Quality Improvement

“So, [VMPS] is this wacky Japanese innovation technique, but it's really a group of people who are interested in doing things a bit differently.”

Ford Parsons, Class of 2016

Virginia Mason is well recognized internationally for the Virginia Mason Production System (VMPS), a management method that seeks to continually improve how work is done. VMPS is based on the Toyota Production System, a manufacturing approach that Toyota has developed and used for more than 50 years to produce some of the world’s best automobiles. This system empowers frontline staff to prevent errors as well as identify and eliminate waste in patient care. And because of previous work done to increase efficiency in the system, residents spend more time talking with, listening to, and treating patients rather than doing “scut work.” Behind the inscrutable Japanese terminology and relentless focus on reducing waste, there is a highly effective mechanism of change that strives to make Virginia Mason an incredible place to work. View our VMPS fast facts »

As a result of quality improvement efforts, Virginia Mason had the lowest 2016 all-cause 30-day mortality rate in the state.

Virginia Mason also showed much lower (5 percentage points or more) 30-day mortality rates compared to statewide numbers in the following conditions: heart attack, COPD, pneumonia, acute cerebrovascular disease and dementia.

In May 2016, Virginia Mason won two Qualis Health Washington Quality Awards recognizing work to reduce central line-associated infections (CLABSI) and to identify and treat sepsis. See other recent award highlights.

“Quality improvement is part of the fabric of our daily lives … the quality improvement culture has seeped into our mindset.”

Camille Johnson, Chief Resident 2015-2016

Just by working at Virginia Mason, residents benefit from continuous system improvements. They immediately notice little things that make their lives easier, such as evidence based note templates, order sets, and glycemic control graphs. In addition, residents directly participate in improvement activities and become well versed in tools such as root cause analysis and PDSA (plan-do-study-act) cycles. Constant change is so ingrained within the culture of Virginia Mason that our residents start internalizing these habits and behaviors almost without realizing it. Instead of accepting the status quo, our graduates ask questions such as “why is this happening?” and “how can this be done differently?”

Opportunities to get involved in quality improvement

“It is because of VMPS that we embrace a culture of change so that we are continuously improving ourselves.”

Ana Jensen, Chief Resident 2016-2017

Through the Systems-Based Practice elective, residents participate in major system-wide improvement efforts through week-long rapid process improvement workshops (RPIW) as well as more focused two-day “Kaizen” events. This provides more in-depth exposure to VMPS methodology and hands-on experience. One resident was even able to align her involvement in a lower GI bleed workshop with future career plans in gastroenterology.

Residents report issues with patient safety (called “patient safety alerts”) and assist in their resolution. Several resident ideas have been implemented, including creating a “no AM labs” order to reduce unnecessary lab draws and using messaging within the EMR to reduce the volume of pages. There are also plenty opportunities in clinical informatics — the use of technology to improve patient care.

Leadership in Quality Improvement Pathway

New in July 2017, residents with a strong passion for quality improvement may enroll in the Leadership in Quality Improvement Pathway after matching as a categorical or primary care resident. Designed to prepare residents to become innovative leaders in health care, the pathway is open to residents with all career interests — primary care, hospitalist or fellowship. The pathway features a longitudinal curriculum with protected time for classes in quality improvement, leadership, and change management; meetings with key organization leaders; participation in quality improvement events; and completion of a capstone quality improvement project. Residents will gain hands-on experience in VMPS methodology, including identifying and eliminating waste, creating a value stream map, leading innovation exercises, promoting change, and eventually leading their own improvement event. Throughout the process, residents receive extensive one-on-one coaching with an expert in VMPS, as well as mentorship from their project sponsor. Learn more about the Leadership in Quality Improvement Pathway.

In reality, how you train in residency has the biggest impact on how you practice long-term. Training in a culture where process improvement is assessed in every aspect of care delivery, from timing of antibiotics to patient food delivery to eliminating waste in the billing department (my first Kaizen experience), sets the tone for your career. Better never stops!”

— Jackie Lemon, Chief Resident 2020-2021