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

throwback thursday lean blog

For today's “Throwback Thursday,” I recently re-watched parts of a DVD I helped produce a few years back for the ThedaCare Center for Healthcare Value — Thinking Lean at ThedaCare DVD: Strategy Deployment, Alignment & Leadership.

In the video, ThedaCare's CEO, Dr. Dean Gruner, is talking about their “True North” objectives. First and foremost in that list is safety. We can include patient safety and provider/employee safety in that discussion.

In Lean and the Toyota Production System, safety ALWAYS comes first. When people talk about “Lean Safety,” that seems pretty redundant to me. But, I'd rather hear talk of Lean and Safety than have people ignore safety and only focus on efficiency or cost.

2018 Update: What's Going on at ThedaCare?

Dean says this about safety, in particular:

“If we can't do things safety, why should we be doing them in the first place?”

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As you enter a Toyota plant (in San Antonio or Japan), you walk through a green “safety arch.” It's symbolic, but it's a powerful message. It says “safe work is the door to all work… let us always pass through this door first” – like this image shows:


Update June 2016: Here's an image from a video shot by Paul Akers that shows a Toyota safety arch in Japan:

Screen Shot 2016-06-09 at 1.11.36 PM

It's the ultimate “respect for people” for leaders to recognize a human principle that we don't want people getting hurt or killed. Nobody should get hurt at work. Patients shouldn't get harmed in the hospital. Staff shouldn't be exhausted at the end of the day. This all goes hand in hand… take care of the staff so they can take care of the patients.

Recently, I attended a patient safety conference, where the consistent theme was LEADERSHIP. Leaders need to take a strong, principled stand that safety is the first goal. Safety is the culture. There can be no sacrifices made in the name of throughput or production numbers, in a hospital or a factory.

Are your organization's leaders speaking out every day about the need for safety? Are they taking action to change the culture instead of just lecturing people or throwing slogans around? Are they starting every meeting with a safety minute? Or, is safety something that senior leaders think they can somehow delegate and not be responsible for?

2018 Update: What's Going on at ThedaCare?

You can watch a preview of the DVD below (and check out a new one they've released on “Beyond Budgeting”):

What commitments are you and your leaders making to put safety as a foremost priority?

You can also “throwback” to my podcasts with Dean:

  • #119: (5/31/11) Dr. Dean Gruner, on Strategy Deployment at ThedaCare
  • #144: (4/16/12) Dean Gruner, MD on ThedaCare, Lean, and ACOs

What do you think? Please scroll down (or click) to post a comment. Or please share the post with your thoughts on LinkedIn – and follow me or connect with me there.

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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. Safety is so important. As a registered nurse starting out, I was frightened by the realities not taught in school; The unsafe patient ratios, the short changes and 16 hour shifts, no time for breaks or to eat, equipment that didn’t work…And not only that but there was a big lack of communication and respect between management and front line staff. Costs came before safety. Staff were burnt out, miserable, and didn’t work as well as a team because of that. Dollars are trumping safety everyday, and patients, families and staff are struggling. I was a nurse for a year and a half, and now, I’m headed in another direction.

    • Melissa Jirovec, thanks for your brave comment. There’s too much lip service given to quality and patient safety in healthcare sadly… this is true in the U.S. and in Canada (it looks like you work there). It’s sad that both of our systems can too often make cost-cutting too much of a priority (an approach that ironically doesn’t really reduce real costs) instead of quality and safety. If we take better care of nurses and staff, they can provide better quality and safety for patients, and costs will truly go down. I’m so sorry that you’re frustrated with healthcare, but I don’t blame you. Hospitals and their leaders need to better support nurses and everybody involved.

  2. So true Melissa, thank you for sharing. So many talented and dedicated Nurses like you are leaving the profession for the reasons you state among others. Sorry to see you and the talent departing. There are not many leaders like Dr. Gruner that I’ve worked with in my healthcare career. I’m doing my best to influence the industry to shift it’s focus that’s aligned with profit and safety (staff and patients), as is Mark. The two issues are essential to an improved US Healthcare delivery system. The CMS fines recently levied are the leading indicators that tell us that the healthcare industry will have a very difficult time dealing with. Some will fail miserably and close their doors.

  3. As the spouse of a long time nurse, hearing the day to day stories which happen behind the scenes is simply disturbing. The focus is on the all mighty dollar, while patient safety, quality of healthcare and employee wellness is compromised. Recently, a new leader was introduced to my spouse’s hospital. Nurse to patient ratios were increased, clinical staff is being forced to work extended hours from what they signed up for with the constant threat of termination if not willing to comply, and the ER was told to selectively choose which types of cases they will accept through the doors.

    Morale is at an all time low as are patient sat scores and safety. To the point that several of my spouse’s colleagues are looking elsewhere for employment and Myself personally will think twice about having any procedures performed at this facility.

    Over the past 3-5 years, the focus has been on building multiple new facilities, costing hundreds of millions of dollars, to create that “patient friendly hotel setting” in order to attract business. That works in the short term, but long term quality of care and positive outcomes are what health systems need to be focused on. The real challenges nurses have to deal with on a daily basis, just add to the already critical patient environment. Hospital administration needs to realize that without quality providers, a safe delivery of care and proper outcomes, their multi-million dollar hotels will sit vacant.

    Wake up Folks and put the “Care” back in Healthcare! For employees and patients.

    • Nickey – I’m really sorry to hear about that. I think you’re absolutely right… the focus of healthcare leaders needs to change, otherwise the clinical staff can’t do their best work and everybody suffers…


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