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Most performance excellence content reads like it was written by a methodology textbook. This session reads like it was written by someone who actually does the work, has done it for 20 years, and started her career as a middle school PE teacher coaching 800 kids before budget cuts pushed her into healthcare.
Shawna Forst is the Performance Excellence, Quality, and Risk Coordinator and Lean Healthcare Coach at MercyOne Newton Medical Center. She has been a Lean healthcare facilitator since 2007. She also has a BA in physical education with a coaching endorsement, an MBA, a CPHQ, and a Lean Green Belt. The combination is unusual enough to be worth a webinar on its own. What makes the session useful is that the parallels she draws aren't cute -- they're operationally specific, and they map directly to how CI work actually succeeds or fails.
This isn't a tools page. It's a coaching page, and the people who run successful improvement programs in healthcare and elsewhere will recognize themselves in it.
Shawna's framing throughout: performance excellence professionals are coaches first. The methodology is real, but the people work is what determines whether the methodology produces results. Both PE teachers and PEX professionals spend their days encouraging, holding accountable, documenting, observing, and trying to keep groups of well-intentioned humans pointed in the same direction. The skills transfer more directly than most people would expect.
She walks through eight specific parallels. What follows is the substance, organized for someone who wants to apply it.
The childhood game where the leader yells red or green and players have to freeze or run. Shawna's connection: most of healthcare quality work is, at the operational level, the same thing. Watch the data, see what's red, see what's green, decide what to do about it.
Her practical point on the dashboards she builds in KaiNexus: color matters because it makes interpretation faster, especially for board members and senior leaders who aren't living inside the data day to day. A chart that shows a metric trending below the lower limit in March communicates instantly. The same data in a spreadsheet communicates eventually.
The deeper point for CI leaders: don't underestimate the work of making data legible. Visualization isn't decoration -- it's the difference between data that drives action and data that gets nodded at and forgotten.
Shawna asks the audience to think about a great coach or teacher they had growing up. Not the easy ones -- the ones who pushed them, supported them, and were the first to clap when they broke through. The point: the people who shaped them weren't the ones who told them what to do. They were the ones who showed up alongside them, expected more of them than they expected of themselves, and recognized progress when it happened.
Performance excellence work runs on the same dynamic. CI leaders who only point out problems exhaust the people they're trying to develop. CI leaders who only encourage produce comfort without growth. The job is to do both, and the balance shifts depending on the person and the moment.
Shawna's specific tools at MercyOne: KaiNexus auto-email reminders for leaders ("I am a professional nagger -- managers get many, many reminders and follow-ups from me, that's what they pay me to do"). Gamification badges for fun competition and recognition. Automated tracking for leader rounding. Senior leaders clicking "like" on documented work so the people doing the work know someone is paying attention.
The "like" point is worth its own moment. She describes managers being far more engaged when a C-suite member or supervisor logs in and acknowledges what they did that week. Documentation into dark holes is demotivating. Documentation that gets seen and acknowledged is the loop that keeps people going.
Shawna ran 80 students per class through a middle school gym every other day. Attendance, dressing out, grading, behavioral issues, planner notes, parent communication. The volume of documentation is real, and it has to happen alongside the actual teaching.
Healthcare improvement work has the same shape. Rounds documentation, project tracking, near-miss reporting, leader standard work, monthly tasks, new hire follow-ups, strategic plan updates. If the system supporting it is fragmented across spreadsheets and email threads, the work either doesn't get done or it gets done badly. If the system supports it well, the manager logs in, sees what's due, completes it, and moves on.
The MercyOne use cases Shawna walks through include leader rounding, daily huddles, project tracking, new hire 90-day follow-ups, strategic plan tactics, monthly manager tasks, and copies of any KPI tied to operations. The unifying principle: the manager has one place to go, work auto-routes to them, and reminders trigger automatically.
The 90-day new-hire follow-up example is specific and worth lifting. New hires fill out a "get to know you" form at orientation -- favorite meal, favorite song, communication preference, what they want to learn in their role. At 90 days, the manager is automatically reminded to complete a follow-up form: does the new hire have one or two colleagues they can go to, do they know where to go for things, do they attend huddle, would they feel comfortable running huddle, do they know where the recognition postcards are. The structure ensures the cultural onboarding actually happens, even when the manager is dealing with everything else competing for attention.
In Shawna's first teaching job, the math teachers sat with the math teachers, the science teachers with science teachers, and Shawna ended up in what they called the odd bunch -- PE, home ec, wood shop, music, computer. The connection: they all taught the entire student body, while the subject-matter teachers each saw a slice.
That bird's-eye view created collaboration the subject teachers couldn't have. When a wellness grant brought in treadmills, computers, and pedometers, Shawna and the home ec teacher could pair healthy eating with physical activity in a way that reached the whole school. They could see patterns across kids that none of the subject teachers could see from their narrower vantage point.
The CI parallel: performance excellence professionals see across departments and silos in a way most other roles can't. That visibility is the asset. It lets you spot when two departments are working on similar problems separately, when a supposedly-unique unit issue is actually a system issue, and when a value stream that crosses functions has a handoff problem that nobody owning a single function can see.
The practical move Shawna names: be the bridge. Help departments map their processes together. Get out of the room and ask people how they perceive what's happening. Connect the dots that nobody else is positioned to connect.
The metaphor Shawna uses for units that feel left out, unique, or unfairly treated. In every healthcare organization she has worked in, multiple departments have told her some version of "we're the redheaded stepchild," followed by a list of why their challenges are special and prevent them from succeeding.
The reality, of course, is that everyone thinks this. The OR thinks it. Med-surg thinks it. The ED thinks it. Lab thinks it. Each unit has real challenges, and each unit has built a story where their challenges are uniquely difficult.
The countermove she uses is structured cross-observation. A surgery nurse who wonders why med-surg can't take the patient faster goes and watches what it actually takes to get a med-surg room ready. A specific story she tells: the surgery nurse's instinct was "I gave you my 10-minute heads-up call, why aren't you ready?" After watching what med-surg actually does to prepare a room, the conversation shifted. Both sides still want fast handoffs. Now they're working on it together instead of blaming each other.
The other countermove is data. Objective information about what's happening by shift, by department, by diagnosis often shifts the conversation away from "we're uniquely struggling" and toward "here's what's actually going on, and here's where we can collaborate." For data-driven people -- engineers, healthcare professionals -- this often lands harder than narrative.
The frame she pulls in: the issue belongs to the customer (in healthcare, the patient). Whatever the politics or the personal grievances between units, the patient's experience is the rallying point everyone can stand behind. Nobody on the team is okay with a pregnant patient sitting in a clinic waiting room for an hour to get a blood pressure check, which is the example she walks through. Once the framing shifts to the patient, the blame game loses its energy and the actual problem-solving begins.
Sometimes parents called upset that their kid was failing PE. Sometimes the kid was an athlete the parent assumed was getting good grades automatically. Shawna's response was always the same: walk through the documentation. The kid wasn't bringing gym clothes. They were tardy. They missed days. They didn't participate. They caused problems in class. Each piece had been recorded. The grade reflected effort and responsibility, not athletic ability.
The same dynamic shows up in performance excellence work. When a project is missing deadlines, when output is poor, when accountability conversations get hard, documentation and transparency are what make those conversations productive instead of personal. KaiNexus's timeline feature shows the full progression of a project -- when something was deferred, when a task was archived, who was helping, when the decisions were made. Shawna says it has helped her remember why decisions were made on projects that span a year or more, and it has helped her have honest conversations about what's not getting done and why.
The deeper point: accountability conversations are easier and fairer when the record is clear. Both for the person being held accountable and for the person doing the holding. Documentation isn't bureaucracy -- it's what makes the conversation about the work instead of about who's right.
The story Shawna tells with visible emotion 30 minutes into the webinar. As a young PE teacher she was invited to a parent-teacher conference for a student about to be removed from the school. The format put all the teachers on one side of a table and the parent on the other. Each teacher took a turn telling the parent how bad the kid was.
When it came to Shawna, the only thing she could say was: he's always good for me. He's a joy to have in class. He participates. He helps put the equipment away. He never causes problems in the locker room. Let me know how I can be part of the solution.
She was 23. She wasn't sure where the response came from. Looking back, she was surprised by herself given how many mistakes she made elsewhere as a young teacher. But the moment stuck with her, and it shapes how she shows up to performance excellence work two decades later.
The connection to PEX: as the improvement professional, you see colleagues and operations from a side most people don't. You sit in on the patient complaints. You hear the staff vent. You see the side of the situation that doesn't make it into the formal incident report. The ability to take really smart, well-intended people and set them up for success requires a different kind of presence at different times. Sometimes the most useful thing you can offer isn't a methodology -- it's a different perspective on the person everyone else has already given up on.
She names the questions worth asking, both about students and about staff: what are the precipitating factors? What's going on in their life? What part is positive? What do you like most about them? What are their strengths? Those questions don't replace accountability. They make it possible to have accountability conversations that don't crush the person on the other side.
Shawna's framing as she pulls the eight parallels together: PE teachers are trying to raise healthy kids who become healthy adults. Performance excellence professionals are trying to raise healthy organizations and healthy communities. Both are about feeding nourishment into a system so it gets stronger and stays that way.
The mission-level point isn't sentimental. It's an observation about why people stay in either field for decades. The tools change. The metrics change. The political dynamics change. What doesn't change is the underlying work of helping people perform at their best in service of something that matters. PE teachers and PEX professionals both have access to that, and both are at their best when they remember it.
A few specifics from how Shawna runs the work at MercyOne worth pulling out for CI leaders thinking about implementation.
Leader rounding is treated as a habit-building tool, not a compliance exercise. Step one is simply tracking that it's happening. Step two is documenting what's heard. Step three is moving from "what did we hear" to "what are we doing about it" -- and using patterns across rounds to identify projects worth spinning up.
Daily huddles are expected across every department. The huddle is short. There's standard work for what gets covered. Notes are shared across the facility. One administrative member visits each department's huddle at least once a month -- partly to see what's on the board, partly to build relationships.
The platform handles the things that would otherwise eat manager time. Auto-emails when something is due. The default board that opens when a manager logs in, with everything they need in one place. Cards filtered the right way for each role. Quick edits the CI team can make themselves to keep the system useful as the work evolves.
The transparency point matters here too. Shawna can keep work private within a leader's lineage -- the unit owns its work -- while senior leadership can see across the whole house when they need to. That balance lets the system serve both autonomy and oversight, which is harder than it sounds.
Shawna is direct about the role KaiNexus plays in her work. The platform is the connective tissue that makes the coaching, documentation, accountability, and visibility possible at the scale a 25-bed hospital requires from a small PEX team. It supports project work, but more importantly it supports the rhythms underneath the project work -- the rounding, the huddles, the tasks, the follow-ups that compound into culture over time.
If you're trying to do performance excellence work without the infrastructure to support coaching at scale, the work either doesn't happen or it depends on heroics. Neither is sustainable.
Shawna Forst is the Performance Excellence, Quality, and Risk Coordinator and Lean Healthcare Coach at MercyOne Newton Medical Center. She has been a Lean healthcare facilitator since January 2007 and has spent 20+ years in healthcare quality, safety, infection control, emergency preparedness, risk management, and performance improvement. She holds a BA in physical education with a coaching endorsement from Simpson College, an MBA from Western Governors University, a Certified Professional in Healthcare Quality (CPHQ) credential, and a Lean Green Belt.
Why does performance excellence work resemble teaching and coaching?
Both roles require helping groups of well-intentioned people perform at their best. Both depend on a balance of encouragement and accountability. Both involve significant documentation, observation, and follow-through. The methodology each role uses differs, but the underlying skills -- listening, coaching, building trust, holding accountability without crushing people -- are the same. Performance excellence professionals who think of themselves as coaches first tend to produce more sustainable results than those who think of themselves as project managers first.
What does effective coaching look like in healthcare improvement?
It looks like supporting people through hard problems, holding them accountable with respect, providing structure that reduces friction, recognizing progress when it happens, and being honest about what isn't working. Shawna's framing: the best teachers and coaches she remembers weren't easy or universally nice -- they were the ones who pushed her further than she would have pushed herself, and were also the first to clap when she broke through.
How does documentation support accountability without becoming bureaucracy?
Documentation is what makes accountability conversations about the work rather than about who's right. When a project is behind, the timeline shows what happened and why. When a manager misses a task, the system shows it cleanly. When a parent or stakeholder challenges an outcome, the record speaks. The trick is making documentation low-friction enough that managers actually keep up with it -- which is where automation, reminders, and one-stop platforms matter.
Why do leaders sometimes resist patient safety rounding or leader rounding generally?
Often because they aren't comfortable with the format, or they don't see how to make time for it on top of everything else. Shawna's experience: educating, supporting, and coaching leaders is step one. Tracking that the rounding is happening is step two. Showing leaders what comes out of the rounding -- the patterns, the projects, the wins -- is what builds the habit. Without visible follow-through, rounding becomes a checkbox exercise.
How do you handle the "we're the redheaded stepchild" department?
Cross-observation between units, paired with objective data. When a department believes their challenges are uniquely difficult, having them watch another department's work often shifts the perspective. So does looking at data across shifts, departments, or diagnoses. The goal isn't to dismiss the department's experience -- it's to broaden the frame so the conversation moves from blame to collaboration.
What's the right balance between praising people and pointing out problems?
Shawna defaults to roughly five compliments or positive observations for every piece of corrective feedback, drawing on what she learned in teaching. The point isn't a literal ratio -- it's awareness. If you're always praising and never addressing issues, you're missing the work. If you're constantly correcting without recognizing what's going well, the team loses energy. The balance shifts by context. The discipline is being conscious of which mode you're in.
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