In 1969, childbirth included hand restraints and relegated mothers to a silent, passive role rather than recognizing them as active participants. Women had no say in how to deal with labor. Lamaze, for Maribeth Hetherington’s doctor, registered as cultlike.
But welcoming her first child not only made Hetherington aware of Lamaze; it made her recognize the need for it. Her love of teaching—she’d majored in secondary education—and her desire to help other women inspired her to instruct child-birthing classes. She then returned to school for the required nursing degree. “It was empowering for a woman to have some level of control and involvement in the birth of their child, and that was never there before,” she says.
Despite switching career paths, Hetherington’s pursuit of teaching never waned. In fact, it became an integral thread in her profession. While working in hospital nursing at Affinity Health System, she taught long-term-need patients how to self-administer IV medications. “When patients had a vested interest, they could learn so much so quickly,” Hetherington says. Her effort quickly gained popularity and turned into a full-fledged home-infusion program. “It’s very satisfying, I think, to be part of someone’s development and then kind of stand in the wings and see them succeed,” she says. “I’ve always enjoyed that.”
Throughout her 33-year nursing career, her numerous roles have included clinical, middle-management, and executive-leadership positions in integrated hospital systems, managed healthcare (that is, regional and national HMOs and PPOs), and home healthcare.
As the vice president and chief nursing officer at ThedaCare, Hetherington helped lead the organization’s hospitals to be one of the first healthcare organizations to adopt Toyota’s “lean” management system. During this massive cultural transformation, she oversaw the clinical standards for two hospitals in the system and led several system-wide initiatives. Among them was the development and implementation of an innovative, new care model. It reduced a number of downstream wastes, elevated the nursing role, decreased cost per case by 25 percent, decreased length of stay by 21 percent, and ultimately increased nursing, physician, and patient satisfaction—all while producing stellar clinical quality outcomes before her eventual retirement.
One organization that took notice, however, was Ministry Door County Medical Center, which later enticed Hetherington to step out of retirement and into the position of chief change officer. She initially agreed to a short-term role, but now, more than five years later, she’s still working on process improvement for the Wisconsin-based medical center.
“We’ve been working over the past few years creating a closed-loop management system—integrating evidenced-based leadership principles along with lean thinking to engage and empower everyone on a daily basis in a constant quest for improvement,” Hetherington says. “‘Lean’ provides the methodology to it.”
She also helped create aligned organizational strategies and goals that cascaded down to divisional leadership and to the front line.
This revised process encourages staff to engage in daily problem solving. “We are an organization on a cultural transformation where engaged team members incorporate the philosophy that improving the work is the work,” Hetherington says. Leaders, she explains, mentor their teams by asking vital questions: “What does it mean to win? Are you winning? How can I help you win more often? And if you are not winning, what are you doing to improve?”
To make this work, each of the 44 departments at Ministry Door County Medical Center has a visual management board that informs all resulting efforts. Focusing on five key pillars—culture, service, quality, finance, and growth—the departments then work on their specific metrics and improvement areas. As a whole, the organization aims to implement 100 ideas monthly, to foster continuous improvement.
As with any change, there are a few slow adopters—managers reluctant to relinquish power and frontline employees shirking the opportunity for additional responsibilities. But overall, feedback remains positive. “It’s just blossomed in the departments,” Hetherington says. “There are so many smart people and people who want to have that say in their work.”
Beyond her own leadership, Hetherington attributes the initiative’s success to a few key factors: critical CEO buy-in; in-place cultural elements, including principle-centered leadership, respect, humility, and being people-oriented; avoiding layoffs; and the approach itself. “There are lots of different tools you can use, but it’s only 20 percent tools and 80 percent people and culture,” she says.
With employee commitment scores being the highest in the entire Ministry Healthcare System, Ministry Door County Medical Center’s method proves the value of employees owning their roles. According to Hetherington, people feel empowered, valued, and part of the process. And that is what Hetherington loves.
“I think it’s helping other people develop—being able to teach someone to do something they didn’t think they were capable of,” she says. “It’s very exciting for me.”
Despite the immense effect that her initiatives have had, Hetherington notes that cultural transformations don’t just happen overnight. “We started this four years ago, and while we have accomplished a lot, we’re still in kindergarten,” she says. “There’s so much more to be done.”
Photo by Jason Mann