Case study 3: Virginia Mason Medical Center

The experience of the Virginia Mason Medical Center, a high-performing health care organisation in Seattle, United States, shows how improvement can be achieved from within.

The Center’s leadership team, keen to improve patient safety and quality of care, visited Japan in 2001 to learn about the Toyota Production System (TPS). On their return to Seattle, they began to develop the Virginia Mason Production System (VMPS). This involves the systematic use of a management method in which the patient is put first. Sources of waste are identified and eliminated over time through value stream mapping and other techniques. In essence, the VMPS focused on defining, observing and critiquing existing care processes, setting and measuring targets, developing and experimenting with improved processes; and implementing them.

Commitment from all levels of the organisation

The VMPS would not have happened without the initial commitment of the organisation’s leaders, and would not have become successfully embedded without engaging staff at all levels. Hundreds of staff were trained in methods of quality improvement, with a strong focus on identifying and tackling variations in care and developing ‘standard work’. But the process was not without its setbacks;  a small number of physicians interpreted it as a challenge to their prized autonomy, and chose to leave the Center to work elsewhere.

It has been argued that one of the advantages the Medical Center had in undertaking this improvement work was its structure. As a large integrated delivery system, with an exclusively affiliated and salaried medical group, supported by a cohesive culture, it had or was able to develop the capabilities needed to bring about change.

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