Dr. John Kenagy opened the session with a story that became the spine of everything that followed.
While doing research at Harvard Business School on what makes some organizations resilient and innovative, Kenagy had the chance to have lunch with Hajime Ohba — at the time, the head of the Toyota Production System Support Center, and a legendary figure in the development of Toyota in America. Kenagy described Ohba as gentlemanly and easy to talk with. They spent most of the lunch with Ohba asking Kenagy questions about his work.
Midway through, Ohba looked directly at him and said: "Would you like to know the secret of the Toyota Production System?"
Kenagy described his reaction honestly. He gulped. He started looking around for a pen and paper.
Ohba held his hands out in front of him, palms down, one hand high and one hand low. "All the other consultants and managers implement solutions down on the people doing the work," he said. "What they don't understand is the work always changes in unpredictable, even unknowable ways underneath them."
Then he repositioned his hands — palms up, fingers spread, supporting from below. "Toyota is different. First, we develop the people. And everything flows from that."
The session that followed is Kenagy's attempt to take that observation and apply it rigorously to the problem of leading improvement in complex, dynamic systems — using healthcare as the case study but, as he was clear from the start, applicable to any complex adaptive organization. The frame he gave the audience was a simple binary they were going to apply to example after example: Kata 1, where management implements data-driven solutions downward into the work, versus Kata 2, where leadership develops people so that everything flows from that. Two columns on a piece of paper. Tally marks. Honest about which way each example actually leaned.
Most of the marks went into the Kata 1 column. That was the point.
Dr. John Kenagy knows healthcare from many perspectives — as a vascular surgeon, executive, academic researcher, author, and innovator. His most meaningful experience was as a patient following a critical injury in 1982, when he fell out of a tree and broke his neck. He recovered fully but spent six months disabled and learned firsthand how often the wonderful things that happened to him came on the back of individuals going the extra mile, not through the system itself. As a Visiting Scholar at Harvard Business School, his research translated leading-indicator systems from resilient companies like Toyota, Apple, Intel, and Amazon into healthcare, working with Steven Spear, Kent Bowen, and the late Clayton Christensen. He is the author of "Designed to Adapt." Adaptive Design and Ideal Patient Care are registered trademarks of John Kenagy.
Kenagy walked the audience through four decades of healthcare management — the late 1970s through 2021 — and asked the same question at each stop. What does Mr. Ohba think of this kata?
In the late 1970s and early 1980s, U.S. healthcare was already more expensive than the rest of the developed world. The response was managed care. Kaiser Permanente approached Kenagy's surgical group with a capitation model — a flat fee for surgical care based on the number of contracted patients. The contract worked. It lasted 24 years and was one of the first examples of what would later be called an accountable care organization. Kaiser got predictable cost and good quality. Kenagy's group, more efficient than Kaiser, made it profitable. Everyone won.
In 1982 Kenagy fell out of a tree. The image he showed of "the doctor with a broken neck" got a laugh. The point that followed didn't. Six months of disability gave him something he hadn't had before — time to watch the system from the inside. What he saw changed his thinking. Many of the wonderful things that happened to him came not from the system delivering reliably but from individuals working around the system to make sure he got what he needed. The system itself could clearly get in the way. The reframe arrived: what if the system made it easy for people to get what they needed?
That reframe pulled him into management. He took on progressively bigger roles — chief of surgery, chief of staff, regional vice president for business development — while continuing to work at the front line as a surgeon. He was, in his words, the same person on both sides of the divide between management and the work. And what he watched the management side do, in detail, was the standard Kata 1 pattern.
By 1994 the kata had a recognizable shape. Implement electronic health records and new data systems. Adopt best practices selected from a growing body of managed-care literature. Collect more data about care and operations. Analyze and plan and predict in offices or, more commonly, in meetings — lots of meetings, because the problems were complex and had no easy answers. Make decisions. Implement them back into the system. Use consultants and new technology when expertise ran short.
Kenagy paused on each element and asked the audience to mark Kata 1 or Kata 2. The pattern was clear. All of it was Kata 1 — sophisticated, well-intentioned, data-driven implementation of solutions downward into the work, exactly the pattern Mr. Ohba had described.
By 1998, the cost curve had bent slightly but the model had two new problems. Managed care wasn't popular with patients or caregivers. And it wasn't profitable. Every large managed-care system on the West Coast — Kaiser included — struggled with profitability. Kenagy's organization responded with what most organizations under cost pressure respond with. They got tough on their biggest variable cost: people. They did the first layoffs in the memory of anyone at the hospital and increased pressure to hit numbers.
Kata 1 again. More vigorous. More desperate. Same underlying pattern.
Kenagy also told the audience what happened next for him personally. He noticed that managers couldn't get data fast enough to be useful in unpredictable workplaces. He noticed that the electronic health record he had proudly helped implement was giving him information he didn't need and making it harder to get the information he did need. He couldn't meet his own needs either as a clinician or as a manager — and he was the same person in both roles. So he left. He took what he thought would be a brief sabbatical to figure it out. The sabbatical turned into a research career at Harvard Business School and the body of work the session was built on.
The Kata 1 pattern continued without him. By 2018, with HHS announcing a "bold new patient-focused approach to healthcare," the elements had multiplied — improved EHRs, larger integrated delivery systems, pharmacy management, value-based payment, CMS pushing the ACO market, population health, price transparency, clinical pathways, social determinants of care. The 2021 version added stronger emphasis on social determinants and racial disparity, the Affordable Care Act, expanded ACA premium subsidies, plans to lower Medicare costs. All of it Kata 1. None of it had bent the curve. The Congressional Budget Office was predicting Medicare would be insolvent within a handful of years.
Kenagy's framing of where this leaves the field was direct. We have two options going forward. We can keep trying harder at Kata 1. There is abundant evidence that trying harder isn't the answer — at some point, repeating a process that has failed thirty times in your own organization stops being optimism. Or we can try something structurally different — a leadership and improvement kata that develops people, the way Mr. Ohba described.
When he asks audiences which they would prefer, everyone picks Kata 2. Then most of them walk out the door and do Kata 1 anyway. The session was about how to actually make the shift.
The intellectual foundation Kenagy drew on for this section came from his work with Clayton Christensen at Harvard Business School, which produced an article in Harvard Business Review on why established successful organizations have such difficulty innovating.
The problem isn't lack of competence. Established successful organizations are extraordinarily good at improving what they already know how to do. The kata that produced their success is precisely tuned to operating their current business. That same kata makes it almost impossible to do what they don't know how to do — which is what innovation requires.
Rather than studying the thousands of organizations that didn't innovate, Kenagy and Christensen studied the few that successfully created a Kata 2 capability inside a Kata 1 organization. The list is short and familiar — Toyota, Apple, Intel, Amazon, others — and the question for any leader is whether they want their organization on that list. If the answer is yes, choices have to be made.
The secret sauce Kenagy identified isn't either/or. Kata 1 systems are data-driven. Data-driven thinking developed in the industrial revolution, it's necessary, and you'll never stop being data-driven. But every successful innovator throughout business history has used a different system as well — they let value drive the data, not the other way around. Every successful startup has to start that way, because there's no data on something that's genuinely new. The great innovations that change industries all come from that direction.
The successful innovators create spaces inside their organizations where value drives data alongside the broader Kata 1 system where data drives value. Both, not either. The Kata 2 capability lives in the spaces where leadership has deliberately decided that this small unit, this discovery effort, this innovation project will operate on different principles than the rest of the organization. That's where the breakthroughs come from. That's also where Kenagy's adaptive design work operates.
The first case study Kenagy walked through made the abstract concrete.
The site was the operating room of a large Northeast urban unionized teaching hospital. The improvement areas were the same as anyone would identify — quality, safety, cost, throughput. The Kata 1 approach would have used data to identify where to focus, run DMAIC cycles or PDSAs, standardize the work, and use more data to audit.
The adaptive design approach started from the same areas of opportunity but centered them on patients rather than on the classification of the problem. Relevant information and simple rules enabled work-based innovation. Each improvement was an A3 experiment, not a project or event.
In six months the OR completed 59 A3s. Kenagy noted this was very early in his work and the team can move much faster now. Each A3 was charted against the four improvement areas to see which were affected. Almost all the improvements had multi-dimensional effects — a change made for quality reasons would also affect safety, throughput, or cost.
Finance did a net present value on each A3. Total dollar savings: $1,672,000. All but one of the financial improvements also affected another key indicator.
The piece that mattered most came from something nobody had been focused on. Surgical volume was never a target of any of the 59 A3s. Staff overtime was never a target either. At the end of six months, surgical volume had increased by 14 percent and staff overtime had decreased by 12 percent. The team was assured this had never happened before in the memory of anyone in the OR.
The lesson, in Kenagy's framing, is Goodhart's law in operation — when a metric becomes a target it ceases to be a good metric. Adaptive design doesn't focus on the numbers. It focuses on developing the systems that drive the numbers. The numbers follow. The 14 percent volume increase and the 12 percent overtime reduction were leading indicators of work that actually changed, not targets to be hit through pressure or incentive.
The second case study made the same point in a different setting.
A Midwestern community hospital chose a poorly performing nursing unit as the place to start with adaptive design. The HCAHPS scores on that unit had been low for an extended period.
The hospitalists on the unit didn't want to participate. They were overworked. They felt stressed. They didn't want anything to do with what they considered crazy new methodology. The adaptive design work proceeded anyway, focused on the nursing system that the hospitalists worked within.
Within months, in the eyes of the patients, the hospitalists had become much better communicators.
Kenagy was emphatic on the point. The doctors hadn't changed their behavior because they were trained on better communication. They hadn't been coached on bedside manner. They hadn't been told they were communicating poorly. What changed was the system around them. The system that supported the work made better communication possible without the doctors having to consciously do anything differently. The patients experienced the change. The doctors, when they saw the results, changed their minds about whether the work was worth participating in.
The unit went from the lowest balanced scorecard performance in the hospital to the highest. Profitability — which Kenagy was careful to identify as a lagging indicator that always follows — followed.
The structural insight underneath both case studies: healthcare is not a machine. It's a complex adaptive system. The Kata 1 approach treats it as a machine — diagnose the broken part, fix it, audit to confirm. Complex adaptive systems don't respond to that treatment the way machines do, which is why the Kata 1 approach produces the chronic frustration that anyone working in healthcare improvement recognizes. The same intervention applied at a different time produces different results. The same metric measured under slightly different conditions tells a different story. The system adapts around the intervention. Mr. Ohba's framing — first develop the people, everything flows from that — is the operationally correct response to systems that adapt, because it's the people in the system, not the system's structural design, that produce the adaptation.
The third case study Kenagy walked through was one of the most revealing.
A great U.S. health system synonymous with quality and excellence, totally committed to improving population health, found itself unable to improve outcomes meaningfully for months despite excellent resources. Physicians, staff, IT, contracting, quality teams, consultants — everyone wanted the improvement. Nothing produced.
People said the system was broken. Kenagy was direct that the system was not broken. He quoted Paul Batalden's well-known framing: every system is perfectly designed to get the results it gets. The system wasn't broken. It was producing exactly what its design produced.
Then, in one of the two groups under study, rapid improvement started. Dramatic improvement followed over the next year.
The improvement didn't start where the metrics first showed it. It started three months earlier, with something that happened in a different cycle of work — something that wasn't visible in the population health data because population health is a lagging indicator. Population health, length of stay, readmissions, profitability — none of these are usable for managing complex, constantly changing improvement work in real time. They tell you what happened months ago. They don't tell you what to do now.
The Kata 2 move is to manage with leading indicators that show real-time progress in the development of people and their capacity to solve problems. The lagging indicators — the population health metrics, the financial outcomes, the satisfaction scores — follow on their own once the leading indicators are moving in the right direction. Trying to manage forward using lagging indicators is, structurally, trying to drive while looking only in the rearview mirror. You can do it for a while. You'll eventually hit something.
The piece of the session that landed hardest, judging by the audience reactions, was a single hour of direct observation.
Kenagy's team observes nurses delivering medications as part of the discovery phase of adaptive design work. The standard process is medication administration — straightforward, well-documented, designed to deliver meds to a nurse's panel of patients within the appropriate window.
In one observed hour, Nurse Jess was responsible for five patients. To accomplish her med pass for those five patients, she worked in three or four physical locations. She changed location 103 times. She talked with 17 different people about more than 100 subjects.
The information exchange these talented nurses manage is remarkable in itself. The question is how the time gets spent.
Of the hour, 23 percent went to direct patient care. Twenty-one percent went to administrative work. The remaining majority — 56 percent — went to what Kenagy's team calls workarounds. Small system failures. Things that, in a perfect system, the nurse wouldn't be doing. The hunt for supplies that should have been in the room. The clarification of orders that should have been clear. The location changes that should have been unnecessary. The conversations to chase down information that should have been available.
Kenagy referenced an Anita Tucker article from Harvard and Wharton that studied nurse workarounds. The number to write down: nurse workarounds cost $95 per nurse per hour. He invited the audience to do the math for their own hospital.
This is the leading indicator data that lagging metrics never reveal. The population health score doesn't tell you that the nurse spends 56 minutes of every 100 working around a system that should be making her work easier. The HCAHPS score doesn't tell you that 103 location changes per hour is what stands between the nurse and the bedside time her patients need. The financial dashboard doesn't tell you that $95 per nurse per hour, multiplied across your nursing workforce, is the cost of workarounds that an adaptive design effort could systematically reduce.
The observation takes an hour. The data is immediate. The implications are concrete. And it produces something senior leaders can see directly that no quarterly report could show them.
After the discovery work, leadership has a binary choice. The discovery has revealed something specific about the current state. Leadership says yes or no.
If they say no — we like our current best practices, we learned a lot but this isn't for us — Kenagy's team doesn't try to convince them. They thank everyone and move on. The discovery itself was low-cost, low-risk, high-reward, fast. The conditions for adaptive design to work require leadership genuinely willing to engage, and a leadership team that has decided against engagement doesn't become a good candidate by being persuaded harder.
If they say yes, the work proceeds through a sequence Kenagy described as toolboxes, each with specific methods, skills, and measurable tools attached. Simplification is the first toolbox. The key principle is that Kenagy's team doesn't make the improvements as outside consultants. They teach, coach, and develop people inside the organization to do the work. These internal people are what Kenagy calls "learner leader teachers" — they learn the methods, they apply them, they then teach others.
As internal capability builds, the unit moves from simplified to coordinated, where internal problem-solving teams develop and operate across the organization. Coordinated work develops into collaborative work as teams begin sharing learning across units. Collaborative develops into synchronized adaptive care — the state Mr. Ohba's framing implies, where the organization can adapt continuously to unpredictable change because the people who do the work have been developed to do exactly that.
Each toolbox has measurable leading indicators. This is the structural shift that makes the leadership kata work. Senior executives, distant from the front line, don't need lagging financial metrics to know whether the work is succeeding. They can see, in weeks, whether the first unit has moved from simplified to coordinated. That observation is the trigger for the decision to start two more units. Progress is predictable. Replication and scaling become straightforward decisions based on visible evidence rather than acts of faith based on prior successes elsewhere.
The role of leadership in this model isn't to make the new solutions. It isn't to implement what the consultants recommended. It's to validate, replicate, and scale the success that the developed people are producing. That role is genuinely different from the role most senior healthcare executives currently occupy. It's also, in Kenagy's framing, the role that the work actually needs them to occupy if the organization is going to develop a Kata 2 capability.
The Q&A surfaced a question Mark raised honestly about how this work actually lands with senior executives. Discovering you're part of the problem is uncomfortable. Telling executives they're part of the problem usually triggers defensiveness that shuts down any possibility of progress.
Kenagy's answer was structural. The problem-solving method itself solves this. The work doesn't start with an accusation. It starts with observation — direct, in the gemba, watching what actually happens. The learner leader teachers learn to observe and discover the same thing every audience discovers. The system is chaotic. The workarounds are everywhere. Once everyone has seen it, everyone has experienced it. The observation is shared. The senior leaders see it at the same time the front-line staff sees it. No one ties a solution to the observation — the observation only creates a shared picture of where things actually are.
From there, the staff is invited to surface specific problems by raising a hand the next time they don't have what they need to meet patient care needs ideally. It takes about a nanosecond. The last place Kenagy's team worked, a CNA held up her hand and said the ED had just admitted a patient to her room and the room wasn't ready and she hadn't known. That becomes the problem the team solves — small, specific, holdable in the hand. Solving it requires extending up the organization to the extent needed. The ED director gets pulled in. The work pulls leadership into the problem rather than leadership being told they should be involved.
The discovery that leadership is part of the system that produced the problem happens inside the work, not outside it. The defensiveness Mark named as predictable doesn't get triggered because nobody is being told they failed. Everyone is being shown what the system currently does, including the parts of the system that are leadership behaviors. The path forward is collaborative work on the problem, not a confrontation about responsibility.
Another question — whether the pandemic represents opportunity or barrier for significant change in healthcare — produced an answer worth pulling out.
Kenagy's view was that the pandemic is a huge opportunity precisely because the stress of the experience opens senior leaders' eyes to the possibility that there are better ways to operate. Nobody wants to do this again. The willingness to consider structural change is higher than it has been in a long time.
He added a practical observation about senior leadership engagement. Not every executive can do this work, and not every executive will. But in his experience, there is always an angel up there — someone in the senior team willing to extend their wings around something different. Making it safe for that person to say "let's try this in just one unit, just one place, just one thing" is a significant part of the work. The front-line work happens naturally once it's permitted. The identification of the angel and the creation of safe conditions for them to permit the experiment is the leadership-level intervention that unlocks everything that follows.
Mark added a connection from his own experience. Some healthcare organizations were notably adaptive during the early waves of the pandemic — standing up high-volume testing sites, solving bed capacity challenges, organizing efficient vaccination operations. Many of them pointed back to years of continuous improvement work as the foundation that made the agility possible. Others, without that foundation, fell into a Kata 1 command-center pattern — issue the commands more quickly and better results will follow. The difference between the two groups during a high-stress moment was a direct test of which kata the organization had actually built before the stress arrived.
The leadership and improvement kata Kenagy described is human work that no platform performs on a leader's behalf. The discovery has to happen. The observation has to be done at the gemba. The development of internal learner leader teachers has to be done by leaders willing to coach and teach. The shift from a consulting model where outsiders make improvements to a development model where insiders build capability has to be made by the leadership team itself.
What infrastructure does in this context is reduce the structural friction that makes the leading indicators of progress invisible to leaders who aren't at the front line. Kenagy noted explicitly that the work always works, but that isolated, distant leadership often lacks the relevant actionable information about what's happening now to make the decisions the kata requires. The opportunity he identified for technology — and the partners he said his organization was looking for — is exactly this gap. The simplified-to-coordinated transition is measurable. The coordinated-to-collaborative transition is measurable. Senior executives who can see these transitions happening in weeks have the information they need to decide whether to replicate and scale. Without that visibility, the work gets done at the unit level and stops there, because the leaders who could authorize spreading it don't have evidence they trust.
The shift from lagging to leading indicators that Kenagy identified as essential to managing complex, unpredictable work is also a structural shift in what infrastructure has to capture. Population health, length of stay, profitability — these are easy to track and useless for managing in real time. The leading indicators of people development, problem-solving capability, and system adaptation are harder to capture in conventional reporting structures and considerably more valuable for the decisions a Kata 2 leadership team actually needs to make.
Goodhart's law — the principle that a metric ceases to be a good metric when it becomes a target — has implications for how improvement work gets tracked. Counting A3s and tracking their multi-dimensional impact, rather than driving a single metric to a number, is closer to what the adaptive design approach actually requires. The 59 A3s in the OR case study weren't targeted. The 14 percent volume increase and 12 percent overtime reduction emerged from work focused on developing people and centering on patients. Infrastructure that supports tracking work this way, rather than forcing it into single-target frames, is what lets the Kata 2 pattern survive contact with organizational reporting requirements.
None of this changes what Kenagy was teaching. The kata is the work. The development of people is the work. The willingness of leadership to validate, replicate, and scale rather than make and implement is the work. What infrastructure does is keep the leading indicators of that work visible to the leaders who need to see them, across the scale at which most healthcare organizations actually operate.
What is the difference between Kata 1 and Kata 2? Kata 1 is the management system that implements data-driven solutions downward into the work — the dominant pattern across most established organizations. Kata 2 is the management system Hajime Ohba described to John Kenagy as the secret of the Toyota Production System: first develop the people, and everything flows from that. Kata 1 produces good results in stable, predictable work. It struggles in complex, dynamic, unpredictable work where the underlying conditions change in ways the implemented solutions can't anticipate. Kata 2 produces sustainable improvement in complex work because the people doing the work are developed to adapt continuously, rather than being given solutions they then have to execute.
Who is Hajime Ohba and why does his framing matter? Hajime Ohba was the head of the Toyota Production System Support Center and a legendary figure in the development of Toyota in America. He shared with Kenagy a specific framing of why the Toyota approach differs from standard Western management: rather than implementing solutions downward onto people doing work that always changes underneath, Toyota develops the people first and everything flows from that. The framing is structural rather than philosophical — it describes how complex adaptive systems actually have to be managed if the goal is sustainable improvement rather than temporary results.
What is adaptive design? Kenagy's term for the methodology he developed translating leading-indicator systems from companies like Toyota, Apple, Intel, and Amazon into healthcare. Adaptive Design and Ideal Patient Care are registered trademarks of John Kenagy. The approach uses relevant information and simple rules to enable work-based innovation, with leadership developing people internally rather than implementing solutions from outside. Each improvement is treated as an A3 experiment rather than a project or event. The work proceeds through a sequence of toolboxes — simplify, coordinate, collaborate, synchronize — with measurable leading indicators at each stage.
Why doesn't trying harder at Kata 1 work? Because Kata 1 is structurally tuned for stable, predictable work. Complex healthcare systems aren't stable or predictable. The same intervention applied at a different time produces different results. The same metric measured under slightly different conditions tells a different story. Trying harder amplifies the pattern that's producing the chronic frustration rather than addressing the structural mismatch between the management approach and the type of system being managed. The evidence is in the data: U.S. healthcare costs have risen continuously despite decades of increasingly vigorous Kata 1 efforts to control them. The repeated failure is evidence that the approach isn't fit for the problem, not evidence that the next round of the approach will finally work.
What is the secret sauce Kenagy identified? It isn't either/or — it's and. Successful innovators don't abandon Kata 1 data-driven thinking. They build Kata 2 capability alongside it, in specific spaces where value drives data rather than data driving value. The Kata 1 system continues to operate the existing business. The Kata 2 spaces develop the new capabilities, products, services, or operational approaches that the data-driven system couldn't have generated on its own because the data didn't yet exist. Both systems running in parallel is what distinguishes the small number of organizations that successfully innovate from the much larger number that don't.
What did the operating room case study demonstrate? A large Northeast urban unionized teaching hospital ran 59 A3 experiments in six months in its operating room. Total dollar savings were $1,672,000. Almost all improvements had multi-dimensional effects across quality, safety, cost, and throughput. Most striking, surgical volume increased 14 percent and staff overtime decreased 12 percent — neither of which had been a target of any of the 59 A3s. The case demonstrates Goodhart's law (when a metric becomes a target it ceases to be a good metric) and the adaptive design principle that focusing on developing the system that drives the numbers, rather than focusing on the numbers themselves, produces better results.
Why did improving the nursing system improve physician communication scores? The hospitalists at the Midwestern community hospital didn't want to participate in the adaptive design work. They were overworked and stressed. The work focused on the nursing system around them. Within months, the patients rated the hospitalists as significantly better communicators — without the hospitalists having been trained or coached or asked to do anything differently. The system around them changed in ways that made better communication possible. The case illustrates that healthcare is not a machine but a complex adaptive system, and that changing the system can produce results that targeted behavioral interventions would have struggled to produce.
What is the significance of the 56 percent workaround time in nurse observations? Kenagy's team observed Nurse Jess for one hour. Of her five-patient med pass, 23 percent of her time went to direct patient care, 21 percent went to administration, and the remaining 56 percent went to workarounds — small system failures that, in a perfect system, she wouldn't have been doing. She changed location 103 times, talked with 17 different people on more than 100 subjects. Anita Tucker's research from Harvard and Wharton estimated that nurse workarounds cost $95 per nurse per hour. The observation makes visible an enormous improvement opportunity that lagging metrics like population health scores or satisfaction surveys never reveal.
Why are leading indicators preferred over lagging indicators for managing complex work? Because lagging indicators — population health, length of stay, readmissions, profitability, satisfaction scores — describe what already happened. They can't be used to manage real-time decisions in unpredictable environments because by the time they show a change, the moment to intervene has already passed. The leading indicators in adaptive design are about the development of people's problem-solving capability and the movement of units from simplified to coordinated to collaborative to synchronized adaptive care. These indicators are measurable in weeks, not quarters. They give leadership the information needed to decide whether to replicate and scale while the work is still in motion.
How should top executives participate in this work, rather than just supporting it? Supporting it isn't enough. Kenagy was clear on this. Executives need to be part of innovation teams, sometimes drawing A3s themselves to help solve the problems that surface at their level. The discovery phase is deliberately short — two to three days — because executives don't have a lot of time. The work doesn't ask them to abandon their other responsibilities. It asks them to be specifically and concretely engaged with the leading indicators of progress and the binary choices that drive replication and scaling. We don't think our way to new ways of acting, Kenagy noted. We act our way to new ways of thinking. The participation is what produces the leadership development the kata requires.
What about executives who discover they're part of the problem? The discovery happens inside the work rather than as an external accusation. The observation phase shows everyone — front-line staff and senior leaders simultaneously — what the system currently produces. No solutions are tied to the observations. Specific problems then surface from staff raising hands when they don't have what they need to meet patient care needs ideally. Solving those small specific problems often requires extending up the organization to whatever level the problem requires. The leadership discovery of their own contribution to the system happens collaboratively, as part of solving a concrete problem, rather than as a confrontation about responsibility.
Why is the pandemic an opportunity rather than a barrier for this work? Because the stress of the pandemic experience has opened senior leaders' eyes to the possibility that there are better ways to operate. The willingness to consider structural change is higher than it has been in a long time. Nobody wants to repeat the experience. Kenagy also pointed out that not every executive can or will do this work, but in his experience there's always an "angel" in the senior team — someone willing to extend their wings around something different. Making it safe for that person to permit a small experiment in one unit is often the leadership intervention that unlocks everything that follows.
How does adaptive design relate to traditional Toyota Kata? Kenagy described his approach as a direct natural extension of traditional Kata methods. The traditional starter kata approach uses visual boards, daily coaching sessions, and the structured Improvement Kata / Coaching Kata pattern. Adaptive design uses a somewhat different approach but operates on the same underlying scientific method — improvements as experiments, close in time and place to the work, low cost, low risk, high reward, fast. Adaptive design extends into a generative new place focused on developing the internal people who will be producing solutions, rather than the outside coaches producing them. The biggest jump isn't the technical extension. The biggest jump is changing the leadership habits that the existing kata has reinforced over decades.
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