Part 3 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.
Lean is about three things: reducing cost, improving quality and getting staff engaged to improve their morale and interest in working for the company. And if you do it right, you get all three of those things.
When we started we were just experimenting with tools and we realized that they are very powerful and as we moved along we realized that this is a lot more… than just tools. It’s really about cultural change and that’s certainly where the organization is today. It’s changing the people.
The focus with lean is clearly on front line workers …. That’s the difference between a Six Sigma thing, which is really about statistical process control and management control, versus a lean method where we’re really focusing on respecting that every worker has a brain and that they can figure out problems, solve them and not pass defects on to the customer…. Philosophically that’s fundamentally different from other things, other fads that management’s gone through over the years. 
There really is a philosophy behind lean. It’s focused on respect for people and continuous improvement…. The key with a lean methodology is that the leadership style is radically different.
I believe there are many, many ways to implement lean effectively in organizations. I’ve seen all kinds of different ways of doing it. So there isn’t any one way to do it. But there are some key factors…, they’re almost like toll gates, that you have to go through in order to be successful.
- The first one is really defining purpose…. Frankly most healthcare organizations don’t have a [clear] purpose. We see patients; what does that mean? What are you actually trying to achieve? What are your goals?
- What are your “true north” metrics?… is the second thing once you’ve defined purpose. What are the true north metrics that are driving the organization? And does everyone in the organization actually know what they are? You should be able to go out on the floor and the nurse in the ICU should be able to tell you what the true north metrics in the organization are. And I know for a fact that in 99.9% of organizations in America you won’t find that.
- The other core component is transparency of performance and humbleness of your performance. The reality is that no matter who you are, no matter if you’re the Mayo Clinic, you’ve got lots of improvements to make because the industry is so fraught with defects and problems. So it’s incredibly important to have transparency and willingness to be open to reporting your defects, as well as your good performance.
- And then I think the methodology is critical…. Lean is clearly a well-documented methodology. Do you have a methodology that’s consistent that everyone understands the words and the process, or not?
In the end this is all about changing me…. The CEO has to change, the frontline worker has to change and everybody has to change. So the question is: What do you have to change to? You have to change from a top-down autocratic typical healthcare management process to a Toyota management process, which is completely different. [It’s] focused on mentoring, facilitating, teaching, learning how to solve problems and identifying defects and solving problems immediately, so they’re not passed along to the next customer.
[...] What Lean Means to Me [...]