Waste Not, Want Not: Inside the Virginia Mason Production System

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A decade ago, the executive team of Virginia Mason Hospital and Medical Center (VMHMC) in Seattle, Washington, flew to Japan for training in the Toyota Production System (TPS), a continuous–process-improvement method pioneered by the automobile manufacturer. Lucy Glenn, MD, chair of VMHMC’s radiology department, says, “We began to understand how applicable this method was to health care. So many of the things we do in health care are processes. Everything that surrounds the physician–patient interaction is a process that can be improved.” The result of this training was the development of the Virginia Mason Production System (VMPS), which takes the principles of the TPS (also known as lean production) and applies them to health care. The radiology department was quick to adopt the new system, performing seven week-long workshops in 2002 alone to learn to use the lean tool set. “Subsequently, we learned to do rapid-kaizen (-improvement) events, which are two-day process-improvement events,” Glenn says. “Week-long rapid–process-improvement workshops are for more complex issues.” Critical to the adoption of the VMPS was the goal of putting patients first, which was introduced in the hospital’s 2001 strategic plan. Glenn explains that the objective of many of the radiology department’s process-improvement events is improving the patient experience. “In any area of radiology you can think of, there are opportunities,” she notes. “One of the things we strive for is elimination of waste, and one of the biggest wastes is time. Offering same-day access for patients is critical to making imaging a value-added service. You want to be timely in providing the imaging and timely in reporting the results.” Identifying Targets Process-improvement methods are applied to targets large and small; a key facet of lean production is an emphasis on the authority of frontline staff to understand how their own processes can be optimized. Richard Lee, administrative director of radiology operations at VMHMC, says, “We go to the people who are actually doing the work and are in immediate contact with the patients. We have a process where we ask them to generate ideas as to what could be improved, and that’s where it starts—from identifying how our processes could be made better for the patient.” At the other end of the pipeline, Lee says, administrators look at improving value streams to reach clinical, financial, and operational goals. “That macro perspective can result in process-improvement events and kaizens as we work a value stream from the top down,” he notes. “If it’s a more complicated issue, it may result in a series of kaizens. Process improvement can start anywhere in the organization.” In the VMPS, quality and cost are viewed as being inextricably linked, Glenn says, meaning that an opportunity for improvement in either area can launch a process-improvement project. “The more you improve quality, the more you reduce cost—because you are eliminating waste,” she explains. “You could reduce cost without improving quality, but that’s not what we’re after; we’re after reductions in the number of defects, in the amount of lead time, and in the waste within a process. Those will lead to cost reductions, but the ultimate goal is to improve quality.” In fact, Lee says, in lean production, cost is seen as a symptom of quality problems. “It’s symptomatic of waste and defects,” he observes. “We’re not thinking, ‘Let’s get rid of this cost.’ Instead, if a cost is out of line with what it should be, we’re considering what the implications are for the process. The tools are designed to address quality, not cost.” Radiology-department Projects In 10 years, the radiology department at VMHMC has tackled an array of issues using lean tools. Glenn says, “We’ve applied them to every area of radiology: all of the different modalities—CT, MRI, ultrasound, the breast-imaging center, and every section. We made a huge push to be able to offer same-day access to all of our modalities. We worked on our backlog to understand what really created that and how to take care of it, on an ongoing basis.”

VMPS Radiology Events In 2011, the radiology department of Virginia Mason Hospital and Medical Center (Seattle, Washington) performed two week-long rapid–process- improvement workshops and three kaizens. + Participants in a scheduling workshop (Integrated Procedural Center) planned and designed a resource-scheduling process that is transparent, integrated,