john s. toussaint, m.d. thedacare center for healthcare value · outcome. it requires little...

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John S. Toussaint, M.D.

ThedaCare Center for Healthcare Value

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Customer

Value

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1. There is a relationship between

principles, systems and tools.

2. We focus on both key results and the best behavior to achieve those results.

3. We actively leverage our systems to drive the best behavior.

REFLECTIONPOINT

Source: Institute for Enterprise Excellence

ALIGN PRINCIPLES

INCIPLES

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Providing a simple unifying purpose, focusing and aligning all

parts of the organization on achieving long-term goals.

Think about how and why components work together across the

organization and the impact of your individual area / department

on the whole.

Create value for the patient

Focus all aspects of the organization on activities that consistently create measurably better outcomes at the lowest cost, highest quality and are valued by the patient, family, community.

Create constancy of purpose

Think systemically


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Seek facts and continuously experiment to learn, improve and achieve desired outcomes systematically. Every employee is a scientist and sometimes experiments don’t always work, but every experiment produces knowledge. Think “win-win”.

Flow & pull valueChallenge our existing processes to create flow of value that streamlines upstream and downstream connections – triggered by customer. Minimize batching.

Focus on process

Focus problem-solving efforts on improving processes - not on fixing people.

Embrace scientific thinking


IMPROVE PRINCIPLES

IMPROVE PRINCIPLES (Continued)

Understand & manage variation

Assure quality at the source

Seek perfection

There will always be variation. What is the variation telling us? Our systems and processes produce two type of variation: 1) Random, common cause; 2) Assignable, special-cause. When we don’t know the difference our actions can lead to confusion, delay & waste.

Stop, correct and eliminate defects and problems before moving to the next step, process, department or customer. Do not depend on inspection to provide quality.

Constantly seeking ways to improve our systems and processes. Challenge the status quo.

Source: Institute for Enterprise Excellence 7

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ENABLE PRINCIPLES PRINCIPLES

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Lead with humility Seek input, listen to understand, be open to new ideas, and continually learn. Once we think we have all the answers… we will have failed.

Respect every individual

Foster the continuous development of skills & talents in people to

create an environment where individuals are actively engaged in

improvements. Provide a safe environment physically & emotionally.

Knowledge-flow is one of the most significant competitive advantages.

Learn continuously Learning does not stop after graduation. Change is occurring at an

exponential rate and we must continue to deepen our understanding

and share our learning with others.


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How much does this impact

‘True North’HIGH

(2+ categories)

Moderate(1-2 categories)

LOW (None)

How much does this impact

a strategic objective?

LOW (None)

Is this a ‘System/Corp.”level mandate?

N

Does this directly impactcompliance or

regulatorystatus?

LOW (None)

Will this shut us down?

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M

Y

H

M

Y N

Wait listMission Critical Important On Hold

Will this initiative compromise

any TN metric negatively?

N

H/H M/H M/M

Is it alignedwith our Purpose?

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15Source: Ted Toussaint, Atrius Health

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Strategy Development

• Without an effective strategy development

process organizations will be effectively deploying the wrong strategy.

• The best strategy deployment system in the

world doesn’t make up for the wrong strategy.

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Strategy Development

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A New Method of Strategic Thinking

• Use voice of the customer to create new, unique, relevant value.

• Knowledge created through understanding the needs of customers

based on careful collection of data.

• Think long-term, but understand that your strategy is all based on

assumptions.

• Test your assumptions through rapid experimentation using rapid

PDSA learning loops.

• Understand environmental realities, culture and social trends, as

well as competitors.

• Understand new policy or technology options - not necessarily

based on customer needs.

19Source: Jeff Hunter Strategy LLC

A New Method of Strategic Thinking

Source: Alan G. Lafley & Roger L. Martin

“Playing to Win”; Jeff Hunter Strategy LLC19

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The Experiment

� What is our riskiest assumption?

� What is our hypothesis?

� What rapid experiment can test our hypothesis?

� What behavior are we measuring?

� What measurable results indicate

success?

The 3W’s

The Outcome

Source: Jeff Hunter Strategy LLC 20

The Outcome

New Operations System

(model cell experiments

with subsequent

comprehensive spread)

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24Used with permission of Atrius Health.

All rights reserved.

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Source: Allen C. Ward and Durward K. Sobek II

“Lean Product and Process Development” 24

SBCE = Set Based Concurrent Engineering

26Source: Ted Toussaint, Atrius Health

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Used with permission of Atrius Health.


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Used with permission of Atrius Health.


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INTRA BUSINESS

MODEL INNOVATION

DISRUPTIVE

BUSINESSMODEL

INNOVATION

UN

IQU

EN

ES

S O

F

SO

LU

TIO

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AMOUNT OF DESIGN

THINKING REQUIRED

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What is the process to spread the model cell?

• Immersion of spread sites

• Clear senior leadership sponsors

• A manager responsible

• Adopt or adapt

• Physicians can’t have veto power over standard

work

What is the process to spread the model cell?

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ThedaCare Physicians Care Delivery Model –Onstage and Offstage

The Patient Experience

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The Supporting Processes

Source: ThedaCare Physicians

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My Biggest Failures Engaging PhysiciansMy Biggest Failures Engaging Physicians

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• When I identified a great lean physician leader, I didn’t formalize their

leadership

• Physicians participated in improvement events when their expertise

was not needed

• I didn’t understand how broken our processes were for our doctors

• Model cell thinking didn’t arrive until many years into our journey

• I did not explain to our doctors the why behind what we were doing

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with subsequent


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Who needs to be involved in problem solving?

• Many problems can be solved with front line teams when the there are tight constraints on processes. A clear cause and effect relationship exists between the solution and the outcome. It requires little departure from the current way of doing things.

• Complex problems have loose constraints and a front line team using lean tools such as VSM, Bar Charts, Standard Work etc. would have a difficult time designing a solution. These problems require “design thinking” to build new “emergent practice” as opposed to a best or better practice. This requires great creativity and departure from the current way of doing things.

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with subsequent


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The New HR Procedures

• No layoff philosophy

• Re-deployment

• Dealing with poor performing employees

• Profile of the ideal manager including key behavioral indicators

• Change management

• Leader behaviors include coaching for improvement and development

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The New HR Procedures

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Finance

• Most organizations do not have the wherewithal to consider eliminating budgets

• C-suite and board expect finance to be cops of the

budget not improvement champions

• Cutting staff is the common way to cut costs even

though it only works in the short run

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Finance

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Clinical Business Intelligence

Assessment

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Focus on processEmbrace scientific thinking

Flow & pull valueUnderstand & manage variation

Assure quality at the source

Seek perfection

Break-through Thinking Monitor & Maintain Predictability Adapt & Adjust

Continuously learn by listening,

seeing and translating observations. Support new models of care delivery developed by front line.

Monitor the outputs of each system to

ensure stability and a standard outcome. Continuously challenge the process to identify areas of improvement.

Adapt the tools by making

incremental adjustments that all shifts agree with. Treat tools as a countermeasure not a solution. Structurally solve area problems daily.

Create value for the patientCreate constancy of purpose

Think systemically

[leadership] [management] [front-line]

Establish Direction Organizing & Translating Setting & Achieving Goals

Develop a vision and strategies to

achieve that vision. Set high but reasonable targets. Communicatethe direction on a regular basis.

Establish a structure to achieve the plan.

Organize and allocate resources. Monitorstructure to ensure consistency and alignment to plan.

Identify meaningful goals that can

be accomplished in their area that directly affect the overall vision and strategy. Daily report on status and needed support.

Lead with humilityRespect every individual

Learn continuously

Motivate, Mentor, Inspire Empower, Involve & Coach Develop & Share

Energize people to develop and

overcome barriers to change. Daily be in the work area to listen to understand. Embrace failure; celebrate success.

Empower authority within parameters of area

to improve and solve problems. Break-down silos by involving cross-functional teams to solve value stream issues. Coach problem solving daily.

Be a self-developer. Find

opportunities to grow and develop to better support the organization. Share with others what is working and what is not working.


AL

IGN

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IMP

RO

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[principles]

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The hardest thing is to build the culture of trust. It starts with sincere interest in the other person.

• Manifest by the type of questions asked

• Do we genuinely care what the other

person has to say or are we looking for

confirmation of our answers?

• Listening is not waiting to talk

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Great Leaders Ask Great Questions

• Focus on questions that start with “what” and “how”

• Avoid “yes” “no” questions

• Questions should be open ended

• Avoid asking questions that have an embedded solution (your solution) implied

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Source: Edgar H. Schein “Humble Inquiry:

The Gentle Art of Asking Instead of Telling”

Great Leaders Ask Great Questions

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Senior Leader Self-Assessment on

Fundamental Behaviors

Levels of frequency, duration & intensity

Level 1: Rare, Undeveloped, Indifferent

Level 2: Irregular, Experimental, Apparent

Level 3: Frequent, Predictable, Moderate

Level 4: Consistent, Stable, Persistent

Level 5: Uniform, Mature Tenacious

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Source: John Toussaint, “A Management, Leadership, and

Board Road Map to Transforming Care for Patients”

Frontiers of Health Services Management, Spring 2014

Senior Leader Self-Assessment on Fundamental Behaviors

john s. toussaint, m.d. thedacare center for healthcare value · outcome. it requires little...

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