Hospital leaders attribute process improvement with turning around the organization

In Seattle, Washington, one of the nation’s earliest hospitals to embrace and implement Lean and the Toyota Production System reports strong improvement in clinical care, along with sound finances. This is positive affirmation for those clinical laboratories and pathology groups that are using Lean methods in their own organizations.

It was almost 10 years ago when the 336-bed Virginia Mason Medical Center (VMMC) took its first steps to implement Lean. During the academic medical center’s decade-long journey, use of out-of-the-box thinking and process improvement methods helped VMMC earn a slew of national recognitions for its award-winning outcomes produced by Lean. It calls its flavor of Lean the “Virginia Mason Production System.”

Restoring Financial Stability at Virginia Mason Medical Center

Ten years ago, VMMC faced difficult challenges as a healthcare provider and money was one of them.

“We were already close to closing on our bet-the-farm strategy,” said Gary Kaplan, M.D., CEO and Chairman of VMMC, “and it didn’t feel good, but it actually allowed us to have some conversations we might not otherwise have had.”

In a Healthcare Informatics article, Kaplan said that the turnaround for VMMC began with the realization that successful organizational principles in other industries could be transferred to healthcare.

(Here is a new book authored by Charles Kenney and published by Productivity Press that outlines how Virginia Mason Medical Center used Lean and process improvement methods to achieve its decade-long transformation into an award winning medical center.)

(Here is a new book authored by Charles Kenney and published by Productivity Press that outlines how Virginia Mason Medical Center used Lean and process improvement methods to achieve its decade-long transformation into an award winning medical center.)

Pathologists may want to take note of this fact. Kaplan looked outside of healthcare to identify management strategies and techniques used by successful companies. He then adopted these and introduced them into his hospital. Lean and the Toyota Production System were central to Kaplan’s management plan.

“There are a lot of innovations in this [performance improvement] work, and there’s a lot of out-of-the-box thinking taking place,” he said. “And number one was the realization that our own industry did not have all the answers. Not only that, the [hospital] industry was unconsciously a part of the problem—or [a] set of barriers—[that] we needed to break through.”

Several other epiphanies occurred to senior leadership at Virginia Mason Medical Center as well, once they embarked on their journey of discovery. One crucial realization was that the patient, and not VMMC itself, was the true customer.

Lean and Quality Management Methods Put Patients First

“That’s something that’s ongoing,” said Kaplan. “Because the norm in healthcare is so deeply ingrained, and we’re so acculturated, that it’s an ongoing challenge—but critically important. Because before we could look at other industries, we had to realize we were not the customers.”

Other process-improvement steps that took place at VMMC included:

  • Aligning expectations through “deep conversations” to foster widespread change,
  • “Owning” the final Virginia Mason Production System, and declaring it the only production system that would be run at VMMC,
  • Securing buy-in of all senior leadership at the hospital.

As a hospital CEO, Kaplan is refreshingly candid about the problems facing hospitals. “We’ve got some serious issues in healthcare, and we need the public to understand what they are,” said Kaplan. “In fact, there are plenty of people in healthcare betting on the naiveté, or the impenetrability of the public to not be able to change their thinking. So I want the public—and particularly the employers—to understand not only that they have skin in the game, but that they also have lots of power.”

Kaplan went on to say that IT is a critical element of process redesign. Having accurate and real-time information is what drives processes that are designed to achieve zero defects. However, for IT to be successful, organizations must first remove dysfunctional processes prior to automation.

“You have to redesign your work first,” he said. “The data comes first; and IT can help eliminate manually based errors.

“You have to realize that the status quo is unsustainable, and that we as leaders have an obligation. That management courage—leadership courage—is probably the single most important thing you need to have, and that leaders can become champions,” Kaplan concluded.

Dark Daily
has been an early and ardent voice to encourage pathologists and clinical laboratory managers to understand and adopt process improvement principles such as Lean and Six Sigma. In fact, since around 2003, in many hospitals, it was the clinical laboratory that was first to implement Lean methods. Often, it was the success of these Lean projects in the medical laboratory that caught the attention of the hospital administrators, and led to a wider use of Lean, Six Sigma, and similar methods in other areas of the hospital or health system.

—Michael McBride

Related Information:

Transforming Culture, Transforming Care: Virginia Mason’s Groundbreaking Journey to Healthcare Reform (Healthcare Informatics)

Executive War College 2011 special session audio recordings: Lean for Lab Leaders!

2011 Lab Quality Confab Process Improvement Institute