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John S. Toussaint

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A plea for hospital ‘management by process’


John S. Toussaint, M.D.,  CEO of the Thedacare Center for Healthcare Value discusses how hospitals can’t approve outcomes without better managements.  He is the former CEO of Thedacare, an integrated health system in Wisconsin, where he introduced the Toyota Production System principles in 2003.

He makes a pitch in this Harvard Business Review piece for “management by process” instead of the traditional  “management by objective.”

He says among many other things: “{O]ld-fashioned management-by-objective systems often work to actually undermine all of the good works by those frontline improvement teams.”

Management by objective “encourages certain behaviors, such as top-down bureaucracies and seeking whom to blame for problems or unmet goals instead of how to fix or achieve them. Information sharing is often seen as more threatening than helpful.”


“The healthcare organizations that have switched to management by process train every leader — from shift supervisors to senior executives — to lead their teams in problem solving with the scientific method. In this case, however, managers and executives are not expected to fix problems; they are trained to facilitate problem solving by those that best know that work.”








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