Transforming Health Care

The more you know about lean transformation the more you'll envy the Virginia Mason Medical Center (VMMC) for having the right people in the right places at the right times. At the end of the 1990s VMMC faced a struggle for survival as an in-the-black, separate entity. The CEO, Gary Kaplan, an MD and highly regarded executive saw the need for dramatic action and found it, after energetic searching, in Toyota Way thinking and acting. He created and nurtured the informed consent of the board of directors and, through John Black, engaged the Japanese consulting firm Shingijutsu. The executive team joined in embracing what became known as the Virginia Mason Production System (VMPS) and, with the clinical staff, hammered out the Virgina Mason Medical Center Physician Compact, the basis for concordant action in the VMPS.What's really to envy is the constancy of purpose that VMMC has maintained: when transformation efforts flagged or failed or worse - and they did, regularly - execs and docs, with board support, doubled-down and solved the problems. Each time that happened momentum increased: physicians saw better outcomes and less wasted effort, patients had better experiences, nurses spent more time actually helping patients, payers got to spend money where it mattered more, medical errors (and malpractice insurance cost) dropped dramatically, the list goes on and on, each recovered success synergizing more successes.As Donald Berwick points out in his Foreword, VMMC isn't perfect yet but, crucially, improvement continues apace: the board of directors, unified behind the VMPS, is chaired by Carolyn Corvi (the Boeing exec who, with Shingijutsu guidance, made the moving line in 737 final assembly happen), executives have become sophisticated in lean system dynamics, clinical staff are well aligned with the VMPS, and VMMC runs significantly in the black. Now all VMMC needs is a rational system of health care payment in which outcomes are rewarded instead of procedure delivery.The author, Charles Kenney, has produced a highly readable book with plenty of rich, authentic-seeming detail. I am a fast reader somewhat familiar with the sorts of issues addressed in the book, yet despite this being a relatively short book Kenney presents so much to think about that the pleasure of reading the book lasted much longer than anticipated.

This concept is so singularly important to what the future of health care can be and needs to be that it must not fail. It is a difficult journey to cast out the old preconceived wasteful ways that do not lead, but instead follow the ingrained status quo. As with Toyota before it in vehicles, Virginia Mason has taken unimaginable strides to improve the process to put the patient (its own product line) at the top of its pyramid and direct everything else toward that end. The study shows that "production" methods are not specific to individual industries but pertain to any and all businesses. The drive to improve safety and eliminate waste were at the core; the financial benefits of a lean, value-added enterprise were an unintended plus.I give the book's content five stars. I give the author only four. Whether he himself or his editors were to blame, I can't know, but there were inconsistencies in the printed words.

A good chronicling of Virginia Mason's journey to lean. It illustrates the long and involved history of initial inspiration, learning and the trials and tribulations of converting processes and organizational culture. For those thinking this is an easy course to take, or that it is simply the latest in corporate fads, the case of Virginia Mason will show them otherwise.The shortcomings of the book, to me anyway, is that it is mostly about the challenge and achievements of organizational change. It was fairly light on what aspects of lean/six sigma worked. I would have liked to read more about specific tools (e.g., VSM, 5 S, heijunka, kanban) and their use. Where were they successful, where did it take several tries, how can we readers learn from your experience. These are mentioned here and there, but insufficiently to help the rest of us in our own journeys.It is a useful tool for upper management. They may not be interested in the getting into the weeds. but they are interested in the time and devotion it took to change the organization.

As a nursing healthcare administrator who was at Virginia Mason when the Toyota Production System (TPS) was first introduced in 2002 and was in the first group of leaders to be certified in Lean, I can honestly say this is a fair and accurate account of what it takes to become a Lean healthcare organization.John Black, prior Boeing engineer and expert in Lean, first introduced Lean to Virginia Mason, under the tutelage of Senesis Nakao and Iwata. "Lean is not for the faint of heart" is saying it mildly and success will come as a result of a top-down (and everybody in) initiative.I would recommend The Toyota Way to Healthcare Excellence by John Black. This book provides Lean specifics and details the early work @ Virginia Mason.Don't be surprised if you start out as a "concrete-head" meaning you don't believe lean manufacturing can cross over to healthcare (patients aren't cars)...but, as I say in my lean lectures, "We in healthcare want what Toyota wants...safety, efficiency, and quality."