Back in 2009, I pointed an early iPhone at my TV and recorded a Fox News segment about ThedaCare's collaborative care model. The footage is grainy. You can see the glare on the screen and hear the room around me. I'd forgotten I still had it until recently.
I'm sharing it because of what it captured. This was ThedaCare near the height of its reputation as a model for Lean healthcare, and the segment puts collaborative care on camera in a way that's hard to find anywhere now. Transcript follows at the end of the post.
What the video showed
The reporter, Griff Jenkins, was traveling the country during the 2009 healthcare reform debate (this aired on Greta Van Susteren's “On the Record”), looking for systems that delivered better care at lower cost. He landed in Appleton, Wisconsin. The pitch was collaborative care, a redesign of inpatient hospital care that I'd been writing and talking about for a few years by then.
Here's the part that holds up. Within 90 minutes of a patient's admission, a team would gather at the bedside: the physician, the nurse, the pharmacist, and often the patient's family. They'd examine the patient together, build a single care plan, and put it where the patient could see it, including the expected discharge date. The patient and family didn't have to reconcile three separate plans from three professionals. There was one plan, and it was visible to them.
The video also catches a detail I love. Before collaborative care, nurses were spending up to three hours a shift hunting for supplies. The fix wasn't a poster about teamwork. It was a “nurse server” stocked inside each patient room, so the supplies were where the work happened. A kanban system. A systems answer to a systems problem. See that about 2:25 into the video.
Then there are the bigger claims. Dr. John Toussaint, ThedaCare's former CEO, who by then was leading the nonprofit that became Catalysis, cites a 25% reduction in the total direct cost of inpatient care. Griff floats a bigger number: if every hospital in the country ran like ThedaCare, you might save $400 billion in Medicare inpatient costs over ten years. Toussaint doesn't flinch. “That's correct,” he says.
I'd treat the $400 billion as a 2009 talking point, not a forecast. But the results in the original pilot unit were real and documented elsewhere, including in my own books: patient “very satisfied” scores climbing from the high 60s into the 90s, and costs dropping by roughly a third before the model spread.
ThedaCare wasn't borrowing a few tools from manufacturing. They were running a management system, measuring performance close to real time, and making the work visible so problems could surface. The collaborative care model people flew in to see was the output. The management system was the engine.
What came later
If you've followed ThedaCare's story, the footage is bittersweet.
In 2018, I wrote about a very different kind of news. ThedaCare had eliminated its centralized continuous improvement function and let go of its remaining Lean facilitators. The official statement didn't use the word “Lean” once. The retired CEO, Dr. Dean Gruner, had already described, candidly, how the organization drifted toward hierarchy and an over-reliance on specialists, the opposite of what Lean is supposed to produce.
I want to be careful here, because two things tend to get blended together. The 2018 changes were about the improvement infrastructure: the central team, the facilitators, the management system documented in books like Beyond Heroes. That isn't the same as switching off collaborative care as a way of delivering care at the bedside. I don't actually know what happened to that.
Is collaborative care still a thing?
So I went looking. The page that described collaborative care, hosted by Catalysis, is a 404 now. The model that two decades of site visitors flew to Appleton to study doesn't seem to have a home on the web anymore.
That absence isn't proof of anything. Pages get reorganized. Programs get renamed. But it's a strange thing to watch a 2009 video describe a care model in the present tense, full of specifics, and then come up empty looking for a current description of it.
Maybe collaborative care lives on under a different name. Maybe pieces of it survived even after the central improvement group went away. Maybe it's so routine now that nobody bothers to write it down. Or maybe it faded along with the system that built it. I shot that footage off my TV in 2009 because I thought I was recording the future of healthcare. I can still find the recording. I can't find the model. What does that tell us about how any of this survives the people who believed in it?
ThedaCare on Fox News (2009): Transcript
Introducing the ThedaCare Segment
Greta Van Susteren: …doing what your senators and members of Congress should be doing right now. We're checking out different healthcare systems to see what works. Our own Griff Jenkins and our “On the Record” producer, Kerry O'Connor, went to a hospital and a clinic in Appleton, Wisconsin, to investigate ThedaCare.
Griff Jenkins: With the raging debate over healthcare at town halls all across America, have we lost sight of one of the most important goals — delivering better care while cutting costs? We found a system here in Appleton, Wisconsin, that does just that. It's called ThedaCare. Dr. Toussaint, one of your biggest innovations at ThedaCare is collaborative care. What is that, and can we see it?
Dr. John Toussaint: Sure. Come on in.
What Is Collaborative Care?
Dr. John Toussaint: The nurse doesn't have a separate plan of care from the doctor or the pharmacist. They all work together, in collaboration, to deliver the best care for the lowest price.
Griff Jenkins: How does the collaborative care team work?
Dr. John Toussaint: Within the first 90 minutes of a patient's admission, the pharmacist, the physician, and the nurse all come in — I see them coming in now from all ends of the room — along with the patient, and in many cases the patient's family. The team does the exam, asks the questions, and develops a care plan together.
Griff Jenkins: What do you each do?
Pharmacist (Dana): I'm the pharmacist.
Nurse: I'm the nurse. I use the care plan as a map to guide the patient from admission to discharge.
Physician: I'm the physician. I direct the team, introduce myself, and make sure the patient is comfortable and that their immediate needs for pain medicine or nausea are taken care of. We examine the patient together and go over any abnormal findings. That goes into their patient education folder or up on the board, so they can see who's taking care of them, what the major issues are, what tests we have planned, and, most of all, when they can get out of here.
Griff Jenkins: As a patient, do you feel more secure getting better care with a whole team working at once?
Patient: Oh, yeah. It's a lot more organized. It cuts down my hospital time by quite a bit.
Supplies at the Point of Care
Nurse: Before collaborative care, nurses were spending up to three hours a shift looking for supplies. So we came up with the idea to put a nurse server right in each patient room, with all the supplies you need right here. No longer am I running down the hall to get an IV bag. They're right here.
Paying for Population Health
Dr. John Toussaint: We have a set number of patients we care for in Appleton. If you improve their total health — their diabetes is better managed, they have fewer complications, we do fewer heart surgeries — then we get paid more. Think about how that might change the way we deliver care in the United States. We need to move to a population health type of payment system, whether it's a public plan or a private plan. Right now there's nothing in the bills that has anything to do with that.
The Cost Results
Griff Jenkins: I'd put money on this: there are about five or six thousand hospitals in the country. If all of them modeled their programs after ThedaCare, you could save 400 billion dollars in Medicare inpatient costs alone over ten years.
Dr. John Toussaint: That's correct. What we've found is that as we've redesigned inpatient care using these tools, we've seen a 25 percent reduction in the total direct cost of inpatient care.
Griff Jenkins: How does ThedaCare deliver care? What makes it so efficient?
Dr. John Toussaint: We're constantly asking the question: does every step we do in a process deliver better value to the patient? We actually map every single step in a care process.
A Congressman on the Healthcare Debate
Griff Jenkins: Congressman, you're an allergy specialist and a doctor, and you're in Washington now. What's wrong with the healthcare debate we're having today?
Rep. Steve Kagen: Everywhere I go across Northeast Wisconsin, people tell me the same thing: “Hey, Dr. Kagen, let's fix what's broken and improve on everything else we've already got, at a lower price.”
Visual Tracking and the Toyota Connection
Griff Jenkins: We're here at one of ThedaCare's 23 primary care facilities. The waiting time is cut down, the process is efficient, and the patients are getting better care.
Dr. John Toussaint: These visual tracking centers are everywhere at ThedaCare — in every clinic and every department of the hospital. They track exactly what you'd see on a Toyota production floor: quality, people, service delivery, and productivity. We're measuring performance almost minute by minute in this clinic — how long it takes to get lab results, how we're doing on quality, how we're doing on the productivity of the workforce, both the physicians and the staff.
Why Isn't Washington Paying Attention?
Rep. Steve Kagen: The idea that an insurance company can no longer discriminate against you because of a preexisting condition — if you're a citizen, you ought to be in the risk pool in your neighborhood — well, that idea came from Northeast Wisconsin.
Griff Jenkins: While ThedaCare is unique to Wisconsin, programs in 14 other states have had similar success applying the same principles. Major institutions like Johns Hopkins University and UCLA have implemented programs just like it. The question now: why aren't the folks in Washington coming here to take a look, and why aren't we hearing more about it in the national debate? You can see more of our visit to Wisconsin on GretaWire.
