Virginia Mason Medical Center: Kaplan’s Role and Learnings from Toyota
Virginia Mason Medical Center: Kaplan’s Role and Learnings from Toyota
Introduction
Virginia Mason was founded on 1920, when two physicians decided on a new medical practice approach, sharing one vision, “A single place where patients could receive comprehensive care for virtually any medical problem”.
Over the course of successive decades, practice grew potentially as it evolved to a world class-medical facility. On the tip of twentieth century, the Virginia Mason, being a nonprofit organization (reorganized from partnership), with a 336-bed care hospital and 400 physicians and multiple clinics located throughout the region, was a facing an alarming problem for the first time.
It was clear that by 2000 the Virginia Mason needed to change. It was when Dr. Gary Kaplan was appointed as the CEO and recognized the “sense of crisis” that has been going over the medical center.
Gary Kaplan’s Role on Change and Innovation
It was evident that Virginia Mason was facing a financial problem. But beneath the surface, it was more than money that the Virginia Mason was facing: it was about the clinical quality.
It was less quantifiable than finance, but Kaplan and fellow doctors knew that it was more urgent since it was striking the heart of their core mission.
Kaplan played a pivotal role as he began to question himself and the Medical Center about how could they prove that they were providing the best quality of medicine practice especially when the Institute of Medicine reported that 98,000 people dying annually from medical errors.
Kaplan had been part of the on-going board, discussing about how to counter the problems and about a year time, the Virginia Mason started its plan by being a patient-centered center but it would be physician-driven, “a physician-led place”.
They needed to keep in front of them all the time and that is of the patient. The patient should not have to wait in the emergency room or on the phone. They should strive to give the patient everything they need and only what they need.
But they needed a method on how to achieve their vision and mission, and it was when a series of serendipitous events led to the discovery of the Toyota Production System.
Toyota Production System: A New Challenge
Mike Rona, VMMC’s president, was seated next to John Black on an airplane that led to the discovery of VMMC’s method adaption, the Toyota Production System (TPS).
Kaplan and the board decided that they had a similar goal with Toyota. The VMMC became entrenched in an overwhelming new challenge: how to institute a production model in health care. The TPS reduces cost by eliminating waste of production, time, material, space, movement, and excess inventory. Its principle and tools are:
Just-in-time Production. Produce only what is needed, and only what is needed.
Jidoka (Quality Control). Detect abnormalities in the production process and immediately halt work to respond to them.
Standard Work. Streamline processes to eliminate nonvalue-added activities and to make abnormalities glaringly obvious.
Innovation. Emphasize innovation by frontline workers to solve production problems.
Kaplan and Rona however, experienced a little resistance to garner support. It was on 2002, that senior executives of VMMC visited Toyota in Japan and began to realize that Toyota’s Production system can be used even in Health Cares.
Virginia Mason Production System: Learning from Toyota
In 2002, Virginia Mason embarked on an ambitious, system-wide program to change the way it delivers health care and in the process improve patient safety and quality. It did so by adopting the basic tenets of the Toyota Production System (TPS), calling it the Virginia Mason Production System, or VMPS.
They also implemented a No Lay-offs policy wherein employees would be trained to move to other areas when their units improved efficiency to the point of being overstaffed.
Value-stream Mapping. A simple flow chart with medical-centered metrics. It is visually mapping the flow of steps and through that; employees can see the waste, the opportunity, and the defects.
The 5s. A system for organizing physical space which stood for: sort, simplify, sweep, standardize, and self-discipline.
The 3P (Production, Preparation, Process). An improvement strategy used to redesign space according to flow which enhances service delivery in the convenience of the patient and patient visitors.
Everyday Lean. Encouraged employees at every level to participate in adding value to patients need and reducing waste. It standardized submitting of proposals and solutions. It also recognized top three employees in a monthly basis.
Patient Safety Alert System (PSA). PSA applies whenever a safety hazard or mistake was identified. The medical procedure will be aborted, and the whole team of a department, including the Chief of Medicine, the Vice President of Quality Compliance and including the CEO will conduct a root-cause analysis to address the underlying problem.
Bundles. Is a collection of best practices from medical literatures and Institute for Health Care. VMMC adopted specific steps to prevent ventilator-acquired pneumonia, surgical-site infection, and central-line infection.
Adaptability of VMPS to other U.S. Hospitals
Kaplan’s way of making the VMMC successful was drastic and risky. Other U.S. hospitals can learn from VMMC and adapt its system. If a health care can do it, they why not as big as hospitals?
But, they should have a strong implementation, innovative leadership, commitment and skill.
Physicians should also be involved in hospital governance, truly care for their patients and not just by being after the payment.
Overall, it should start for leaders to have passion. Leaders need to care and to feel emotionally connected with their work and their vision. They need to share that passion and inspire others. They need to never lose sight of why they went into medicine.
But just appealing to the heart without a rational and intellectual foundation is also not the ultimate or best leadership approach. They should also consider the resources and think of alternatives to counter any problems that will occur. It is about having the best doctors, but surrounding them with the best systems. Similarly, you want to get great nurses and others, and surround them with the best system so that they can do their best work.
A shared value and a shared goal make more successful organization but they would need both the system and the highly talented people working in that same place.
