Clinicians “studied what the best people were doing, figured out how to standardize it, and then tried to get everyone to follow suit … And the start-to-finish standardization has led to vastly better outcomes.”
- Dr. Atul Gawande
During the past couple months, the quality improvement work at Virginia Mason has been singled out by two of the nation’s most prestigious publications: The New York Times and The New Yorker magazine. In a lead editorial, the Times highlighted VM’s “rigorous internal reviews to eliminate waste and inefficiency.”
In a recent New Yorker article, Atul Gawande, surgeon and author, cited VM’s work taking responsibility for “the total experience of care, for the costs, and for the results” in certain areas. Dr. Gawande’s article focuses on precisely the kind of standard work in other industries that produces excellent results. Read the full article: Annals of Health Care, Big Med; Restaurant chains have managed to combine quality control, cost control, and innovation. Can health care?
This notion that health care can learn from other industries is at the heart of the Virginia Mason journey applying the principles of the Toyota Production System (TPS) in health care. Somewhat predictably, there has been pushback already against some of Dr. Gawande’s points about the applicability of restaurant management methods to health care.
CEO Gary S. Kaplan, MD, and his leadership team at Virginia Mason, experienced this same pushback – quite vigorously – 11 years ago when VM began adapting TPS to health care in the form of the Virginia Mason Production System.
“People aren’t cars,” was the refrain then. Eleven years later, the method has not only proven effective at Virginia Mason, it has spread to numerous organizations throughout the health care world.
And now, Dr. Gawande’s article further enhances the case that industry – in this case restaurant chains – have a great deal to teach health care providers. A Cheesecake Factory manager told Dr. Gawande of the negative experience his mother had with a medical issue and Dr. Gawande asked the man, “what he would do if he were the manager of a neurology unit or a cardiology clinic.” The restaurant manager said he didn’t know anything about medicine, but when Dr. Gawande nudged him further, the man replied:
“This is pretty obvious. I’m sure you already do it. But I’d study what the best people are doing, figure out how to standardize it, and then bring it to everyone to execute.”
One of the most encouraging recent developments in health care is that this approach to standard work – a concept at the core of TPS – is clearly gaining traction in health care. Dr. Gawande writes about an orthopedic surgeon at his Boston hospital who has sought to standardize joint-replacement surgery.
“Customization should be 5 percent, not 95 percent, of what we do,” the surgeon told Dr. Gawande. That surgeon “gathered a group of people from every specialty involved —surgery, anesthesia, nursing and physical therapy — to formulate a single default way of doing knee replacements. They examined every detail, arguing their way through their past experiences and whatever evidence they could find.”
The clinicians involved with joint replacement “studied what the best people were doing, figured out how to standardize it … And the start-to-finish standardization has led to vastly better outcomes.”
Certainly that has been the experience at VM – dramatic improvements via standard work in clinical areas across the board. The question facing so many health care organizations is:
Are we moving rapidly enough to identify and apply standard work that can reliably improve quality and control cost?