Part 2 of 4, Full Interview
Gary S. Kaplan, M.D. has been chairman and CEO of the Virginia Mason Medical Center (VMMC) in Seattle since February 2000.
“Lean” feels pejorative sometimes. Cut to the bone. That kind of thing. Up until about two months ago I liked to call it the “Toyota Production System applied to healthcare.”
We call it the Virginia Mason Production System [VMPS]. Lean is the technical method that we use as part of VMPS, but a big part of our foundational work includes the work we’ve done and continue to do in establishing and maintaining a shared vision and aligned expectations. We’ve done that work through our physician and leadership and board compacts, which challenged many old assumptions and old expectations that did not align.
We’ve been at it longer than anybody in healthcare and it goes back to our strategic planning process ten years ago when we became really clear about our organizational aspirations and quality as our core business strategy around our customer.
Our board asked us, “Who is your customer?” Like everybody in healthcare, we said, “The patient.” And they said, “Time out. If that were really the case, why do things look the way they do?” And as we looked at the way things looked – we were quite typical for healthcare – everything was designed around the doctors and the nurses and the managers and all of the people who work in healthcare, and not really around the patient.
I travelled to leading healthcare institutions across the country. Nobody had a management system in healthcare that we wanted to adopt or emulate. Then, almost serendipitously, we started hearing from our colleagues at Boeing in late 2000 or early 2001 about the results they were seeing with the Boeing Production System. So we started learning about it and studying it in depth.
We took our entire executive team to visit leading lean companies in the United States, particularly the Wiremold Company in Hartford, Conn., which is profiled in Lean Thinking, and began to realize that this had huge potential for us. That was late 2000 and early 2001 when we began the journey, and we’ve never looked back.
The board was very supportive in our work to find a management system. This is where we took a major departure from anyone else at that time in healthcare. Still today, there are only two or three places in the country that have adopted what we call the Virginia Mason Production System as a management system.
One of the things we did early in our journey at the advice of our colleagues at Boeing was to take our entire executive team to Japan. Our first trip to Japan was not until June 2002, which was about 15-16 months after our first workshop or first Rapid Process Improvement Workshop [RPIW].
I’ve lost count. I think this summer I’ll be leading our twelfth team to Japan. On every one of those trips a board member or two joins us. It’s a requirement actually in the first term of one’s board tenure. We’ve really achieved alignment from the boardroom to the frontline to make this happen.
Before we ever heard about Toyota we said, ‘We need to change; we need to find a better way.’ The old implied assumptions in our organization wouldn’t allow us to do the things we needed to do to truly put the patient first, to truly seek a zero defect environment.
Nothing is as powerful as to touch the methods and the tools. So that when you’re on an RPIW, when you’re on a kaizen event, if you’re on a gemba kaizen in Japan, it’s really transformational for people. That takes skeptics and people in the middle trying to fly under the radar and gives them a kind of see/feel experience.
Understanding the current state in great detail is a critical early step in the improvement work. When we came back from that first trip to Japan we said we wanted all major areas of the medical center to have current state value streams. Only then can you realize all of the opportunity for improvement. That was critical and continues to be critical to understanding the opportunity and moving this forward.
Your Feedback