On the Mend

Lean Enterprise Institute, Inc. (2010)

In On the Mend John Toussaint, MD, former CEO of ThedaCare, and Roger A. Gerard, PhD, its chief learning officer, candidly describe the triumphs and stumbles of a seven-year journey to lean healthcare, an effort that continues today and that has slashed medical errors, improved patient outcomes, raised staff morale, and saved $27 million dollars in costs without layoffs.

Winner of the Shingo Prize.


Everything seemed to be running so smoothly that morning. A peach pie was already in the oven, the beefsteak was in marinade and fresh beets were boiling on the stove. Standing at the kitchen sink, with her husband of 46 years beside her making a sandwich for lunch, Lee Parker was satisfied everything would be ready for the evening's dinner party.

And then she had the most curious feeling. It was like her left arm was fading or being erased, pixel by pixel. She looked for her arm, certain that it would be going or gone, and saw it hanging at her side. Just hanging there. Her left leg weakened suddenly and buckled, pulling her body heavily into the counter. John Parker put down his sandwich, asked Lee if she was all right. Her words came out sloppy: "No, I don't think so."

It was 12:45 p.m. and a small blood vessel in a right branch off her middle cerebral artery had just slammed shut, probably blocked by a bit of plaque. Blood flow to the region upstream was cut off and, without oxygen pumping through the arteries, brain cells were beginning to die off at a rate of about 1.9 million per minute.

The next hour would be the most critical 60 minutes of Lee's life. Someone dies of stroke every 45 seconds in the United States. It is the third leading cause of death and the number-one cause of serious, long-term disability. John grabbed a chair, set Lee on it and called 911. The Appleton Fire Department and emergency medical technicians, responding from the Number 6 Station just blocks away, were there within five minutes. Struggling to form words and push them out of her mouth Lee asked the emergency technicians to turn off the stove.

Lee still remembers looking out of the ambulance window as it sped to Theda Clark Hospital, 10 miles away in Neenah, Wisconsin. They were going so fast, the trees were all a blur.

Lee was suffering an ischemic stroke, which is much like a heart attack in that a blood vessel becomes blocked and starves surrounding tissue of oxygen. Treatments include drug therapy or using a catheter inserted into the groin and fed up through an artery into the brain to suck out or grab and pull out the clot. Time to treatment is the most critical factor in a patient's chance for recovery and that makes the Stroke Center at Theda Clark Hospital the perfect place to illustrate lean healthcare's third principle: Minimize Time.