A Retired Hospital CEO Shares the Employee Feedback That was "A Bucket of Cold Water to the Face."

Today, I've released a podcast interview with Dean Gruner, MD, who recently retired as CEO of ThedaCare, a health system in Wisconsin that has been considered a world leader in the practice of "Lean" in healthcare.

In our discussion, Dean shares many reflections about their successes as well as some frank and honest lessons learned.

Dean said:

"I'm going to say something harsh here. Amongst our team we believe that we, at a certain point, started to read too many of our own press clippings, and we stopped studying what was really going on."

When one of their senior internal Lean experts left the organization, Dean decided to "do a reflection on how we're doing before hiring a replacement."

In his own words:

"What we did is we had one of our previous organizational development (O.D.) facilitators come back. First week in January of 2016, we got all of our senior leaders and vice presidents together, about 40 people in a room. She broke us into six or eight teams and gave us an interesting assignment.

She had every table draw a picture on a flip chart and their assignment was to draw a picture of what the culture was of ThedaCare today. Then after that hour everybody showed their pictures and were reported out.

"It was a bucket of cold water in our face."

What they drew was a picture of an organization that had become very hierarchical and required approval from senior leaders to do things. It had become an organization that was very dependent on facilitators to do improvement work.

"[We had become] an organization that had become much more inflexible and more rigid than we ever had imagined. All those things are exactly the opposite of what you intend to do with Lean."

We looked at ourselves and said, "How did this happen? We've been doing this for 12 years. We've got everybody who comes here and tell us how great we are. One of the answers was, we hadn't sat down and looked in the mirror really thoughtfully for several years.

This had just happened gradually and maybe it's akin to the boiled frog metaphor. We just didn't really think it through. Then, when we looked at it further, we decided to take this and have manager focus groups. I challenged the team that I wanted to get through all this within 60 days.

We couldn't wait forever to make a decision. Kathy Franklin went and met with -- I think it was 15 -- different groups of managers, all with about 10 to 15 groups, so 150 people. Same process. How'd we draw our pictures, what it showed. At the end of this time, we came back together a month later.

We had 40 some pictures in the room of what people felt the organization was like. It just was not pretty. It was the same thing -- rigid.

"What we learned from that is some people had interpreted Lean that it was all about creating standard work. I heard stories from people that would open up and tell me what really would happen."

Dean said his favorite story happened in New London.

"This woman is a CT and MRI technician. On a weekend she's called in to do a scan on a patient. She comes in, does the scan on the patient. Then her process is that she takes the patient back to the emergency room, because they come through the emergency room. She then comes back to her area, turns off the scanner, does all documentation and waits.

This particular day she comes in. She does the scan on this patient from ER. Afterwards, the patient's feeling lightheaded. She's, "I'll tell you what. Why don't you sit here, then, in this room," or whatever, "and I'll get you some orange juice. And you get your bearings, and I'll do my documentation, turn the equipment off, and I'll take you back to the Emergency Room."

She does things out of sequence. She's gets done turning the equipment off and then she forgets the patient. She goes home. She gets home and about 20 minutes later she remembers this, so she frantically calls the Emergency Room and says, "Hey, I forgot the patient." They go and get the patient. It's a small hospital, so the patient was, "No harm, no foul."

It took 20 minutes extra and everything was fine. The next day she goes and she tells this to her supervisor about what happened, and the supervisor...What would you think you would say, if you're the manager, to somebody who made this error? What would you tell them? The manager told her, said, "You know what you need to do?

"You need to sit down and write a standard work for this so it never happens again."

"There comes to a point where people stop thinking, started to take a standard work as the solution for everything when, in reality, we pay people to think and to learn. We had gotten away from that."

We came back and then we decided...We thought more deeply and we read some of the stuff from Michael Hoseus, Gary Convis and Jeffrey Liker and some of the things that they had written about it. I've got two favorite quotes that I've got here in front of me.

From Convis and Liker in their "Toyota Way" view of the culture said, "If there's a recipe for Toyota's success, it is deep, time-consuming, and expensive investment in developing everyone in the organization, and truly believing that your employees are your most precious resource."

Then Michael Hoseus, "The most common mistakes implementing Lean is thinking that Lean is a set of tools to be delegated to some Lean champions to implement while leaders go around running the business as usual."

I would say we made some of the mistakes that they referenced there. We developed a group of ThedaCare improvement system facilitators to do improvement in work throughout our organization. Yes, I still was all on a rapid improvement at least once a year or more often, but we stopped spending time investing in leadership.

"That's where investing in people, developing them, and, in my mind, served by leaders who really respect me. That's where the magic is, I think."

It might have slowed our rate of improvement for a couple of years, because we were learning some difficult lessons. Now that we think we've learned these lessons, we think we're back accelerating again. I guess that's why they call learning and why they call it work. It's not like it's easy, or anybody would do it.

I think it helps explain. In retrospect, now I can stand back and reflect on this.

"It does help explain why there is such a high attrition rate for organizations that start Lean. They just focus on the tools and how to do an X matrix, and a rapid improvement, and the kanban, and blah, blah, blah."

Certainly, those are the ones that tends to run out of steam in three to five years. Now, if they just focus on processes, they tend to flame out, too. If you think about what Toyota and others do, taking that long view is hard because you really viewing it. Then you're going to focus on people, and their learning, and on the tools, and on the teamwork, and on leadership.

You're going to do all of that. That can be a little overwhelming, but I think that's what we've learned, and that's why feel already good about the future for ThedaCare even though we had to go through a couple of challenges to really help us learn some of these lessons."

I appreciate Dean sharing his honest reflections. If you'd like to hear more from Dean about his nine years in the CEO role and his positive outlook for the ThedaCare's new CEO and future, you can listen to the podcast or read the entire transcript here.

?Mark Graban (@MarkGraban) is a consultant, author, and speaker in the “Lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen. Mark is also editor of the book Practicing Lean.

He is also the VP of improvement and innovation services for the technology company KaiNexus and is a board member for the Louise M. Batz Patient Safety Foundation. Mark blogs most days at www.LeanBlog.org.