 Let's do it. It's an early damp morning and I'm walking to the hospital where I've been working the last couple of weeks. If you were close to me you would see that I have a very firm face and I walk with a fast pace because we have some serious problems. First of all, we are not making any money. Five patients, 120 staff that doesn't add up. Secondly, we are not paying our staff correctly. We're paying them below the minimum standard in the city, which is a crime. And thirdly, we found out that the operational permit to even run a hospital has not been renewed in one and a half year. But that's not why I'm walking so fast because I want to check in on the renovation product that we've been running. As I enter the hospital, something is off. I see buckets of water, buckets collecting water dripping down and when I look up I see big stains of mold and there's a stench of mold in there. This is our x-ray machine and that bucket collects 100 liters of water. But hold on, there's a whole other floor. So I go back up, get back outside again and I look up and I see this. What's missing from this picture? There's no roof. But hold on, it's raining every day in the city. Have they not put the roof back on? So I go back in again and I see more and more disturbing signs of something being really off. Here's water dripping down into our pharmacy. I'm no electrician but water into the fuse box could not be good. And even Jesus has mold on him. So now I go back up again to the second floor and I'm greeted by this site. The roof has practically been thrown down on the floor and then lying there for days where rain has soaked it into a moldified big mush of earth and rubble. And there's a horrible stench here. I also realized that I'm the first one from the hospital up here. They don't know. I continue around the second floor here and I see that about 60% of all our beds in the hospital is destroyed. The site is too much for me and I fall down to my knees and I start to cry. The only thing we could do really was to start to dig. I was in these exact clothes when I started and I didn't even have any shovel. We could just start to throw things out of the window. But in the back of my head I had one thought. This hospital is dead. There's no recovery from this. Hello and welcome to this presentation on how agile principles save the hospital or if you want to how transparency trust and vulnerability save the hospital. Because I realized after a while that that's actually the thing that made the difference. I wanted to tell that story today. I'm Marcus. I have been worked as a programmer, consultant and an agile coach for a very, very long time. Most things I do is around lean and agile and when I don't do that I care about my family, my instrument, the euphonium and my church, the Salvation Army. I also written a book on Kanban. It's actually the best book on Kanban I ever written. And today you're lucky because one of my good friends is here and we wrote it together and he had come across a code so you can get that book for 40% off. So if I'm an IT guy why am I in Indonesia and doing stuff to that poor hospital? Well me and my wife we decided to work a couple of years for our church, the Salvation Army that runs six hospital and 17 clinics in Indonesia. I was supposed to help all of these hospitals establish strategic plans but that progressed pretty slowly so instead we could help the hospital that was in this city where I lived. Bandung, who heard about Bandung before? Joakim, okay. Eight million people live there, right? So it's a pretty big city. I wanted to tell this story from the perspective of three women so it will be like a short slivers of information here and maybe not the complete story. And the first lady I want you to meet is Ibu, but that Ibu means Mrs. So Mrs. but that I'm Mr. Marcus by the way. And this is a story about transparency. But before I can tell that story you need to get some more information. We had many problems as I said but we decided that the number one problem was cash flow. Someone actually calculated that we were six weeks out of bankruptcy when we started to make these changes. So we needed to get patients to come to our hospital or this will all be over. So we made that our priority number one. Priority number one, so important that we're working on it. The strange thing was that people seem to know about this but they just didn't care. So I needed a way to show them the state and not only that I needed a way to make them feel how this was as well. So we got together and started to calculate it. How much money do we need to run this hospital for a month? But this is expressed in Indonesian rupees per month and I can't even pronounce this. So we broke it down and said okay what's that per day then? But still that doesn't make any sense because it was like 20 million rupees per day when the lady in the laundry that I told that to she earned 1 million rupee per month. So she could not relate to that. So what we did instead was that we started to count how many patients to be served in a day. And we came up with okay we need to serve 134 patients in one day. And we made that our target and we made a huge diagram much bigger than needed because I drew it and I'm about 30 centimeters taller than the average Indonesian person. So they could never reach but that was not the problem because we were so far off. Here's the goal and here we are. So what do you think happened when I showed them this diagram? Well something like that. I'm rushing now because I have so little time. There were not much reaction. I just saw people looking blankly before them or doing something with their phone or giggling in the back. So I got really angry actually and because I wanted them to see this and I went up and I drew another line this one and in my anger I misspelled it. This is the break even point and I told the staff every time we're below that line we lost money by having the hospital open that day. And that everyone understood. So we got some really good things out of that visualization and we collected them in some kind of ruleset or code for how to do good visualizations. Well code and code it's more like the pirate code. We break it if we need it too. But here's the Bonsu Rumasakit means hospital so the Bonsu hospital visualization pirate code. The first one is that you want this to be big meaning that everyone can see it. Put it in the corridor make it visual make it interesting to look at. The second is that it needs to be easy for everyone to understand. Thirdly we're focusing on trends because we're measured to learn. I don't care if it's 76 or 78. I care if it goes up when it's supposed to go up. We need a target. We realize because otherwise it got really boring pretty quickly and speaking of that you want stuff that moves and updates frequently. We could have shown this once a month but then we have lost the interest immediately. Now we show the staff every morning how we did yesterday and it took two days before you could hear this. Stuff like that. Because people engaged. Let me tell you what happens if that's the case. Ibu Butet here she's a physiotherapist slash receptionist at the hospital. She came up to us after we have shown this diagram a couple of times and she said I have an ID to get more patients to the hospital. At this point in time the Indonesian government was implementing the public health insurance for the first time ever in Indonesia. 250 miljoner people got access to public health and needless to say the hospital were not ready. The government was not ready and the people were not ready. But Ibu Butet met these people every day because she was in the reception and she said I know what questions they ask. I have an ID for how to make this better. And we said perfect let's do it. Not so fast she said if we do this I want a big banner outside the hospital that says this is where BPGS the public health insurance is fast easy and comfortable. Was it yeah my Indonesian slips my mind sometime. That was really strange but okay let's do it. So we put it on there. Here's the proof and you know what amazing things happen. This is just a couple of days after she came to us. This is a month after because that let me go back. This is the first time we were above 120 the break even point ever. So I bought cake to an entire hospital which cost me about five dollars. And then this is the first time we're above our target. It can be done and I bought cake again. And then six months later we did other things as well but six months later this happened. We had to pull up a share to reach that. But this is an amazing point in time because all of a sudden we were not losing money on average. On average we were making money every day. But the most amazing thing was that BPGS the governmental branch they called us up and said we hear good things. Can you please host the workshop for other hospitals of your size in the city. This is the director of the hospital we'll meet her later. Imagine the pride of her here. Her hospital was in Rubbles just six months ago. And now she's the role model for all of these people that are also running hospitals there. And then I went all the way to the back here and I found the Ibo Butet. She's just the receptionist. So what happened here. Well the first thing we did was that we start where we are. Where. So we didn't invent anything new. We just said OK this is the place we are. And we were very transparent with. This is what we need to be to do. And then we showed everyone with a visualised understandable and metric that matters that everyone could relate to. People through our door. Everyone can understand that. And finally we supported initiatives from the floor. So when Ibo Butet came to us we listened. Even though she was just a receptionist. Second lady I want you to meet is Ibo Elche. This photo is actually taken this summer. If you zoomed in you could see her lipstick on my color here because we had just hugged before this. Ibo Elche. She's a general manager of the hospital. That means that she's in charge of anything that is not health or finance. And that's a lot of things in a hospital. So it's you have security ambulance food. They were stitching stuff together. They were doing laundry. And then they were doing maintenance. And this hospital was suffering hugely under a lack of maintenance. She came to us because she was under severe pressure. You see the faces of the other people here. They don't like her and they got nothing done. And she got really stressed as well. And sadly I was partly to blame. Because we were running a morning meeting with the management team every day now. And when we did that her priorities changed like this. So now people got so frustrated waiting for the maintenance staff that they bypassed her so she had to play catch up. So she said this I have a lot of things to do but I get nothing done. Anyone recognize that? And I don't want to go around the hospital anymore because every time I go into a room I get more things to do. And she was sobbing when she said that thing. So we decided to try to help her. And it was really a blessing because we were discussing such stupid details in the management team for example which is the best order of the doctor's names outside the hospital or what kind of net do you need to get rats out of the sewer. That's from my house by the way. So I took one of my few direct decisions and I said okay from now on Ibu Elci we trust you to take care of maintenance for us. We will not talk about that here. You do that and report back to us on Fridays. And then we gave her some structure over her days also so we said in the morning you have a morning meeting with your staff for 15 minutes. Then you go around the hospital for one hour so we only had a time box for that. Not until you're done but for one hour. And then we did something else in the afternoon we added an hour of slack time. Don't book anything here. This is for stuff that you didn't have time to do in the rest of the day. Finally with not finally one more thing so second to finally we said that we want you to limit how many things you are doing at the same time. So do three maintenance things. And when I said that something really strange happened because she looked up to me with tears in her eyes and she just said can I do that. Yes you can do that. That is called being a professional saying no. The last thing we did was to make the policies around all of this very explicit and a very good example of that was that we told the maintenance staff don't work on anything that is not written on this yellow slip and that yellow slip was in the pocket of Ibo Elchi. So they didn't do anything until it was written and she wrote it. So what happened then. Well three days after we made all of these changes but of course that was pretty easy to do. She came up to me and she said I have nothing to do. And I was really worried. I thought something has gone horribly wrong but okay let her rest. And then on the first Friday we were supposed to get the report back from Ibo Elchi. But in Indonesia there's 35 public holidays per year so a good place to work by the way. So we had to wait for another week and just before she started to report I realized that I don't know how many things they normally get done in a week. So I said how much. Oh well three things usually two to three things. Okay so two weeks six eight ten. I'm hoping for ten. Ibo Elchi reported 46 items completed in three weeks in two weeks. And remember that she said that she had nothing to do. So it was the best morning meeting of my life. It took so long that I had to drag up a chair and after a while I actually started to record it. So I wanted to show this little movie of Ibo Elchi here and I want you to watch her and watch the faces of the other people. Two weeks ago they were hating her guts for not getting stuff done. And I hope that the sound is not too loud. Suda that means it's fixed. Sempurna wins with excellence. So what happened here. Well to be quite honest we just uncovered Ibo Elchi's awesomeness. But we did that with some really simple tools. We moved the authority to the information. We showed Ibo Elchi trust and required transparency back. We made policies explicit and we limit the working process. I'm wearing this shirt for another reason as well. Three weeks after this happened she came to me and she said Marcus your sleeve has come untied. And I'm a Swedish man. So I said I'll stitch that up later tonight. But she said no I can do that for you. Come on Ibo Elchi you can't do that you're a general manager. No I have time. So she took me to her small office that's located under the stairs like Harry Potter. And I had to take this off. It was about 30 degrees warm. But she still wrapped me in a blue blanket and I snuck in to her office. Her English is not good and my Indonesian is crap. So it just got silent. And we sat there for a while as she stitched this together for me. And it was a beautiful moment of sharing gratitude for her new situation at life. Which was easy for me to make room for. Very quickly the last thing I want you to talk about. I want to talk about is for the entire hospital. Remember where we started. I went in here and I came down. And then when I came down the stairs I met the management team. And they looked at me and they said Marcus help us. And I responded in the only way I could respond. I said no you need to help me. I have no idea how to run a hospital. This is the director of the hospital Dr Lillian. And she needed help and all she got was well this guy. White IT guy from Sweden. So we both said we don't know what to do. I have no ID. So we showed each other vulnerability. We said we don't know. We said I was wrong. We were very open with that unlike some other. Leaders in our world. So when you do that amazing things can happen. This is the last photo I have of the hospital. This is like half of the staff. And we said goodbye like can you see me by the way. So we said goodbye in this after this photo. And when we did that they all lined up in a long row. And we were hugging each other. And I kind of expected that because we spent so much time together. But what I did not expect was that they were all whispering the same kind of things in my ear. As we hugged and they said this. You were friendly. We were bad but you didn't scream at us. You wanted to help us. They were not expecting that. They were expecting someone to come there and yell at them and then tell them what to do. Here's the problem. I can't do that. I'm too friendly. But I don't know how to run a hospital. I still don't know how to run a hospital. But they do. I know how to get stuff done. So together in both our vulnerabilities we actually created something immensely strong. And they evolved the hospital. In the hospital long after I left them as well. And that's what you can do to engage an entire staff by showing vulnerability and transparency like this. So I worked for about one hour a day at this hospital except for when we were digging. They did the rest. They were the heroes. I was merely a guide. Summary. Ibu Butett showed me what transparency can do to engage everyone in the hospital. Ibu Elchi showed me that trust and letting someone take care of their situation can actually increase both productivity while at the same time have a sustainable life. Dr Lillian and the entire hospital staff showed me how vulnerability can unlock the potential of the entire organization. And with that I want to say thank you for listening. And I promise the staff that I will always wear this uniform when I talked about them. And I also promised them that I will say to hand member Katjanda God bless you. Tack så mycket för att ni lyssnade om ni vill ha. If you want to read more there's a book with more details. Thank you. Thank you sir. Yeah. Oh thanks a lot. Thank you.