Virginia Mason Production System
In 2002, Virginia Mason embarked on an ambitious, system-wide program to change the way it delivers health care and in the process improve patient safety and quality. It did so by adopting the basic tenets of the Toyota Production System (TPS), calling it the Virginia Mason Production System, or VMPS.
While some medical centers have initiated projects using TPS, Virginia Mason is the first to integrate the Toyota management philosophy throughout its entire system.
"Production" in Health Care
How does the term "production" apply to health care? Patients of course are not cars. Yet both manufacturing and health care are filled with complex production processes. In health care these processes include admitting a patient, having a clinic visit or having surgery. These processes should embrace the concepts of quality, safety, customer satisfaction, staff satisfaction and cost effectiveness. The Virginia Mason Production System is all about optimizing each of these on behalf of our patients.
- How VMPS Works
- Benefits of VMPS
- VMPS Success Stories
- VMPS Fast Facts
- VMPS in the News
- Virginia Mason Institute
Virginia Mason's vision is to be the Quality Leader in health care. This vision requires adopting a paradigm shift from expecting errors and defects, to believing that the perfect patient experience is possible. Key to accomplishing this is understanding that staff who do the work know what the problems are and have the best solutions. VMPS strategies range from small-scale ideas tested and implemented immediately to long-range planning that redesigns new spaces and processes.
Virginia Mason uses several continuous improvement activities, such as Rapid Process Improvement Workshops (RPIWs) and kaizen events focused on incremental changes, as well as 3P workshops intended to completely redesign a process. Virginia Mason has held 850 continuous improvement activities involving staff, patients and guests.
- Patients spend more value-added time with providers, and VMPS helps providers deliver the best possible care.
- Patients benefit from greater safety, less delay in seeing physicians for care and more timely results and treatments.
- Virginia Mason staff benefit by having less rework and greater opportunities to care for patients — one of the primary reasons many choose health care as a profession.
- The reduction of waste in administrative processes that support patient care but take valuable resources ultimately benefits customers. As a nonprofit organization, savings are reinvested to support Virginia Mason's mission to improve patient health and well-being.
We have had many successes with VMPS. Below are a few examples of how VMPS has improved the quality of patient care.
PSA System Improves Patient Safety
Virginia Mason used VMPS to develop a Patient Safety Alert (PSA) system requiring all staff who encounter a situation likely to harm a patient to make an immediate report and cease any activity that could cause further harm. If the safety of a patient is indeed at risk, an investigation is immediately launched to correct the problem. From the program's inception in 2002 through 2009, 14,604 PSAs were reported. Most reports are processed within 24 hours — a significant improvement from when reports took three to 18 months to resolve. Patient safety at Virginia Mason has increased and professional liability claims have dropped.
One-Stop Care for Patients with Cancer
Using VMPS, the Floyd & Delores Jones Cancer Institute at Virginia Mason was redesigned with a laboratory and pharmacy inside, eliminating the need for patients to travel throughout the hospital for chemotherapy. Now, all cancer services are brought directly to the patient in his or her private treatment room. For one patient, this reduced the length of a chemotherapy visit from 10 hours to two and saved about 500 feet of walking at each visit.
Getting Back to Nursing
In most hospitals, nurses spend about 35 percent of their time in direct patient care. With VMPS, Virginia Mason nursing teams increased it to 90 percent. They used RPIWs to evaluate their work and make improvements. Instead of caring for patients throughout a unit, nurses work as a team with a patient-care technician in "cells" (groups of rooms located near each other). The cell model allows nurses to monitor patients and quickly attend to needs. Also, the most commonly used supplies for each unit were moved to patient rooms so nurses reduced walking back and forth to get supplies. Steps walked per day fell from 10,000 to roughly 1,200.
Hyperbaric Center Increases Patient Capacity
When the Virginia Mason Center for Hyperbaric Medicine could no longer accommodate all the patients needing treatment, many assumed the solution was a new building to house larger chambers. Instead, Virginia Mason used VMPS tools to design and build a new hyperbaric center in existing hospital space, which saved $2 million in construction costs and increased capacity from two to three patients at a time to as many as 20.
Express Treatment in the Emergency Department
Emergency departments (ED) are a major entry point for hospitals and can be a bottleneck. ED patient care is typically more expensive and involves longer wait times. Using VMPS, the ED team at Virginia Mason learned to predict appropriate staffing levels for times of greatest demand. A "team sort" process using standard clinical assessment tools to quickly identify and sort patients' care needs was implemented. Those requiring minimal services receive express treatment and are discharged without going to patient-care beds. This creates capacity for patients who require more extensive services. This work helped Virginia Mason decrease the number of hours the ED was closed and unable to receive new patients by more than 90 percent over the past two years. In 2011, Virginia Mason will move its ED into more efficient space and the team sort process will allow the team to care for more patients.
Faster Revenue Cycle
VMPS principles are used in all areas of the organization, not just in clinical settings. The Finance Department began using VMPS to address outstanding revenue (revenue owed to the organization that had not been paid in a timely manner). The team improved Days Revenue Outstanding (DRO) in the clinic from 52.3 in 2003 to 29.4 in 2009 and in the hospital from 66.5 in 2003 to 42.6 in 2009. Cash deposits improved from $471 million in 2003 to $794 million in 2009.
Primary Care Achieves Positive Net Margins
Primary care has long been a money-losing area of health care and often a good year means breaking even. Primary care teams in Virginia Mason's eight locations used VMPS to realign their work and improve the patient experience. Teams analyzed how supplies and providers "flowed" through the day. By making key changes, such as doing non-direct patient care (reviewing lab results, calling the pharmacy) in between patient visits and setting up each exam room identically with needed supplies, providers were able to see more patients in shorter work days with better quality care. Doctors, who previously stayed until 8 or 9 p.m. doing paperwork, now leave by 6 p.m. The turnaround time for lab results also improved from 25 days for normal results to two days or fewer. Today, these clinics consistently achieve positive net margins and see more patients without sacrificing time spent with each patient.
- A clinic transforms the patient experience (Health Tech today, Nov. 2009)
- Health Care's Infectious Losses (New York Times, July 5, 2009)
- A Carmaker As A Model For A Hospital? (CBS Evening News, June 6, 2009)
- Virginia Mason's new hospital designed for care transformation (Seattle Times, Jan. 8, 2009)
- What Medicine Can Learn From Business (U.S. News & World Report, June 17, 2008)
- Seeking Perfection in Healthcare (Healthcare Executive, May 2008)
Virginia Mason Institute (VMI) is a non-profit corporation that provides education and training in the VMPS management method to other health-care providers and organizations. VMI was established in 2008 in response to growing industry demand to learn how Virginia Mason has applied lean manufacturing principles in health care. Learn more about the Virginia Mason Institute.