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John Toussaint on What a Complete System Transformation Looks Like In Healthcare

by Lean Leaper
May 21, 2015

John Toussaint on What a Complete System Transformation Looks Like In Healthcare

by Lean Leaper
May 21, 2015 | Comments (0)

Earlier this month, Planet Lean published an article with John Toussaint, lean healthcare leader and CEO emeritus of ThedaCare and CEO of the ThedaCare Center for Healthcare Value on what it takes to transform the broken healthcare system in the United States. Read highlights below and let us know what challenges and changes you're seeing in healthcare in the comments.

On the biggest challenge for senior leaders when creating their first "model cell":

"The first step is to recognize that change is necessary, followed by admitting that you need to change. Not just your organization - you. You might need to change only a little. Most of us need to change a lot. If you pride yourself on your ability to make quick decisions and set people straight, your leadership style is going to need an overhaul."

On the role of the improvement team if you have a dedicated one:

"Think of the improvement team as the bloodstream of an organization. People move through the team acquiring knowledge the way that blood acquires oxygen. These new lean thinkers are then spread through the organization, bringing a specific kind of energy to the front line."

On what a lean management system looks like and needs to entail:

"The daily management system is now defined as standardized work at all levels of management to enable a daily dialogue about the most important facts of the business.

It is designed to ensure that everyone is working on the right problems. It is not a set of top-down objectives established on high... a lean management system is [an atmospheric system], where facts on the ground rise like vapor from a lake to mix with the decisions and strategies that fall from above. In the cloud, strategies are informed by facts on the ground, and decisions made at the top are relevant to the front line."

On how to share the good improvement work you're doing once you have a "model cell" with the rest of the organization (and how not to):

“'The problem was we did a tell-and-sell. We went into each clinic and described the model cell and all the benefits they would be getting, and I think the natural human reaction to that is resistance,' James Hereford, who was leading the transformation at Group Health, told me. 'So, we heard a lot of reasons why our processes wouldn’t work in that clinic. ‘We’re different,’ people said, or, ‘My patients are different.’ The real problem was that we didn’t ask, we told.'

James’s learning? Allow each spread unit to put their fingerprints all over the work. When we spread model cell work, it wasn’t important to me that each clinic or department had the same standard work. It was important that there was standard work."

On how to use data most effectively in healthcare:

"Frontline teams still don’t have meaningful information for improvement. Our goal was to create a system that collects and analyzes data and delivers up-to-date results to frontline clinicians to help them make better decisions and take action. We called the system Clinical Business Intelligence (CBI), and the idea was that people on the front line would use the system to know everything from the current inpatient infection rate to whether units are over- or understaffed. People could then base improvement efforts on current facts..."

In summary:

"[Lean transformation requires] core set of principles to guide the system, committing to personal change as leaders, focusing on creating a model cell addressing a critical need, developing a lean central office with appropriate expertise, and creating a daily management system that includes leaders’ standard work. Learning to spread the model cell work requires supportive administrative functions. These include changes to human development, finance, and IT systems."

The views expressed in this post do not necessarily represent the views or policies of The Lean Enterprise Institute.
Keywords:  culture,  healthcare,  leadership,  model line
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