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Knowing this, I have watched with great interest as Kim Barnas and her team at ThedaCare hospitals in Wisconsin worked at transforming their culture by redesigning the system of daily management. After two years of experimentation, discussion, and study, they found a more deliberative approach to leading a lean healthcare system. By changing the expectations of what managers and frontline supervisors actually do each day, Kim and her team pushed the roots of lean deeper into the organization. This encouraged new ways of thinking, which led to new behaviors. Instead of adding continuous improvement to the list of manager’s duties, improvement became the organizing principle of their work. Thus, a new management system emerged and it was clear that this was the secret sauce that so many had been seeking. Kim discovered that changing a leader’s work content changed the leader as well. From frontline supervisors to top executives, new management duties encouraged everyone to become more respectful, improvement focused, and process orientated. Instead of managing by exception—running after today’s unique emergency—they fixed processes. They standardized processes. In doing so, more improvements to clinical processes remained in place. Projects initiated by frontline caregivers were aligned with the hospital’s major initiatives and relevant to the unit or clinic. Continuous improvement became the working method instead of the extra task.
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