on the mendOn the Mend, Revolutionizing Healthcare to Save Loves and Transform the Industry is the story of a Lean transformation by ThedaCare, a healthcare system based in Wisconsin. The book provides stories about the Lean thinking based changes ThedaCare made, the challenges those changes entailed, and the effort it took for Lean to gain traction in the organization. Importantly the book identifies the need for Lean thinking to be an ongoing conscious effort or the organization risks sliding backwards.

Toussaint was the CEO of ThedaCare during this Lean transformation, and like Art Byrne his approach toward the Lean transformation was to be directly involved with encouraging experiments and improvements on the part of ThedaCare employees. The book discusses some of the failures, and attempts to be as open as possible about the experiences, good and bad, on route to an overall improvement of the system.

On the Mend may be even more useful to leaders outside the healthcare industry. It is not an instruction manual for transformation, however Toussaint’s and Gerard’s openness regarding the challenges they faced provides an understanding of the kinds of difficulties Lean thinkers are going to face in changing their enterprise. There are two lessons worth addressing. While ThedaCare’s management was busy helping the organization undertake the Lean transformation, management itself was not changing. It took the people of ThedaCare to push back to management to help them realize that senior managers must also change how they are accustomed to working, including adopting Lean practices such as standard work. The other lesson was that in a large organization it is difficult to get everybody on a Lean process improvement team quickly, yet it is important to let everyone know what the Lean transformation is and why it is happening. ThedaCare ultimately discarded consultant advice not to provide all employees with some initial Lean training and orientation.

If you lead an enterprise, or a major division in an enterprise, On the Mend will be an extremely useful resource. Because it does not intend to be a Lean primer, read a book such as This is Lean by Niklas Modig and Par Ahlstrom or Lean Thinking by James Womack and Daniel Jones first if you have not already.