Lean Production at Virginia Mason
In the early 2000s, Seattle’s Virginia Mason Hospital was not performing as well as it should have been. Financial returns were low, patient satisfaction was subpar; too many errors were occurring during patient treatment, and staff moral was suffering. Gary Kaplan, the CEO, was wondering what to do about this when he experienced a chance encounter with Ian Black, the director of lean thinking at Boeing. Black told Kaplan that Boeing had been implementing aspects of Toyota’s famous lean production system in its aircraft assembly operations, and Boeing was seeing positive results. Kaplan soon became convinced that the same system that had helped Toyota build more reliable cars at a lower cost could also be applied to health care to improve patient outcomes at a lower cost.
In 2002, Kaplan and a team of executives began annual trips to Japan to study the Toyota production system. They learned that “lean” meant doing without things that were not needed ; it meant removing unnecessary steps in a process so that tasks were performed more efficiently. It meant eliminating waste and elements that didn’t add value. Toyota’s system applied to health care meant improving patient outcomes through more rapid treatment, and eliminating errors in the treatment process.
Kaplan and his team returned from Japan believing in the value of lean production. They quickly set about applying what they had learned to Virginia Mason. Teams were created to look at individual processes in what Virginia Mason called “rapid process improvement workshops.” The teams, which included doctors as well as other employees, were freed from their normal duties for 5 days. They learned the methods of lean production, analyzed systems and processes, tested proposed changes, and were empowered to implement the chosen change the following week.
The gains appeared quickly, reflecting the fact that there was a lot of inefficiency in the hospital. One of the first changes involved the delay between a doctor’s referral to a specialist and the patient’s first consultation with that specialist. By examining the process, it was found that secretaries, whose job it was to arrange these referrals, were not needed. Instead, the doctor would send a text message to the consultant the instant he decided that a specialist was required. The specialist then needed to respond within 10 minutes, even if only to confirm the receipt of the message. Delays in referral- to treatment time dropped by 68% as a consequence of this simple change, which improved patient satisfaction.
