Beyond Heroes

ThedaCare Center for Healthcare Value (2014)

Hospitals have long relied on heroics to save the day—on one brilliant nurse or physician to fix the problem at hand. The result is a lot of people rowing in opposite directions, putting safety and quality at risk while increasing costs. This is the story of an organization breaking that habit.

Like a growing number of healthcare organizations around the world, ThedaCare, Inc. has been using lean thinking and the principles of the Toyota Production System to improve quality of care, reduce waste, and become more reliable. But lean thinking was incompatible with ThedaCare's old top-down, hero-based system of management. Kim Barnas, president of the hospitals, shows us how she and her team created a management system that is stable and lean, from front-line supervisors to the president, to spur continuous improvement.


Like most of my fellow leaders, I saw the benefits of lean as the economy stagnated in the mid 2000s and cost pressures on healthcare increased. We had all seen plenty of improvement programs, but lean was the first that was a complete operating system, balancing the needs of patients, caregivers, and the bottom line. Lean thinking was helping us improve quality for patients, reduce costs, and engage employees like no other approach.

About three years into this initiative, sometime in 2006, I was involved in improvement events in a cancer treatment value stream focusing on radiation oncology. We were getting breakthrough results: improving labor productivity by 20 percent, improving same-day access to one's doctor by 30 percent, and slashing the time it took to move a patient from diagnosis to treatment from weeks to days. After a slow start, physicians had become more engaged in lean and were sometimes driving improvement work. Patients were on every kaizen team, helping to shape and guide our priorities. Sustaining our improved processes was a struggle, but I was sure we would solve that problem, too. It felt like we were sailing with a strong tail wind.

Then we hit a snag that could have sunk our lean initiative. And the snag was us. What hospital executives were asking of our line managers was slowly strangling our lean improvement efforts. We were heaping on more work, expecting managers to guide lean efforts while performing the same managerial duties as before, in the same way as before. And we expected them to figure out how on their own. This was nothing new. Like our throw-her-in-the-deep-end training, these competing priorities were another strike against our leaders.

One day, the very frustrated manager of a hospital Intensive Care Unit yelled at me in my office (in a respectful Wisconsin way, of course), "You've changed the way our teams work, but you haven't changed how we lead. We don't have the tools for this."

Another manager wept in my office. Both of these were good and steady leaders, so I knew there was a real problem. I talked to other managers and to executives in ThedaCare's two main hospitals and everyone recognized the truth of the ICU manager's statement and acknowledged the general frustration. Managers at ThedaCare are dead center—the bull's eye—of our leadership structure. They are responsible for front-line supervisors and entire units; they answer to vice presidents and other executives. New and daunting responsibilities were pressing down from above and below. It was no wonder that cracks were starting to show at this level.