Management on the mend  - A review by Jordan Aronhalt

Management on the Mend
is a follow up to Dr. John Toussaint's 2010 book, On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry. In full disclosure, I hadn't read the author's first book, and instead jumped right into Management on the Mend. On a trip in July of 2017, I and a few other colleagues visited Maine Medical Center in Portland, Maine, where we were able to shadow leadership as they conducted their daily management practices.  During the visit, I was able to see several of the lean management practices Dr. Toussaint describes in his book. I was impressed by what I saw at Maine Medical Center, and after their Operational Excellence team recommended Management on the Mend, it jumped to the top of my reading list.

The book is an educational and instructional guide on how to set up your hospital for a lean transformation. It starts off by describing what lean is and is not. The author puts it very succinctly, "lean is not a healthcare improvement program. It is an operating system within a management system that requires a complete cultural transformation."

The book then walks the reader through the major steps of a lean transformation, as supported by his own experience at ThedaCare, the well-known, multi-hospital health system out of Wisconsin. For the experienced process improvement specialist these steps won't be anything new, but Dr. Toussaint weaves in numerous anecdotes that give the reader guidance on how his methods may give you the best chance for your success. Ideas like building a model cell, agreeing on values and principles, creating a central improvement team and restructuring the roles of administrators to support the front-line care givers.

Dr. Toussaint provides some great examples of potentially flawed management systems used in healthcare today. For example, the reason the front line caregiver comes to work every day is to save lives, get people well and get them out of the hospital. The caregiver is not worried about how to grow the cardiac service line volume by five percent.

"Think about why people come to work in healthcare every day. What are their highest aspirations for their patients and community? They probably do not include growing the cardiac service line by five percent" (quote)

Early in the book, Toussaint links this type of thinking to management by numbers system of Alfred Sloan, the former GM CEO from the 1920s to the 1950s. Many of my healthcare experiences felt in line with Dr. Toussaint's conclusion, as I've seen many organizations that seem to be victim of the financial tail wagging the hospital dog.

The author also mentions the time wasted on creating financial and other reports that aren't used for decision making. As administrators and improvement engineers, we often talk about removing inefficiencies on the front line, but rarely do we look at our own work with the same level of scrutiny.

Management on the Mend is a compelling argument to begin introducing lean as a management system into your facility today. For the healthcare improvement engineer, the book can provide you with an experienced perspective of lean applications to help promote the acceptance of your future lean program. For the administrator, this may be an exciting look into a new operating system that can help you break your current paradigm, and find more efficient ways to engage with the front line in driving improvements and the performance of your facility.

PS – A special thank you to the Maine Health Operational Excellence team for spending a day allowing us to visit their facility and providing valuable insight and guidance.