The Lean Prescription

xi

Foreword

It has been my personal and professional good fortune to know Patty

Gabow for well over a decade. at included the period when she was rst

encountering the theory and practice of Lean production, and beginning

to see how it might t Denver Health, the organization that she had led,

brilliantly, for years before.

A leader of lesser curiosity and intellect might well have treated the new

management method casually, as many have done—trying the “quick

study” approach—the “ClisNotes™” version, delegating the tasks early,

moving her own time and attention on to other stu, and setting up a pro-

grammatic oce somewhere down the corridor or down the street, out of

sight if not completely out of mind.

What I saw was dierent, and sorely needed in the ranks of healthcare

executive leader ship and governance. I saw an accomplished executive,

who had every apparent right to rest on her considerable laurels, nonethe-

less begin transformation for real. In retrospect, that is astounding.

When Dr.Gabow began the journey she describes in this book, Denver

Health under her guidance was not a oundering struggling place. Far

from it. Her managerial skill, clinical vision, political savvy, and dedi-

cation to mission had placed her organization at the very front rank of

American academic medical centers and, among them, one of the nest

examples of a totally integrated healthcare system in the nation. Even

though Denver Health was by and large a safety net system with high reli-

ance on Medicaid payment and many patients with no payment source at

all, it had under Dr.Gabow turned a positive margin in every single year

of her leader ship, and had matured an enviable network of community-

based primary care clinics without one whit of compromise in the quality

and energy of the tertiary agship hospital. Indeed, by independent met-

rics, Denver Health had some of the best healthcare quality and outcomes

in the entire nation.

Without a burning platform—in fact, starting on a platform most hos-

pital leaders would kill for—what on earth was Patty Gabow thinking?

Transform? Why?

It is the mark of a truly great leader, and Dr.Gabow is one, to see beyond

the present to the destinations that may lie ahead, and to the icebergs