Joining me today for Episode #312 of the podcast is Jeff Hunter, author of the excellent book Patient-Centered Strategy: A Learning System for Better Care.
Jeff was with ThedaCare in Wisconsin, where he was Senior Vice President, Strategy and Marketing for the health system. After retiring from ThedaCare, he has been a faculty member for Catalysis and has started his own consulting firm, Jeff Hunter Strategy. Read his full bio.
The discussion focuses on why strategy must be more than an annual event or static document. Jeff explains how traditional strategic planning often creates overburden and disconnects improvement efforts, and why a learning-based approach rooted in PDSA cycles is more effective. He shares insights on how senior leaders must change their own behaviors, modeling iterative learning and making strategic choices that provide clarity and focus.
Jeff also reflects on the role of differentiation in healthcare–how organizations must define what unique value they deliver, and what “winning with customers” looks like in their context. He describes the importance of testing assumptions, treating strategy as a hypothesis, and using rapid learning cycles to adapt. For executives, strategists, and Lean leaders alike, this episode offers practical lessons on aligning strategy with daily improvement and building a culture of organizational learning.
Streaming Player:
For a link to this episode, refer people to www.leanblog.org/312.
For earlier episodes of my podcast, visit the main Podcast page, which includes information on how to subscribe via RSS, through Android apps, or via Apple Podcasts. You can also subscribe and listen via Stitcher.
Transcript:
Announcer:
Welcome to the Lean Blog Podcast. Visit our website at www.leanblog.org. Now, here's your host, Mark Graban.
Mark Graban:
Hi, this is Mark Graban. Welcome to episode 312 of the podcast. It is July 31, 2018. Joining me today is Jeff Hunter, author of the excellent and relatively recently released book, Patient-Centered Strategy: A Learning System for Better Care. Jeff was with ThedaCare Health System in Wisconsin for 24 years, where he was, at the end, the Senior Vice President of Strategy and Marketing. After retiring from ThedaCare, he's been a faculty member for Catalysis and he has started his own consulting firm, Jeff Hunter Strategy. You can find links to all of that, a link to his book, and other things that we mention in the episode by going to leanblog.org/312.
In today's podcast, we discuss a number of topics, including how a good strategy is a necessary input for a strategy deployment management process, some of the problems with traditional approaches to strategic planning, and why an iterative Plan-Do-Study-Adjust approach works better than static plans. Thanks for listening.
Hi Jeff, thank you for joining us here on the podcast today. How are you?
Jeff Hunter:
Great, Mark, thanks for the invitation. Looking forward to this.
Mark Graban:
Yeah, well, I'm looking forward to you talking about your book, Patient-Centered Strategy. Before we get into the book, could you start off by introducing yourself and a little bit about your career path?
Jeff Hunter's Journey in Healthcare Strategy
Jeff Hunter:
Sure. I've always been in the field of health administration on senior leadership teams. I've always had a responsibility for strategy, among some other things. A long time ago in my career, I actually spent a couple of stints as a rural hospital administrator. But then as I began working more in systems, I got more focused on the strategy role. I spent the last 24 years of that with ThedaCare in Appleton, Wisconsin, as a senior leader. And that's where I got my introduction to Lean thinking.
Since then, I retired from ThedaCare three years ago, and I've continued my own path, trying to learn more by interacting with Catalysis and their clients, and with other industries. What I've been doing is facilitation of strategic thinking. And that's really where this system has been built: how we can turn strategy from an event that we do every once in a while to a capability that leadership teams have.
Mark Graban:
And by that system, you mean, as you refer to in the book, a “strategic management system,” building that through your work with other organizations, is that correct?
Jeff Hunter:
Yeah. In fact, the full title of the book is Patient-Centered Strategy: A Learning System for Better Care. So we see it as a subsystem for strategic management; it's a subsystem of an organization's entire Lean management system.
Mark Graban:
And that's definitely one of the themes we'll talk about today: moving from strategy as an event that happens, creating a report every three or five years, to becoming more of an ongoing learning system. Listeners undoubtedly know about what you might call PDCA or PDSA cycles, and I think your book does a great job of articulating how that applies to strategy. Can you maybe introduce the book a little bit before we delve into those topics? How do you summarize the book, what's the intended audience, and maybe even talk a little bit about how the book came to be?
Jeff Hunter:
Well, the book came to be really at the request of John Toussaint and the team at Catalysis. We were all experiencing the same thing as we were trying to introduce Lean to healthcare organizations. We continued to see adoption of the daily improvement system, but it was being hindered by overburden that was occurring from the lack of strategic choice-making. We had used some of these techniques actually at ThedaCare, and John had seen them and thought they were pretty effective. We used them at Catalysis to make strategic choices, decide what's important now, defer other things for later, and figure out how to deploy them through rapid learning cycles. He thought that that was very effective and really wanted the content built out around that.
So again, over the last three years, that's really been the mission: to flesh this out not just as a series of interesting tools, but as a system that does require the behaviors of senior leaders to foster that kind of innovation and improvement mentality in their culture.
The C-Suite as the Intended Audience
Mark Graban:
And so Jeff, who would you say the intended audience is? Would you hope every hospital C-suite executive picks up the book and learns from it?
Jeff Hunter:
Yeah, it really is intended for the C-suite because I learned the hard way that I had to change my behaviors if I was going to model the way for my teams to be able to create greater value for their customers. It took a lot of change on my part. I try to tell that story in the book as an introduction. And then we get into the system that we've learned that does require these senior leaders to model Plan-Do-Study-Adjust thinking. Because if the senior leaders can apply PDSA thinking to the strategy process, it builds the muscle that's required in the organization for PDSA to be applied at every level.
So it's applicable for the C-suite. It's also applicable for the central improvement office people who are trying to coach up to the C-suite to help engage them in this transformation to a high-performing organization.
Mark Graban:
And when you talk about, “You had to change your behaviors,” that's something that John Toussaint has talked about from his time as a CEO when you were working for him. I imagine it helped to have John as CEO setting that tone.
Jeff Hunter:
It was critical for me. I thought I was all-in and supportive of Lean for the first three years of ThedaCare's adoption of it, but all I was doing was cheerleading. I didn't think it had anything to do with me or what I did. And as I saw John change his style–John jokes about this a lot, that he was the epitome of a command-and-control type leader when he first became CEO–and when I saw how this was changing him and the discussions I was having with him and his challenge to me, he gave me an assignment to help him figure out how the senior leadership team can apply Lean so that the senior leadership team is actually creating more value. And that's what got me on the journey.
That called upon me to question all of the fundamental thinking that I had been taught for all those years in the old management school. I had to question everything. I had to get out of my office. It changed everything from how I related to direct reports, where I related to direct reports, what the nature of my activities were. But again, that took a long time. That wasn't an overnight thing.
Strategy, Unique Value, and Winning
Mark Graban:
As we delve in, I think it's interesting to frame strategy as iterative learning, developing people, and not thinking of it as a document or a plan. Before we talk about strategy deployment, what is strategy? How do we know if we have a strategy that's worth deploying?
Jeff Hunter:
Yeah, I was always taught that strategy is about creating unique value. So whether you're in American healthcare or Canadian healthcare or any other industry, strategy is about what we do differently from others, what makes us so unique in the eyes of our customers and in the value that we create for them. We've got to carve out some time, in addition to our basic operational effectiveness, to spend some time figuring out what we are going to do differently that is going to create a unique value for customers. And that's what strategy is to me.
Mark Graban:
And so how does that idea of unique value or differentiation apply in healthcare, where the old mindset has been that every hospital should pretty much do everything?
Jeff Hunter:
It has been a challenge. Historically, we have become an industry where the incumbents, the large hospital organizations, have seen themselves as all things to all people in a 45-mile radius. And so it has been a challenge to get healthcare organizations to ask themselves what they do for unique segments. They didn't have to for a long time because every year our revenue would go up, there was more demand for our services, and we were able to raise our prices. But that gravy train stopped years ago. Demand for inpatient hospital services across the country is declining, outpatient services is flattening. And so it's at this point that the incumbents have got to start thinking about what is it that we actually do that creates unique value.
Mark Graban:
One thing you touched on in the book builds on the work of A.G. Lafley and Roger Martin on strategy and the idea of “winning.” What does it mean for an organization to define what it means to win?
Jeff Hunter:
Yeah, I have learned so much from Lafley and Martin. And Matthew May is the one who really got me thinking about this term “winning.” What it did for me is it simplified the terminology. I think of winning as a description of the ideal state in Plan-Do-Study-Adjust thinking. “What would winning look like?” sounds like a vision statement to me. And “how would I know if I'm winning?” sounds like true north metrics to me. So when I put that all together, that becomes the ideal aspiration that really guides me. This system is not about short-term thinking. You're always looking at your current state, then you look at your vision, that winning aspiration, and you're guided by that. Then you use the systems thinking principles of idealized design where you experiment your way toward that vision.
Mark Graban:
And in healthcare, does it make people feel uncomfortable? Let's say if I've got a competing health system in town, does my winning mean that that other organization then loses?
Jeff Hunter:
You know, I like to think about it as “winning with customers.” So what does winning with customers look like? And that ideal state could be an ideal state of a healthy organization, and it could also be an ideal state of a healthy community. I thought I might have challenges when I would be using this terminology with health systems in Canada or South Africa, and they didn't find any problem with this terminology at all. It brought the idea of vision and true north to life. While I will occasionally get some pushback on the term “winning,” because people don't see themselves in a competing situation, in all of these countries, they know they are competing for resources and attention.
PDSA, Hypothesis Testing, and Learning Loops
Mark Graban:
When you talk about the choices that organizations have to make, this is something John Toussaint and Dean Gruner both talked a lot about. Can you talk a little bit more about how organizations might rethink that process of deciding what to work on?
Jeff Hunter:
Yeah. There is some basic thinking that we have to overcome. One is that strategic planning is this event that we do every once in a while where we have to pack in all the things we might have to do in three to five years, as opposed to the new thinking, which is, “Let's understand our current situation and the most pressing strategic issues that we have to solve for now and those that we can defer to later.” If we can increase the throughput through our strategic planning value stream, if we can learn faster and better, then we can actually process more of these strategic initiatives over time.
Strategic planning is the same problem-solving approach that clinicians use with patients every day. “Where are we today? What are the most pressing strategic issues? When we look at our current state compared to our vision, what do we need to solve for? What experiments might we run? How quickly can we learn? And then how do we spread that learning?” The more muscle we build, the better we get at that kind of thinking, the more strategic initiatives we can actually process if we will prioritize them.
Mark Graban:
So you talk about PDSA being this foundational skill in the strategic process. Is there a certain sequence that you've seen or recommend in terms of whether it should start with the executives or at the frontline?
Jeff Hunter:
As usual, the answer turns out to be situational. I believe that we can bring the C-suite's attention to it sooner when we see this as a common language. PDSA thinking is a common language that we share with the front lines in a healthcare organization. So it has the potential of getting us on the same page. PDSA thinking applies in daily improvement, it applies to big rocks, and it applies to solving the biggest strategic issues.
Mark Graban:
So you talk about, and I love the word “hypothesis,” you know, instead of knowing this is the right strategy, we have a hypothesis that this is the right strategy. And you talk also then about assumptions that go into a strategy or a hypothesis. Can you talk more about the importance of going and testing assumptions? And I love the question of “what must be true?”
Jeff Hunter:
You bet. This was one of the biggest lessons that I had to learn. My role was not to think up great ideas, throw those ideas over the wall, and if those ideas didn't work, it must have been somebody else's fault. This is what I learned from Roger Martin and Matthew May. When I initiate an action, when I begin a strategy, I am changing the world. I can't fully anticipate how customers are going to react or what competitors are going to do. There is no such thing as perfect information.
So when I say, “I think we should do this to close a certain gap,” I have to ask myself, “What must be true for that scenario to play out the way that I want it to?” That's where you get into the most critical, unknown assumptions. Your hypothesis is very dependent on that assumption working, and you really don't know the answer. So that's where you begin your experimentation, using Lean learning loops or design thinking.
You've heard me use an example of how that finally got through my head when I was a rural hospital administrator. I get a phone call from one of our rural CEOs. He says, “I have this idea that the reason people aren't coming from a town south of me up to my hospital is they have a transportation issue. So what would you think if I bought a van and hired a driver and started a transportation service?”
Well, I know what old Jeff would have done, which is, “Let's do the market research that's going to take us three months, and that's a $100,000 idea, so we got to run it through the whole ThedaCare decision process.” Instead, all I had to say on that same phone call was, “I don't know, that could be a good idea. What must be true for it to work? What is the most critical assumption that you're making where you don't know the answer?” And he said, “Well, I don't really know if people are going to use it.”
So I just asked him, “Is there a fast, cheap way that you can test that assumption?” And he said, “Yeah, you know, actually there is a transportation service down here that I could rent on a per-use basis, do the marketing, and test that assumption.” And so he ran that test and found that it really wasn't solving the problem to the degree that he thought. So he just pivots and he's on to his next idea for almost no time and no money.
Lean as Strategy and Final Thoughts
Mark Graban:
Operational excellence or Lean often is taking place at the frontline, departmental, operational level. How do you view Lean? Can Lean be a strategy, or is it more part of an overall strategic management system?
Jeff Hunter:
Well, I believe that Lean thinking is absolutely foundational and critical, at least for me, in my approach to how we can create better value in the world. Now, can our strategy… if we're doing Lean, can that be our strategy? I guess if no one else is. We used to think that at ThedaCare. We felt that our differentiation was being created by the fact that we were applying Lean and the rest of the industry was saying, “No, Lean can't be applied to healthcare.” But once healthcare began to adopt this whole idea of performance excellence and started to narrow the gap, then we had to begin to ask ourselves, “Okay, where are we going to apply this decision-making?”
We have to ask ourselves, “What are we going to do differently? What new standards are we going to develop? What new, fresh initiatives are going to develop that are going to create unique value in the eyes of our stakeholders?” That's very relevant. That's strategy. That's strategy deployment. So I believe Lean thinking is necessary, but it's not sufficient because you have to ask yourself where you are going to apply your efforts in the areas that are going to create the most important value for your customers and your patients that is going to make you unique and indispensable in their eyes.
Mark Graban:
Yeah, to be more unique. Let's not do the wrong things righter through operational excellence. Sometimes we have to step back and ask those challenging questions of what we should be doing. And I think that's where your book is a really helpful addition to the literature for organizations that are trying to figure this out in healthcare. And I hope people outside of healthcare will read the book and that it will prompt them with some good ideas.
Again, our guest today has been Jeff Hunter, author of the newly released book, Patient-Centered Strategy: A Learning System for Better Care. Jeff, where can people buy the book? Where can they find you online if they want to learn more?
Jeff Hunter:
The book they can find at Amazon.com. They also could find it at catalysis at createvalue.org. My website is jeffhunterstrategy.com. So that's the easiest way to reach me.
Mark Graban:
There you are. Well, Jeff, thank you again so much for the opportunity to talk today. Thanks for talking about your book, and again, thank you for being a guest with us today.
Jeff Hunter:
I appreciate it, Mark. Thanks for having me.
- Podcast with Matt May
- Where / how can people buy the book?
Thanks for listening!
Please scroll down (or click) to post a comment. Connect with me on LinkedIn.
Let’s build a culture of continuous improvement and psychological safety—together. If you're a leader aiming for lasting change (not just more projects), I help organizations:
- Engage people at all levels in sustainable improvement
- Shift from fear of mistakes to learning from them
- Apply Lean thinking in practical, people-centered ways
Interested in coaching or a keynote talk? Let’s talk.
Join me for a Lean Healthcare Accelerator Trip to Japan! Learn More
