went slow. I like that. And it's obviously a combination of the words ties in and nexus. So the idea is that you would do continuous improvement kind of in an interconnected way at an organization. And I'm proud to say that Mark and I met on Valentine's day of 2011, and he has been a part of the company since its early days. I like to think of him as keeping us on track to, to the, to the mission and the, the I'm going to use quotes again, air quotes, the correct application of lean practices. And so we're honored to have had you part of the team.

Mark Graban (33m 36s):
Oh, thanks. And so, yeah, I w I was gonna say in the interest of disclosure that I've been a contractor, a part-time and employee part-time employee and investor part of the team have kind of access in different ways, but one observation and, and, and going back to 2011, 2012, we talked about this a lot, Greg, if you know, being intentional around the culture, and one thing I'll, I'll give you and Matt as the other co-founder credit for, as the day-to-day leaders of the organization is creating an environment where people aren't blamed or vilified when something goes wrong.

Mark Graban (34m 17s):
Because as, as you have experienced differently than I have around health care, when people get named blamed and shamed, when a mistake occurs, that leads to the hiding of problems. And then if you cover up the problem, you can't learn from it as an individual or as a leader, as an organization. So the one thing that comes to mind answering my own question a little bit of how do you create a culture where people are learning from mistakes? I think that comes back to the idea of eliminating fear, eliminating blame and creating an environment where yes, we can reflect, but we've got to do so in a way that's constructive instead of just beating ourselves up or even worse, beating someone else up in a proverbial sense,

Greg Jacobson, MD (35m 3s):
I think, and you'll have to correct me if I'm wrong on, on who kind of uses the 85 to 15 rule. But if you go into something that 85% of defects for errors are based on a inadequate process and only 15% of those are based on true human error, you end up creating a culture and I've, I've worked in cultures in the past, especially on the healthcare where the, the burden of identifying and error there is shame associated with it.

Greg Jacobson, MD (35m 43s):
And, and there is sometimes such a rigorous process that you are going to get involved, that if there was no harm that happened nine times out of 10, it's just not going to get reported. And, and any, any physician nurse, anyone that actually does clinical medicine will nod their head up and down. I mean, I've worked in over a dozen medical centers over the last 20 years in, in different countries. And, and it's just, and I'm talking about the small stuff like, Oh, the person got 600 ofMotrin instead of 800 of Motrin. Well, I mean, that's really an opportunity for improvement, but you know, not having a system that makes that easy and celebrates that experience, not because we're happy someone got 200 milligrams less than they should have gotten, but because they provided an opportunity to look at a process to see if we could make that safer, because you know, the next medication error could be, you know, 10X of the amount of heparin that someone is given and heparin, as you know, is a blood thinning medication.

Greg Jacobson, MD (36m 49s):
And that, that can be, and has been life-threatening. And that, that mistake may have been prevented. I don't know how many times this happened, but I know you, and I both know the specific case that we're thinking about, but that may have been permitted, had there been a different culture and a much smaller impact error was made that had there been a process to evaluate that it could have prevented other things. And so I've just, just, just this past couple of days, we, we, we did a retrospective as we do with every release and that we do, we did a release on Friday or two Fridays ago, and the dev team product team all get together.

Greg Jacobson, MD (37m 36s):
And I'm just, I'm so proud of that team. The quality of the work that they do is, is so high. And even though they do that quality, they also are looking for ways to improve. And so, and so it's, it's, it is a pleasure when you work in that framework that we're, we don't want to overprocess things, but we're going to focus on process to see if we can eliminate mistakes in the past or mistakes in the future. So I, I I'd like to think we do a good job of it. Yeah.

Mark Graban (38m 13s):
It's, it's an ongoing effort and challenge, and that reflection leads to growth, which leads to more likelihood of success. I think so. And that's why…

Greg Jacobson, MD (38m 24s):
I will be appreciative of your appreciation.

Mark Graban (38m 27s):
That's true. And that's why, you know, we're, we're, we call the podcast my favorite mistake. It's not titled beat yourself up over something that you did. So thanks for leading by and for talking about mistakes and more importantly, the learning that, that comes from those. So I am appreciative of our guests. He's Dr. Greg Jacobson, again, emergency medicine, physician co-founder CEO of KaiNexus. Greg. Thank you. Thank you so much for being a guest.

Greg Jacobson, MD (38m 56s):
Thank you very much for having me Mark. And I always like to remind people that there is no better day than today to start working on continuous improvement, whether that's personally or whether that's at your organization, what you do matters. And so just get to it and best of luck.

Mark Graban (39m 17s):
Thanks, Greg. Thanks for listening. I hope this podcast inspires you to pause and think about your own favorite mistake and how learning from mistakes shapes you personally and professionally. If you're a leader, what can you do to create a culture where it's safe for colleagues to talk openly about mistakes in the spirit of learning, please subscribe, rate, and review the podcast. Our website is myfavoritemistakepodcast.com. See you next time.

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