“Continuous flow maximizes quality, reduces defects and makes waste much more obvious so that you can eliminate it. Flow reduces waste, chaos and costs. And it makes your value stream transparent – you can see it.”
– Cindy Rockfeld
In the turbulent world of health care today, success depends upon the ability of an organization to excel in many areas. One of the essential areas is learning.
Every day, it becomes clearer that the status quo is a prescription for failure. An organization choosing the status quo over continuous learning and improvement will inevitably fall behind.
Virginia Mason, at its core, is a learning organization. Team members are engaged in an ongoing learning process based on the Virginia Mason Production System (VMPS), adapted from the Toyota Production System.
While Virginia Mason team members learn in a wide variety of ways, one of the most important is known as the Kaizen Fellowship, an advanced 16-month program for a select group of leaders designed to provide a deeper understanding of the Toyota methodology and tools. Fellowship applicants must have completed the organization’s VMPS for Leaders curriculum and Rapid Process Improvement Workshop certification.
Linda Hebish, administrative director, Kaizen Promotion Office, was among the early Kaizen fellows in 2006. “It is intense because you do the fellowship while doing your regular job,” she says. “The intent of the program is to offer additional leadership development opportunities to those already certified and knowledgeable in the Virginia Mason Production System and to have them go through a concentrated application of tools and principles to gain a deeper understanding of how the management method works.”
Linda points to two leaders who recently completed the program: Roger Woolf and Cindy Rockfeld.
Roger serves as administrative director of Pharmaceutical Services, and he found the initial phase of the fellowship – extensive reading and then discussing the readings with other fellows – to be particularly valuable (See below for a sample of readings).
“The fellows would get together, and we would try and teach our colleagues about our own value stream and how we hoped to improve it during the fellowship,” says Roger. “We were helped immeasurably by the active engagement and guidance of our leaders, including Linda Hebish, Kathleen Paul (vice president, Communications and Public Policy) and Diane Miller (vice president and executive director, Virginia Mason Institute). And Sarah Patterson (executive vice president and chief operating officer) participated in vast majority of our academic sessions, which shows you the commitment executive leadership to the fellowship and our learning. She really challenged us.”
Roger, Cindy and the other fellows would gather to dig into a particular aspect of lean, such as mistake-proofing, visual controls or level-loading. “We would read about it, discuss it within the group and then apply it to our own value stream,” says Roger.
He found the combination of academic study, intense discussion and presenting to senior leaders within the organization, to be challenging and immensely edifying.
In his fellowship work, Roger focused on sterile drug preparation. “In the pharmacy we have a sterile compounding room with very clean airflow to make drug preparations. We focused on creating flow and mistake-proofing the processes since many of these drugs are high risk and making a mistake could be catastrophic.”
The fellowship, says Roger, helped immensely in improving the safety of sterile drug processing preparation. Perhaps more than that, the program helped Roger become a stronger leader. “I loved it,” he says. “It challenged me immensely. It taught me a lot about reflection – reflecting on what we have done in the past and what we can do today to improve. And I now have a much better understanding of VMPS concepts.”
Cindy serves as administrative director, Ambulatory Services, and says her fellowship experience “gave me deeper knowledge of VMPS and how to apply it. I feel like I am a lot more thoughtful about it.”
She says the goal all along was to better understand the tools and methodology to improve flow throughout her area. “One of the most valuable things about the fellowship is the deeper discussions we had as a group,” she says. “Some of the discussions were theoretical, some were operational and they all collectively helped deepen and solidify our knowledge.”
The Japan tour for Kaizen fellows focuses on the concept of flow and the fellows witnessed flow in a variety of manufacturing settings. “We visited factories making airplane engines, circuit boards, farm equipment and more,” says Cindy, “Our focus was always on how they implemented flow and how we could apply the lessons at home in our value streams.”
Cindy found the cumulative impact of the fellowship learnings very powerful. After all the rich discussions with colleagues and work on her value stream, and reading and the Japan visit, a light bulb switched on for Cindy.
“I realized that all of the concepts together – the tools and the VMPS method – get you to continuous flow,” she says. “If you apply the management method, use the tools and trust the process, you will get to flow, and the benefits of that are really significant. Continuous flow maximizes quality, reduces defects and makes waste much more obvious so that you can eliminate it. Flow reduces waste, chaos and costs. And it makes your value stream transparent – you can see it.”
Cindy applied much of what she learned in her fellowship to the value stream for patients undergoing colonoscopies. “We want continuous flow for our patients and our providers,” she says. “We want patients flowing seamlessly from check-in through the procedure and through recovery without any breaks, defects or waits in our system.”
Consider this striking improvement: The amount of time it took for a patient to go through the colonoscopy process from entering the clinic to going home was 3 hours and 25 minutes. When improvement techniques were applied, that was reduced by more than an hour to 2 hours 23 minutes. This makes for a much improved patient experience and enables Virginia Mason to increase productivity.
“And I know we can get it lower still,” says Cindy.
Sampling of books Kaizen fellows read during their studies
- A Study of the Toyota Production System by Shigeo Shingo and Andrew P. Dillon
- The Toyota Way: 14 Management Principles from the World’s Greatest Manufacturer by Jeffrey Liker
- Creating a Lean Culture: Tools to Sustain Lean Conversions by David Mann
- The Hunters and the Hunted: A Non-Linear Solution for Reengineering the Workplace by James B. Swartz