A number of health systems have scored impressive gains in improving outcomes and patient satisfaction and lower costs by applying the Toyota Production System (TPS) to redesign “lean” clinical and administrative processes, eliminating waste and boosting quality. But in all too many cases, when the leader who championed TPS left his or her organization, these efforts began slipping. We know this firsthand: This happened at Wisconsin-based ThedaCare. When one of us (John Toussaint) left in 2008, its performance in terms of quality (as measured by the Centers for Medicare & Medicaid Services’s metrics for Next Generation accountable care organizations) fell from best in the nation to middle of the pack.
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