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In On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry, the authors, John Toussaint and Roger Gerard, talk to us about Thedacare’s lean  journey. Within their hospital group, they decisively confirm the case for evidence-based delivery of care, a concept that goes hand-in-hand with evidence-based clinical medicine. Thedacare (now Catalysis) is a mid-sized, not for profit healthcare provider in Wisconsin.  They manage hospitals, clinics and nursing homes.  Dr John Toussaint was the CEO of Thedacare during the implementation of lean and Roger Gerard the Chief Learning Officer. The combined views of an expert in organisational development and clinical practitioner turned manager makes for unique insights into the process of change.

The ’before’ scenario is familiar to those working in healthcare: functional units operating in silo’s with limited consultation  between specialities, poor communication, autocratic management, , numerous redundancies and waste in the system.  Another common feature of working in hospitals is the commonplace shame and blame culture.  The authors’ state that ‘shame and blame is so prevalent in the healthcare industry that it is often cited as the underlying culture of hospitals.’

Thedacare changed this culture and the traditional delivery model by challenging the status quo, redefining roles and setting new standards.  Their new model for healthcare delivery incorporates all functions as full partners in patient care. This is made possible by an in-depth understanding of the customer journey from start to end, including the involvement of suppliers and patient’s to help improve the journey. Thedacare has set their true north and all improvements are measured against their true north principles, namely: Customer Satisfaction, Safety/Quality, People and Financial Stewardship.

A method that was used effectively to improve the team-work approach in a new collaborative care unit was to get the organisational development team to work with staff for weeks in a mock-up patient-care unit, practising role-play and responding to fictitious scenarios.

Thedacare created a safe space for their staff and encouraged healthcare professionals to air their grievances. These frustrations were then channelled into improvement activities, allowing all employees to become problem-solvers.

The authors do not shy away from sharing the failures during the journey and the challenges in sustaining results.   Becoming a lean organisation is a journey that each department, within an organisation, needs to walk. The cultural shift required to coach all employees to become problem-solvers is the crux of lean implementation.   The culture of continuous improvement cannot be replicated; it needs to be practised every day.

The enabling factor to all of the above is a change in the traditional management style.  Toussaint and Gerard state that it took them three years to realise that they, as the organisation’s senior leadership, were implementing a new system of doing, without addressing the required changes within their management structure and that this was creating resistance.  The need for leadership not only to adjust their level of involvement, but also to change their traditional ways of managing is a key point in the book.  Leadership needs to spend time in the actual workplace (gemba), with the purpose of observing and learning, not teaching and telling.

Part of the preparation for finding a successor for John Touissant was to list the most important attributes of a lean leader. Two pivotal attributes, which are not commonly seen on non-lean leadership lists, were 1.Having a keen interest in problem-solving and 2. Being in the middle of the action and not stuck in an office. In lean organisations senior leaders are always the key to sustaining the transformation.

On the Mend shows that when healthcare delivery is designed around the true patient journey the result is an organisation with less waste, duplication, and content staff who spend enough time with patients. And all of these aspects add value to the patient, and as such improve the quality of care. The book does not provide a toolbox or shortcuts.  It describes the really difficult journey that is required in organisational culture-shifts – and this difficult content is often not addressed in books. They do this by including the whole journey, rather than just focusing on the highlights and successes. This full picture is immensely valuable to managers wishing to embark on a culture change, because it gives a realistic overview of what one might encounter.

Thedacare has become an exemplary demonstration of how the lean principles can improve the delivery of healthcare with positive results on performance indicators including mortality rate, operating cost, and average length of stay.

Who should read this book?  This is an important book for all healthcare professionals, regardless of their role.  Anyone with an interest in improving healthcare will find value in reading it.  The book is a must-read for senior leadership whilst planning a lean transformation.  If you are not working within healthcare you might find the book interesting although some of the detail in the cases discussed might not make sense.

Review written by Charmaine Cunningham