John Toussaint, MD -- Lean in Healthcare: Getting Started

Part 2 of 6, Full Interview

John S. Toussaint is CEO emeritus of ThedaCare, and CEO of the ThedaCare Center for Healthcare Value. As a strong proponent of applying the lean methodology to rooting out waste across the healthcare industry, we asked John about his experience at ThedaCare, specifically how he measured the return on their lean initiatives.

Before I became the CEO at ThedaCare, I was the Chief Medical Officer for eight years and we did a lot of different experiments, science experiments I would say, in improvement, most of which were really, in the end, unsustainable and failures.… What I was looking for was a sustainable methodology from a standpoint of driving continuous improvement and we decided that that didn’t exist in healthcare back then.

[We] started to investigate manufacturing companies and trying to understand what they were doing differently in terms of quality and sustainability of change and we visited a number of different manufacturing companies…. We finally ended up 40 miles down the road at Ariens, snow blower and lawn mower company, which had been on the journey for about five years when we connected with them. We spent some significant amount of time on the shop floor there, talking to the executives and seeing the before and after of their transformation.

We really started to see a lot of correlations between delivering patient care and making snow blowers, believe it or not…. [We started to see that it wasn’t] a lot different than patients on carts, if we add caring and compassion…. What we really needed to do was redesign the whole process so that we had cellular units that are actually managing the quality and output of the care delivery process. And so we started our journey with our visit to the snow-blower company.

I was very unhappy with our performance, both from a quality and a financial perspective. It was inconsistent and unreliable. We could deliver spectacular results one day and horrible results the next. And it was clear that we didn’t know what we didn’t know about quality. There’s no question that over the years, as the quality performance has dramatically improved, the costs have come down significantly.

[Pursuing lean] was a top down decision. The senior team was for the most part in agreement with that. It wasn’t just my decision. It was really our decision. We’d all been to the snow blower factory and the other factories and… we weren’t sure this was the right thing to do, but we weren’t sure it wasn’t the right thing to do. And we all knew that we needed to do something different because it was driving us nuts, this unreliability.

There’s so much low hanging fruit when you first start that if you can’t save a few million dollars out of the chute you’re really not doing it right. We actually started in the finance area because I really wanted to engage our CFO, because I knew if he wasn’t engaged, then this would be a real uphill battle. Within the first six months [we] put $12 million of cash in the bank just by improving accounts receivable… So I made an immediate believer out of him.

Full Interview