Wisconsin Healthcare Leaders Featured at IHI

Professor Len Berry from Texas A and M spent the entire fall semester of 2011 embedding himself in three Wisconsin healthcare delivery organizations: Gundersen Lutheran, ThedaCare and Bellin. A few years prior to that he had embedded himself in the Mayo Clinic. On Tuesday, he facilitated a panel discussion with the 4 CEOs from these organizations. Mayo's CEO was from the Mayo Health System's Luther Middlefort in western Wisconsin.

The discussion was lively and Dr. Berry asked a number of questions regarding the cultural aspects of creating organization focused on high performance. Each of the four health systems are in the top 15 hospital referral regions in the nation for cost and quality with ThedaCare leading the pack at No. 5.

When Len Berry asked the group, "How did you get there?" Jeff Thompson of Gundersen Lutheran said, "It starts with the understanding that everything we do will be built on excellence." ThedaCare's Dean Gruner commented that "our success is based on our ability to develop our people." Randy Linton of Luther Middlefort explained the process of integration of a small system into the big Mayo system and how that's made them better as an organization. George Kerwin discussed Bellin's community focus.

When asked, "What do you wish you had done that you didn't?" Jeff Thompson said, "More transparency of physician and organizational performance." He mentioned the Wisconsin Collaborative for Healthcare Quality was a significant driver for their improvement activity because they could compare themselves to the state's other great organizations and visit them to learn. Dean Gruner said he wish they had started their lean journey earlier. This despite being one of the first organizations in the nation to apply lean principles in health care starting in 2003.

The interesting thing is that each organization is a high performer but Gundersen and ThedaCare have leveraged the lean methodology whereas the other two have a home grown set of processes to improve results.

I have had a lot of conversations lately with health care leaders from around the world about whether the lean methodology is truly replicable across the industry. Two of the four highest performing health systems in the country are using it as well as more than 50 others who are in various stages of implementation (http://www.createvalue.org/delivery/hvn/members/) which suggests that the methodology is replicable and scalable across the industry.

I think the reason most healthcare leaders aren't applying lean is they don't really understand it's a method to create a high performance health system. Because of this, I am publishing two papers in early 2013. One is titled, "The Promise for Lean in Healthcare" which will appear in The Mayo Clinic Proceedings in January. It outlines the principles of the lean in healthcare. The other article will appear in the ACHE journal Frontiers of Health Services Management. In this article, I will describe the entire management system required to support the lean transformation. This management component is what is missing at most places that I visit and has not been codifed well. I think these two additions to the literature will be timely and help describe the details of the methodology so that CEOs and physician leaders have a road map to follow. Links will be posted on our web site when the articles are published. In the meantime the most important thing for everyone to do is just get started and learn by doing. For a detailed description of this, I refer you to my book "On the Mend" the final chapter addresses how to get started.