A Leadership Journey in Health Care

Virginia Mason's Story

Charles Kenney

• Publisher: Productivity Press
• Year: 2015
• ISBN:
  9781498760430
• Edition: 1
• Topic: Business
• Subtopic: Operations
• Index: Business

Since adapting the principles of the Toyota Production System to health care in 2002, Virginia Mason Health System has made enormous leaps forward in quality, safety, patient experience of care, and affordability. It has achieved world-class levels of patient satisfaction and has been honored as one of the safest hospitals in the country.A Leadersh

Chapter 1

To Be the Quality Leader and Transform Health Care

At the University of Texas Medical Branch in Galveston, Kathy Shingleton enjoyed perks afforded to many senior health care executives. On her first day of employment, she drove to work, bypassing all those employees who were looking for parking spots on the street or blocks from campus, and she pulled into a designated spot marked by her name and title. She walked a short distance to her corner office, filled with custom cherry furniture and upholstered chairs. Her view encompassed the Gulf of Mexico where, on many evenings, the sunsets were showstoppers.

When Kathy was recruited to be the vice president of human resources for Virginia Mason in 2011, she found herself in a very different situation. She was a highly qualified candidate for the position, with her MBA and PhD in education and leadership. She had served in a variety of successively more responsible positions at the University of Texas for 23 years. When Kathy arrived for work in Seattle, she discovered that parking was not available on campus because those slots were reserved for patients. She scrambled to find off-campus parking and ended up parking three blocks away and having to walk up a steep hill to arrive at her office. (To make matters worse, the parking she was able to locate required her to pick up her car by 6 pm every evening. So as a result, some evenings she would have to move her car to another parking lot.)

And then she arrived at the “executive suite” of offices. This involved descending a flight of concrete steps to the basement of a three-story structure built in the 1940s. She entered the bunker-like facility, which formerly served as a hospital warehouse and supply area. Her office—about one-fifth the size of her Galveston space—was nearly identical to the other 13 offices occupied by senior executives along the subterranean hallway: 12 by 12 foot spaces, low ceilings, small desk, and table, and of course no windows. “When they showed me to my office, I kind of laughed,” recalls Kathy. “I thought, ‘Okaaayyy .’ In Texas executives got parking spaces first, and then patients got what was left. When I came to Virginia Mason it was immediately clear that the patients came first in everything. ”

Sometimes appearances matter. Sometimes something as mundane as a parking space offers clues to a richer story—a story that speaks of a deeper culture. The executives along Kathy’s hallway reside there because space in any medical center is a precious commodity and the best available space at Virginia Mason goes to patients.

Consider the case of the renovated cancer center. When the facility was nearly completed, architects and designers met with staff members who would be working within the space: doctors, nurses, receptionists, medical assistants, and more. This was in the earliest days of the Virginia Mason adaptation of the Toyota Production System to health care—a time when the current culture was in its infancy. When the staff gathered in the new space several physicians laid claim to one office or another, spaces on the exterior of the floor with large windows and plentiful natural light. But then something happened that has been repeated over and over again every day many thousands of times since then. Someone in the room uttered the words that possess more power than anything else at Virginia Mason: Who is at the top of our pyramid? Who comes first in everything we do? And the team fell silent for a moment as people looked at one another. Suddenly there was clarity: Of course the perimeter rooms would go to patients! These perimeter spaces with natural light and leafy views became infusion rooms where cancer patients enjoyed reclining lounge chairs, flat-screen TVs, wireless Internet, and small refrigerators with cold drinks. And so it was that the physicians and other staff members occupied the inner portion of the floor, an arrangement enabling staff members to communicate easily and serve patients well.

Virginia Mason Is Different

Denise Dubuque experienced the difference firsthand when she left Virginia Mason in 2008 to take a position at another provider organization. “At Virginia Mason we had an egalitarian sense that every team member has something valuable to add,” she says. “That is for real at Virginia Mason. It is real and it is in the DNA. It’s not just words. And that’s why I came back. I believe anything is possible at Virginia Mason. Sometimes the more urgently something needs to be done the better the work we do. We make things happen quickly. We are agile in responding to whatever is happening. And I think we are set up to be really successful in this crazy, turbulent health care environment.”

Virginia Mason is different from other provider organizations throughout the nation in many ways, and the most obvious differentiator is the organization’s success during the past dozen years in adapting the Toyota Production System as its management method. Virginia Mason is recognized as among the leaders—perhaps the leader—in applying lean management to health care. While that distinction lies at the core of what differentiates Virginia Mason from the vast majority of health care organizations in the United States, it is certainly not the only distinguishing characteristic.

Virginia Mason’s declared vision, for example, is “to be the quality leader and transform health care.” This does not mean the quality leader and transform health care in Seattle or the Northwest but throughout the United States . Jim Young, chair of the Virginia Mason board of directors, says that he, along with his board and management colleagues, wholeheartedly embraces this idea: “I do not believe it is overly audacious for us to want to transform health care across the country.”

Carolyn Corvi, Virginia Mason board member and former executive vice president at Boeing where she led production of the enormously successful 737 line of aircraft, puts it this way:

We are a place so many people come to learn. We can be a signpost for anybody who is serious about wanting to improve quality, safety, and affordability. The imperative in health care is to change and innovate fast—we owe it to every family in America to do that—to get much better much faster. We must transform nationally, balancing speed with the ability to make change sustainable.

What concerns me is that people are wasting time grasping at different methods to try to do this. I am convinced, based on what we have accomplished at Virginia Mason, that there is no better way to do this. People shouldn’t fumble around experimenting with different methods. They should recognize that this is the better way and get on with it.

Since Virginia Mason began applying Toyota Production System–inspired principles more than a decade ago, the organization has achieved significant advances in quality, safety, and efficiency, all while lowering costs. Virginia Mason’s experience over more than a decade is living proof that the most effective affordability strategy is the relentless pursuit of quality. As of 2014, all major inpatient procedures and care episodes at Virginia Mason were 20–60 percent more affordable than they are at other Seattle-area hospitals and well below the national average. If Virginia Mason’s results were somehow applied across the nation the quality, safety and cost challenges in American health care would be all but solved.

Since adapting the Toyota Production System to health care in 2001, Virginia Mason has achieved world-class levels of patient satisfaction across the organization and has been honored as one of the safest hospitals in the country—so safe that the cost of professional liability insurance at Virginia Mason has declined 74 percent since 2005. Throughout the financial crisis starting in 2008, there were no layoffs at Virginia Mason and the organization continued to share annual bonuses with employees. When Intel Corporation sought to improve the quality of care for their employees while controlling costs, they partnered with a team at Virginia Mason. When Wal-Mart sought the highest quality and value for their employees, they selected a small handful of providers including Virginia Mason to deliver specialty care in cardiology, spine care, and total joint replacements.

Virginia Mason teams have reduced operating room turn times in some cases to just 22 minutes and have cut wait time for patients with low back pain from 31 days to same-day access. Women seeking mammograms park their cars and have completed the process in so little time there is no parking fee. Previously, nurses in the hospital spent only abo...

Table of contents

• Foreword
• A Leadership Story
• Chapter 1 - To Be the Quality Leader and Transform Health Care
• Chapter 2 - Strategic Plan
• The Power of Alignment
• Chapter 3 - New Management Method, New Ways to Lead
• Chapter 4 - Respect for People
• Essential to the Virginia Mason Production System
• Chapter 5 - We Are a Leadership Team, not a Compilation of Leaders
• Chapter 6 - Identifying Talent, Developing Leaders
• Chapter 7 - A Very Different Kind of Board
• Chapter 8 - The Virginia Mason Institute
• Leading the Vision to Transform Health Care
• Chapter 9 - Virginia Mason’s Essential Elements
• Endnotes