Virginia Mason Medical Center

Case 1. What is Gary Kaplan trying to achieve at Virginia Mason? 

Dr. Gary Kaplan was trying to achieve change at Virginia Mason.

He envisioned the transformation of Virginia Mason Medical Center into the quality leader in health care and sought to lead the organization toward this vision. When Dr. Kaplan joined VMMC what attracted him to the medical field was a collaborative team approach and Virginia Masons’ unique culture that was created in the early 1900’s. With time VMMC started to face challenges, competition was fierce and VMMC soon began to experience financial troubles. 

In addition, its employees were unhappy and the staff morale around the hospital was declining. Kaplan noticed that change had to be made to the way VMMC ran its hospital.

Kaplan proposed that VMMC follow Toyota Production System management method to restructure the way it ran its physicians, nurses and support staff. He felt that NMMC’s goals were similar to Toyota, especially putting the customer/patient first, focus on quality and safety, and a commitment to employees.

Kaplan was trying to achieve this change while keeping the unique culture that VMMC began with so many years ago. 

2. How does the Toyota Production System fit into his strategy? Dr. Kaplan and executives at VMMC had created a strategic plan focused on becoming the quality leader in healthcare; however he lacked a system to achieve this goal. Kaplan felt the Toyota Production System (TPS) was an appropriate match for the VMMC because of the similarities in goals that they both shared and desire to achieve them.

VMMC’s new vision aligned with Toyota model including its priorities of putting the patient/customer first, along with satisfying quality, safety and its employees. Traditionally, VMMC had taken cost savings approaches by consolidated less profitable business lines (obstetrics, mental health) and reducing academic spending (travel, research time). Kaplan felt these activities were putting academics to the wayside. He sought to apply TPS for other cost savings opportunities such Just in Time (JIT) production. 

Similarly, he felt the detection of abnormalities in the production process could be applied to patient care. TPS was not the first production model to be imported into the health-care delivery organizations.

For decades hospitals had tried several management models drawn from production industries such as Total Quality Management (TQM) and Six Sigma. VMMC has previously utilized TQM in the 1990s, but the concepts had failed to gain traction. Kaplan’s first strategy would be to get a visual of the current process that takes place. Value-stream mapping would give him a better idea of the gaps in VMMC’s work flow.

Value-stream mapping would encompass patient check-in, visits, inventory and flow of equipment. 

Kaplan felt that by starting with the value-stream mapping it would set the base for the implementation of Virginia Mason Production System. By applying the plan of action that TPS used and modifying it to fit VMMC, within the year Kaplan started to see positive results from the various strategies that were exercised. 

3. What is your view of the “people are not cars” debate? We agree with the statement that “people are not cars” and that each patient is unique when it comes to diseases, treatments, and personal emotions. With that being said, when a new process or system is in place some people have difficulties adjusting to change, they tend to look at the negative vs. the positive outcomes that can be achieved from a new model/process such as VMPS.

Also, people tend to want change to take place immediately and that is not always the case. When something new is being implemented it will most likely take some time to reap the benefits.

We believe that there are tangible benefits can be realized through the adaptation of the TPS model. 

Opponents argue the TPS system jeopardizes their autonomy and clinical creativity. However, the system adapted from TPS, actually seeks to maximize patient outcomes through the elimination of waste and efficiency improvements. In return freeing up more time for clinicians to spend with patients, families, or pursuing academic endeavors. 

4. Is Kaplan’s approach transferable to other US hospitals? We believe that Kaplan’s approach is transferable to other US hospitals.

Proven results have been demonstrated especially for the oncology or cardiovascular units. I think that these two departments will seek the most benefits from Kaplan’s approach. This approach was already tried by The University of Pittsburgh Medical Center (UPMC) and they saw benefits early on in the transition process. For instance, they applied TPS and they immediately saw a decrease in patient waiting time, patient registration, medical chart and having supplies available. If UPMC is able to switch to a manufacturing model, then any other US hospital will be able to do the same as long as they are able to modify the process to their environment and culture.

We believe VMMC was uniquely poised for success. 

The executives, board of directors, physician, and staff were willing to embrace change. VMMC was founded on the principles of teamwork to offer patients comprehensive medical care. To be replicated in other hospitals solid leadership and support must be obtained throughout the organization. A commitment to achieve the goal and belief in the strategic plan is essential.

The implementation of VMPS has shed positive outlook on both the process and metrics. For example, the redesign of the physical layout for treatment rooms has not only improved the patients view but also it created more space so that physicians and nurses are maximizing their travel time and communication. 

Equally important, this new amount of space increased the number of visits from 120 to 188, a 57% increase and it also reduced patient travel per each visit from 1,600 feet to 375 feet, a 76% decrease. Moreover, the built-in pharmacy improved the delivery system which minimized the wait time from 2 hours to 20-30 minutes and 20 minutes to 1 minute respectively. This goes to prove that higher efficiency would also improve the hospitals metrics and quality.

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