Acknowledgments – Becoming the Change: Leadership Behavior Strategies for Continuous Improvement in Healthcare


This book has been a big team effort on a journey that has taught us so much. We have been blessed with many who have crossed our paths and changed the course of our mindset. Without the many experiments, teachers, coaches, and mentors from around the world, this body of knowledge would not have been possible. Our role has been to work with and observe many healthcare leaders as they learn the methods of organizational excellence. Leaders have helped us to create clarity by testing hypotheses, practicing new ways of thinking, and helping us learn what leaders need to know to transform organizational culture for improvement. This has occurred in many countries and in very different cultures. We have been humbled by the amazing work of dedicated healthcare leaders as they change themselves. As we have learned from them, we have tested and improved both our thinking and our learning systems with the intent to help others learn the concepts, tools, traits, and behaviors that make up the organizational excellence method. In fact, we have standardized much of the learning content, which we have outlined in this book. Now we and you can continue to learn from and improve it.

As a community, we grow and delight in each other’s success and contributions. We would like to expressly thank the myriad of leaders who have contributed to this work. These people and many of you continue to challenge, influence, and inspire us every day. For that we are sincerely grateful.

A special thank you to those who allowed us into their world as this book was written. Your reflection and willingness to share your personal thoughts as well as the work of your organization is so much appreciated. It is the backbone of our book.

Dr. Susan P. Ehrlich, CEO of Zuckerberg San Francisco General Hospital; Dan Schuette, former Board Chair of St. Charles, and Joe Sluka, CEO, St. Charles, Bend Oregon; Megan Haase, a board member, family nurse practitioner, and the CEO of Mosaic Medical of central Oregon. Don Shilton, retired CEO, St. Mary’s General Hospital; Christine Henhoeffer, RN, and a past board chair of St. Mary’s General Hospital in Kitchener, Ontario. Eric Dickson, MD, CEO of UMass Memorial Health Care in Worcester, Massachusetts. Kathy Krusie, senior vice president, Community Physician Network Operations at Community Health Network. Grey Dube, CEO of Leratong Regional Hospital Johannesburg, South Africa, and Gladys Bogoshi, CEO of Charlotte Maxeke Johannesburg Academic Hospital, Gauteng province, South Africa. Carlos Scholz-Moreno, director of strategic initiatives for a large multispecialty physician group in Northern California; Didier Rabino, lean sensei, Value Capture, and former vice president, HealthEast; Kathryn Correia, CEO, Legacy Health and former CEO, Health East. Georgina Gardner, RN, manager of the pediatrics unit at UMass Memorial; Kathleen Hylka, director of Strategic Space Planning at UMass Memorial. At Berkshire Healthcare NHS Foundation Trust: Julian Emms, chief executive, Rosemary Warne, clinical director, Nikola Pollard, head of financial transformation, and Alex Gild, CFO. At UMass Memorial: Tod Wiesman, chief learning officer and VP of organizational people development, Laura Flynn, director of performance, learning, and education, Jena Adams, a consultant in organizational and 230people development. Sandra Geiger, SVP of People at Atrius Health; Robert Azevedo, MD, physician in chief of a large multispecialty physician group in Northern California; Al Pilong Jr, former COO, Munson Healthcare and CEO of Novant Health UVA Health System; Eliza (Pippa) Shulman, DO, MPH, Atrius. The innovators, teachers, and coaches of the Catalysis faculty: Adam Ward, George Higgins, and Ted Toussaint. And Heidi Betzinger, leader of the Catalysis Development Value Stream.

We were also supported and influenced by so many others.

We are grateful to Margie Hagene, Catalysis faculty. Her work with personal A3 and coaching is groundbreaking, and without her clear vision, great communication, and dedication we would not have been able to connect traits and behaviors of leaders as a gap in the transformation journey.

A special thank you to Karl Hoover, Catalysis faculty and wonderful coach who developed the idea of using radar chart assessments for personal improvement.

Thank you to our Catalysis board of directors: Kathryn Correia, Orry Fiume, Mark Hallett, George Koenigsaecker, Kevin McNamara, John Shook, Steve Shortell, Kevin Shulman, Ken Snyder, Jeff Thompson, Peter Ward, and Lisa Yerian. Your guidance has helped us thrive and stay true to our vision and mission

Thank you to the Catalysis staff—you are a brilliant team of people. Without you, John and I would be lost and much less effective. We are grateful to you every day. A special thank you to Heidi Betzinger, Angela Brubacher, Nicole Christensen, Karen Flom, Peter Mariahazy, Paul Pejsa, Rachel Regan, Sara Thompson, Stephanie Van Vreede, Brian Veara, Chris Weisbrod, and Sara Woerishofer.

Our appreciation to the Shingo Institute, Utah State University, for the deep work they continue to inspire and develop. Our work would not be possible without their leadership and model.

We are saddened by the passing of Paul O’Neill, who died the month before this manuscript was completed. He was a Catalysis founding board member and truly the world’s greatest safety leader. He embodied every behavior we have written about and inspired us all.

Our roots lie with LEI: John Shook, James Womack, Jean Cunningham, and Josh Howell—thank you for jointly publishing this piece of work. We were born from the LEI model and continue to be inspired by your work. We value our relationship as we share commitment to the lean community.

We share a great sense of gratitude to Emily Adams; without you the community would not hear our message. Thank you so much for demanding clarity while developing a cohesive message and helping us to author a collection of learning.

Thank you to Helen Zak; we still feel your voice and mission as we work through how to present new thinking to the community. As the leader who began the forums model—thank you for creating a system for learning, sharing, and connecting with executive leaders around the world. This model continues to grow and improve with the support and leadership now provided by Rachel Regan, Kathy Franklin, Elizabeth Warner, Pam Helander, and Elaine Meade.

The foundation of our work often lies with all of our Catalysis Healthcare Value Network members past and present. Thank you for the commitment to learning, experimenting, and sharing that has built a community of operational excellence. Your voices resonate as we ask you to share your experiences and influence each other.

We have learned so much from all the leaders in our CEO forums, US and European. As they share their development 239and experiment with their learning in the work, we can bring forward guiding examples for others to try. This book is full of the evidence they have provided.

We continue to be committed to our work in South Africa. A special thank you to Norman Faull and Anton Grutter from Lean Institute Africa for bringing us into their work. Together we are making a difference in a part of the world that has few resources but great passion and heart for improvement.

Much of our work is focused on the executive and board leadership. Without our valued partners, Value Capture and KPMP Canada/UK, to extend our reach and focus on the ground, we would not be successful. Our partnerships have made us all stronger and extended our reach around the world. Jake Raymer, founder of IEX, we are so grateful for the relationship we have developed over the last years. Your insight is most evident as we discuss strategy deployment and the x matrix. Theresa Moore, you advanced our thinking and standardization in so many ways! We appreciate your partnership.

Our work continues because of our faculty. This group of dedicated practitioners, leaders, teachers, and coaches continues to be the backbone of who we are. You share our vision and spread our mission though the transformation process and bring with it additional insight that helps us all continue to improve. A sincere thank you to Katie Anderson, Joanne Bicknell, Lydia Chudleigh, Yvonne DeGroot, Mike De Luca, Jennifer Dieter, Patsy Engel, Mark Graban, Nancy Gurnee, Michael Hoseus, Jeff Hunter, Tim Johnson, Jim Marks, MD, Jill Menzel, Mike Orzen, Steve Player, Mike Radtke, Maryjeanne Schaffmeyer, Jason Schulist, Don Shilton, Scott Smith, Ted Toussaint, Adam Ward, Didier Rabino, Mark Hamel, and Linda Mirkes.

Our gratitude continues for all our teachers, mentors, and coaches. Thank you for continuing to share your insight, support, and gifts with us. Without Jose Bustillo and George Koenigsaecker, we may not have found the path that our journey is now grounded in.

Tom Hartman joined us to develop our executive coaching. His deep knowledge of lean, executive roles, and coaching made us better. As we worked together we are so grateful to him for making the standards explicit. He helped us to standardize our coaching approach based on the Shingo principles. He also helped us apply the principles to improve our lean management system training.

Our families are always the greatest source of support and inspiration. In fact, they are the team that keeps us going. They see us for who we are and challenge our thinking in different ways. Without them the grounding in our work would suffer. We cannot express the gratitude we feel for their unconditional love and dedication that gives is the courage to continue this work. To our true partners in life, John’s wife, Susan Toussaint, and my husband, John Utrie, we say thank you!