Links for Buying my Book

Again, the main site for my book is www.leanhospitalsbook.com. I have some exciting new endorsements, including from John Touissant. I'm thrilled he would be so generous after reading a preview copy:

"Mark Graban's book has documented what is now happening in hospitals all across America as we learn to apply the Toyota Production System methodology to healthcare. This book lays out the nuts and bolts of the lean methodology and also describes the more difficult challenges, which have to do with managing change. Graban's book is full of wins -- these are the same type of wins that are happening at Thedacare every day. I wish I could have read this six years ago, as it might have prevented some of the mistakes we made in our lean transformation journey."

John S. Toussaint, MD, President/CEO
ThedaCare Center for Healthcare Value

The book is available through many retailers:

• Productivity Press (Price reduced to $40.50 recently)
• Amazon.com ($40.50 - 10% off list price)
• Barnes & Noble ($40.50)
• Buy.com ($42.50)
  

A number of you have asked about autographed copies, which is very nice of you. I can think of three options:

• Buy the book and ship it to me for signing (some "muda" there)
• I'll send you an autographed label that you can place inside your book
• I might do something where you can buy it through me and I'll ship it to you signed... with a small premium that I would donate to the Josie King Foundation or some other patient safety group.
  

Email me at mark (at) leanhospitalsbook (dot) com if you're interested in any of those options.

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Nice ThedaCare Article

JS Online: Tending to improvements in health care

Here's a nice overview article about the Lean efforts of the ThedaCare health system in Wisconsin.

Some highlights:

ThedaCare estimates that its work to improve efficiency in 2005 and 2006 cut costs by $22 million a year, without layoffs, while reducing medical errors.

That's a nice example of how cost and quality can be improved together, with Lean.

The health care system also has shown that lower costs don't mean lower quality. Last year, only one of 193 bypass patients who required only one graft died at a ThedaCare hospital, a mortality rate of 0.5%, compared with The Society of Thoracic Surgeons benchmark of 1.7%. ThedaCare's mortality rate for other bypass surgeries also beats national benchmarks.

Lean's not a "silver bullet" but it's an important method for hospitals:

Most health care economists agree there is no single solution to controlling the rise in health care costs. But eliminating the waste in the health care system is considered one of the best hopes.

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A Bigger Job for ThedaCare's Toussaint

Appleton Post-Crescent: Your Fox Cities News Source - ThedaCare CEO takes new job

ThedaCare is one of the recognized leaders in the use of Lean and the Toyota Production System in hospitals. He has resigned as CEO of the health system to take on a new job focused on improving healthcare throughout the country.

ThedaCare announced Thursday that Toussaint, who has served as president and CEO since April 2000, resigned that post and will lead the new ThedaCare Center for Creating Value in Healthcare, an organization dedicated to finding ways to reduce health care costs for providers, businesses and individuals. The program will be based in the Fox Cities.

"We need leadership to focus on this issue," Toussaint said in an interview with The Post-Crescent. "I've done what I can in statewide and national activities, but really it's hard to do both jobs effectively."

Dr. Toussaint is one of our best advocates for driving Lean improvements in quality and cost throughout healthcare. Let's all wish him the best in his new mission and organization.

Some highlights of their improvements:

ThedaCare has drawn medical professionals from around the world in recent years, mostly to observe how the system has been able to cut costs and improve care delivery without reducing staffing levels. Cutting $23 million from its operating costs was a five-year process, Toussaint said.

Toussaint said ThedaCare has come a long way since its lean efforts began nearly five years ago.

"Our quality of care is what I'm most proud of," he said.

...

"We've taken waste out, so patients are not waiting for things," he said. "One of the real benefits we've seen is that we've had zero medication errors because of the collaborative care model. It just goes to show when you reduce waste, quality improves and costs go down."

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Iowa Healthcare Leadership and Lean

Leadership Symposium (Iowa)

It sure seems like Iowa gets mentioned here on the blog quite a bit, for lean manufacturing and lean healthcare.

John Touissant, of ThedaCare (in Wisconsin), is speaking at an Iowa healthcare symposium April 22 (unfortunately, it appears to not be open to the public).

I saw Dr. Touissant speak in the UK last year, he's a very good speaker about lean and healthcare improvement.

John Toussaint, MD, is the Chief Executive Officer of ThedaCare Inc., which is composed of four hospitals, 21 clinics, home care, hospice, senior services, and behavioral health. He has been responsible for introducing the ThedaCare Improvement System, a model of continuous improvement, that is transforming ThedaCare to the same level of quality performance achieved only by manufacturing companies.

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Hospitals Learning from Hospitals

Oshkosh Northwestern - Systems turn to ThedaCare

There's a great sense of community and sharing in the hospital space -- something the manufacturing world can learn from, I think. Sure, it's possible to spend your whole career working in a single hospital and never seeing other ways of doing things, but hospitals have a few built-in mechanisms to help with sharing and spreading of ideas:

• A history of peer inspections (through certification organizations)
• Labor mobility (people jumping from institution to institution)

Can hospitals do more to share best practices and good ideas? Of course. There's such an opportunity for the manufacturing world to do the same thing, especially in non-competing cases. Does your town have an organization of local manufacturers who help each other out? Or, are you hung up on the idea that only people inside your sub-industry and market can help you? You'd be surprised how much a shoe manufacturer might be able to help a company that makes tubing. Having fresh eyes and new perspectives can help. Maybe you can try an exchange with a neighbor in your industrial park? Walk each others' processes and see what questions come up. I've written before about a local Lean group I was a part of when I lived in Phoenix.

Maybe another inherent advantage hospitals have is that hospitals are basically like other hospitals (except for specialty hospitals... but they're still hospitals). Does that encourage better sharing and collaboration? A hospital in Florida might be more willing to help a hospital in Washington, since they're not competitors, so that dynamic is different than in manufacturing.

Back to the article I linked to... it's about hospitals visiting ThedaCare, in Wisconsin, a hospital that gets a lot of attention for their impressive Lean efforts.

ThedaCare is no stranger to finding ways to reduce patients' time in a hospital while ensuring they receive optimum care.

For the past four years, the Appleton-based health system, has applied lean methods, similar to models followed by many manufacturers who are streamlining production to reduce costs.

Those principles also have worked for ThedaCare. Today through Friday, representatives from Appleton Medical Center and Theda Clark Medical Center in Neenah, will meet with about 150 health care leaders from nine different systems across the country.

Read the rest of the article...

Have you tried to increase collaboration in the manufacturing world? What have you tried? What would you like to try? Click "comments" to let us know. What can we do to help facilitate this? We've been able to use the blog a few times to put people in touch (with me playing middle man). Can we do more of this?

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AME and ThedaCare to Host Lean Workshop

From the Association for Manufacturing Excellence, of which I'm a proud member. I wish my schedule allowed me to attend this event:

LEAN IN HEALTHCARE ON DISPLAY AT AME WORKSHOP FEATURING THEDACARE

Neenah, Wisconsin, August 21, 2007 – Those interested in getting a closer look at how Lean manufacturing techniques are being used to help improve healthcare can learn from one of the nation’s leaders. A one day workshop sponsored by the Association for Manufacturing Excellence (AME) will feature ThedaCare and will take place on September 12 at the ThedaCare facility in Neenah , Wisconsin .

“ThedaCare is an integrated healthcare delivery system in North East Wisconsin that is currently in its 4th year of lean implementation and is one of the nation’s leaders in Lean adaptation for healthcare,” says Ralph Keller, President of AME. “The primary focus of the ThedaCare Improvement System (TIS) is 10% annualized quality improvement and cost reduction through the radical removal of waste from core delivery processes.”

Attendees at the workshop will gain an understanding of how TIS can improve quality, reduce costs and provide a better patient experience. They’ll learn the role of cultural development in assuring a sustained lean approach, the use of lean tools and approaches as applied to the healthcare environment , how through a gemba walk, ThedaCare is applying lean approaches to improve patient care, and how ThedaCare evolved, and is continuing to evolve, an effective change model throughout its community of professionals. There will also be a round table discussion where attendees can discuss future uses for Lean in a healthcare setting.

Cost for the workshop is $195 for AME members and $345 for non AME members (includes a one year AME membership). The event is recommended for those with middle to high level knowledge of Lean practices. For more information call (224) 232-5980 or visit www.ame.org and click on events.

About AME

The Association for Manufacturing Excellence is a not-for-profit association of over 5,000 members dedicated to the sharing of knowledge on leading-edge topics that help companies stay competitive in a global marketplace. AME cultivates understanding, helps members analyze and exchange ideas on productivity methods, and teaches how these methods can be successfully applied in the pursuit of excellence.

Since its founding in 1985, the Association for Manufacturing Excellence has expanded its focus beyond manufacturing to many functional areas of the enterprise and into many industries, all of which benefit from advanced management techniques. AME is practitioner-based, and its events and workshops focus on hands-on learning and knowledge exchange among peers. For more information visit www.ame.org or email info@ame.org.

-----------------------------------

I actually heard CEO John Toussant say that defects were being reduced 50% per year, not 10% per year. It really is impressive sounding progress they are making.

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Profile of ThedaCare's CEO

John Toussaint, M.D. - Profile

From the University of Iowa alumni site, here's a nice Q&A with one of the leading advocates for Lean in healthcare, Dr. John Toussaint, CEO of ThedaCare, which is mentioned often here on the Lean Blog. Let's consider this a mental "palate cleanser," since he has such a positive attitude about improvement, leadership, and teamwork. You won't hear a lot of excuses from Dr. Toussaint.

From the Q&A:

Please describe your professional interests?

Presently I am doing a lot of work on quality improvement. Our organization of 5,300 employees is on a journey of continuous improvement. We are learning from Toyota how to create defect free care for our patients using the ThedaCare Improvement System.

Do you have an insight or philosophy that guides you in your professional work?

My philosophy is to improve something everyday. Our industry is stuck on compliance, not improvement. We are changing that at ThedaCare.

If you could change one thing about the practice or business of medicine, what would it be?

Stop the shame and blame and start working together as a team to improve the care we deliver.

What do you see as "the future" of medicine?

It is bright, but it will be about improvement not apprenticeship. Go spend a day at Toyota and you will see the future of healthcare.

Great lessons that can be applied anywhere.

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ThedaCare Continues the Lean Journey

ThedaCare program gets boost

ThedaCare has already been seen as a leader in applying lean to hospitals, but its good to see they are continuing their efforts after three years. It's also nice to see a manufacturer (Miller Electric) partnering with a health system to improve (via lean coaching and financial support).

"It's really about improving reliability and reducing errors but also improving care our patients receive," said Kathryn Correia, senior vice president of ThedaCare, Appleton Medical Center and Theda Clark Medical Center in Neenah.

"We've all experienced or heard stories about hospital stays fraught with unnecessary delays in treatment or discharge, or a myriad of other issues that relate directly to a lack of collaboration and coordination among caregivers," Correia said. "Waiting for hours for a needed procedure — or even something as simple as being discharged — because no one anticipated or planned for your needs, is needlessly expensive, and leads to inefficient care and poor outcomes."

Beyond using lean "tools," the ThedaCare effort is looking at changing the teamwork dynamics of hospital care:

The future care model is based on every patient receiving care from a core team made up of physicians, nurses, pharmacists, therapists and other clinicians. The core team will work side-by-side during a patient's entire hospitalization. Each patient's care will be tracked to instantly provide information about the quality and efficiency of the care being delivered.

It will be interesting to see what "side by side" means. I heard a comment at a hospital recently, "Doctors used to talk with each other." Health providers often communicate only through written notes, which are full of opportunities for errors and miscommunications. Steven Spear has written a lot about the idea of improving handoffs and reducing communication errors in healthcare.

Lean is about more than implementing kanban systems and visual controls. It's about rethinking the value added care that is delivered and it sounds like ThedaCare might be doing that.

Lean Healthcare: Another ThedaCare Article

Appleton Post-Crescent - Finding a better way

Another article on a hospital organization that has been working on lean transformation. An earlier article is found here.

Lean Healthcare: Thedacare

According to this article, ThedaCare has been modeling the Toyota Production System to implement lean for the last 2 years. There is some explanation of what ThedaCare terms 'Rapid Improvement Events' where a cross functional team of people collaborate on finding ways to cut out waste (reducing wasted movement was the example given). The same team develops a process, puts it into action and monitors results.

What is most striking to me about this article however, is the extent to which ThedaCare seems to have embraced the higher level elements of a lean mind set. Granted this is only one article, but a couple of important points stand out that indicate they are doing much more than implementing a few basic lean tools:

The customer is clearly the focus - Dr. John Toussaint, ThedaCare's CEO is quoted, "…helped us save $12 million, but more importantly it has allowed us the ability to improve what we offer our customers." There are further comments in the article that refer to helping employees provide higher quality care.

ThedaCare is a learning organization – the whole point of the article was that ThedaCare invited a group of visitors to see how they have made lean work for them. (The US Army was listed as one of the organizations who sent representatives). They also have a Chief Learning Officer who is quoted in the article.

They have a greater sense of purpose (greater than making money) and a long-term philosophy. The last quote from Toussaint in the article clearly supports this. "We have a huge problem with health costs in this country. We need to do something."

It's encouraging to see an example that is so much more than a couple key process improvements mixed in with some 'buzz words' and statements of short term cost savings.