Society for Health Systems Conference – Roger Gerard, ThedaCare


Roger Gerard, PhD

Saturday at the Society for Health Systems conference, included an excellent keynote address from Roger Gerard, from the ThedaCare health system, co-author with Dr. John Toussaint of the book On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry.

Some key points:

Roger made a great point that the idea of “creating a burning platform” is often an exercise in “how do we manipulate people?” He thinks intentionally  creating and using a crisis is “manipulative” and “creates disengagement.”

He thinks it's silly when leaders say ” we have to go to the Gemba to help,” when they should be going to learn and listen, instead.

Roger admitted that, early in the acclaimed ThedaCare journey, they made some mistakes. It was too much of a top-down initiative and the entire senior leadership team was not fully aligned. They started with Lean in decidedly non-clinical areas (such as freeing up cash in the revenue management cycle), but they erred by not properly engaging physicians and there was too much blaming back and forth.

Roger said “we failed miserably to ensure early staff/provider awareness, involvement and compensation. They had an ambiguous unwritten policy on no layoffs. With that and other problems, “we were going through the motions, but were not ready for the ride.”

Nobody's Lean journey is perfect. It's great that Roger can admit that.

Roger defines Lean in a nice, succinct way: “Figure out what the work is, take the waste out, further satisfy the patient needs.”

He had provocative thoughts on the idea of a leader “driving culture change.” He said, “it's highly disrespectful,” as if “somebody said to you, ‘I'm going to change your personality'” as an individual. He said it's “arrogant” to think you can drive culture change — that you have to respect and honor the existing culture. He added, “o We have to come into our orgs listening and learning, understanding the culture” and “o The culture will change, but you have to respect the community as a complex system.”

Roger also had brilliant thoughts on the common complaint about “resistance to change.” He said, “Resistance is a teacher – every time somebody resists something, you are about to learn something.”

Let that sink in… instead of complaining about the “resistance” (and blaming the people for being resistant), instead be ready to learn from it. Roger added, “How can you handle resistance? Welcome it.”

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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. Nice summary of some provocative thoughts. I especially like the last comment. At my previous employer, we used to stress to leaders to expect and embrace resistance, because after all, one of the laws of physics is that there cannot be forward motion without some friction.

    • Great point, Tim.

      I think it takes a confident leader to embrace that so-called “resistance.” It seems that the more insecure leaders are the ones who want to be controlling, etc. – if one can generalize and play armchair psychologist.

      How do organizations develop capable, confident leaders who can engage people this way? How much is the result of the selection process and how much is development?

      I know ThedaCare is doing A LOT around leadership development and their “Human Development Value Stream” that I didn’t blog about here.

      Read more on that via google.

  2. this comment helps to guide and understand change…

    “Resistance is a teacher – every time somebody resists something, you are about to learn something.”


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