On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry

by John Toussaint, Roger Gerard, M.D. Toussaint, John, et al.

Book Overview

Part case study, part manifesto, this groundbreaking new book by a doctor and a healthcare executive uses real-life anecdotes and the logic of lean thinking to make a convincing argument that a... This description may be from another edition of this product.

• Format: Hardcover
• Language: English
• ISBN: 1934109274
• ISBN13: 9781934109274
• Release Date: September 2010
• Publisher: Lean Enterprise Institute, Inc.
• Length: 181 Pages
• Weight: 1.22 lbs.
• Dimensions: 0.8" x 6.1" x 9.3"

Customer Reviews

A welcome cut-to-the-chase book

I have to agree with another reviewer that the real-life examples of patients' experiences with the system make the book particularly compelling. I do workflow assessment and redesign for EHR adoption support for one of the new federal RECs (see [...]), and I'm a long time ASQ member and QI operative. This is the best yet of the many I have read on the topic of Lean applicability to health care. I think this book should be widely read by the lay public, rather just another swell preach-to-the-QI-choir tome. As a tech matter, they had me at page vi in the Foreword: "Lean transformation is all about Dr. Deming's Plan Do Study Act (PDSA), otherwise known as the scientific method." Ding, ding, ding, we have a winner. IMO, God created Dr. Deming, whereupon She rightfully rested. Much that has followed (e.g., "Six Sigma") is mostly about affixing fancy new labels to bottles of venerable fine wine. Had I the money, I'd buy a copy of this book for everyone in my company, and for all of my family and friends.

A Lean Learning Experience

This past weekend I finished up reading On the Mend. I started the book one morning over a cup of coffee and it was either a large cup of coffee or a very engaging book. I noticed a craving for a 2nd cup after 75 pages. I also noticed that it was actually a work day and I needed to start my day, the perils of having an office at home. The book reads similar to other business novels such as The Goal or The Goldmine except for the fact it is true. This is Thedacare's story and the authors discuss successes and failures in the same voice. It was quite interesting and this might be a stretch but at times it felt like the drama was unfolding. The book truly represents an organization's Lean Journey and I would recommend if for any organization for an overview of what that journey may entail. I was disappointed at first that it was as short as it was 150 pages. However, I found myself this past week starting to go back and have to admit that referencing and rereading parts of it over was much easier. The subtle attention to detail and the preciseness of the statements made for a true Lean Learning experience. For example, I had gained additional insights on finding Change Agents within an organization. Actually in review, Change Agents were only mentioned on 3 pages. On broader perspective the book was about change and the authors illustrated their 5 Stages of Change with a simple diagram, that I recommend referencing as you read the book. The difficult steps that you can imagine in taking a Healthcare facility of this size and character through a Lean Journey were well documented. It started at why they began and ended with choosing a successor to continue the journey. They also gave an outline on how Lean can be applied in healthcare from a broader perspective. P.S. It was just simply fun reading and I even noticed the type of paper the book was printed on.

A Common Sense Approach to Lean

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?" Also, I usually mention that Virginia Mason in Seattle did in fact close their OR after a sentinel event back in 2004. In the future, I will mention the example you used in the book about the action that Kathryn Correia took to shut down the unit's surgical suites. However, these examples, in my opinion, tends to show that even if we become a lean organization, we will still make mistakes but we will try to correct them the right way. 4- I loved the collaborative care example. Currently, we are re-designing our admission/discharge processes and I am lobbying to use the ThedaCare model. 5- The way the book illustrated the paractice of time stamped activities by the minutes is a powerful illustration of the importance of time not only from a financial aspect but from a quality of care and clinical outcomes point of view. 6- The emphasis on sustainability is very powerful and interesting as most lean initiatives tend to falter after a period of time. You are right in saying it is "the biggest challenge" as skeptics will say "we told you lean does not work." 7- I loved the argument that "Lean can't be delegated." Many of the senior managers I have met and work with emphasize that the lean team needs to provide

Review of On the Mend by John Toussaint and Roger Gerard

I read this book over the weekend on my Kindle. It is a clear and understandable presentation of using lean in healthcare. The book describes the story of how ThedaCare, a health system in northeasten Wisconsin, transformed itself by studying, planning, and implementing lean principles over the course of several years. The successes as well as the challenges are described, and the authors stress the importance of leadership commitment, practical training, continuous learning, and trusting in the process. ThedaCare is well recognized for its contributions in establishing a lean culture in a major healthcare system, and this book is an interesting and incisive summary of the work that they have done.

Real Healthcare Reform

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.