Book Review: On the Mend

While I am not a Lean Healthcare professional per say I am a Lean professional that has worked in various aspects of healthcare.  My experience varies from the patient floor, to the ER and OR, to long term care, to psychiatric ward and a few things in between.  Most of my family are healthcare professionals of some kind and I have been on both sides of care.  So when I had the opportunity to review On the Mend I jumped on it.

On the Mend, authored John Toussaint, MD and Roger A Gerard, PhD, is about the seven year Lean healthcare journey of the author's medical system Thedacare.  After some false starts with trying to improve clinical performance they went outside healthcare for an improvement strategy.  They studied the manufacturing industry and found Lean.  The Lean principles they learned had to be adapted to healthcare.

The first part of the book is about defining the principles that make up the lean healthcare process.  In summary they are:

The principles are presented with real life medical examples from the authors' Lean journey.  This creates a compelling reason to adapt these principles.   For instance, they relate the loss of time in healthcare to the loss of muscle, loss of brain, or even loss of life.

Focus on patients and design care around them.

Identify value for patient and get rid of everything else (waste).

Minimize time to treatment and through its course.

Continuous improvement of work practices every day in every area.

The second half of the book focuses on people aspect of Lean healthcare.  John and Roger introduce the leadership skills needed in a lean environment, how to engage Doctors in the process, how to create the problem solver culture, and how to develop future lean healthcare leaders.  The examples in this section are more personal in nature as you might expect. I particularly liked Roger's "communities of practice" where he describes the five stages of change: initiation, reality, resistance, compromise, and integration.

The book ends with a nine step action plan for starting lean initiatives in healthcare.  Based on the authors experience they recommend:

1. Identify the crisis.  What is the platform for change?
2. Create a Lean promotion office.  Critical for planning and managing change.
3. Find change agents.  They will help lean take root in your organization.
4. Map your value streams.  Understand the true patient experience.
5. Engage senior leaders early in strategy deployment.  Improvements must be focused on what is important.
6. Acquire and disperse knowledge broadly.  Learning and applying knowledge is necessary for everyone.
7. Teach a man to fish (or, become a mentor).   You need to create the leaders you want.
8. Involve suppliers in Lean.  Invite them to join in improvements and develop partnerships.
9. Restructure your organization into product families.  Design value from patients' perspective.

They conclude with this advice: Don't let anything stop you.  Trust the improvement process.

The real-life examples of patients' experiences with the Lean system make the book particularly compelling.  The book has plan that can be used to guide other healthcare organizations to sustainable improvement. They further prove this can be done without compromising the patient care; on the contrary it is improved.

The book is short, non-technical, and can easily be read in one day.  However, due to the subtle attention to detail you will find yourself re-reading it to truly get the most out of it. 

I definitely recommend this book to healthcare professionals and those practitioners associated with either the quality or upper management functions.

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