The Virginia Mason Medical Center in Seattle Washington is widely regarded as a leading case study in the benefits of applying lean manufacturing principles to healthcare.
The leadership team first visited Japan in the early 2000’s to learn about lean culture directly from the likes of Toyota, and has since received attention globally, including from Japanese medical centers, for their achievement in adapting lean principles to improve the healthcare experience for their patients and staff.
Dr Paul Smith, Director of lean consulting firm Shinka Management, recently interviewed Chairman and CEO Dr Gary Kaplan and Transformation and Executive Sensei Dr Henry Otero, regarding their experience leading Virgina Mason’s lean healthcare transformation journey. The following is an exert of the interview held in Kyushu, Japan.
Paul Smith: What is the Virginia Mason Production System and what does it seek to achieve?
Dr Henry Otero: It’s a management system by which we direct all our activities and align the goals of the organization and the work we do every day.
It’s also a robust organizational system which guides us in understanding who we are as an organization, what goals we are trying to achieve and how those goals align with the work that we are doing throughout the organization, with a view of achieving world-class management.
One mistake is to believe that we only need to learn the tools and methods to become a lean organization. The other is to believe that leaders don’t have to lead or understand the methods deeply. The leaders must be the most committed to understanding and utilizing the methods in order to be role models for the rest of the organization.
There’s a big difference between lean as a project improvement method whereby we just use it to solve problems with tools and ideas, versus a management system which aligns the work we do every day and helps us to accomplish the goals we want to accomplish within our organization.
Smith: Why did Virginia Mason look to a Japanese management methodology to be its guiding light?
Dr Gary Kaplan: We don’t think of it as a Japanese system but as a system that was started and perfected in Japan; in some ways it goes back to Deming and others. A lot of people ask us why we go to Japan to learn – if we want to learn the very best surgical technique, we go to the place that does it the best to learn. That’s how we think about management.
I think the bigger question was why did we, healthcare professionals, go to manufacturing? Because that was a big departure. Historically in medicine, we’ve always thought that we had all the answers, and that those answers were somewhere in the healthcare industry. But, when we were looking for a management method, we didn’t find it. Nobody in the U.S. had one in healthcare.
Smith: And when you did have a look at manufacturing...
Dr Kaplan: We saw Boeing. We heard what Boeing had been doing. We met somebody who had been working at Boeing, John Black. He had been leading the Toyota Production System development at Boeing. So, we went to Boeing to learn from them. Before we ever came to Japan, we went to a company called Wiremold, and met with Art Byrne. The whole executive team visited Wiremold in December of 2001. It was amazing. Unlike Henry or myself, most of the executives had never been in a factory. So, we were beginning to think that maybe the answers were outside of the healthcare industry. That was a big departure for us.
Smith: When did you decide to take your executive team over to Japan? What was the purpose of doing that?
Dr Kaplan: Well, the people at Boeing said that if you were really serious, you need to go to the source, you need a deep immersion experience. We came home totally different – we were thinking differently – that’s why we continue to take people to Japan almost every year.
Smith: What was the difference? Was it knowledge or attitude, or was it belief, a change of thinking about what’s possible?
Dr Otero: We have lots of answers to that. One answer is that it was learning in a different culture, looking at something that you were not familiar with seeing; Toyota’s history, Toyota’s production, working on a line in Hitachi; and then each night was a debrief, a very long debrief of what we saw, what did it mean to what we were doing at Virginia Mason, and what is the relevance to healthcare? And those discussions were the best when people started to talk about what their real hopes were for themselves and when we started to realize that things could be different. There was a way to do it differently. You didn’t have to be stuck in the way it was currently being done. You could aspire to do something different. You could see in front of you, what you are aspiring to. That was very motivational to people. For some people, it was that switch – they just caught on fire. That was the most important trip I have taken in my life. It fundamentally changed the way I think about healthcare and what my motivations were.
Dr Kaplan: I think the best aspect of that is to take people out of their comfort zone. Being in our comfort zone keeps us from processing information. We always fall back on what we know to be true and our foundations. Here, we are out of our comfort zone. We levelled the hierarchy. When you have a surgeon dependant on a nurse or medical assistant to help them understand what’s going on in the assembly line it flattens the hierarchy that exists in healthcare.
As Henry says, a big part of the trip is being away from home and in the deep conversations we have with each other, many of which are structured fundamentally – I lead those – and many of them are also impromptu conversations including confronting our own weaknesses or things at home that aren’t going well that we are hesitant to talk about. These trips have been powerful enough that we continue to do them.
Smith: Fast forward to today and looking back over the journey and some of the outcomes, what is it that you feel most strongly about in terms of what’s been achieved?
Dr Otero: As I look across the organization, it is people’s focus on the patient and how they approach problems. Their questions about what benefits the patients. What you keep seeing and hearing at Virginia Mason is people asking what’s best for the patient, and this guides us to which ideas we are going to implement and in what direction. I think this is the culture piece that I don’t see or hear anywhere else.
A lot of people say that they are patient-centered, but you have to hear it from the leaders. Can they give up their own self-guided interests to those of the patient? When you see that happen, you know you are in a special place, as that doesn’t happen very often.
Dr Kaplan: Yes, I would agree and it’ is the hardest thing to change and the most important. The management system is really important, the tools and creating flow, providing hope, but it’s the cultural change and the willingness that is key. I think we challenge some really deeply held assumptions about our culture and it sounds like such a no brainer, so obvious. But it’s really, very profound when you think about changing the culture in medicine. Some people say, well if the patient is first, if the patient is at the top, does that mean that the doctor is at the bottom? And there are a lot of conversations about things like that. Some people had to leave the organization because they couldn’t go there.
To read the full interview, see: Lean Health Care Interview
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