- Email: [email protected]
Interview with John Toussaint, MD
Healthcare 2 (2014) 78–79
Contents lists available at ScienceDirect
Healthcare journal homepage: www.elsevier.com/locate/hjdsi
Interview
Interview with John Toussaint, MD Brian W. Powers n 250 Longwood Avenue, Boston, United States
art ic l e i nf o Article history: Received 16 October 2013 Accepted 19 December 2013
John Toussaint, MD, is the CEO ThedaCare Center for Healthcare Value and the CEO emeritus of ThedaCare. He was also the founding Chair of the Wisconsin Collaborative for Healthcare Quality, a quality and cost reporting initiative, and the Wisconsin Health Information Organization (WHIO), as well as the non-executive leader of the Partnership for Healthcare Payment Reform in Wisconsin. He has participated in many Institute of Medicine subcommittees, including most recently the Value Incentives Learning Collaborative, the CEO Checklist for High Value Healthcare, and the Pay for Performance for Physicians subcommittees. In addition, he has served or serves on Governor Doyle’s eHealth board, the Wisconsin Payment Reform Initiative advisory board, the Center for Healthcare Quality and Payment Reform advisory board and the WHIO board for Wisconsin. Toussaint received his undergraduate degree from Cornell College and his medical degree from the University of Iowa. He is a member of the Editorial Board of Healthcare. Brian Powers: As CEO of ThedaCare you were one of the first executives that applied Lean management strategies to healthcare. Now at the ThedaCare Center for Healthcare Value you are working to spread these strategies. How receptive are healthcare executives to these ideas? John Toussaint: There is a great deal of interest. Much of this is driven by the declining revenues for healthcare from government payors. Amidst this climate, executives are looking for a methodology that simultaneously delivers improved cost and quality. Lean is the only method that works to do that. BP: Have you found that there is more of a demand for these strategies than when you first began this work? JT: Yes. There will be 750 senior executives at our up-coming 2-day site visit to Thedacare. This is up from only 250 two years ago. Furthermore, we will have over 2000 leaders in our workshops covering Lean management, and the principles and practice of Lean. In 2011, there were zero.
n
Tel.: þ 1 131 444 7889. E-mail address: [email protected]
2213-0764/$ - see front matter & 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.hjdsi.2013.12.003
BP: What are the principal challenges faced by healthcare executives as they implement these types of delivery improvement strategies? JT: These strategies are about changing culture. The goal is to have every employee actively identify and solve problems every day, which builds a culture of continuous improvement. This requires that leaders change their behavior. They must shed the usual autocratic behaviors and become mentors, facilitators, and teachers. BP: What can be done to help overcome these challenges? JT: There must be a personal commitment to change. A site visit to a great Lean company can produce an emotional reaction in leaders. This is the best way for them to realize there is a gap in their leadership style. They should visit organizations like Thedacare, Virginia Mason, or the Christie Clinic in Champagne. It will change them forever. BP: Still on the topic of delivery transformation, I wanted to spend a moment speaking about the role of physician leadership. Physicians are increasingly occupying executive leadership roles at hospitals and health systems? What unique attributes can physicians bring to these roles? Are there any shortcoming or potential drawbacks to this trend? JT: Some of the best hospital leaders I’ve seen are physicians. At the same time, some of the worst hospital leaders I have seen are physicians. It’s less about being a physician and more about understanding how to be a great improvement leader. Most business schools do not teach the operational excellence leadership skills needed to be a great Lean leader. I learned it from manufacturing leaders not in formal education programs. BP: You have written about how your successes with Lean at ThedaCare were successful at reducing costs, but ultimately reduced revenue due to fee-for-service payment structures. What payment reforms are necessary to align delivery innovation with improved financial performance?. JT: We need to reward value in healthcare and stop rewarding volume. This means we need to dismantle the fee-for-service payment system and build an outcomes payment system. Personally, I think that some sort of prepaid system such as a per member per month payment or global capitation makes the most sense. We
B.W. Powers / Healthcare 2 (2014) 78–79
gained a lot of experience managing risk when Thedacare owned and operated a health plan. These same skills are crucial now as we begin to manage risk as a delivery system. BP: Are there any payment reform initiatives that you are particularly excited about?. JT: We are trying to create an experiment where the Centers for Medicare & Medicaid Services, commercial insurers, and state Medicaid plans all come together and pay the same way. This will be the next point in breakthrough thinking. BP: Your work at the Center also focuses on price transparency, and there is some interesting work taking place in Wisconsin on
79
that front. Could you speak about that work, and any early lessons that are emerging?. JT: We have created an organization in Wisconsin, called the Statewide Value Committee, to improve healthcare value. This is a multi-stakeholder organization in which each participating organization has agreed to a core set of value measures for value based-purchasing and other activities. Furthermore, we have been publicly reporting physician performance in the state for 10 years. Many of the measures for both of these efforts are those which healthcare executives are already familiar with. The critical step has been developing a consensus for their use at the state level.
Contents lists available at ScienceDirect
Healthcare journal homepage: www.elsevier.com/locate/hjdsi
Interview
Interview with John Toussaint, MD Brian W. Powers n 250 Longwood Avenue, Boston, United States
art ic l e i nf o Article history: Received 16 October 2013 Accepted 19 December 2013
John Toussaint, MD, is the CEO ThedaCare Center for Healthcare Value and the CEO emeritus of ThedaCare. He was also the founding Chair of the Wisconsin Collaborative for Healthcare Quality, a quality and cost reporting initiative, and the Wisconsin Health Information Organization (WHIO), as well as the non-executive leader of the Partnership for Healthcare Payment Reform in Wisconsin. He has participated in many Institute of Medicine subcommittees, including most recently the Value Incentives Learning Collaborative, the CEO Checklist for High Value Healthcare, and the Pay for Performance for Physicians subcommittees. In addition, he has served or serves on Governor Doyle’s eHealth board, the Wisconsin Payment Reform Initiative advisory board, the Center for Healthcare Quality and Payment Reform advisory board and the WHIO board for Wisconsin. Toussaint received his undergraduate degree from Cornell College and his medical degree from the University of Iowa. He is a member of the Editorial Board of Healthcare. Brian Powers: As CEO of ThedaCare you were one of the first executives that applied Lean management strategies to healthcare. Now at the ThedaCare Center for Healthcare Value you are working to spread these strategies. How receptive are healthcare executives to these ideas? John Toussaint: There is a great deal of interest. Much of this is driven by the declining revenues for healthcare from government payors. Amidst this climate, executives are looking for a methodology that simultaneously delivers improved cost and quality. Lean is the only method that works to do that. BP: Have you found that there is more of a demand for these strategies than when you first began this work? JT: Yes. There will be 750 senior executives at our up-coming 2-day site visit to Thedacare. This is up from only 250 two years ago. Furthermore, we will have over 2000 leaders in our workshops covering Lean management, and the principles and practice of Lean. In 2011, there were zero.
n
Tel.: þ 1 131 444 7889. E-mail address: [email protected]
2213-0764/$ - see front matter & 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.hjdsi.2013.12.003
BP: What are the principal challenges faced by healthcare executives as they implement these types of delivery improvement strategies? JT: These strategies are about changing culture. The goal is to have every employee actively identify and solve problems every day, which builds a culture of continuous improvement. This requires that leaders change their behavior. They must shed the usual autocratic behaviors and become mentors, facilitators, and teachers. BP: What can be done to help overcome these challenges? JT: There must be a personal commitment to change. A site visit to a great Lean company can produce an emotional reaction in leaders. This is the best way for them to realize there is a gap in their leadership style. They should visit organizations like Thedacare, Virginia Mason, or the Christie Clinic in Champagne. It will change them forever. BP: Still on the topic of delivery transformation, I wanted to spend a moment speaking about the role of physician leadership. Physicians are increasingly occupying executive leadership roles at hospitals and health systems? What unique attributes can physicians bring to these roles? Are there any shortcoming or potential drawbacks to this trend? JT: Some of the best hospital leaders I’ve seen are physicians. At the same time, some of the worst hospital leaders I have seen are physicians. It’s less about being a physician and more about understanding how to be a great improvement leader. Most business schools do not teach the operational excellence leadership skills needed to be a great Lean leader. I learned it from manufacturing leaders not in formal education programs. BP: You have written about how your successes with Lean at ThedaCare were successful at reducing costs, but ultimately reduced revenue due to fee-for-service payment structures. What payment reforms are necessary to align delivery innovation with improved financial performance?. JT: We need to reward value in healthcare and stop rewarding volume. This means we need to dismantle the fee-for-service payment system and build an outcomes payment system. Personally, I think that some sort of prepaid system such as a per member per month payment or global capitation makes the most sense. We
B.W. Powers / Healthcare 2 (2014) 78–79
gained a lot of experience managing risk when Thedacare owned and operated a health plan. These same skills are crucial now as we begin to manage risk as a delivery system. BP: Are there any payment reform initiatives that you are particularly excited about?. JT: We are trying to create an experiment where the Centers for Medicare & Medicaid Services, commercial insurers, and state Medicaid plans all come together and pay the same way. This will be the next point in breakthrough thinking. BP: Your work at the Center also focuses on price transparency, and there is some interesting work taking place in Wisconsin on
79
that front. Could you speak about that work, and any early lessons that are emerging?. JT: We have created an organization in Wisconsin, called the Statewide Value Committee, to improve healthcare value. This is a multi-stakeholder organization in which each participating organization has agreed to a core set of value measures for value based-purchasing and other activities. Furthermore, we have been publicly reporting physician performance in the state for 10 years. Many of the measures for both of these efforts are those which healthcare executives are already familiar with. The critical step has been developing a consensus for their use at the state level.