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.
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.
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.”