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Beyond Heroes

A Lean Management System for Healthcare

By: Kim Barnas


Build a Team of Front Line Problem Solvers with Beyond Heroes

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Product Description

Hospitals have long relied on the heroics of brilliant nurses or doctors acting alone to save the day. Such heroics often result in temporary workarounds and quick fixes that leave not only patients and quality care at risk but also increase costs.

Beyond Heroes: A Lean Management System for Healthcare by healthcare management leader Kim Barnas is the story of an organization that extended the culture of excellence from solitary individuals to an entire healthcare system.

Like a growing number of healthcare organizations around the world, ThedaCare used lean thinking and the principles of the Toyota Production System to improve the quality of care, reduce waste, and become more reliable. The core work of this transformation involved changing the culture, including how individuals at all levels responded to problems, thought about patients, and interacted with one another.

Whereas lean thinking was incompatible with ThedaCare’s old top-down, hero-based system of management, Barnas, during her tenure as senior vice president of ThedaCare, worked with a team of people to create a lean, stable management system to spur continuous improvement.

Using the stories of ThedaCare’s doctors, nurses, and administrators to illustrate lean principles, Beyond Heroes shows how ThedaCare developed the following essential components of a new management system focused on continuous improvement:

  • Daily status reports, or conversations between managers and supervisors or clinical leads
  • Daily team huddles to widen the conversation about opportunities for improvement, roadblocks, and ongoing projects
  • Managing to the established standard by auditing standard work in order to achieve, teach, and coach for best practices
  • Front-line problem solving using the scientific method
  • Transparency regarding defects as well as accomplishments
  • Advisory teams to fill in gaps in the managers’ areas of expertise, provide fresh perspectives, and take responsibility for the overall performance of drivers (targets or goals) in that area
  • Scorecards for each manager developed and maintained by the advisory team to track progress against drivers
  • Standardizing the work of leaders to create a repeatable, reliable system of managing for improvement

Barnas explains, “These elements add up to developing people, solving problems, and improving performance across the board rather than in solitary individuals.”

She adds, “By extension, ten years from now, our business performance system will not look like it does today. As we move forward with continuous improvement, each iteration of our system will help us evolve into the next best practices, with healthcare providers and administrators moving together in the same direction to meet the needs of patients.”

In addition to exploring the eight essential components of the lean system, Barnas introduces four executives from healthcare systems across North America who have implemented ThedaCare’s system, sharing the lessons they learned along the way.

She concludes, “Beyond Heroes is not just a call to action or an argument for a better healthcare system. It is a necessary roadmap through the rocky terrain ahead, one that healthcare leaders can and should customize to their special needs.”

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Download the appendix figures from Beyond Heroes




  1. Paul O'Neill

    (verified owner):

    Every healthcare system in the United States should master the ideas in this book and practice them every day. If they did, we would see a revolutionary improvement in medical care outcomes and massive cost reductions.
    Paul O’Neill, 72nd Secretary of the U.S. Treasury

  2. Maureen Bisognano

    (verified owner):

    Beyond Heroes is a practical and helpful guide for all leaders in healthcare. It fills a wide gap in the lean literature, and offers applicable steps for leaders no matter where they are in their improvement journey.
    Maureen Bisognano
    President and CEO of the Institute for Healthcare Improvement

  3. Jeff Liker

    (verified owner):

    If you are in the midst of a lean transformation in any industry you must read this book! … Kim is a natural story teller and we feel the struggles, resolution, and great joys of success!
    Jeffrey K. Liker
    Professor, University of Michigan and author of The Toyota Way

  4. Patrick Conway, MD, MSc

    (verified owner):

    Beyond Heroes outlines the leadership system necessary to achieve dramatic improvements in healthcare. … This book will help shape the healthcare leaders of tomorrow.
    Patrick Conway, MD, MSc, quality improvement and health policy expert at the Centers for Medicare & Medicaid Services

  5. Amir Dan Rubin

    (verified owner):

    Beyond Heroes…. serves as a tremendously instructive guidebook on deployment of a Lean Management System as it demystifies abstract concepts through practical approaches, guidance, and real world examples.
    Amir Dan Rubin president and CEO of the Stanford Hospital & Clinics, Stanford University

  6. George Koenigsaecker

    (verified owner):

    Lean success is critically dependent upon leadership developing a different approach to leading, one that is consistent with the principals/practices/and values of lean. Kim Barnas demonstrates exactly how to do that in Beyond Heroes.
    George Koenigsaecker, president of Lean Investments LLC

  7. Kathryn Correia

    (verified owner):

    This book is essential reading for every executive who wishes to strengthen their lean transformation. It is deceptively simple, and amazingly powerful: respect and invest in your managers by creating a system that both sustains the gains of lean AND coaches managers to lead in a new way. Without the management system, lean is just another healthcare fad.
    Kathryn Correia, President and CEO of HealthEast Care System

  8. Michel Tetreault, MD

    (verified owner):

    Thank you Kim for creating such a great book! Clear, concise and practical you help any serious reader easily grasp many fundamental concepts and then, suggest possible implementation strategies. I took away more than 20 ‘pearls of wisdom’. A rare occurrence in one book, for which I am in your debt. Congratulations!
    Michel Tetreault, MD, President and CEO of St. Boniface General Hospital

  9. Mark Graban

    (verified owner):

    Many people talk about lean management, but Kim Barnas is one of the few who have actually built a robust lean management system in healthcare. Beyond Heroes will be immeasurably useful to organizations that are looking to move beyond tools and projects to a culture that creates the best patient care and a far better workplace for healthcare professionals. This book is full of impactful stories and meaningful, practical advice that is grounded in the realities of healthcare, while making real the potential that every organization should be achieving. I’d strongly recommend this book to every healthcare leader – read it, talk about it, and put in the hard work required to make these meaningful changes happen.
    Mark Graban, VP of Innovation and Improvement Services, KaiNexus

  10. Jeff Thompson, MD

    (verified owner):

    Beyond Heroes hits that rare sweet spot between theory and case reports. This book is a clear path to high performance guided by well tested system design suggestions and illustrated by practical examples for the front lines. Readable, understandable, and if followed, transformational.
    Jeff Thompson, MD, CEO at Gundersen Health System

  11. Don Shilton

    (verified owner):

    Beyond Heroes, A Lean Management System for Healthcare, should be required reading for any healthcare leader who has begun or is thinking of beginning the lean journey. Kim Barnas has done an excellent job of describing ThedaCare’s business performance system – the secret sauce that has helped make ThedaCare so successful. This book will be a valuable guide and resource for years to come.
    Don Shilton, president & CEO of St. Mary’s General Hospital

  12. Bill Krolicki


    I just finished the book “Beyond Heroes” and really enjoyed it. I had read David Mann’s book “Creating A Lean Culture” which stressed the importance of standard work. Having now read your book I have a much deeper understanding of what I need to do in order to make my leader standard work more effective.

    I thought Beyond Heroes did a great job of laying out the “system” or “infrastructure” that needs to be put in place to make lean really effective and part of the company culture.

    I wish I had read it earlier. I guess I worried the book would have too much about health care specific issues and not be applicable to my finance department. Then I realized that most of the books I read about lean are based on industries (like TPS and cars) that have nothing to do with my finance department.

    When I was looking for something that talked about the nitty gritty of managing a lean system, Beyond Heroes looked the best and I’m glad I read it. I’ll recommend it to others.


    Bill Krolicki
    Furniture Origins