Why change how we do things after 80+ years?

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Several years ago we realized that our management approach was not able to evolve fast enough to keep up with the changing environment

So we searched for a new philosophy and systems that could evolve ahead of the increasingly harsh environment. We looked around in health care and saw

Then we looked outside our industry, and found a model that we were sure could work in health care— the lean thinking philosophy, which we now call the Virginia Mason Production System (VMPS). J VMPS is modeled on the Toyota Production System, a management method with a halfcentury track record of success.

We’re in good company „ Toyota „ Honda „ Boeing „ Porsche „ WireMold „ Genie Industries

Japan Study Mission

Participants: •Visit the Toyota Museum •Participate in a Gemba Kaizen event at Hitachi air conditioners •Visit the Toyota assembly line •Commit to applying their learnings to a process they own within 12 months

Objection Virginia Mason is dealing with human lives, not industrial products. How can methods for improving manufacturing work be applied to a service like health care? J No argument that we are delivering something very different from a car. We are helping people who are sick, worried, vulnerable and afraid. These interactions can’t be mechanized. In fact, we want to be able to increase the valueadded time spent with our patients. J VMPS can help us do that by examining and improving the tremendous number of “processes” that surround and are embedded in patient care and support functions. For example, turning over an OR room is like a pit stop for a race car – and we know this has been improved over and over again.

What is VMPS? „ It is the method by which we manage and deliver on our mission and vision

VMPS Strategies „ Rapid Process Improvement Workshops „ Kaizen Events „ 5S Workplace Organization „ 3P (Production Preparation Process) „ Patient Safety Alert System (stop the line) „ Standards Alert System „ Everyday Lean Idea System „ Staff and Leadership Education & Training „ Evolution of Infrastructure

Improving the Infrastructure helps „ Focused goals aligned with organizational goals „ Explicit measurable targets „ Accountability for implementation and sustained results „ Enhanced leadership structure „ Enhanced “gemba” support „ Improvement never ends and is full-time work

Rapid Process Improvement Workshops (RPIW) The Virginia Mason Production System uses Rapid Process Improvement Workshops (RPIW) as its main tool to eliminate waste, improve processes, and increase productivity. There are “standard” measurements taken before and after each RPIW that quantify process improvements

RPIW Basics „ Go to the gemba and watch the process „ Collect data, down to the second, include the waiting time „ Separate value-added activities from the waste – get rid of the waste „ Simulate the improved process „ Create standard work „ Measure and track the improvement

The wastes „ Waiting „ Movement „ Transportation „ Defects „ Inventory „ Over processing „ Over production

RPIW Example Areas „ GI Endoscopy flow „ Operating Room turnover „ Radiology flow „ Specimen collection mistake proofing „ Pharmacy mistake proofing „ Emergency Department „ RN Rounds „ Capital budgeting „ Product review „ Instrument turnover „ Preference cards „ Case carts „ Omnicell standard set-up „ Implant standard process „ Non-stock inventory „ Receiving „ Information flow

Basics of the Lean Supply Chain „ Product standardization „ JIT deliveries – low unit of measure „ Delivery to point of care „ No warehouse „ High inventory turns „ External set-up (kits) „ Level demand

More lean supply concepts „ Highly automated– EDI „ Mistake-proofed „ Products pulled through the chain „ Standardized processes and data protocols „ Fewer vendors „ “New” relationship with vendors

What do we need from Manufacturers & GPO’s? „ Universal product code systems „ Reward innovation „ Put more products through distribution „ Transparency through the entire supply chain