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Book Review: ThedaCare’s lessons for lean providers

October 12, 2010
On the Mend
Revolutionizing Healthcare to Save Lives and Transform the Industry
By John Toussaint, MD and Roger A. Gerard, PhD with Emily Adams
Lean Enterprise Institute, Inc.

…humans will try anything (and everything) easy that doesn’t work before they try anything hard that does work.  And that’s where we are in healthcare.  All the easy fixes have been tried and only the hard things are left.

Those were the words of James Womack, the eminently quotable founder and now former chairman of the Lean Enterprise Institute, upon the publication of On the Mend.  Healthcare organizations have been slow to adopt lean production but, with this new book by John Toussaint and Roger Gerard, the authors hope to make up for lost time.

Of course, the best time for healthcare organizations to begin their lean journey has been “now” for quite some time.  But perhaps this “now” will prove more propitious as we reflect upon the recently concluded healthcare debate and prepare for the new reality the Patient Protection and Affordable Care Act promises to inaugurate.

This book is not a how-to.  Nor is it a workbook.  And it’s not the result of a vast academic research program like The Machine that Changed the World.  However, it is a worthwhile read for anyone involved with healthcare delivery.  Part memoir, part manifesto, On the Mend leaves the reader with a realistic appreciation of the challenges and triumphs one can expect when embarking upon a lean transformation.

The more engaging examples revolve around ThedaCare’s efforts to apply lean principles to reduce the time between arrival and treatment for two life threatening conditions: heart attack and stroke.  A potential heart attack or stroke victim arriving at a typical American hospital would be astonished by the unnecessary steps that stand between them and lifesaving treatment.

In an automobile factory, time spent waiting unnecessarily is unfortunate.  In a hospital, time spent waiting can mean death.  Although ThedaCare was already an industry leader, they attacked wastes systematically, scientifically and thereby improved patient outcomes.

For those, like myself, who come from a lean manufacturing background, it takes some concentrated thought to translate lean principles to a healthcare environment.  Fortunately, Drs. Toussaint and Gerard provide some helpful translation, listing the eight wastes of lean healthcare, quoted below.

The Eight Wastes of Lean Healthcare

1. Defect: making errors, correcting errors, inspecting work already done for error.

2. Waiting: for test results to be delivered, for an appointment, for a bed, for release paperwork.

3. Motion: searching for supplies, fetching drugs from another room, looking for proper forms.

4. Transportation: taking patients through miles of corridors, from one test to the next unnecessarily, transferring patients to new rooms or units, carrying trays of tools between rooms.

5. Overproduction: excessive diagnostic testing, unnecessary treatment.

6. Overprocessing: a patient being asked the same question three times, unnecessary forms; nurses writing everything in a chart instead of noting exceptions.

7. Inventory (too much or too little): overstocked drugs expiring on the shelf, under-stocked surgical supplies delaying procedures while staff goes in search of needed items.

8. Talent: failing to listen to employee ideas for improvement, failure to train emergency technicians and doctors in new diagnostic techniques.

Some credit the recent and ongoing healthcare debate for directing focus on lean techniques for reducing healthcare cost and improving patient safety.  While the resulting legislation promises vastly improved access for the millions of Americans lacking health insurance coverage, it is yet to be seen whether the changes will align incentives in a way that pulls waste out of the system.  Once providers are more clearly rewarded for efficiency and effectiveness, the same way the marketplace rewards auto makers for productivity and product quality, the lean approach advocated by Drs. Toussaint and Gerard will be the obvious way to achieve breakthrough improvement.

RK2 Advisory LLC requires book reviewers to declare conflicts of interest.  Conflict of interest exists when the reviewer has ties that could inappropriately influence his or her judgment, whether or not judgment is in fact affected.  Examples include but are not limited to financial relationships through employment, consulting arrangements, stock ownership, and exchange of goods, services or favors, either directly or through immediate family.

Reviewer’s statement on conflict of interest: A copy of On the Mend was provided to Mr. Ostrow by the publisher free of charge.

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