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1- I am sure some so-called "Lean Expert" will say that the book is not a "technical" illustration of lean. I happen to believe that the greatness of On the Mend lies in the fact that it is not technical. Rather, it is a practical illustration of how an organization can realize gains from using few tools, and at the same time, utilize the best capital it already has: the experience and involvement of the organization's own people. 2- I think this is the first book on lean that fully addresses clinical areas with real examples i.e. STEMI, Stroke, primary clinic and laboratory. Most lean books talk about supply chain, sterilization areas and process related to production. 3- The introduction touched on Toyota's recent problems (page 3) and explained that this is a reminder of the consequences of failing to adhere to lean principles. I believe that the problems that Toyota faced, and the subsequent actions taken by the company, provide us with better examples as to why we need lean. When I am asked about this issue (which is almost every day), I reply by asking the person: "Do you remember what Toyota did first after the problems became public knowledge?" Most say that Toyota acknowledged the problem. I remind them that one of the first actions that Toyota took was to stop producing cars. Toyota asked its 137,000 employees to stop producing cars until a new process is designed and put in place to repair current defects and ensure that the new cars do not have the same defect. My argument proceeds to ask, "Are we in healthcare ready to close the OR, pharmacy or lab if we discover that errors (I have been using the term error instrad of defect because most healthcare workers will say we handle people not machines) have been committed?Read more ›
I couldn't wait for this book to come out as I was somewhat familiar with the ThedaCare story through articles and other media outlets. Rather than wait for the book to be shipped, I downloaded it using the Kindle for PC option. I devoured this book in a few hours, however I will be studying it for many more.
I was most impressed with the ThedaCare team's demonstration of two key principles of lean - Respect for People and Humility! This book should open the eyes of healthcare leaders and politicians alike in seeing the possibilities of lean (Continuous Improvement) in lowering costs in healthcare, while improving quality of care, patient satisfaction and employee engagement.
I appreciated the honesty in admitting past mistakes and the candor used in how those mistakes were corrected. For example, one of the many key points made in Chapter 5 - Continuous Improvement, while speaking of past attempts at improvement, "In the end, we saw the enemy of our improvement efforts and it was us...Improvements ended when the project was over because nobody was in charge of sustaining change and measuring results." "Looking back at the best of the failed improvement programs, there are two repeating themes: empowering staff-the doctors, nurses, and managers actually doing the work - and measuring results. Without a method, these necessary attributes are nearly impossible to hard-wire into the daily habits of staff. Continuous improvement is that method." This observation demonstrated to me that the leadership at ThedaCare had been through the hard work and had learned that there are no shortcuts to improving.
It is time for the rest of us in Healthcare to step up and be the change we all want to see and not wait for change to happen to us. Congratulations and thanks to John, Roger and the rest of the the Thedacare team for being the pioneers and sharing their experience with the rest of us.
While I am not a Lean Healthcare professional per say I am a Lean professional that has worked in various aspects of healthcare. My experience varies from the patient floor, to the ER and OR, to long term care, to psychiatric ward and a few things in between. Most of my family are healthcare professionals of some kind and I have been on both sides of care. So when I had the opportunity to review On the Mend I jumped on it.
On the Mend, authored John Toussaint, MD and Roger A Gerard, PhD, is about the seven year Lean healthcare journey of the author's medical system Thedacare. After some false starts with trying to improve clinical performance they went outside healthcare for an improvement strategy. They studied the manufacturing industry and found Lean. The Lean principles they learned had to be adapted to healthcare.
The first part of the book is about defining the principles that make up the lean healthcare process. In summary they are: Focus on patients and design care around them. Identify value for patient and get rid of everything else (waste). Minimize time to treatment and through its course. Continuous improvement of work practices every day in every area. The principles are presented with real life medical examples from the authors' Lean journey. This creates a compelling reason to adapt these principles. For instance, they relate the loss of time in healthcare to the loss of muscle, loss of brain, or even loss of life.
The second half of the book focuses on people aspect of Lean healthcare. John and Roger introduce the leadership skills needed in a lean environment, how to engage Doctors in the process, how to create the problem solver culture, and how to develop future lean healthcare leaders.Read more ›