Why lean? Because it works


“It is the way we do our business. It is embedded within our culture. It is how we work.”
– Dana Nelson-Peterson, RN

Dana Nelson-Peterson, RN

Dana Nelson-Peterson, RN

Thirteen years ago when Virginia Mason started its bold move to adapt the Toyota Production System to health care, there were too many naysayers to count. Some people literally laughed out loud.

But the Virginia Mason Production System has proven time and again that it reduces waste, improves efficiency, strengthens the bottom line and, most importantly, improves the quality and safety of patient care.

In an industry where fads and flavor-of-the-month improvement techniques are so common, the question is how has Virginia Mason done it? How have they been able to stick with it all this time?

And the answer is simple: Because it works.

“It is the way we do our business,” says Dana Nelson-Peterson, RN, administrative director, Ambulatory Care Nursing. “It is embedded within our culture. It is how we work.”

Janine Wentworth, RN

Janine Wentworth, RN

Janine Wentworth, RN, administrative director, Hospital Patient Care Services, has seen flavor-of-the-month initiatives at other organizations but she says the Virginia Mason work bares absolutely no resemblance to that.

“It started with our senior leaders and they never wavered,” she says. “They put the methodology in everything they did, and they never wavered from their commitment or their vision. Our senior leaders walk the talk. They went to classes, got certified, learned the tools, led classes. They were unwavering. That’s how it became our language and our culture.”

Says Nelson-Peterson, “The word unwavering is really accurate, and even as we have seen executive leadership change over the years, the common thread continues to be using the Virginia Mason Production System as our management method.”

Both women believe early successes using the method and tools helped convince many throughout the organization that the system was for real. Early success redesigning the oncology service line completely focused on what was best for patients was a key moment that drew attention throughout the medical center.

“We sustain a lot of the work we do,” says Nelson-Peterson, “But we don’t sustain everything. We use PDSA (Plan-Do-Study-Act) cycles and if something doesn’t work, we might try it a second or even a third time.”

Many of Virginia Mason’s early kaizen events produced impressive results that increased the level of credibility for the methodology – and the level of excitement around the new way of working.

“Early on, there were some RPIWs (Rapid Process Improvement Workshops) and other events that made really significant improvements,” says Wentworth. “There were small improvement teams that improved flow in some areas within a few days – improvements that would have taken weeks in the past. Those things really got the team’s attention.”

Adds Nelson-Peterson, “One of our strategies is that when new leaders come in, we get them into kaizen events right off the bat, immerse them right away into an RPIW or a 3P (Production, Preparation, Process). And sometimes they are incredulous – this really is how you do the work here!”

“I overheard a conversation between two transporters in the elevator talking about mistake-proofing the work,” Wentworth says. “The people here who do the work understand the work. They understand the method, the language and the tools.”

How has lean worked at your organization?

Leave a comment


  1. Reblogged this on Joy Space and commented:
    And it works great…

  2. Can’t wait ’till my visit in 3 weeks!

  3. Hi to all, how is the whole thing, I think every one is getting more from this web
    page, and your views are pleasant in favor of new users.


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