Before he even walks into an exam room to greet a patient, Kimberly, Wis., family physician Montgomery “Monk” J. Elmer, MD, already has a good indication of how the patient’s health is holding up. On a rainy day this spring, he had good news for Jim DeBruin, a jovial 79-year-old patient with diabetes visiting for a routine follow-up visit.

“So you’re still passing,” Dr. Elmer said as a smile spread across his face. In his hand, he held a printout of DeBruin’s laboratory test results, showing his glycated hemoglobin reading of 7.6%.

“As long as we’re under eight, you’re OK,” Dr. Elmer added. DeBruin’s blood had been drawn only minutes earlier by a medical assistant at the clinic, which is part of the ThedaCare health system in Appleton, Wis. The sample was analyzed at a lab on site at the clinic.

This just-in-time approach to lab testing and patient care is a principal example of how physician leaders at ThedaCare have earned an outsized reputation within health care for their widespread implementation of the so-called lean-management methods that helped Toyota Motor Corp. become the world’s biggest automaker. Although taking a manufacturing approach to medicine is most commonly associated with hospitals, ThedaCare is implementing the idea aggressively in primary care.

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Chicago Teaching medical students by using virtual electronic health records. Embedding students in clinical care from their first weeks in medical school. Training tomorrow’s physicians to be leaders of interprofessional teams and deliver safer, higher-quality care. Giving students pursuing primary care the opportunity to speed their path to practice and averting dire physician shortages.

These are among the ambitious goals set forth by the 11 medical schools that won approval from the American Medical Association’s expert advisory panel. The $1 million grants awarded to each recipient over five years will give the schools the time and resources to implement changes that the AMA, physicians and educators hope will spark the biggest transformation of U.S. medical education since Abraham Flexner’s 1910 report set the standard for modern physician training.

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