Part 3 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.
When we came home from that very first trip to Japan we declared the Virginia Mason Production System as our management method. That was different. Most places are focused on lean as a quality improvement method or as a process improvement method. For us it’s our management system. It’s how we run our entire organization; whether it’s the finance department, the IT department, the critical care unit, inpatient services, or primary care. It’s a management system.
That generated a fair amount of push back early on. “What do you mean it’s a management system?” “We’re finance we don’t have to do this” “We’re IT. We do computer programming. We don’t have to do this.” And my response each time was, “Wrong. This is how we will run our company. This is how we will run our heath system. If you’re a senior leader, you have to go on this trip to Japan. If you are an administrative director, you will become certified. Not only will you learn about lean and VMPS, but you will be required to teach it and lead it.”
Leadership commitment is huge. It’s not optional. If you want to be a leader here, this is how you lead. These are the skills you will develop and build. When we recruit new leaders, this is an expectation. We want new ideas from the outside, but this is what it means to be a senior leader at Virginia Mason.
One component of the VM management system is cross-functional management. Intersecting value streams are inherent in healthcare but underappreciated in our historical, silo approach to care delivery. When you look at those value streams you realize that everyone’s value stream interfaces with many other value streams. And so you begin to think about cross-functional management. You begin to think about the supply chain intersecting with the clinic visit, which leads to the operating room procedure, which then leads to the hospital stay, which has other intersecting value streams.
There are many, many things we’ve learned over the years that are part of effective execution. Goal setting is something that is not well understood when we talk about lean as a management system. It’s about management by policy, which includes hoshin kanri goal planning.
When we set our annual goals this past year we began the process at the end of April. It involved and touched everyone in the entire medical center as part of the goal determination process. I toss overarching organizational goals to the executive team, who begin to populate it. They then toss it down to the next level of the organization, who process it and toss it back up. There are iterative “catch ball” processes throughout the medical center with work units, teams and individuals providing input. It’s a very engaging process.
Two things happen: you get higher quality goals, and you become aware of things you wouldn’t otherwise be aware of…. Once the goals are put in place, you have a much greater, pre-existing understanding, knowledge and buy in than if they just came down from on high. This is all part of what we talk about when we talk about a management system.
One of the things we’re rolling out right now is standard work for management, and that’s very enlightening. While we preach standard work as one of the pillars of VMPS, some leaders are like, “That’s standard work. I believe in that, but it’s not for me. It doesn’t apply to my work.” That’s wrong. When you create standard work for managers, you free up a lot of time to do other things.
Thinking about the work, understanding the work, mapping the work, creates huge capacity. I’m not saying we’re there yet in all aspects. We still get pushback, but that forces us to sort and simplify, the basic things that come with 5S.
[...] 3) Lean Is a Management System [...]