“One of our great strengths at Virginia Mason is that team members feel very connected to the organization and its mission.”
- Sarah Patterson
At Virginia Mason, things were going well. It was 2007 and the organization was in its sixth year of applying the Virginia Mason Production System (VMPS). Thousands of kaizen events had enabled Virginia Mason to provide higher quality, safer care, and do so more efficiently.
But data tracking results of the improvement events revealed a bothersome trend: In too many cases, improvement gains measured 90 days after the end of an event had slipped. Some slippage was to be expected, but what was concerning was Virginia Mason was only measuring 90 days post event. What would they find if they re-measured one year after the event? Would any of the improvements still be in place?
This challenge was hardly unique to Virginia Mason. Sarah Patterson, executive vice president and chief operating officer, spoke to many health care leaders around the country who were also confounded by their organization’s inability to sustain improvements.
“I talked to a lot of people who felt like they had to solve the same problems over and over, work unit by work unit,” says Sarah.
When Sarah and her colleagues analyzed the problem they went back to the roots of their work adapting the Toyota Production System to health care and realized there was an important module they had not studied in any particular depth. That choice had been made deliberately at the time – there was only so much Virginia Mason could handle at any given moment.
The module, called World Class Management, has three components:
- Management by Policy (hoshin kanri), which is a method to provide focus, direction and alignment within the organization;
- Cross Functional Management, which provides alignment across the organization toward full customer satisfaction;
- And Daily Management, which is essentially standard work for leaders.
“Management by Policy provides focus and direction,” says Sarah. “It is really the process by which the organization determines what it will work on, how it will do the work and how it will measure the results.”
Sarah and her colleagues could see throughout the organization there could be better alignment on goals that really mattered. It seemed clear that Management by Policy (hoshin kanri) was designed to help improve how connected people felt to the work being done.
“We use it to set our organizational goals and direction for the year,” says Debra Madsen, associate general counsel and administrative director, Legal and Administration Operations at Virginia Mason. “The bottom line is in order to align and engage everybody in the organization on what the organization considers the most important work, you need a very inclusive process for setting your goals.”
Says Debra, “It shines a bright light on our most important goals so team members understand our priorities. It is a great way to establish goals and engage everybody in the process.”
In the past, to develop annual goals, executives would make a list. But that’s all changed. Now, under the hoshin kanri approach, there are four elements to annual goal setting:
- Check and Review
Reflection is an environmental scan to make sure multi-year plans are still focused on the right things. “We look at what is going on both in the national and local environment – do we have any big changes (health care reform might be a good example) that we need to take into account in our annual goals?” says Sarah. “We also look at internal data from our staff and patient satisfaction surveys – is there anything they are telling us that we should take into account?
“The reflection phase involves preparing a written analysis of our strengths, challenges, and opportunities both externally and internally, and then sharing it throughout the organization,” says Sarah. “This transparency is really critical. If managers and team members don’t know what the challenges and opportunities are, how can they possibly feel a sense of urgency and engagement?”
Catchball is all about feedback and engagement with as many Virginia Mason employees as possible. It involves leaders throwing ideas to the organization, seeking input, and having staff throw back the ideas for revisions. It involves exchanging ideas and hashing things out in both formal and informal sessions.
“A lot of catchball is letting people know what we are working on already, why it is important and what we are shooting for next year,” says Sarah. “There is a real richness in the conversations. It isn’t about sending out emails or just formal meetings, it’s about a lot of one-on-one communication.”
[We’ll discuss Deployment and Check and Review in an upcoming blog installment]
Why is this important to our organization?
An essential part of the hoshin kanri process is identifying a problem or objective and making clear why it matters to the medical center; who needs to be involved to reach the goal; determining what resources are required and how progress will be measured.
The planning process thus involves a good deal of negotiating among and within departments. There is only so much any one organization, department, division or individual can accomplish. During annual goal planning – which typically starts the beginning of June and runs through the remainder of the year – there is enough openness, negotiation, give and take to arrive at consensus.
“When you do this right, the impact is that you have people who are engaged and empowered,” says Sarah. “They know what the organization is about and they understand how they can contribute to it every day. So it is not all about leaders making every move. You have created an ability for the entire organization and everyone in it to make improvements. At Virginia Mason, we use our strategic plan to start many of our meetings, and we talk about how whatever we are discussing will contribute to our strategic plan.”
The intensive focus by Virginia Mason leaders on communicating and having dialogue with team members has resulted in survey results showing one of the organization’s great strengths is that team members feel very connected to the organization and its mission.
“This is an essential part of creating a learning organization and an engaged workforce that’s out there moving your key initiatives forward,” says Sarah. “If everybody is contributing to the effort you will go further faster.”
“It gives us focus and alignment,” says Debra. “There are places where people go to work and face a lot of ambiguity about what they are doing and why they are doing it. With this process there is not a lot of ambiguity. People know the goals, they understand the why of the goals and they know their personal role in helping to reach those goals.”
“The kaizen fellowship program builds its own set of senseis who continue improvement and question whether we have waste within our own improvement processes,” Gillian says. “It helps make the application of lean even more dynamic.’’
|Delivering patient-centered, coordinated primary care
Last year, the delivery of patient-centered, coordinated primary care was a major Virginia Mason goal. It is on the goal sheet again this year.
“The environment is changing so rapidly that we decided we had to accelerate work on our primary care model,” says Sarah. “This emerged during our environmental scan when we looked at the trends — health care exchanges, the environment with employers, and the local marketplace. We said this is really important and will be for how we serve our patients – delivering outstanding quality, patient-centered primary care at a lower cost.
– There was some work going on but it was narrowly focused and looking at health care reform and what was going to be required to create the new model we needed to elevate our whole effort to redesign our primary care strategy.”
“It’s gone fine and what we were trying to accomplish by elevating it to an organizational goal is to create more urgency and more alignment of the importance of this effort and the need to devote resources and leadership bandwidth to ensuring that we are moving it forward – including the staffing model such as how we use our very valuable, different skill sets such as pharmacists, medical assistants, nurses, technicians and more.”