“As a VMPS specialist, I should be driving and accelerating VMPS so much so that a department is functioning on their own and I can move on to another area and do the same thing.”
Cindy Jo Allen, RN
Since Virginia Mason began the process of adapting the Toyota Production System to health care 13 years ago, its Kaizen Promotion Office (KPO) has played a pivotal role in countless improvements throughout the organization.
The purpose of the KPO is to accelerate the impact and application of the Virginia Mason Production System to the operations of Virginia Mason. We focus on service lines that are important to the overall organizational performance and where operational commitment is very strong. These service lines or value streams become the learning labs for the rest of the organization.
In 2008, Orthopedics (specifically total joint patients) became a priority area due to a focused growth plan and identified area of acute length-of-stay reduction opportunities. VMPS specialists and the KPO directors partner with operational leaders to accelerate their VMPS learning cycles. Some specific areas specialists support include developing the current state patient perspective value stream, working with operations to identify a future ideal state patient perspective value stream, and coach to create a kaizen plan to move the current state to the ideal state.
In addition to coaching and educating, the KPO monitors re-measures to assure sustainability. In our total joint patient population, the acute length-of-stay has decreased from a baseline of 86.4 hours to 60.2 hours. Other ways VMPS specialists support the operational work include developing new standard work as the inpatient unit transferred from our Central Pavilion to Jones Pavilion by leading or coaching multiple small kaizen events (one to three days).
Some key principles of VMPS that are apparent in the Jones Pavilion are:
- Supplies and tools, such as computers, at point of use (5S)
- Pod assignments that reduce team member walking and keep caregivers at the patient’s bedside, using appropriate layout to reduce the burden of work (5S)
- “Med Room in Use” signage to eliminate interruptions (visual control)
Because of our commitment to implementing Daily Management (using VMPS as our management system) the team can quickly resolve issues with little coaching from their leaders. For example, nurses were noticing Foley catheters were not being removed according to the protocol. The team started tracking elements such as which patients, at what times, and for what reasons, on a visual board (off-stage area). Their objective was to get to the root cause to understand why the protocol (standard work) was not being followed.
The portfolio of a KPO team member covers the full spectrum of the organization from surgical suites to accounting, from sterile processing to flow in primary care.
Cindy Jo Allen, RN, for example, has been working with clinic, surgical and hospital teams to improve the experience of patients having total joint replacements. She also supports the general surgery team’s focus on major pancreas and liver surgeries.
“One of the things that makes my job exciting is that there is a real commitment from the surgeons to improve their work,” she says. “On the other hand, one of the challenges for teams can be understanding what KPO’s role is. We support them in improving their own work, as opposed to telling them how to do it. They are the ones who do the work so they have to do the change.
“As specialists, we’re not here to do the work for you because it should be the work you are doing on daily basis. Our job is to help you build improvement into your daily work.”
VMPS specialists have a unique view of the work being done at Virginia Mason. They work at the frontlines in a variety of areas and have a strong overall sense of the improvement direction of the organization. And while Virginia Mason has been on its lean journey for well over a decade, VMPS specialists know the challenge of sustaining the commitment to the production system.
“We work to bridge the gap of kaizen and VMPS being viewed as something extra,” says Cindy Jo. “Our ubiquitous dissemination of standard work for leaders helps bridge that gap and make clear the implementation of VMPS is how we do our work. It’s not something we lay on top. It should be embedded.”
In her work, VMPS specialist Tanita May, RN, routinely sees the power of VMPS. Using the method and tools not only “eases the burden of work on people, but when something is broken we can go in and use the tools to fix it,” she says.
Tanita has a master’s degree in nursing and was drawn to KPO “to learn more about how VMPS can help me increase my skill as a nurse. It’s great to be on a team where you are constantly learning. As a VMPS specialist, my job is pretty multifaceted. It changes week to week.”
Some weeks she might coach others to make sure they are ready for a kaizen event, while the next week she may be teaching VMPS methods to a class.
One of her current projects is working with Evan Coates, MD, Lara Pomernacki, RN, and Christin Gordanier, RN, on the sepsis nurse-initiated protocol. This protocol, called “Sepsis Power Hour,” aims to empower nurses to act quickly to treat patients showing signs of sepsis. Since nurses are always at the bedside, they are more apt to pick up subtle, yet serious, changes in a patient’s condition. This protocol will allow nurses to start treatment for sepsis in the moment they assess for signs and symptoms of sepsis.
If the nurse is able to start the process of treatment while notifying the doctor, then Virginia Mason is using the scope of nurses’ competency to improve patient outcomes.
Tanita’s role is to meet with the team weekly to help determine the production plan for the rollout of Sepsis Power Hour. She provides VMPS expertise to advise the group on change management. The Sepsis Power Hour project is particularly complex in that it involves every department in the hospital.
“Dr. Coates and Christin are a fantastic team, and my job is to help remove barriers and support them while moving the work forward,” Tanita says.
How does your organization ensure the work is always moving forward, continuously improving along the way?
Virginia Mason Annual Report
We are proud to share the 2013 Virginia Mason Annual Report. Read about our patients, the treatment they received at Virginia Mason and how it has improved their lives.