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. The authors know this firsthand: This happened at Wisconsin-based ThedaCare. When one of the authors (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. Through the authors’ research in health care and other industries, they’ve identified a set of practices that can stop this collapse and sustain a culture of continuous improvement after the departure of a leader who was passionate about TPS. They include the following: incorporating TPS in succession planning for the CEO and board members, instilling lean behaviors in managers at all levels, creating your own success stories, and establishing a TPS operating system.
