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The pathway to higher quality and lower costs is the same

March 18th, 2013

by Gary S. Kaplan

Across the United States, there are pockets of brilliance in healthcare. But there is too much variability, with unsustainable costs and inconsistent quality.

We need more than pockets of brilliance. We need to expand our definition of brilliance to confront the suffocating costs of healthcare, and focus on an approach that provides little variability, lower costs and consistent quality of care--for every patient, every time.

Virginia Mason Medical Center in Seattle was the first in the nation to adapt the Toyota Production System as the framework for managing a medical center. We call our version the Virginia Mason Production System (VMPS). It is our management method to identify and eliminate waste and inefficiency in the numerous processes that are part of the healthcare experience.

By streamlining repetitive and low-touch aspects of care delivery, our physicians, nurses and other clinical staff members are freed to spend more time talking with, listening to and treating patients. We are discovering it is possible to provide high-quality care with lower resource utilization.


An example of how this works at Virginia Mason is something we call "being in flow." Changing how primary care works in our clinics has increased levels of satisfaction for medical professionals and our patients.

By reengineering processes, we have created flow stations where the physician works in partnership with a medical assistant who breaks down the paperwork, phone calls and emails into small lots that can be handled throughout the day in flow, rather than in a huge batch at the end of the day.

Since it takes less time to work small lots immediately after seeing each patient, they have reduced not only the burden of work, and the work day, but costs as well. Physicians are freed up to spend more quality time with their patients, and medical assistants flourish as crucial members of the care team.

Flow also has significantly impacted hospital care at Virginia Mason. Combining flow with skill-task alignment, and simply taking the waste out of processes, has enabled us to rethink many of the old tapes in hospital care.

Our nursing teams used the VMPS rapid improvement workshops to redesign the flow of work so they could focus more on patient care. Instead of caring for patients throughout a unit, nurses now work as a team with a patient-care technician (PCT) in "cells" (groups of rooms located near each other).

The cell model makes it easier for nurses to monitor patients and quickly attend to their needs. Steps walked per day have fallen from 10,000 to around 1,200.

We also evaluated nurses' duties and reassigned non-skilled work, such as room setup, to other staff, increasing the nurse-to-patient time from 35 percent to more than 90 percent in areas where cells have been implemented. Communication between nurses, PCTs and rounding physicians also has improved.

We are achieving the seemingly contradictory outcomes of lower costs and higher quality.

All of us in healthcare have a moral imperative to make care better, faster and more affordable. Using the tools of the Virginia Mason Production System, we are finding that the pathway to higher quality and lower costs is the same.

Gary S. Kaplan, M.D., FACP, FACMPE, FACPE, is chairman and CEO of Virginia Mason Health System in Seattle. He also is a practicing internal medicine physician at Virginia Mason and a founding member of Health CEOs for Health Reform.


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