is about life at the very top of the world's forests, a distinct aerial
realm where an estimated 30 million species share their space with
leaves, branches, rain, sunlight and wind. Life on the ground is
interconnected with life on the top and everything in between. In fact,
survival of the whole forest depends on the success of the life at every
level. And health care organizations have much in common with forests.
The design team envisioning a new Kirkland Clinic at Virginia Mason Medical Center in Seattle studied rainforest ecosystems
as they considered how different teams of specialists, internal
medicine and family medicine providers could blend individual design
needs for their own patients while working together on whole clinic with
core support services. As a result, the Mountain, Meadow and Beach
corridors in the clinic allow the teams to share resources and operate
autonomously as needed.
In his new book Accelerating Health Care Transformation with Lean and Innovation, internationally renowned consultant Paul Plsek describes Virginia Mason Medical Center's continuing work to integrate Lean
and innovation in pursuit of "the perfect patient experience." Learning
from analogies in nature is one tool. Word play was another.
Participants in a workshop convened for design of another clinic used
the word "lagoon" to temporarily sum up a guiding metaphor. A lagoon is
flexible because it supports both fresh and salt water and while it
looks calm and beautiful it's teeming with life under the surface.
In 2002, Virginia Mason adopted the basic tenets of the Toyota Production System, called it the Virginia Mason Production System,
and integrated it throughout the organization in an ambitious program
to change the way it delivers health care and improve patient safety and
quality. Plsek, a management guru and expert in large scale change in
complex systems, served as the center's chair of innovation. He explains
lucidly and with dozens of examples why Lean and innovation are
complementary. Lean is about standardization that improves flow and
removes waste, and it stretches people's thinking by aiming for
perfection even when that seems impossible. That requires busting myths,
re-thinking basic assumptions, and examining practices in other
industries. During various change efforts, staff members were asked to
study weather forecasting, air traffic control, and computer virus
detection for any key features that might relate to improvement in
hospital care. Inspired by the fast food business, Virginia Mason began
the first drive through flu vaccine program.
tools of lean and the directed creativity described by Plsek brought
about a clinic operation so well designed that patients were seen
immediately, eliminating the need for a waiting room, and an infection
prevention and communication system so efficient that time needed to
identify a catheter associated urinary tract infection was reduced from
seven hours to 11 minutes. Plsek talks about the long commitment to
create a learning organization, where all community members are
introduced to VMPS, all engaged in improvement, and leaders learn to
coach and support learning. Plsek discussesa commitment to andragogy-the
education of the adult learner, who unlike the child or complete
novice, needs opportunities for application of new concepts, dialogue,
and guided reflection in a safe environment that permits the learner to
challenge and unlearn old and deeply held beliefs and assumptions.
Plsek makes clear, none of this is quick or easy. He quotes reflection
by Virginia Mason neurosurgeon Dr. Farrokh Farrokhi who studied the
Toyota system in Japan and came come to understand that the Japanese
after 50 years are still perfecting their system, and the journey of
lean and innovation is infinite. "I now realize that paradoxically, what
you need is patient urgency," Dr. Farrokhi said. Listen to tomorrow's PlexusCall with Paul Plsek and Daniel Pesut.