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Management on the Mend


Worldwide, the best healthcare organizations have senior managers who lead by example at the front lines of care, delivering better healthcare in an era of continuous change and ever-increasing expectations. These thriving healthcare systems also engage staff at every level to solve problems and embrace change. John Toussaint, MD, who in his seminal book On the Mend chronicled how a large cradle-to-grave health system revolutionized the way care is delivered, now addresses how healthcare organizations everywhere can successfully transition to lean healthcare, creating better value for patients while eliminating waste from the system. Management on the Mend: The Healthcare Executive Guide to System Transformation details a model for lean transformation that shows leaders how to embrace an operating and management system that accomplishes the reciprocal goals of a) empowering all frontline caregivers to practice medicine while finding and solving problems and b) empowering all managers and executives to support the work of the frontline caregivers. “Achieving these dual goals requires a complete cultural transformation,” notes Dr. Toussaint. He explains, “Fundamentally, the two jobs available in a lean organization are problem solver and problem solver support staff. Most healthcare organizations could not look more different from this lean model.” Through the lens of 11 diverse organizations, Management on the Mend illustrates how the following essential steps transform healthcare organizations into lean organizations: Laying the foundation by doing the vital pre-work of establishing, understanding and admitting that change is necessary, both organizationally and personally Building a model cell, an area where lean thinking and organizational resources create a mission-critical transformation that can be used as a demonstration and teaching tool for the rest of the organization Establishing the organization-wide values and principles that will guide the work Creating a central improvement office Redesigning the frontline management system Spreading the work throughout the system Realigning the organization’s people, policies and practices to support this work Overcoming barriers such as medical education programs that churn out individuals rather than team players, the lack of publicly available outcomes data for quality and cost, and perverse payment incentives Reflecting the flaws and triumphs of the many dozens of healthcare organizations around the world the author has studied and assisted, Management on the Mend is the story of many journeys and one conclusion: lean healthcare is not only possible, it’s necessary.
About the Shingo Institute

Housed at the Jon M. Huntsman School of Business at Utah State University, the Shingo Institute is named after Japanese industrial engineer Shigeo Shingo. Shingo distinguished himself as one of the world's thought leaders in concepts, management systems and improvement techniques that have become known as the Toyota Business System. Drawing from Shingo's teachings and years of experience working with organizations throughout the world, the Shingo Institute has developed the Shingo Model™ which is the basis for several educational offerings including workshops, study tours and conferences. It also awards and recognizes organizations that demonstrate an exceptional culture that continually strives for improvement and progress. Those interested in more information or in registering to attend the 30th International Shingo Conference may visit