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Center Point Blog

A Letter to Physician Leaders

Jim Marks, the Chief of Staff and Chief of Anesthesia at San Francisco General Hospital (SFGH), in this open letter to his colleagues, details the importance of teaching the principles and thinking behind lean management, the work ahead of his organization, and what they’ve accomplished so far. The shift in thinking required to switch to a lean management system is difficult work, but as he explains below, it’s well worth the effort. Continue reading →

There is More to Performance Management Than Just Tools and Technology

Posted on by Brian Veara

I come across many healthcare organizations that struggle with performance management. What I hear and see are intelligent, dedicated people all trying to help their organization improve. Most EMR implementations do not include a clinical business intelligence strategy. Vendors have come in and convinced the organization’s leaders that their software can somehow automatically improve performance. The software is so easy to use it will be self-service. The vendor will demonstrate the ad-hoc data discovery capabilities that anyone can do. All the organization has to do is submit their data and the improvements will begin. Oh there’s also a large expense of at least $250,000 just to start. Many organizations that have spent much more than that and are not seeing any significant improvement. Why?

There is more to performance management than just tools and technology. The ThedaCare Center for Healthcare Value has formed a peer-to-peer learning network called the Clinical Business Intelligence Network, or CBIN for short. Our shared learning has led us to a deployment sequence in performance management of Mindset, Skillset, and Toolset. While technology is very important, the deployment of technology without the proper organizational mindset and skillset will not be successful. The analytics must be supporting an improvement methodology like lean. The organization must be skilled in producing, consuming, and using data to take actions on insight.

Our network has developed a formal assessment process to help an organization build an actual strategy and roadmap. We also have designed a skills matrix development process to help accelerate an organization’s analytical journey. The focus is on developing and maturing the mindset and skillsets needed to be successful in actual performance improvement. While we certainly discuss technology, the main emphasis of our learning, sharing and connecting, is on people and processes.

There are several symptoms of a performance management system in need of help: Is your organization improving at the desired pace? Are you spending a lot of money on tools and not satisfied with the actual results? Do you have a strategy and roadmap for organizational performance management? Is your analytical maturity focused on latent performance measures? There is help available. Start by reading Management on the Mend by John Toussaint, MD. This book describes the model, step by step, through people in 11 organizations who are transforming into high performance healthcare organizations. Please join the Clinical Business Intelligence Network and our other peer-to-peer learning network, the Healthcare Value Network to learn, share, and connect with others who are also on this transformation journey.

Brian Veara, Program Director
ThedaCare Center for Healthcare Value

Prioritizing Your Work: What to Work, When

Posted on by Kim Barnas

Post 4 of 4 in a Blog Series by Kim Barnas

I’ve visited a number of organizations and one of the recurring problems I’ve seen is lack of an effective prioritization process. I think this is paramount. In this world of competing priorities and regulation we must have a way to focus on the “vital few,” demonstrate and stabilize the improvement, and move on to the next “vital few.” We will accomplish more sustainable solutions with added focus.

There are three things you need to have: Continue reading →

Performance Process: Accountability

Posted on by Kim Barnas

Post 3 of 4 in a Blog Series by Kim Barnas

As I visit healthcare organizations around North America, people come forward sharing concerns that they are hitting a wall, even within the management system. Often what I hear is that they have implemented stat sheets and huddles, but not all of them have implemented a performance review process. The management system is just that—a system!  The goal is to develop people to solve problems and improve performance.  How do you know if your problem solving is driving improvement if you are not measuring it? Continue reading →

Solving Problems: Why You Need a Process

Posted on by Kim Barnas

Post 2 of 4 in a Blog Series by Kim Barnas

If you encourage staff to identify defects, you better have a process to solve them. Often the first step is to bring those defects forward to a huddle. In the book Beyond Heroes, we recommend that this conversation occurs at a huddle board (visual management) with your staff. During this huddle, you identify and discuss defects which have been brought forward from various sources—status sheets, staff, ancillary areas, or physician. A system to prioritize these opportunities is essential.

Continue reading →

Daily Management: Making it Visible

Posted on by Kim Barnas
Status Check In Being Conducted

Status check-in being conducted

Blog Post #1 of 4 in a Series by Kim Barnas

One of the first components needed in a management system is a way to look at your day. We call that our status sheet. It’s a daily check-in. It could be a huddle, it could be a conversation, whatever it is that you are doing, but it is at the front line and focused on identifying what is happening in the business today. How can you proactively think about your business in a way that solves problems before they occur?

The status check-in is a way of doing three things: Continue reading →

This is Truth

This will be my last blog post as an employee of the ThedaCare Center For Healthcare Value.  I am very grateful to have the opportunity to work with some terrific people who are trying to make a difference.  I’ll be moving on to other work where I’ll be contributing to the “gang tackle” of healthcare transformation in other capacities.  If you are curious about what I’ll be doing, you can follow my exploits at

A few years ago I had the good fortune to tour a company that is a supplier for Toyota, Honda and other companies.  The gentleman that was showing me around would occasionally talk about advice that he was given from his sensei from when he worked at Toyota.  Apparently, this Japanese gentleman would try to emphasize important points by making this statement, “this is truth”.  I was thinking about this as I was asked to offer some reflections on my time at the Center over the past six years.  So, here’s my “top 10” list: Continue reading →

Practical Advice on Payment Reform

In order for payment reform to be successful from the perspective of purchasers, payers, providers, and patients, Harold Miller, President and CEO of the Center for Healthcare Quality and Payment Reform asserts that there are four separate goals which must all be met.  If you’re familiar with Harold Miller’s work on healthcare payment reform, then you know he is thoughtful, thorough, and detailed. This is evidenced in his April 2015 publication Continue reading →

What Do Patients Really Want?

It’s 10:30 pm and I am sitting wide awake in my newborn’s hospital room wondering if I will ever be able to take him home. It seems like we have been here forever and nobody is telling me anything; I am not even sure how serious my son’s condition is!  I feel frustrated and powerless, so I just keep watching my baby from the rocking chair next to his incubator. He looks so small and alone; I just want to pick him up and hold him. Continue reading →

Cars and Healthcare—Important Lessons Learned

Posted on by Helen Zak

What do making cars and delivering healthcare have in common? More than you think! Manufacturing and lean principles apply, although the details differ. For instance, making cars and caring for patients both include producing on demand, immediately, defect free, one at a time, without waste or error in an environment that is physically, emotionally and professionally safe.

A 2010 episode from NPR’s This American Life (approximately 1 hour in length) discusses what makes GM and Toyota different, using their 1984-2010 joint venture—New United Motors Manufacturing Incorporated. “Stopping the line” is one of the organizational differences highlighted and this has parallels in the healthcare world.  Continue reading →