On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry
Merry, Martin D., Inquiry
On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry. By John Toussaint and Roger A. Gerard, with Emily Adams. Cambridge, Mass.: Lean Enterprise Institute, Inc. 2010. 191 pp. $30.00.
This is a "must-read" book for everyone in health care leadership positions health care trustees, senior managers, and physician leaders.
In 2001, the Institute of Medicine published its landmark report, Crossing the Quality Chasm. This was a follow-up to its earlier "blockbuster" report in 1999, To Err Is Human, which made public the huge costs of human suffering caused by medical errors in a U.S. health care enterprise that had, by the turn of this century, become too complex to manage safely via "traditional" health care management practices. Chasm offered no specifics, but instead a high-level blueprint of how health care in the United States could move beyond medical errors and patient harm. This report called for nothing less than a total top-down, bottom-up "redesign" of health care in the United States, everywhere from national health policy to local health care systems.
On the Mend." Revolutionizing Healthcare to Save Lives and Transform the Industry brings Chasm to reality. For leaders who wish to gain a real "feel" for what "top-down, bottom-up redesign of health care" entails at the local and regional level, this book is an essential guide. It plots the story of ThedaCare's journey from what was already, in the late 1990s, a comparatively excellent regional health care system in northeastern Wisconsin to a truly visionary, 21st century health care system that might be the model for hundreds of local and regional health care endeavors throughout the United States. For this reviewer, it is the best rendering yet in reference to a down-to-earth, practical description of what it takes, from leadership and management process perspectives, to create a health care system of the future-one that takes quality to new levels, contains costs, reduces patient harm, and enhances the patient/family experience in an unprecedented manner. In other words, and as its numbers affirm, ThedaCare is on the cutting edge of delivering true health care value to its patients and the communities it serves.
This book actually tracks two parallel stories. The first is that of ThedaCare, a regional integrated health care system in northeastern Wisconsin. The second is that of co-author John Toussaint, M.D., as he grew from the traditional medical staff leader within this system (chief of medicine at one of its hospitals) to a "fully-evolved" physician executive--chief executive officer of the entire ThedaCare system.
This is no "Pollyanna" story. Toussaint and Roger A. Gerard, Ph.D., ThedaCare's expert in organizational development and learning, candidly describe their early 2000s commitment to introduce "lean" elements of the Toyota Production System--assisted by an intimate partnership with Ariens, a local Wisconsin manufacturer of snow removal equipment-and they discuss both the successes and failures that accompanied these early efforts.
This is one of the deepest values of this quite personal story: achieving true health care transformation is not for the faint of heart. The authors share that even their earlier successes fell short of achieving the transformation they sought. An early revelation was to focus their efforts on three overriding priorities:
 Becoming totally patient focused, in the broadest sense of not only clinical outcomes, but also overall patient experience;
 Delivering true value, highest quality in the context of contained costs;
 Concentrating on time, accomplishing all that needed to be done to fulfill the first two priorities in the shortest time possible. …