During 2003, Virginia Mason staff continued in their quest to make the organization the Quality Leader in health care by applying their management philosophy — the Virginia Mason Production System (VMPS) — to all areas of the medical center.
The management philosophy, which is based on the Toyota Production System, enhances Virginia Mason’s mission to improve the health and well-being of the patients served.
“Several years ago, we realized that management approaches typically used in health care were not able to evolve quickly enough to keep up with the changing health care environment,” says Gary S. Kaplan, MD, Virginia Mason chairman and CEO. “While health care is advanced in technology and understanding of disease, its management systems have changed little in the past 50 years. It is these systems that VMPS focuses on and where great strides can be made.”
This management system fits in well with Virginia Mason’s strategic plan by putting patient’s first, demanding the highest quality in care, being obsessed with safety, providing high staff satisfaction and contributing to a successful economic enterprise.
During the past year, Virginia Mason continued its focus on the Virginia Mason Production System through four-day sessions called Rapid Process Improvement Workshops (RPIWs). Since the management system was implemented in 2001, VM staff members have evaluated and scrutinized processes from nearly all areas of the medical center. The staff continually look for areas for improvement. Then, teams of staff members connected to those areas use VMPS tools to analyze the work of individual staff members and processes.
Once the group has determined whether or not the work staff members are performing is really necessary — and benefiting patients — they look for ways to reduce variation by implementing standard work, to reduce handoffs by creating flow, to eliminate non-value added work and to reduce defects and errors. They also look at the physical requirements of the work such as heavy lifting, standing on step stools and reaching. Then they make simple changes to the work environment to eliminate those things that present physical challenges.
“It is not unusual to have a customer service representative, who is closest to the patient at different points during a patient encounter, making changes to the way a physician does his or her work,” says J. Michael Rona, President. “And vice versa.”
Many staff members have been involved in Rapid Process Improvement Workshops. Additionally, a majority of the staff members have been trained on the basics of the Virginia Mason Production System.
“We’ve also made a commitment to our staff that there will be no layoffs related to this work,” says Rona. “This frees them to concentrate on process improvements without worrying about continued employment. Once staff have the opportunity to experience the power and potential VMPS holds for our organization, they are excited to use the tools to improve work in their own areas.”
VM STAFF HAVE BENEFITED BY HAVING LESS REWORK AND FRUSTRATION AND GREATER OPPORTUNITIES TO CARE FOR PATIENTS.
In addition to increasing patient safety, quality and staff satisfaction, Virginia Mason is seeing financial savings as a result of VMPS and RPIWs. For example, in the Section of Gastroenterology, the medical center planned to add additional procedural space. Using VMPS tools, the staff analyzed current operations and discovered that they were not using the space efficiently. By reducing room turnover times and evenly distributing patient appointments throughout the day, they were able to avoid costly changes to facilities.
Most importantly, this work is providing great benefits to patients. Staff is analyzing patient movement throughout the care process and identifying and eliminating waste in that process. “For patients, that translates to less time waiting to see the doctor, less time waiting for test results and less time waiting for treatment plans,” explains Dr. Kaplan. “We are identifying the things that add value to their experience and making sure we have ample time for those things while reducing the non-value-added elements of their experience with Virginia Mason.”
“Our work with the Virginia Mason Production System brings us closer to our vision of being the Quality Leader and achieving our mission of improving the health and well-being of our patients,” adds Rona.
THE VIRGINIA MASON PRODUCTION SYSTEM IN ACTION
The examples cited below support the ultimate goal of the Virginia Mason Production System: spending value-added time with patients. Patients are the focus of the organization.
A CT scanner is an expensive piece of health care equipment. Radiology CT technicians are at a premium and difficult to recruit. By focusing on the value-added time while a patient is actually on a scanner, the Rapid Process Improvement Workshop addressing CT scanning determined that information-gathering and patient prep did not have to take place while the patient was on the table, nor did it have to be done by the technicians. The VMPS concept employed is “set-up-reduction,” which looks at necessary work that can be done ahead of the actual procedure to maximize the use of the equipment itself and the appropriate use of technicians versus supportive personnel.
THE RESULT: More patients moved through the scanner. Two CT technicians were freed up, allowing them to fill positions that had been open many months.
By applying the principles of VMPS, particularly continuous flow, the Rapid Process Improvement Workshop team determined a process that allowed the new Center for Hyperbaric Medicine to be constructed in current hospital space rather than requiring a new building as originally planned. Implementing continuous flow increases patient quality and safety because patient transport will not have to occur between the hospital and a separate hyperbaric unit.
THE RESULT: Increased patient quality and safety; savings of $2 million.