When you think about how to make your business run more efficiently, learning a new language probably isn’t the first solution that comes to mind, but that’s exactly what the staff at Virginia Mason Federal Way have done.
Patients don’t know it, but when they walk into a waiting room, they’re actually stepping foot into the genba, Japanese for the shop floor. And kanban is the reason their doctors have the supplies they need in the exam room.
It’s a foreign language for those who aren’t familiar with the Virginia Mason Production System – or with the Toyota Production System, on which the VMPS is modeled.
VMPS was born out of a conversation between CEO Gary Kaplan and a former Boeing employee about the aerospace company’s utilization of the Toyota Production System.
Just as the Toyota Production System, and Boeing’s adaptation of it, outlined a management philosophy and practices that would save money and eliminate waste, overburden and inconsistency, VMPS provided a method for the organization to consistently measure and improve its operations and efficiency.
Since VMPS launched at the health system’s 10 campuses across the Sound in 2002, Virginia Mason has hosted countless workshops to continually work toward its mission of transforming health care and creating a patient-focused experience.
At Federal Way, Virginia Mason’s largest satellite, staff participate in more than a dozen improvement activities each year, including two or more five-day rapid process improvement workshops, known as RPIWs, and about 10 to 15 shorter, kaizen events.
“Our team had to get used to some pivotal Japanese terms,” recalled Margaret Brewer, administrative director at the Virginia Mason Clinic in Federal Way. “One of them was kaizen, which means continuous improvement, and, the real story, we’re never done with our work. It’s never perfect, there are always improvements that can be made.”
For everyone in the organization to learn the new lingo, Virginia Mason started offering an Intro to VMPS course.
Managers and selected administrative and physician leaders, then, receive additional training, which gives them authority to host and sponsor improvement workshops.
Brewer is one of four of the 50 physicians and 200 staff at Federal Way who are certified leaders in the program.
One of the most successful workshops at the local campus was on telephone service levels.
Employees and patients had complained about the phone service for years, Brewer said. They tried a number of fixes, including embedding the phone staff with the teams in the back office and having everyone responsible for answering the phones, but none of it worked.
“Our patients were having a difficult time getting through. They were on hold a long time. It just was not good service,” Brewer said. “One day, I received a fax brought over by one of my physicians from a referring physician outside the institution that started, ‘I’m sending you this fax because I couldn’t get through on the phone.’ That was what we call a ‘see-feel-change moment.’ I read that and I thought, ‘Enough.'”
Brewer led the RPIW in October 2011 with the goal of an 80 percent service level, meaning 80 percent of calls would be answered in three rings or fewer.
She used staff from internal medicine, because it was the largest department, and from orthopedics, because of the surgical specialty, which had 47 percent and 56 percent service levels, respectively.
“Clearly, we were not even remotely meeting the needs of our patients,” Brewer said. “So we pulled together a team and, by the end of the week, we had simulated changes that over the next 30 days had succeeded in getting us greater than 80 percent.”
These improvements included tweaks as simple as moving the phone staff, which, in general internal medicine, was located in a small room away from the department, to front-and-center in the front office. This gave the staff situational awareness and the ability to signal for help. They also improved communications and continued to track their success.
“Starting from day one, every morning, an email comes out – to this day it still happens almost two years later – with what was the service level the day before?” Brewer said. “How many calls came in? What was the service level? Did anyone hang up inadvertently because we couldn’t get to it fast enough? Following the success of this workshop, we did three other kaizen events here at Federal Way and the change was so dramatic – and the phone service issue was actually across the institution – that senior leadership decided we were going to roll this out throughout, and they did.
“We’ve had such positive feedback. I think this was the most successful RPIW I’ve ever been apart of, and I loved how it flowed throughout the organization.
Saving energy, time and money
Also worked into the foundation of VMPS was the Japanese concept of 5S, a method of organizing a workspace for efficiency and effectiveness. At its simplest, 5S is a list of five Japanese words that all start with “s”: seiri, seiton, seiso, seiketsu and shitsuke.
Transliterated into English, the five “s” words remain: sort, straighten, shine, standardize and self-discipline.
“The jumping off point here in Federal Way, once we had the initial education in place, was this process of 5S – to really evaluate the tools that we had, the supplies that we had, that we needed and the amount that we needed,” said Betsy Alley, medical director of the clinic’s outpatient surgery center.
A lot has changed since she was a resident in anesthesia at Virginia Mason 12 years ago.
When she was hired six years ago as Federal Way’s medical director, one of the things she noticed was the order.
“We didn’t have supplies that were being outdated or weren’t relative to what I needed,” Alley said. “In the past six years, now that I’ve been here and have learned much more about the process, what I have now is the ability to care for patients with what I need, when I need it – rather than worrying about: Is there a piece of instrumentation I need that I don’t have? Or, is there a supply that I’m going to need that I don’t have in front of me?
“I know that if I use six pieces of equipment one day, that our system of kanban (a tool staff uses to signal that supplies need to be replenished) and 5S will get that supply reordered and will be there the next day, the next time I open the drawer,” Alley said. “Not only did that make our job easier and easier for us to care for patients, but it was also the right thing to do, in that we had the right amount of equipment and supplies that we needed.
“We weren’t having supplies that were expired or sitting the shelves costing us money. We were able to take the money we saved, which was quite a bit, and use that toward patient care, rather than boxes on the shelf. For the institution, it’s saved us millions.”
These changes, like others the organization has implemented, have come from the genba.
“You can’t make improvements from an office or a conference room,” Brewer explained. “You have to be where the work is done, with the workers doing the work. So, it’s really a hands-on observational method.”
Evaluating their work from the genba has led to a number of improvements from the patient’s perspective.
For example, in primary care, there’s now a “Provider On-Time Board,” which has a picture of each provider and 3 columns: on time, 10 minutes behind and >20 minutes behind. The board is updated regularly throughout the day so that patients are made aware of any delay.
To assess the flow of patients and providers in Alley’s unit, staff use leader rounding, in which Alley, the manager and supervisor huddle with the other employees at the beginning of the day to assess any possible roadblocks and plan for the day. They also will gather on the genba, throughout the day to assure their plan is in action and come together again at the end of the day to plan for the next and address any recurring issues.
Across the organization, VMPS has increased the amount of time nurses spend in direct patient care from 35 percent to 90 percent. Doctors, who once worked into the evening doing paperwork, now leave by 6 p.m., and the turnaround time for lab results improved from 25 days for normal results to just two days.
The staff has also been empowered, at all levels, to ask questions and make suggestions for improving care and efficiency.
“Staff are encouraged to submit everyday lean ideas,” said Alley. “They’re rewarded big and small for everyday lean ideas. And then they’re shared through our online system to anywhere in our organization, so that someone in the ER has an idea, but it might work down in Federal Way. Or, someone in Federal Way might have an idea and it might work in one of the clinics downtown. That is easily shared throughout our organization.”