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Center Point Blog

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 →

First Things First: Senior Leader Behaviors

In the past two years I have had the privilege of facilitating sessions with senior leadership teams at more than ten healthcare organizations, with the objective of helping them develop their roadmap to operational excellence, or lean.  A number of these teams identified cultural issues as a barrier to transforming their organizations. More importantly, they put these items at the top of their list of barriers to address.

Some examples of cultural issues that have surfaced include:  silo mentality, lack of commitment to team decisions, punitive consequences for surfacing problems, no transparency of results, top-down management styles, and fear in the workplace.  In organizations in which any or all of these behaviors are present, it is impossible for operational excellence to take hold or sustain over time.     Continue reading →

Would You Like Some Humble Pie?

When we observe leadership behavior long enough, we often witness someone in a high ranking position that could use a slice of humble pie.  Because of their position, a leader’s behavior is observed by everyone in the organization.  If the leader communicates the wrong way or jumps to the wrong conclusion, everyone knows. And the consequences of a high ranking leader acting like they know it all, can be demoralizing to employees.

It’s hard for some leaders to show confidence and exhibit pride in their work, but not cross the line to arrogance. Continue reading →

Did You See the Canaries?

Posted on by Brian Veara

One of the advantages I have in my role is to participate in gemba at many organizations.  I can see their lean journey maturing.  I can see their business management systems developing as their leaders iteratively go through cycles of PDSA.  I also see the large amount of process waste that emerges as each unit in an organization builds their visual management system.  This waste is preventable. I will save additional comments on that for my next blog. Continue reading →