Podcast 286 – Dean Gruner, MD on ThedaCare’s #Lean Journey

My guest for Episode #286 is Dean Gruner, MD, the recently retired CEO of ThedaCare, a health system in Wisconsin that has long been considered a worldwide leader in the practice of Lean in healthcare. See this article about his retirement, where he says “I’ve gotten more than I’ve given.”

Dean was previously my guest in Episodes 119 and 144 and I’m thrilled that he took time out of his retirement to talk with me about his lessons learned as he looks back on how ThedaCare’s Lean journey has evolved, including some things he would consider to be missteps and challenges that they used as a springboard to get even better.

I will also be releasing a separate episode where Dean talks about their experiences with Accountable Care Organizations (our topic from #144) and other “big picture” healthcare issues of the day.

I’m including a full transcript along with a three-page PDF summary, as I’ve been doing recently.

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Topics and Questions

  • Dean, you became CEO in 2008… ThedaCare was already becoming well known globally for Lean in healthcare… what was it like taking the reins as CEO?
  • What accomplishments or progress are you most proud of during your time as CEO?
  • What were the biggest surprises or challenges you faced in that role?
  • What are your thoughts on how Lean has evolved at ThedaCare over the past decade?
  • In On the Mend, your predecessor John Toussaint wrote a lot about succession planning and a very intentional strategy for developing a future CEO from the inside. Your successor is an outside hire who was previously a hospital CEO elsewhere… can you talk about the process and what you expect the future to hold for ThedaCare?

PDF Episode Summary

You can download a 4-page PDF summary of this post:

You can also read this highlights article that I posted on LinkedIn:

A Retired Hospital CEO Shares the Employee Feedback That was “A Bucket of Cold Water to the Face.

Videos of Dean Gruner

Past Blog Posts:

What Does ThedaCare CEO Dean Gruner, MD Say About Safety?

ThedaCare CEO Dean Gruner to Retire; What’s Next for ThedaCare?

Annotated Transcript:

Mark: You became CEO in April 2008. At that point, ThedaCare was already becoming pretty well known, even globally for efforts with Lean and healthcare. When John Toussaint was CEO, he was already out and speaking different countries, sharing the ThedaCare story.

In that context, what was it like taking the reins at that point as a CEO, a new role for you, and how many years. I’ll just ask instead of guessing. How many years into that Lean journey?

Dean: We started our Lean journey August of 2003. It would’ve been four-and-a-half to five years when I became the CEO. I can tell you that very quickly in 2008 my worries were not about Lean, but about the financial meltdown and crisis our country faced, and all the economic downturn in our people. That was clearly a lot bigger, my focus in the first couple of years of being the CEO.

Mark: Yeah, those were tumultuous times. What were some of those broader issues? There was the economic concern, concern about the impact on ThedaCare as a system. How did some that economic catastrophe translate to you guys?

Dean: The way it manifested itself in our organization is we have, for 20 years or longer, consistently had a revenue growth of about 8 to 10 percent a year. In fact, over 25 years it averaged, I think, 9.8 percent. When that hit us 2009, our revenue growth was two percent.

We always thought in the ’90s and the first decade of 2000 that it was hard to run a healthcare company. When I looked back I said, “We were living in fat city.” You’ve got 8 or 10 percent revenue growth every year. And we thought that was hard to manage in that world? In the past years, we’ve had two or three percent revenue increases.

Welcome to the world of many other companies. It has caused us to be very diligent about our expense management. We’ve had to look at some of our financial risks and figure out how to mitigate those, which we think we have. Then we, of course, kept continuing our improvement work using a lot of Lean principles and our Lean thinking through the years.

Mark: Even during those times, if your focus was on this big picture, strategic questions, there were still a large team of people doing rapid improvement events evolving the ThedaCare approach to Lean. Did that financial pressure create, in some ways, more of a motivation for why it was important to continue redesigning care, continuously improving?

Dean: I think we had plenty of motivation, but it probably helped to create a little more focus. There was some more of an urgency that we really did mean to continue to do our improvement work.

Mark: How did your role, your time in that role evolve, then, as we moved into that new normal? I think a lot of people, myself included, have the general question of how a CEO spends their time. Did you settle into a little bit different of a groove and routine after the worst of the financial crisis?

Dean: One of the things that I ended up spending more of time on was on to meet collaboratives on how do we create solutions to problems in our community. For instance, we have pediatric and mental health issues. Lots of the health issues are problematic for almost all companies. In most communities, the people that provide those services lose money.

We were losing money on those services. There were two other large providers in our community. Our Children’s Hospital at Wisconsin and Affinity, which is part of the Ascension system. We went through lots of deliberation. It took us about four years, but we finally came up with something that has been very novel.

We actually combined all of our adolescent and pediatric mental health services into one organization that’s jointly owned by the three health systems. By doing that, we were actually able to do some astounding work. We have almost doubled our number of visits in our community in the last four years. We virtually doubled the number of visits.

We’ve improved our access. If somebody has an urgent need for a pediatric psychiatrist, they all get in within a week. They all get it within 48 hours for a counselor. We’ve done this while keeping the financial losses — this is huge money on this — keeping our financial losses the same or less. It’s a revolutionary model, to say the least. We’re very proud of that.

I also did a lot of work with various affiliations of rural hospitals. Our community, we have — other people might find it funny — but our urban community is a community of 200-250 thousand, but we’re situated where we’re always within four or five miles of a farm. We have a large rural community.

We went through a set of conversations and negotiations, and have brought on three rural critical access hospitals to join us in the last five years. The challenge with that is it’s all the relationship building, the structuring those to make sense. Then, once they happened, to then try to integrate them into the existing operations.

For all these communities, they had no background with Lean or any of the other things that we did. Bringing them and integrating them into the ThedaCare system has been very, very rewarding, but very time-consuming, too.

Mark: I had the opportunity to visit one of the critical access hospitals a couple years ago. They were kind enough to host a visit as I was working on the third edition of my book, “Lean Hospitals.” It was New London Medical Center. I remember — I don’t know if he is still there — the president of that hospital was very much into Lean and what they were doing there.

One thing that stands out — and I think ThedaCare had gotten a lot of really positive attention for — reductions in door-to-balloon time. They had stories there at New London about really focusing on hitting that 45-minute target, even when somebody arrived to a critical access hospital, measuring the time from arrival there to…

I forget which of the two main hospitals where heart patients transfer to.

Dean: Appleton.

Mark: To Appleton. They were questioning and challenging. It was getting back down at more of the process improvement care level that the old assumption had been helicopters were faster. Like, “Well, helicopters travel faster than an ambulance,” but they learned — when they, I think, basically did a value stream map — that waiting for the helicopter [laughs] was not a good thing.

That they could actually reduced that overall door to other door-to-balloon time by just getting the patient immediately in a speeding ambulance, which I thought was an interesting discovery of theirs.

Dean: They did learn a lot from that, and it was a lot a lot of fun to watch them. New London, remember Bill Schmidt?

Mark: Yes.

Dean: He’s our chief exec, there. He’s still there. New London became part of the ThedaCare system in 2000, 17 years ago. They’re by far the farthest along. Then these newer locations, we’ve had to bring them up along. It’s not something you can snap your fingers and say, “Oh, I get it.” It takes time and learning to join a system.

Mark: It sounds like, with Bill’s leadership at New London, it would be hard for of someone to say, “Well, this might work at a 300-bed hospital, but we’re too small.” People love pointing out how [laughs] they’re different.

I’m guessing with some of those newer small hospitals that there was already some proof of concept or a model line, if you will, to show that, “Yeah, we don’t expect you to change overnight like you said, but it’s possible.”

Dean: Yep, exactly.

Mark: In episode 119 of the podcast, the first time we had a chance to talk with you, the conversation was mostly around strategy deployment as a methodology. I’m curious what you’re thoughts are of how that evolved? Was that still a helpful methodology over time? What happened in those more recent years?

Dean: We have learned a lot with strategy deployment. Several years ago we actually filmed a video and everybody was proud of us. Then we kept trying to study what really happened. Now, what really happened for us — and it’s so right here from virtually every CEO and everybody in every house — everybody says they’ve got too many inquiries. They can’t possibly get all work done.

In our system what we had tried to do for years is we blocked different parts of the system together. We probably had a dozen different areas of that organization — rural hospitals, physician group, and so on — who would do every September, and they’d start their planning for the following year.

The system leadership team or my executive team will do the same thing. We would work and find right where we would have our top priorities for the following year all figured out as a system. At the same time, all the different parts of the organization, the different…call them divisions or whatever, they would have done similar things.

The conflict then is two things. We would expect that they would then, if you’re in a New London hospital, you would set aside some of the stuff that you want to do and take the system priorities as your first priority. In fact, there was lots conflict with that, and that did not happen well. As end result, we had a proliferation of more work than could possibly be done.

What we did this past year is we changed the process. It’s pretty simple, but, if was easy to figure out, we would have done it five years earlier. What we did is we had all the people in the planning in these various divisions or departments, we brought them all together. There was 30 or 40 people. We started in September to create the system-wide priorities.

I challenged the team and said, “I want you to get down to three things.” Now, to be honest, I didn’t believe they were to going to get down to three things, but I wanted them to focus. What they did then is, as a group of 30 or 40, within six weeks they agreed on the top priorities and there were three things. Three things.

Then, the couple of people leading each department at New London went back to create their New London plan that would support the system-wide three priorities. We’ve been incredibly more focused this past year than we had previously.

Even though we had gone out of recognition for our strategy deployment — because everybody could see the cascade and we used a triangle for a visual effect — it wasn’t and as pure or as effective as it might have seemed. Now we’ve gotten much more focused. We’ve got the three things.

We’re focused tremendously on access, inpatient quality, and restoring our margin so we can reinvest in the organization.

Mark: What would you say…Am I hearing you right that…? I remember, even back when that video was made and I was there with the production team, that there was focus around the true north focus areas and metrics. But, you’re saying there was less focus around the activity or just less understanding that limiting the activity really made a difference?

Dean: I’m going to say something harsh here. Amongst our team we believe that we, at a certain point, started to read too many of our own press clippings, and we stopped studying what was really going on. What was really going on is that, although we had strategy deployment, we had misused some of the terminology.

For instance, true north. That language is real language to describe the ideal state. That’s my belief how it should be used. We had jerry-rigged true north to use it to describe our annual scoreboard — our performance improvement board — and not use it to describe ideal state.

Mark: For example, would you agree an ideal state would be something like Paul O’Neill would talk about — zero harm.

Dean: Zero harm.

Mark: It might be a goal for the current fiscal year that’s greater than zero.

Dean: Correct. For instance, in the last 18 months we have decreased our employee severe injury rate as measured by our DART rate. We shrunk that by 50 percent, which is incredible work, but it still is — I forgot the one number — maybe it’s 40 people a year having a DART. The ideal state is zero, so true north should be zero.

We mixed and matched the language, which, I think, confused people. That’s one of our study and adjust. True north we separate out now. That’s our ideal state. It’s no harm, no injury, no defects, no waiting, and so on, and so on.

Then our scoreboard that we use is — How we’re doing now versus our target fo r improvement for, say, 2017? Then we use the term scoreboard because people are used to looking at a scoreboard.

Mark: I imagine that scoreboard was partly an expectation of, “Here’s how much we expect or hope to accomplish this year. We don’t expect people to go from the current measure to zero overnight or in six months.” I imagine it was also something that…Was that tied into compensation, managerial targets at different levels?

Dean: Some of that does evolve into our gain sharing program for employees and our incentive compensation for the management team. Some of that is there. We try to learn our lesson and try to be thoughtful about that. How do you lead an organization and not default to management by objective? That’s challenging stuff.

Mark: What are the biggest challenges related to that and by MBO? Maybe give your definition because different listeners might have different definitions of what many would call even an older management style or different management style of Lean management?

Dean: What I would like to think is that, when you boil it all down, you want to build off of people’s intrinsic internal motivations and avoid turning their internal drive to make the world better into some extrinsic measurement system, but that’s hard to do.

In fact, in my world, I don’t believe there’s something that I would ever call Lean management, because you manage processes and you lead people. I believe it’s about Lean leadership. In fact, I don’t think it’s about Lean leadership. I think it’s about leadership.

We’ve had to learn a lot of things along the way that have brought me to that conclusion, but they took time. There’s a reason why you don’t go to school at age five to kindergarten and graduate from high school as a six-year-old.

It does some time and, of course, we would love to shorten that learning time so we can learn faster and improve more rapidly, but some of it just, I’m afraid, takes more time than you’d like.

Mark: Sure. Can I ask one other question? There’s a new book out there right now called, “The Lean Strategy,” and there’s debate and discussion on the LEI, Lean Enterprise Institute, website about is Lean a strategy or is Lean something that’s used to accomplish strategy? I’m curious for as deep as ThedaCare had gotten with lean, embraced Lean. Did you ever consider Lean to be the strategy or a strategy? How did you view it?

Dean: I wouldn’t say either of those. In fact, I’m not familiar with the book. Maybe it’s because I’m retired, so I haven’t picked it up, or read it, or read excerpts of it. Maybe what I can comment in on is our personal experience with Lean and what we think we learned in the last year-and-a-half.

As you may know, John Poole has been a Lean leader. He was our internal sensei for what we call the ThedaCare Improvement System. Last December he got a great opportunity. December of 2015 it would be. He got the opportunity to work for a larger health system in San Diego, California, which is where he spent 10 years of his life when he was in the navy.

Now, why would somebody ever leave Appleton, Wisconsin, in January to go to San Diego, California? Obviously, he took that job. When he took that job, one of the first things we had to decide is — Are we just going to replace that job? Are we going to hire somebody for that? We decided that what we’ll do first is we would pause and do a study. We’d do a reflection on how we’re doing.

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What we did is we had one of our previous organizational development (O.D.) facilitators come back. First week in January of ’16, we got all of our senior leaders and vice presidents together. It’s about 40 people in a room. She broke us into I think it was six or eight teams and gave us an interesting assignment. She had every table draw a picture on a flipchart and their assignment was to draw a picture of what the culture was of ThedaCare today. Then after that hour everybody showed their pictures and were reported out.

It was a bucket of cold water in our face.

What they drew was a picture of an organization that had become very hierarchical and required approval from senior leaders to do things. It had become an organization that was very dependent on facilitators to do improvement work.

An organization that had become much more inflexible and more rigid than we ever had imagined.

All those things are exactly the opposite of what you intend to do with Lean. We looked at ourselves and said, “How did this happen? We’ve been doing this for 12 years. We’ve got everybody who comes here and tell us how great we are” One of the answers was, we hadn’t sat down and looked in the mirror really thoughtfully for several years.

This had just happened gradually and maybe it’s akin to the boiled frog metaphor. We just didn’t really think it through. Then, when we looked at it further, we decided to take this and have manager focus groups. I challenged the team that I wanted to get through all this within 60 days.

We had to learn all of the…We couldn’t wait forever to make a decision. Kathy Franklin went and met with — I think it was 15 — different groups of managers, all with about 10 to 15 groups, so 150 people. Same process. How’d we draw our pictures, what it showed. At the end of this time, we came back together a month later.

We had 40 some pictures in the room of what people felt the organization was like. It just was not pretty. It was the same thing — rigid. What we learned from that is some people had interpreted Lean that it was all about creating standard work. I heard stories from people that would open up and tell me what really would happen. My favorite story happened in New London.

This woman is a CT and MRI technician. On a weekend she’s called in to do a scan on a patient. She comes in, does the scan on the patient. Then her process is that she takes the patient back to the emergency room, because they come through the emergency room. She then comes back to her area, turns off the scanner, does all documentation and waits.

This particular day she comes in. She does the scan on this patient from ER. Afterwards, the patient’s feeling lightheaded. She’s, “I’ll tell you what. Why don’t you sit here, then, in this room,” or whatever, “and I’ll get you some orange juice. And you get your bearings, and I’ll do my documentation, turn the equipment off, and I’ll take you back to the Emergency Room.”

She does things out of sequence. She’s gets done turning the equipment off and then she forgets the patient. She goes home. She gets home and about 20 minutes later she remembers this, so she frantically calls the Emergency Room and says, “Hey, I forgot the patient.” They go and get the patient. It’s a small hospital, so the patient was, “No harm, no foul.”

It took 20 minutes extra and everything was fine. The next day she goes and she tells this to her supervisor about what happened, and the supervisor…What would you think you would say, if you’re the manager, to somebody who made this error? What would you tell them? The manager told her, said, “You know what you need to do?

“You need to sit down and write a standard work for this so it never happens again.”

There comes to a point where people stop thinking, started to take a standard work as the solution for everything when, in reality, we pay people to think and to learn. We had gotten away from that.

We came back and then we decided…We thought more deeply and we read some of the stuff from Michael Hoseus, Gary Convis and Jeffrey Liker and some of the things that they had written about it. I’ve got two favorite quotes that I’ve got here in front of me.

From Convis and Liker in their “Toyota Way” view of the culture said, “If there’s a recipe for Toyota’s success, it is deep, time-consuming, and expensive investment in developing everyone in the organization, and truly believing that your employees are your most precious resource.”

Then Michael Hoseus, “The most common mistakes implementing Lean is thinking that Lean is a set of tools to be delegated to some Lean champions to implement while leaders go around running the business as usual.”

I would say we made some of the mistakes that they referenced there. We developed a group of ThedaCare improvement system facilitators to do improvement in work throughout our organization. Yes, I still was all on a rapid improvement at least once a year or more often, but we stopped spending time investing in leadership.

We assumed that, if you were a TIS facilitator, you were capable of doing anything. Some of the mistakes we made is we undervalued the subject matter expertise, and we’d have somebody who was a facilitator for a couple of years and say well, “They’re ready to come back and lead the department. Do they know anything about their department?”

“Well, not really. Well, they’ll learn because they know how to do improvement work,” so we dumped ’em back in some departments and we really weren’t very respectful of them by doing that. We put ’em in situations where there was a high failure rate because we undervalued subject matter expertise.

If we had thought about it, we would have said, “We need subject matter expertise, and we need to know Lean, and we need to know lot about leadership. And how do you lead people forward?”

Mark: It seems like…

Dean: Yeah, so that’s…Go ahead.

Mark: Well, I was just going to say, “And.” There’s a lot of ands with Lean. I remember my first job out of college asking a Toyota trained plant manager, “Our quality is bad. Our cost is bad. Which do we need to work on first?” and he said, basically, “Well no, it’s not or, it’s and. We’re going to work on them together.”

We talk about standard work. It’s not standard work or creativity, and kaizen, and continuous improvement. There’s an and there. Maybe a role for facilitators and a role for subject matter experts in keeping that all in balance, perhaps.

Dean: Yep, and so what we’ve done in the last year-and-a-half is we’ve merged our facilitator group to our TIS group with our organizational team. They were one group of a dozen people that we consider organizational excellence.

Our belief is that the ideal person to help other people with improvement work has a deep understanding of Lean and a deep understanding of organizational development in people. They need to have both.

About six or seven years ago John Shook, I think, had a great learning, and he drew this balance beam. It’s a balance between people and the social side of change, and technical on the product side of change. I think there was big jump in learning at that point.

What we’ve come to believe over the last couple of years is that still is somewhat flawed, that picture, because, really, you don’t have people here and a process over there. People are in processes. It’s that integration of people within a process. That is what you need to have.

That’s where investing in people, developing them, and, in my mind, served by leaders who really respect me. That’s where the magic is, I think. I would say that Lean really is better improvement journey for a bunch of years. Then, probably for a couple of years, the feedback gets in.

It might have slowed our rate of improvement for a couple of years, because we were learning some difficult lessons. Now that we think we’ve learned these lessons, we think we’re back accelerating again. I guess that’s why they call learning and why they call it work. It’s not like it’s easy, or anybody would do it.

Mark: No, this work is not easy and I appreciate the willingness to share reflections on those learnings and adjustments that were being made. I think that’s setting a great example to be willing to take that feedback that you got through those drawings, and not be dismissive of it, and to start looking at the new current state, and adjusting from there.

Dean: I think it helps explain. In retrospect, now I can stand back and reflect on this.

It does help explain why there is such a high attrition rate for organizations that start Lean. They just focus on the tools and how to do an X matrix, and a rapid improvement, and the kanban, and blah, blah, blah.

Certainly, those are the ones that tends to run out of steam in three to five years. Now, if they just focus on processes, they tend to flame out, too. If you think about what Toyota and others do, taking that long view is hard because you really viewing it. Then you’re going to focus on people, and their learning, and on the tools, and on the teamwork, and on leadership.

You’re going to do all of that. That can be a little overwhelming, but I think that’s what we’ve learned, and that’s why feel already good about the future for ThedaCare even though we had to go through a couple of challenges to really help us learn some of these lessons.

Mark: If you look back, history with Toyota, there are people who have talked about and written about how the Toyota Georgetown plant, with its couple decades of history now, went through phases where they discovered and reflected on the idea that they have lost discipline on some key practices related to the Toyota production system, and had to similarly step back and rededicate to do some things.

I think that it’s big complex organizations on…It’s difficult to change them and it can be difficult to maintain diligence.

Dean: What I had last year was reflecting on the problems that faced Toyota about five or six years ago. If you might remember, they had this episode where a police officer in California rented a car and ended up with uncontrolled acceleration. He and the family were killed. There was outrage over this and they were alleging that it was Toyota’s faulty accelerator problems.

The CEO of Toyota came before Congress and apologized. But, what did he say, though, with that apology. He apologized even though, later on, NASA would do the investigation and find out there was nothing wrong with the accelerator problem. The problem was the police officer rented the car and somebody had put the wrong size floor-mat in the car. That was the problem.

But, what he said was, “We have grown too fast. We’ve got a big company disease. We have not invested in our people enough.” When he did that root cause analysis, people have now said, “We need to redouble our efforts on developing and training our people.” He didn’t say, “Oh, we’ve got to do more kanbans, or more this or that.”

It wasn’t a reinvestment in the tools or the processes. “We’re going to reinvest in our people.” I thought about it and said, “You know, if I had been able to understand that when I heard that on the news five, six years ago, I would have done things differently.

“But, you know, hopefully, other people can learn from this and not have to go through quite the same experiences that we did. It will make us better and it’ll make us stronger for having learned these lessons.”

Mark: Right. Well, that’s why the phrase I’ve been using, that we’re always practicing. Lean, culture change, whatever phrase is used. It’s never been implemented any more than somebody could say, “Oh, I’ve implemented golf.”

Well, no, somebody’s got to keep practicing and get better, and then, you might get worse. Look at pro golfers that have had to totally change their swings at different points in their career. Not because they’re terrible, but they thought that’s what they needed to get even better. I make that analogy as a non-golfer. [laughs] I don’t know if you plan on spending more time playing golf now.

Dean: I play golf and I’ve never taken a golf lesson, which is probably a problem. I have probably about a 16 handicap, but I expect I’ll play a little bit more golf in retirement. Although that’s not the only thing I’m going to do, but I’ll do a little bit more of that.

Mark: If you don’t mind me asking, what else do you do? What’s in store for you in retirement from ThedaCare?

Dean: What I’m telling people is, “I’m not sure what I’m going to be when I grow up yet.” What I’m going to do is, I’ve had a series of meetings with my successor, Dr. Andrabi, to introduce him to people, a bunch of meet-and-greets. We’ve got those pretty much completed. I’m going to take the next month or two off.

I’ve got a list of about 10, 12, 15 things on my list. What I’m going to do, then, is get to probably October, and I’ll start thinking about which of those things I want to do. Maybe more people will call me up with ideas. I’m open to ideas.

I’m just not going to make any commitments, probably until October, until I have time to get away from it all, reflect on what would bring me joy, where I could contribute. Some of that might be with ThedaCare. Some of it might be with Lean. Some of it might be with community work in our community. I’ll have to figure that out.

I fully expect that I’ll probably end up working 20 hours a week or something, doing stuff. I just won’t have the 60-hour work weeks, and I won’t have the responsibility of running a health system.

Mark: Yeah, and like you said, you can pick and choose things that bring you joy and satisfaction in whatever ways. Right?

Dean: Yep, that’s right.

Mark: You had talked about being optimistic about the future and Dr. Andrabi being hired. I don’t know the whole history going too far back, but I know John Toussaint was an internal promotion and selection. Same was true for you. John had written a lot about succession planning, and trying to groom people.

Dr. Andrabi was hired from the outside, so I was wondering what your comments were of the balance of…Sometimes organizations want fresh perspectives from the outside. I’m curious what your comments would be on that succession process and your experience there.

Dean: I had a very formal process with our executive committee who does succession planning for ThedaCare. Every year I would give them about 15 pages of material. About eight pages was my standard work walk-through of what we were doing, and the people we were grooming.

A couple years before I announced my retirement was getting closer, we actually went through a process where seven internal candidates went through a one-day independent industrial psychologist evaluation. Which, with that, they developed a development plan with an external coach, industrial psychologist, and they worked that for a year.

I think that really developed a lot of people. I helped develop the process that was used but, once the process kicked off, I was not on the search committee. That was a little strange, but we had some fabulous people on the search committee including a previous board chair who had been on the board for 10 years, knew us well.

In their judgement, after going through all this, they thought that, although we had some very strong internal candidates, that Dr. Andrabi was the best candidate. I was not one of the insiders in that process. I certainly can see why they chose him. He comes from the Toledo market, which is probably three times our size.

He’s got fabulous experience. He’s a family physician like me, so what could possibly go wrong, of course. He has run residency programs, created a statewide ACO with over 3,000 physicians in it. In the Toledo market, there are — I forgot how many — seven or nine hospitals. There’s eight or nine helicopters. It’s much more complex than our marketplace.

You might say, “Well, why is he interested in coming and joining ThedaCare?” because he’s the CEO of this region of Mercy Health, which is more complicated than what we have here.” Frankly, as he tells the story, he had been following ThedaCare for 8 or 10 years, and it was one of a handful of organizations he would consider leaving to join.

Being here, he’s the system CEO at the system board. Before, he was the regional CEO with the regional board. In that respect, it is a bigger responsibility, but in a smaller market. He’s a very personal guy, very smart guy, with great experience. He is very familiar with Lean. In Ohio, I’ve learned, they call it Lean Six Sigma. He’s got a son who’s a black belt, his oldest son.

He’s seen Lean, when done well, accelerate organizations, or else even slow organizations down. I think he comes in as a huge supporter of improvement and working with people. I think he will do well. Right now, he’s been on the job for, whatever it is, a month-and-a-half. He’s just drinking from a fire hose right now, and trying to figure out where we go from here.

Mark: I’m sure, and certainly wish him the best, and everybody at ThedaCare. I’ve met a lot of really fantastic people at ThedaCare, my different visits and involvement in that way. Those ThedaCare people have traveled and shared their story. I’ve always appreciated that willingness to share with others and — I think here’s another and — and to be very humble at the same time.

I’m thinking back to one of the ThedaCare facilitators being at a conference and saying, with a lot of humility, “Well, you know, there’s some things that we’ve done well, but you shouldn’t just copy what we did. Learn from it and go make it better.”

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Read this Book – But Don’t Copy ThedaCare

That’s one thing I’ve appreciated, and I’m sure a lot of that comes from your leadership and other senior leaders there at ThedaCare, so thank you. Thank you for that.

Dean: Well, I don’t know if I deserve the credit for it, but I’ll take it, because that’s exactly what I’d hope would happen for people in our organization.

Mark: This has been a real pleasure. I appreciate you sharing your thoughts and reflections, and really honest, heart-felt reflections. I can’t thank you enough for doing that and continuing the sharing, and the continued practice, and the continued learning.

I’ll give you an opportunity if there’s any other final thought or reflection that you want to share with the listeners. Any advice you would want to give them, regardless of where they’re sitting, here?

Dean: Yeah, the advice that I’d give to them is something I learned from the chair of the department in psychiatry at Mayo Clinic about 25 years ago. His philosophy, he told me, about his work, was, “Life is difficult, and people are complicated, so be kind to yourself.” What I mean by that is, sometimes I think people look for a magic bullet and say, “Oh, Lean. That’s gonna solve my problems.”

Then they get disillusioned because they find it can help them, but it isn’t perfect. That’s just the way it is. Be kind to yourself is — don’t blame yourself too much when things don’t go perfect. You just got to study and adjust or, as li would say, he always says, one of the phrases is, “We will partially succeed.” I believe that’s true. We will partially succeed.

I see more problems across the country when people are too hard on themselves when things don’t go perfect, and so I’m saying, “You know? That’s the way life is. Life is difficult. People are complicated, so let’s study it, and make it better, and keep taking that approach, because it’s not going to be perfect in our lifetimes.”

Mark: That is a great thought to end on, so thank you for sharing that. It gives me — as always from your comments here — a lot to think about. Dean, thank you very much for joining us on the podcast. Again, congratulations to you in your retirement and figuring out your next adventures.

Dean: OK. Thanks so much, Mark. Have a great rest of the day.

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Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an book titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

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