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

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