Urgency, leadership, vision and culture…does Healthcare have this?

Hearing Virginia Mason Health System’s CEO, Dr. Gary Kaplan, speak today at the WCBF Lean Six Sigma Healthcare Summit makes it quickly clear why Lean is the growing undercurrent for a move to accountable healthcare. Virginia Mason was in trouble in 2000 and losing money, its best people, and potentially, their vision.

The clues were found across the organization from publicized mistakes to low worker morale. Virginia Mason had strong indicators that poor quality was catching up not only with an industry that consistently registers a 3% error rate, but with their healthcare network in particular. But what do you do in a system that is in decline because the system is failing not just patients, but doctors and nurses, too?

They needed a leadership change…and even more importantly, a new management system.

Culture change

They had the benefit of being a neighbor to Boeing, where Lean and the Toyota Production System were being used to make remarkable progress in bringing the time to produce aircraft down to less than half while increasing quality. Mistake-proof processes done in standard ways were Boeing’s answer and Virginia Mason suspected that healthcare needed a similar solution. They needed to standardize work and become a more efficient, safer organization.

But to get there required a tectonic shift. Nothing could change until the organization and its physician leadership understood that the real customer of healthcare was not, in brutal reality, the patient, but the doctors and senior staff who make up the care system. Kaplan gives evidence that everyone can understand: The number of discharges on the weekend, which drop significantly as the 5-day-per-week medical staff sets the release rules, which mean “if not Friday, then Monday.” If that isn’t staff-centric, what is?

Virginia Mason developed a plan that put the patient at the top of a pyramid of supporting concepts that include vision, mission, values, strategies and foundational elements. All of this sits atop the production systems (the base layer of the pyramid): Vision and values first, systems later.

The Compact

But change comes slowly, especially when the people involved are some of the smartest and best educated in the marketplace. Doctors aren’t ‘raised’ in a culture of collaboration or shared vision. The Hippocratic Oath doesn’t say much about leadership. A physician-centered world view prevailed in a ‘Traditional Compact‘ of protection, autonomy and entitlement. It had to switch to the needs of society, competition, and the organization’s strengths. They had to create the Virginia Mason Medical Center Physician Compact. This new system of ‘gives’ and ‘gets’ was foundational to change.

The results are dramatic and industry leading. Virginia Mason Medical Center is the post child for excellent healthcare, patient satisfaction, and staff engagement.

Seeing is believing

Kaplan is about to embark on his 13th trip to Japan. Seeing is believing and they’ve learned that organizational buy-in is everything. These trips are a key part of how they change culture in the organization. Staff see standard work in action and its remarkable results. But does a process focus stamp out positive change in the organization? Kaplan answers that age-old process challenge with, “Without standard work, there can be no creativity and innovation.”


Categories: Continuous Improvement, Disciplines, Healthcare, Markets

Author:Chris Taylor

Reimagining the way work is done through big data, analytics, and event processing. There's no end to what we can change and improve. I wear myself out...

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10 Comments on “Urgency, leadership, vision and culture…does Healthcare have this?”

  1. Ron Webb
    May 17, 2012 at 8:25 am #

    Chris, this post gives me hope! It sounds like an amazing story of not only how a healthcare organization can make a turnaround based on sound quality principles, but also a great example of how healthcare is not so different from other industries that it can’t learn from them.
    Boeing is truly a leader in implementing continuous improvement across their organization. Have they had issues? Sure. But, that is a part of continuous improvement, and it isn’t about the issue or mistake, it is about how you respond to that issue or mistake.
    Seeing Virginia Mason take on these issues (and I’m sure they hit many hurdles), and seeing them get these results and continue to progress is amazing. Many healthcare organizations would love to be where VM is right now and just stop and cost. But, as we see all the time in organizations that really adopt this culture, they NEVER stop improving.
    Kudos Virginia Mason and your staff.

  2. May 17, 2012 at 10:52 am #

    Thanks Chris for the great blog post, and covering a topic we at Virginia Mason Medical Center are so proud of. It certainly hasn’t been without learning opportunities along the way. Many people are amazed that we could take a manufacturing system used at Toyota and then apply those concepts into the health care setting. The results have been tremendous and make our employees feel more engaged in the work they do.

    Our blog: http://www.virginiamasonblog.org is a resource for insights along the way to creating a perfect patient experience.

    -Mike Sprouse, Associate Director, Communications

  3. Howard Landa, MD, CMIO Alameda County Medical Center
    May 17, 2012 at 12:47 pm #

    Being in an organization that is just beginning it “Lean” Journey, I have been very impressed with the potential for real change, starting at the process level and extending to real cultural change. Change management starts with intellectually understanding the need for the change but the managing it requires being able to communicate the importance at an emotional, and at times a visceral level, while simultaneously making the right thing to do, the easy thing to do. Those are the aspects that Lean can impact. The early explorations into identification of waste and suboptimal processes appeal at the gut level (the elephant for fans of “Switch: How to Change Things When Change Is Hard”) and the later stages help make the path to “better” easier to follow. It is actually fairly simple, but not at all easy!

  4. May 21, 2012 at 9:04 am #

    I’m intrigued by Virginia Mason’s focus on physician behaviors, moving from physician-centered care to patient-centered care, and the use of a physician compact to achieve the change in behavior. The categories of “what you give” and “what you get” helps. I’ve seen some companies link the behaviors to personal development. I wonder how Virginia Mason tied the physician compact to performance measurement and personal development.

    • May 22, 2012 at 3:01 pm #

      Posting on behalf of Dr. Gary Kaplan (comment by email):
      Brad –
      The Physician Compact is a poweful foundational document and was followed by a Leadership and then Board Compact. We use it in the hiring and recruiting process as well as in the performance management processes. Our physicians are held accountable and our Board holds me and the leadership team accountable for the organizational commitments in the Compact. I can sincerely say that we would not have made the progress we have made over more than a decade if we had not invested in the Compact work very early in our journey.
      Thanks for asking

  5. May 22, 2012 at 8:16 am #

    Thanks Bradford. The compact is a living document. The CEO starts out his monthly meeting with physicians by reviewing the strategic plan and then the compact. It is used daily by the chiefs in meetings with providers over behavior issues. Behaviors outlined in the compact have been incorporated into Group Effort, which is measured annually and linked to compensation. The compact also outlines the obligations of the organization to the physicians. This includes facilitating teaching, education and personal development of providers.

    – Joyce Lammert, MD, Chief of Medicine

  6. Howard Jeffries, MD, MBA, Medical Director, Continuous Performance Improvement, Seattle Children's
    May 22, 2012 at 2:54 pm #

    Thanks for this discussion of the challenges involved with changing culture, especially when physicians are involved and the focus on the patient In order for healthcare organizations to achieve the most from lean transformations, they need active participative physicians. At Seattle Children’s, we continue to explore new methods to increase our physician engagement with continuous lean improvement activities. Much of the improvements that we have made and hope to continue to make have only been possible with the active involvement of front-line physicians, as well as our physician leaders. The initial, hard conversations that we had to focus our activities on the patients and families as the ultimate customer have help us immensely on this journey towards physician engagement.

    • May 22, 2012 at 2:59 pm #

      Thanks for the comments, Dr. Jeffries. This engagement piece is a great topic…how to get people to do what’s right over what pays well (in the near term) and to cooperate when they’re used to being autonomous.


  1. Healthcare, Your Process is Your Product | BPM For Real - May 20, 2012

    […] About Successful Workplace ← Urgency, leadership, vision and culture…does Healthcare have this? […]

  2. PART 1: Would you like to improve your organization’s relationship with your physicians? « Virginia Mason Medical Center Blog - May 30, 2012

    […] more on physician compacts, see Successful Workplace, which recently addressed the topic, leading to an interesting […]

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