A First-Person Lean Leadership Story from John Toussaint, MD


I've had the pleasure to work with Dr. John Toussaint, CEO of the ThedaCare Center for Healthcare Value, over the past year.  John's no “ivory tower” guy, he speaks from his practical and hard-fought experience as the CEO and Lean transformation leader at ThedaCare, the health system in Wisconsin.

John is also co-author of the new book, published by the Lean Enterprise Institute, On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry. Below, I'm showing the video that John recorded to tell a story that is in the book. Watch the video and share your reactions and comments.

I hope you can watch the video. If it's blocked at work, try to watch it home over the weekend, it's a good use of 3.5 minutes.

I'm hoping to get some good discussion here, so I'll just ask questions:

  1. What would you expect the “usual” reaction from a hospital CEO to be when told “we aren't recording medication errors”? Why is John's reaction and response of “thank you” noteworthy?
  2. Where would you strike the balance between holding people accountable for following the process (report errors) versus being understanding and probing to find out “why” they didn't?
  3. Why do you think the problems with using the computer system weren't being reported? How often do you think “bad news” or complaints don't make their way up the chain to the right leader who can help?
  4. Do you think John, as CEO, handled the situation properly, from his description? Is there anything additional he should have done? Anything he did that you wouldn't have done?

You can read more about On the Mend and download sample material at the LEI website. Conflict of interest statement: I work for LEI and played a small role in helping edit the book during the publishing process.

Updated: You can also hear a longer audio interview with John Toussaint (or read it) published by AME. His provocative starting point:

What does a lean leader look like? That's what I'll be focussing on, what it takes to be an effective lean leader. It means, pretty much, that you have to change everything that you've learned in business school, or medical school, or nursing school, and you have to pretty much retool yourself, because our existing education system is turning out autocratic control freaks who manage by the numbers, and they don't know anything about quality improvement, and they don't know how to manage a group of people to actually achieve 100% reliable results. If we don't change ourselves as leaders, we will never be able to transform our companies.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Hi Mark,
    Response to questions
    1. Typical responses would probably be negative. I think John’s response was powerful! He set up a safe environment that allowed for a honest dialogue and promotion of getting to the root cause. What a great example!
    2. I liked John’s approach. I would have to emphasize that we cannot fix what we don’t know about but I heard strong undercurrents of fear in this story. Making sure you have an environment that is safe and supportive is crucial.
    3. The computer problems, albeit frustrating, were probably the last thing to do or take care of in a long list of “to dos”. Sometimes the pace of the day makes you tune out those frustrations. I think the “bad news” does not always make it up the chain for protectionistic reasons. People fear the axe, the same reason things don’t get reported in the first place.
    4. I think he handled it well, especially starting with the “thank you” and setting up the opportunity for dialogue. I am curious about the “manager departure”. Leaves you wanting to know more. Can that inadvertantly reinforce the fear? Or is it for seperate and unrelated issues? What is the take away from the staff?

    Your thoughts?


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