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Management on the Mend: The Healthcare Executive Guide to System Transformation
Five years after his debut book, On the Mend, showed how a large, cradle-to-grave health system revolutionized the way care is delivered, Dr. John Toussaint returns with news for healthcare leaders. There is a clear framework for success for such a transformation. And senior leaders need to be far more intimately involved.While studying and assisting hundreds of organizations transitioning to lean healthcare, Dr. Toussaint witnessed many flaws and triumphs. Those organizations that win – creating better value for patients while removing waste in the system – have senior managers that lead by example at the frontline of care. The best health systems have also discovered ways to engage everyone in solving problems and embracing change.Management on the Mend is the result of years of investigations by Dr. Toussaint of dozens of healthcare organizations around the world. Using their collective experiences, he has built a model for lean transformations that work. This book describes the model, step by step, through people in 11 organizations who are doing the work. It is the story of many journeys and one lean healthcare is not only possible, it is necessary.As senior leaders look ahead to a future that includes radical changes that include population health management, the healthcare payment system, and patient expectations, everyone knows that health systems must be agile to survive. In order to thrive, they must be able to continuously improve. Here is the roadmap for that future.
- GenresBusinessHealth Care
205 pages, Kindle Edition
First published June 7, 2015
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Displaying 1 - 3 of 3 reviews
January 6, 2018
Fantastic book, not just on lean healthcare but leadership in general. Loved the chapter on finance and why the way we currently budget is backwards.
December 9, 2015
Since he stepped down as CEO of ThedaCare nearly seven years ago, John Toussaint, MD, has been making house calls on a global scale.
Toussaint, who launched and led a continuing lean transformation at ThedaCare, a major Wisconsin health system, has been in demand around the world by healthcare executives and doctors trying to do the same -- trim costs while improving patient safety and care. He estimates that he has logged more than 145 such visits in 15 countries, and continues to do two or three per month. Not satisfied to just lecture, Toussaint says a house call always includes a “substantive” visit to where care is delivered so he can observe and ask questions.
Toussaint reports what he is seeing and hearing in his latest book, Management on the Mend. He has good news and bad.
The bad news is that many continuous improvement efforts in healthcare are ailing. Earnest clinicians and administrators make improvements every week, but it’s tough to sustain them. Consequently, “the essential transformation of the organization is not happening,” writes Toussaint, now CEO of the ThedaCare Center for Healthcare Value.
The primary reason is that leaders fail to understand the enormity of the change required, including their own behaviors. Lean healthcare is not an improvement program but “an operating system within a management system that requires a complete cultural transformation.” Too often senior leaders delegate the job of lean culture change while continuing to practice the same old command-and-control methods and behaviors. It’s the organizational equivalent of trying to get fit by hiring a personal trainer while remaining on a diet of steaks and shakes.
The good news is that Toussaint has a cure. While once reluctant to prescribe a best way to lean healthcare, Toussaint and the scores of leaders around the world whom he has visited, have found -- through trial and error -- a model that works, which he lays out for executives.
The first part of the model is, as he writes, “a revolution in six steps.” Basically they are: lay the foundation, build a model cell, establish the value and principles that will guide the transformation, create a central improvement office, redesign the frontline management system, spread the work throughout the system.
The second part is realign the organization’s policies and practices in human resources, finance, and information technology to support the change effort.
This path goes beyond the plan he offered in his 2010 book, On the Mend, which described how ThedaCare changed the bedside healthcare delivery system to dramatically improve quality and costs. In his new book, Toussaint focuses on how to change the management system and ultimately the entire organization in order to sustain the gains and advance the improvement effort.
As he fills in the details of the model, Toussaint draws helpful examples and insights from leaders in 11 lean healthcare organizations to show that there are different ways to follow the prescribed path. For example, he describes two approaches to forming the central improvement team.
MemorialCare in Southern California followed the “training wheels” approach of using an outside consultant to guide the team until it could operate pedal on its own. For the “inside expert” method, Toussaint describes how HealthEast in St. Paul, MN, hired an experienced lean leader to build the improvement team from within.
He also describes the dos, don’ts, and maybes of two different approaches to creating a model cell through the experiences of James Hereford, now chief operating officer at Stanford University Hospital and Clinics, who used both methods in previous positions. The book is filled with such practical examples. The final chapters prepare executives for how to get started and to deal with the three biggest obstacles they’ll face during the change process.
At a time when the one thing healthcare experts agree upon is that we can’t operate the way we have in the past, Management on the Mend provides healthcare executives – and leaders outside healthcare – a proven, step-by-step better way. (Note: I received a review copy of the book from the ThedaCare Center for HealthCare Value, the healthcare partner of the Lean Enterprise Institute, where I work. Check out the ThedaCare Center at http://createvalue.org/ )
Toussaint, who launched and led a continuing lean transformation at ThedaCare, a major Wisconsin health system, has been in demand around the world by healthcare executives and doctors trying to do the same -- trim costs while improving patient safety and care. He estimates that he has logged more than 145 such visits in 15 countries, and continues to do two or three per month. Not satisfied to just lecture, Toussaint says a house call always includes a “substantive” visit to where care is delivered so he can observe and ask questions.
Toussaint reports what he is seeing and hearing in his latest book, Management on the Mend. He has good news and bad.
The bad news is that many continuous improvement efforts in healthcare are ailing. Earnest clinicians and administrators make improvements every week, but it’s tough to sustain them. Consequently, “the essential transformation of the organization is not happening,” writes Toussaint, now CEO of the ThedaCare Center for Healthcare Value.
The primary reason is that leaders fail to understand the enormity of the change required, including their own behaviors. Lean healthcare is not an improvement program but “an operating system within a management system that requires a complete cultural transformation.” Too often senior leaders delegate the job of lean culture change while continuing to practice the same old command-and-control methods and behaviors. It’s the organizational equivalent of trying to get fit by hiring a personal trainer while remaining on a diet of steaks and shakes.
The good news is that Toussaint has a cure. While once reluctant to prescribe a best way to lean healthcare, Toussaint and the scores of leaders around the world whom he has visited, have found -- through trial and error -- a model that works, which he lays out for executives.
The first part of the model is, as he writes, “a revolution in six steps.” Basically they are: lay the foundation, build a model cell, establish the value and principles that will guide the transformation, create a central improvement office, redesign the frontline management system, spread the work throughout the system.
The second part is realign the organization’s policies and practices in human resources, finance, and information technology to support the change effort.
This path goes beyond the plan he offered in his 2010 book, On the Mend, which described how ThedaCare changed the bedside healthcare delivery system to dramatically improve quality and costs. In his new book, Toussaint focuses on how to change the management system and ultimately the entire organization in order to sustain the gains and advance the improvement effort.
As he fills in the details of the model, Toussaint draws helpful examples and insights from leaders in 11 lean healthcare organizations to show that there are different ways to follow the prescribed path. For example, he describes two approaches to forming the central improvement team.
MemorialCare in Southern California followed the “training wheels” approach of using an outside consultant to guide the team until it could operate pedal on its own. For the “inside expert” method, Toussaint describes how HealthEast in St. Paul, MN, hired an experienced lean leader to build the improvement team from within.
He also describes the dos, don’ts, and maybes of two different approaches to creating a model cell through the experiences of James Hereford, now chief operating officer at Stanford University Hospital and Clinics, who used both methods in previous positions. The book is filled with such practical examples. The final chapters prepare executives for how to get started and to deal with the three biggest obstacles they’ll face during the change process.
At a time when the one thing healthcare experts agree upon is that we can’t operate the way we have in the past, Management on the Mend provides healthcare executives – and leaders outside healthcare – a proven, step-by-step better way. (Note: I received a review copy of the book from the ThedaCare Center for HealthCare Value, the healthcare partner of the Lean Enterprise Institute, where I work. Check out the ThedaCare Center at http://createvalue.org/ )
February 8, 2017
On the Mend inspired me enormously when i read it some years ago. This book is an excellent follow-up in providing details on the management system that was only hinted at in the forerunner.
Displaying 1 - 3 of 3 reviews