A groundbreaking history of aging in the US and an innovative blueprint for revolutionizing geriatric care from Northwell Health, New York's largest health care system. The New York Times described Dr. Robert Butler as "the man who saw old age anew." In his 1975 book Why Survive: Being Old in America, Butler argued that for far too many people old age was "a period of quiet despair . . . and muted rage" and he set out to mitigate it. Nearly five decades since he penned his book, a devoted band of brilliant physicians and others in the healthcare field have realized at least a portion of Butler's dream: to recognize and alleviate suffering among the aging. The Aging Revolution is the story of Butler and his disciples: women and men who saw older distressed adults in hospitals and homes, and worse: being ignored by most of the medical establishment. These revolutionaries could not ignore the suffering, and they set out--individually and collectively--to create entirely new ways of caring for aging adults to ease their suffering and improve their quality and length of life. This revelatory book tells a story never-before told in its entirety, recounting the one of the most significant periods of improvement in American medical history. Readers will learn about pioneering individuals, concepts, and ideas that have improved the lives of millions, including: the women who placed the spotlight on delirium and falls--major issues for older adults; the campaign to build and spread Geriatric and Palliative Care; the small bands of doctors who worked the halls of Congress to create a new program that provides primary care along with home visits from healthcare professionals; and the New York-based foundation that has devoted its mission and millions exclusively to improving care and quality of life for aging adults. Today, as a result, chronic conditions that almost always accompany old age are far more manageable. Older people enjoy more options for work and professional development, for education, for leisure and travel, for sports and maintaining physical strength and mobility. For increasing numbers of Americans, life is healthier and richer in the experiences that matter most. Yet, aging in America can still be a challenge and, too often, particularly for the poor, a painful struggle. The range of mental and physical well-being has almost infinite variations: ninety-year-olds running marathons; sixty-five-year-olds incapacitated by stroke. While this book celebrates the incredible progress and strides made in this field, it also highlights areas that need improvement. The authors lay out specific steps that, if implemented, could super-charge the aging revolution and drastically diminish the total volume of older adults suffering in America.

The moving story of an Irish immigrant's life, from a poverty-stricken childhood in Ireland to becoming a captain of industry, After the Roof Caved In is a powerful, poignant look at how hard work and education enabled one young man to change his life and circumstances completely.  Today, Michael J. Dowling is president and CEO of Northwell Health, New York state's largest healthcare provider and private employer, with over 68,000 employees and over 700 facilities. But he grew up in deep poverty in the village of Knockaderry in rural Ireland, in a small home without running water or a stable roof, in a family with little hope for improvement and a place with little opportunity—and he overcame it all to become wildly successful.  After the Roof Caved In is Dowling's rags-to-riches story of his life and journey from his destitute youth to his realization of the power of education and his eventual departure from his home to attend university in Cork, and onward through his life as he gradually improved himself and his circumstances. Full of memories both fond and painful, this powerful memoir examines the family dynamics of his childhood—including the lives of his deaf mother and arthritic father—as well as the social systems of the time, the politics and concerns of the day, and the way a variety of disparate events came together to help Dowling change his life completely. Most importantly, it chronicles his lifelong effort to rise above the circumstances into which he was born and to create the sort of life he dreamed possible.  For anyone interested in the stories of immigrants, the experiences of the Irish in the mid-20th century, or the value of hard work and education in changing one's life, After the Roof Caved In is an essential read, and a heartfelt, deeply moving meditation on an extraordinary life. 

We are in the midst of what may well be the most confusing, turbulent period in the history of modern medicine. This book seeks to cut through the fog and confusion that enshrouds the health care industry to provide clarity on where the industry stands today and where it is headed. The book defines the major challenges in health care through the journey of Northwell Health, one of the largest provider organizations in the country. The central issues in what is nearly one-fifth of the United States economy are played out daily within this not-for-profit organization. Northwell is New York state's largest workers, and $11 billion in annual revenue. The book candidly portrays key leaders within Northwell on the most vexing challenges in health care: How to provide primary and specialty care spending; how to create and sustain an internal system of continuous learning to enable employees at all levels to stay current in an industry that is changing at warp speed; how to provide emergency services in a world where natural disasters and acts of terrorism are inevitable; how to identify new revenue streams to offset reductions from Medicare and Medicaid; and how to push outside the walls of hospitals and clinics to improve the overall health of individuals and communities by working on determinants of health beyond the typical medical practice. The book exists at the intersection of medicine, business, social and public policy. Harvard's Michael Porter has written widely on health care arguing that it is time "for a fundamentally new strategy," but what, exactly? Where is the industry headed? What do the changes and the turbulence mean for patients, doctors, nurses? This book is the product of a learning journey both humbling and rewarding. Over time, lessons learned, improvements made, innovations conceived, have advanced Northwell Health in ways that, some years ago, might not have seemed possible. Northwell has become a national leader not because it is perfect, but because it remains steadfast in its journey to remain humble enough to know that whatever success may be achieved, the journey is about continuous learning and improvement. The goal of the book is to provide a deeper, clearer understanding of what is happening in health care and why; to help illuminate a pathway forward for patients and caregivers most of all, but also for policy-makers and the employers and others who pay for care.

Since adapting the principles of the Toyota Production System to health care in 2002, Virginia Mason Health System has made enormous leaps forward in quality, safety, patient experience of care, and affordability. It has achieved world-class levels of patient satisfaction and has been honored as one of the safest hospitals in the country. A Leadership Journey in Health Care: Virginia Mason's Story supplies an inside look at process improvement from the world leader in applying Lean methods to health care. It presents key lessons learned as well as the best practices developed at Virginia Mason during its 12-year process improvement journey. Just as important, Virginia Mason's culture of leadership at all levels sets it apart from others in the health care universe. Describing why it's critical for leadership to be actively involved in any process improvement initiative, the book illustrates exactly what leadership looks like at all levels within Virginia Mason. In the book, bestselling author Charles Kenney introduces breakthrough new work at Virginia Mason that most health care audiences have yet to read about. He details the reasons why governance has played such a big role in Virginia Mason's success and discusses a game-changing initiative concerning respect for people. After reading this book, you will better understand the active leadership style that has propelled Virginia Mason's success. By following the best practices and lessons learned, you will be prepared to teach, coach, and encourage your team to achieve streamlined and standardized work, sustained improvements, and increased patient satisfaction. Foreword by Carolyn Corvi, Virginia Mason Health System/Virginia Mason Medical Center Boards of Directors; Retired Vice President and General Manager, Boeing Commercial Airplanes

The moving story of an Irish immigrant's life, from a poverty-stricken childhood in Ireland to becoming a captain of industry, After the Roof Caved In is a powerful, poignant look at how hard work and education enabled one young man to change his life and circumstances completely. Today, Michael J. Dowling is president and CEO of Northwell Health, New York state's largest healthcare provider and private employer, with over 68,000 employees and over 700 facilities. But he grew up in deep poverty in the village of Knockaderry in rural Ireland, in a small home without running water or a stable roof, in a family with little hope for improvement and a place with little opportunity-and he overcame it all to become wildly successful. After the Roof Caved In is Dowling's rags-to-riches story of his life and journey from his destitute youth to his realization of the power of education and his eventual departure from his home to attend university in Cork, and onward through his life as he gradually improved himself and his circumstances. Full of memories both fond and painful, this powerful memoir examines the family dynamics of his childhood-including the lives of his deaf mother and arthritic father-as well as the social systems of the time, the politics and concerns of the day, and the way a variety of disparate events came together to help Dowling change his life completely. Most importantly, it chronicles his lifelong effort to rise above the circumstances into which he was born and to create the sort of life he dreamed possible. For anyone interested in the stories of immigrants, the experiences of the Irish in the mid-20th century, or the value of hard work and education in changing one's life, After the Roof Caved In is an essential read, and a heartfelt, deeply moving meditation on an extraordinary life.

Since adapting the principles of the Toyota Production System to health care in 2002, Virginia Mason Health System has made enormous leaps forward in quality, safety, patient experience of care, and affordability. It has achieved world-class levels of patient satisfaction and has been honored as one of the safest hospitals in the country. A Leadership Journey in Health Care: Virginia Mason's Story supplies an inside look at process improvement from the world leader in applying Lean methods to health care. It presents key lessons learned as well as the best practices developed at Virginia Mason during its 12-year process improvement journey. Just as important, Virginia Mason's culture of leadership at all levels sets it apart from others in the health care universe. Describing why it's critical for leadership to be actively involved in any process improvement initiative, the book illustrates exactly what leadership looks like at all levels within Virginia Mason. In the book, bestselling author Charles Kenney introduces breakthrough new work at Virginia Mason that most health care audiences have yet to read about. He details the reasons why governance has played such a big role in Virginia Mason's success and discusses a game-changing initiative concerning respect for people. After reading this book, you will better understand the active leadership style that has propelled Virginia Mason's success. By following the best practices and lessons learned, you will be prepared to teach, coach, and encourage your team to achieve streamlined and standardized work, sustained improvements, and increased patient satisfaction. Foreword by Carolyn Corvi, Virginia Mason Health System/Virginia Mason Medical Center Boards of Directors; Retired Vice President and General Manager, Boeing Commercial Airplanes

For decades, the manufacturing industry has employed the Toyota Production System - the most powerful production method in the world - to reduce waste, improve quality, reduce defects and increase worker productivity. In 2001, Virginia Mason Medical Center, an integrated healthcare delivery system in Seattle, Washington set out to achieve its compelling vision to become The Quality Leader and to fulfill that vision, adopted the Toyota Production System as its management method. Transforming Health Care: Virginia Mason Medical Center's Pursuit of the Perfect Patient Experience takes you on the journey of of Virginia Mason Medical Center's pursuit of the perfect patient experience through the application of lean principles, tools, and methodology. Over the last several years Virginia Mason has become internationally known for its journey towards perfection by applying the Toyota Production System to healthcare. The book takes readers step by step through Virginia Mason's journey as it seeks to provide perfection to its customer - the patient. This book shows you how you use this system to transform your own organization.

We are in the midst of what may well be the most confusing, turbulent period in the history of modern medicine. This book seeks to cut through the fog and confusion that enshrouds the health care industry to provide clarity on where the industry stands today and where it is headed. The book defines the major challenges in health care through the journey of Northwell Health, one of the largest provider organizations in the country. The central issues in what is nearly one-fifth of the United States economy are played out daily within this not-for-profit organization. Northwell is New York state's largest workers, and $11 billion in annual revenue. The book candidly portrays key leaders within Northwell on the most vexing challenges in health care: How to provide primary and specialty care spending; how to create and sustain an internal system of continuous learning to enable employees at all levels to stay current in an industry that is changing at warp speed; how to provide emergency services in a world where natural disasters and acts of terrorism are inevitable; how to identify new revenue streams to offset reductions from Medicare and Medicaid; and how to push outside the walls of hospitals and clinics to improve the overall health of individuals and communities by working on determinants of health beyond the typical medical practice. The book exists at the intersection of medicine, business, social and public policy. Harvard's Michael Porter has written widely on health care arguing that it is time "for a fundamentally new strategy," but what, exactly? Where is the industry headed? What do the changes and the turbulence mean for patients, doctors, nurses? This book is the product of a learning journey both humbling and rewarding. Over time, lessons learned, improvements made, innovations conceived, have advanced Northwell Health in ways that, some years ago, might not have seemed possible. Northwell has become a national leader not because it is perfect, but because it remains steadfast in its journey to remain humble enough to know that whatever success may be achieved, the journey is about continuous learning and improvement. The goal of the book is to provide a deeper, clearer understanding of what is happening in health care and why; to help illuminate a pathway forward for patients and caregivers most of all, but also for policy-makers and the employers and others who pay for care.