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Lean Enterprise Institute

Health Care

Book: Lean Health Care to Cure U.S. Health Care Delivery Waste, Errors

On the Mend tells the true story of how a Wisconsin health system implemented lean health care.

Published: Tuesday, June 22, 2010 - 08:32

(LEI: Cambridge, MA) -- Despite expensive increases in the cost of U.S. health care, Americans too often get mediocre results—or worse. National studies show that 15 million incidents of medical harm—e.g., drug errors, wrong-side surgeries, or infections—occur in the United States annually.

Reducing errors and cost at the same time requires a revolutionary kind of health care delivery—lean health care, according to Dr. John Toussaint and Roger A. Gerard, Ph.D., authors of the new book On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry (Lean Enterprise Institute, 2010). Toussaint, CEO emeritus of ThedaCare, a four-hospital health care system in Wisconsin, and Gerard, its chief learning officer, candidly describe ThedaCare’s lean health care journey, an effort that slashed errors, improved patient outcomes, raised staff morale, and saved $27 million dollars in costs without layoffs.

On the Mend readers will learn:

• How ThedaCare distilled lean principles from industrial companies (including a snowblower maker) into lean health care principles: ones that focus on patients and design care around them, that identify value for the patient and get rid of everything else, and that minimize time to treatment

• How lean techniques of value-stream mapping and rapid improvement events cut the average “door to balloon” time for heart attack patients at two hospitals from 90 minutes to 37

• Why traditional management is the single biggest impediment to lean health care

• How the lean concept of “one piece flow” saved time in treating ischemic stroke patients, increasing the number of patients receiving a CT scan within 25 minutes from 51 percent to 89 percent

• What ThedaCare leaders did to replace medicine’s “shame and blame” culture with a lean culture based on continuous improvement and respect

• How senior leaders at other health care organizations can begin their own lean transformations using a nine-step action plan based on what ThedaCare did—and what it would do differently


John Toussaint is the founder and CEO of the ThedaCare Center for Healthcare Value. While president and CEO of ThedaCare, he introduced the successful ThedaCare Improvement System (TIS), a lean health care system.

Roger Gerard is ThedaCare’s chief learning officer. He specializes in executive and management development, process improvement, and the use of lean methodologies in bringing about significant and measurable organizational improvement.


About The Author

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Lean Enterprise Institute

Lean Enterprise Institute Inc. (LEI) was founded in 1997 by management expert James P. Womack, Ph.D., as a nonprofit research, education, publishing, and conference company with a mission to advance lean thinking around the world. The LEI associates teach courses, hold management seminars, write and publish books and workbooks, and organize public and private conferences. They use the surplus revenues from these activities to conduct research projects and to support other lean initiatives such as the Lean Education Academic Network, the Lean Global Network, and the Healthcare Value Leaders Network. Any company, organization, executive, or manager wishing to join the transformation to a lean way of creating value is welcome in LEI’s Lean Community.