“Three jumbo jets,” my co-worker, SHARE staff-organizer Will Erickson, said to me, just about a year ago. “That's how many people we kill every day in this country, despite having the supposed best healthcare system in the world.” It’s a rough quote of something that he had heard during his own trip to check out Thedacare. Now that SHARE staff-organizer Janet Wilder is just back from her visit to Appleton, I'm reminded of this conversation. I think it provides some useful context for Janet's more recent report. Here are some of Will's impressions:
KD: What is ThedaCare?
WE: ThedaCare is a mid-sized hospital system in northern Wisconsin. It's got about 5500 employees. So, it's half the size of our place, but spread out. The real reason Thedacare is interesting is because it went from being, you know, a decent hospital, and it became one of the first hospitals in the country -- in the early aughts, under the leadership of this guy John Toussaint -- to try to figure out why factories make so many fewer errors than hospitals . . . despite the fact that hospital staff are so extraordinarily well-trained.
KD: Factories?
WE: I think John Toussaint is an interesting guy. When he became CEO, he figured, you don't get to be CEO forever, so you need to pick one thing that you can work on. Basically he was to bring Lean into the hospital. He did it because he was so horrified by the degree of death and disability that our healthcare system creates. You know healthcare is the third leading cause of death in the country? You’ve got heart disease, then cancer, and then being a patient. Only so many of these are like “oopsie” medication errors. They’re system errors, times when the field of medicine knew what would have saved a person, but that thing didn’t get done.
KD: So ThedaCare’s reputation grew out of an idea that hospitals should stop allowing unnecessary deaths?
WE: Basically, yes. That's what he Toussaint kept saying over and over while we were there: three jumbo jets. That's how many people we kill every day in this country, despite having the supposed best healthcare system in the world. That defect rate would not be tolerated in any other industry. So Toussaint figured, you don't get to work on everything--so my thing, the thing that I was gonna do--was figure out how to eliminate those kinds of errors. And we're gonna do that through our processes.
KD: Taking care of patients is different from making snowblowers. Why did they think that factory production methods would be appropriate in a hospital?
WE: Toussaint basically said, I went to my friend Don Berwick asked, ‘What other hospitals are doing this?’ And he said, ‘you could be the first one.’ So Toussaint spent some number of months touring around, looking at factories, trying to figure why their defect rates are so low. He got criticized for that. His response to that was, if only we treated patients as well as the guys down the road treat their lawnmowers, we would be saving a hundred thousand people every year in this country.
The long and short of it is that ThedaCare now, ten years later, is the safest, the cheapest, lowest-mortality hospital in the country. They are now able to see to treat twice as many patients.
KD: Don’t employees there worry they could put themselves out of a job if they’re too efficient?
Thedacare really really believes in -- they evangelize about -- their no layoff philosophy. They have a commonsensical view that the people are gonna be wary of of improving themselves out of a job, or their friends out of job.
KD: So how did they do what they did?
WE: They did all of that by focusing on three things. They're always trying to improve quality, lower cost, and engage staff. This is where John Toussaint really started to catch my attention. He said something like, You know, it's easy to work on one of those things. You can go through and make a particular system cheaper by slashing and burning, but your quality will go down, and your staff is going to be angry. Or you could, I suppose, go around and hand ice cream cones out to the staff to make them happier to work there. Maybe that would work for a little while. But the magical thing about healthcare is that as you improve quality, you lower cost. But you can't really improve quality without without engaging staff.
Your people are the same as our people. They’ve gotten into the profession for the right reasons, to come to work every day, wanting to do an awesome job, deliver great care. Shame on all of us hospital leaders for perpetuating the systems that prevent them from being able to do that, to live out their vocation. People come to work wanting to doing awesome job. They want to work in harmony with their team and their institution. They want to have meaningful work.
KD: That sounds like stuff that SHARE has been saying all along, explaining to hospital leaders that if they want to improve systems, that has to be done by the people who know the work best, the people who do it every day. We’ve seen a lot of dud ideas from previous leaders of our hospital. They hire outside consultants, contract trainers who preach trendy customer service techniques, and fall in love with successful hospitals elsewhere, little of which has improved the work-life of SHARE members. What made you interested to go all the way to Wisconsin to check out ThedaCare firsthand?
WE: Partly, I went because I was accepting an invitation from Eric Dickson. He’s very interested in the model of healthcare that ThedaCare provides. I went with a few different VP’s and Directors from UMass Memorial. We were all scoping the place out. Going there, I knew that ThedaCare has front-line employees at the center of the decision-making, and I’m looking for any excuse to make that happen in our hospital.