The Virginia Mason Experience

Prospering by Standardizing Processes and Improving the Patient Experience by Andis Robeznieks, Modern Healthcare.

Dr. Gary Kaplan, chairman and CEO of the Virginia Mason Medical Center in Seattle Washington was recently interviewed about his experience of integrating Lean manufacturing process improvement at VMMC. Paul Plsek, a management consultant, has also written a new book about that experience: Accelerating Health Care Transformation with Lean and Innovation: The Virginia Mason Experience.

Below are a few excerpts from the interview:

On Organizational Change Management
Change is very, very hard in healthcare. We have learned a lot about change management. Not everybody wanted to come along. There were perhaps 10% who were early adopters, 10% who were very resistant to any kind of change and probably 80% of the people—and I’m talking about physicians, nurses and others—in the middle, just sort of saying we’ll see what happens and this too will pass.

I think we surprised people with our perseverance. Today, we’re possibly the furthest along of anybody in healthcare who’s consciously deployed a management method for more than a decade. But the most significant accomplishment is understanding that the pathway to improving quality and safety is the same pathway to lowering cost, and that involves relentlessly taking waste and unnecessary variability out of our processes. This creates a much higher quality, better patient experience.

It creates an opportunity for people to be empowered to use their best thinking to redesign their work. Our staff, who are closest to the work, are the ones who redesigned the work and in so doing reduced the burden of work.

On Physician Resistance
Traditionally, physician autonomy has been thought to be the sine qua non of professionalism, and that only we know what’s in the best interests of our patients. At Virginia Mason, we’ve been able to move from that approach and we understand that healthcare is impeded, not facilitated, by the notion of physician autonomy. Our physicians are actively engaged in supply-chain initiatives that standardize prostheses. One of our early rapid-cycle improvement events in 2001 was standardizing laparoscopic cholecystectomy trays, enabling us to save $700-$800 for every case by getting all the surgeons to realize that customized setups were unnecessary. We found is that if we eliminated nonvalue-added variation, the result is we create time for the value-added variation that differentiates individual physicians from each other and for patient preferences.

On Measurable Improvement
One of the things I’m most proud of is we’re the only hospital in the U.S. to be named by Leapfrog a top hospital in every year that designation has been given. We reduced cumulative nurse walking distance in the hospital by 750 miles per day, which freed up more than 250 hours of time for direct patient care.

On Measuring Outcomes
Outcomes measures have eluded us in healthcare for a long time. We’re getting better, but it’s a challenge. The entire continuum of care is a challenge to measure, given that we have patients coming in for care from Alaska, Montana and across Washington state, and Walmart and the Pacific Business Group on Health send patients here for heart and spine and total joint care. So it becomes quite difficult at times to measure the entire continuum of care.
One of the interesting things we’ve learned is that standardizing processes is really important even when there is no incontrovertible double-blinded study evidence. The standardization in itself allows us to measure and then it allows us to eliminate defect-prone situations. If a team of people do things nine different ways, that creates opportunities for defects to occur, and that’s what we want to eliminate.

On the Impact of Healthcare Reform
We welcome the changes that are here and are coming. More transparency is critical, and it plays right to our sweet spot. If we are able to improve quality and safety and lower costs, that’s going to allow us to succeed in a marketplace that’s more driven by value than volume. We see reform as a catalyst to accelerate our work, and it’s going to help move the entire industry in ways that will improve quality and lower cost.

Policy Issue
VMMC’s process improvement initiative was launched before and thus independent of the influences of the Affordable Care Act. But of course it was not launched in a free market vacuum independent of industry regulatory influences. Dr. Kaplan welcomes the future impact of healthcare reform as an inducement – or at least catalyst – for change at healthcare organizations that don’t have the predisposed wherewith all to affect the kinds of change accomplished at VMMC.

Others are going to disagree. They will argue that innovation and performance improvement flourish best when individuals’ inherent incentives to act in their best interests are rewarded by market-driven rewards. But is that even remotely possible to achieve in an industry that is already so heavily regulated that market-driven incentives are but a myth that stand in the way of collaboration and coordination?


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