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Virginia Mason's Groundbreaking Journey to the New Healthcare

January 31, 2011
by Mark Hagland
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Interview: Gary S. Kaplan, M.D., Chairman and CEO

In a new book published by Productivity Press, noted author and journalist Charles Kenney presents Transforming Health Care: Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience. Kenney’s new book recounts the compelling story of how leaders at the 336-bed Seattle academic medical center took a hospital organization with pressing financial and operational challenges, and followed a unique path, embracing principles absorbed from the Toyota Corporation and translated them into healthcare-specific concepts and results.

As Kenney documents, the Virginia Mason transformation began a decade ago with Gary S. Kaplan, M.D., Virginia Mason’s chairman and CEO. Kaplan led other senior leaders at VMMC on a journey that was both conceptual and literal, at one point flying about 30 senior leaders of the organization to Japan in June 2002 to observe the Toyota Production System in action and to determine how to begin translating its principles into what eventually became the Virginia Mason Production System. Within a few years, VMMC leaders had turned the organization around organizationally, financially, and above all, with regard to patient safety and care quality, eventually winning numerous national awards and recognitions for the hospital’s quality, and establishing an institute (the Virginia Mason Institute) for healthcare organizations wishing to follow in VMMC’s path.

Recently, Kaplan spoke with HCI Editor-in-Chief Mark Hagland regarding the cultural transformation that has taken place at VMMC, and the role of information technology in facilitating clinical and operational transformation. Below are excerpts from that interview.

Healthcare Informatics: What were some of the biggest early insights you had, in terms of the potential for healthcare leaders to learn from the quality transformation success stories emerging from other industries?

Gary S. Kaplan, M.D.: In fact, that was one of the biggest early insights [the revelation of innovative practices that could be transferred from other industries to healthcare]. There are a lot of innovations in this [performance improvement] work, and there’s a lot of out-of-the-box thinking taking place. And number one was the realization our own industry did not have all the answers; not only that, the industry was unconsciously a part of the problem or set of barriers we needed to break through. So the lesson is to be willing to first listen and then next educate ourselves in the methods of manufacturing, and really deepen our knowledge, and realize that there were things in there that had applicability to our world and our patients and their families, that was like a huge breakthrough.

Another insight, which was articulated quite well in the book, and this occurred before we discovered the Virginia Mason Production System, involved determining who really was our customer, and getting clear about what it truly means to really put the patient at the top. That’s something that’s ongoing, because the norm in healthcare is so deeply ingrained, and we’re so acculturated, that it’s an ongoing challenge, but critically important; because before we could look at other industries, we had to realize we were not the customers. Another area was the compact work. Aligning expectations, having the deep conversations, took months, but we recognized that if we wanted to lead widespread change, we had to have those kinds of challenging conversations. And another big one was declaring the Virginia Mason Production System to be our production system. It was how we were going to think, how we were going to run the place; it wasn’t a ‘one-off’ quality initiative. And finally, changing the minds of senior leadership as a prerequisite to change; that’s why we took the whole team to Japan.

HCI: Early on in the process, long before you had established what became the Virginia Mason Production System, and the local paper published a story about your taking the team to Japan, how did you feel?

Kaplan: We were already close to closing on our bet-the-farm strategy. And it didn’t feel good, but it actually allowed us to have some conversations we might not otherwise have had.

HCI: It’s clear from the book that one of the challenges you faced is the underlying problem of the non-system-ness of the healthcare industry, which remains very ‘mom-and-pop’ in its orientation, even as it surges beyond 17 percent of U.S. GDP.

Kaplan: That’s right; that’s part of the battle. And that’s why I think this book could potentially provide some leverage. Because we’ve got some serious issues in healthcare, and we need the public to understand what they are. In fact, there are plenty of people in healthcare betting on the naiveté or the impenetrability of the public to not be able to change their thinking. So I want the public, and particularly the employers, to understand not only that they have skin in the game, but that they also have lots of power.