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Seeking Perfection in Healthcare


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Table of Contents


Change or Die
Germ of a New Idea
Toyota Mantra: Eliminate Waste

A Daring New Path
The First Trip
An Industrial Symphony
"Aren't You Ashamed?"
The Missing Piece
"This Is Ludicrous"
No Going Back

A Revealing Value Stream
The Patient's Voice
New Space, New Process
Continuous Improvement
Standard Work
A Singular Success

Patient Safety Alerts (TM)
A Nurse's Courage
A Doctor's Courage
Why Shouldn't Everybody Get a Flu Shot?
Mrs. Mary McClinton
Mistake Proofing
A Culture of Safety
Evolution of the PSA System

Stress on Primary Care
Moving the Mountain of Waits
Mistake-Proofing Care: Early Steps
Creating a New Tool
Inventing the Flow Station
Skill-Task Alignment
Primary Care Transformed
Going to Jidoka
External Setup
Biggest Room in the House

Creating a New Ambulatory Surgical Experience
Design Challenge
Listening to Patients
Setup Reduction
Center for Hyperbaric Medicine
Ask Why
Patient Focused

Geographic Cells
In-Room Documentation
Visual Work Environment
Medical Emergency Teams
Hourly Rounding: From Reactive to Proactive
Knowing the Frontline Work
Dramatic Change in Nurse Culture
Shorter Length of Stay

Identifying The Customer
"We Can Do Better"
Value Stream Reveals Huge Waste
Same-Day Access
Marketplace Defines Quality
Home Run
Financial Conundrum
Perverse Incentives

Seeing Virginia Mason with Fresh Eyes
Structure and Discipline
Training within Industry
Standard Work: Hand Hygiene
World-Class Management
Daily Management
"The State of the Union Every Tuesday Morning"
"Everybody Can Be a Leader"

Will You Teach Us?
If You Build It
Role Model
The Virginia Mason Institute
"Accountable Outside Our Own Walls"
The Obstacle of Arrogance
A Nonsystem
A Sense of Hope
The Journey Continues
"We're Just Getting Started"


Applying VMPS to Business Functions
Relentless Attack on Waste
Bringing Flow Stations to Specialty Department
General Internal Medicine: Spreading Innovation in Ambulatory Care
Breaking Down Silos
Skill-Task Alignment
Uphill Battle
Introducing Flow Stations
The New GIM

About the Author

Seattle, WA, USA


If you work in the health and medical care field and you believe you and your institution are as good as it is possible to be, you should read this book. It will reset your standards and show you how to produce more value for your patients at a lower cost. This is a front line story, not a pie in the sky theory or project of the month. It is a story about real people dedicated to the pursuit of habitual excellence. -- Paul O'Neill, 72nd Secretary of the U.S. Treasury & former Chairman and CEO of Alcoa A comprehensive and insightful book that chronicles an arduous journey to achieve an exceptional patient-centered culture using a management system only now recognized as relevant to health care. This is a story of how Virginia Mason became the benchmark against which other health care systems must judge themselves, and a beacon in a field that has resisted change for far too long. -- David M. Lawrence, MD, MPH, Chairman and CEO (retired), Kaiser Foundation Health Plan and Hospitals, Inc. The challenges to our U.S. health care system have never been greater. We are challenged by the high cost of care and less than optimal quality and safety. Virginia Mason Medical Center has been on a ten year journey to demonstrate just what is possible and the results have been profound. What is equally amazing, and must reading for health care leaders, is the story of their journey. It is possible to improve quality and safety while simultaneously reducing cost! -- John Kitzhaber, MD, Governor of Oregon 1995-2003 U.S. health care is replete with stories of failed attempts to improve quality and control soaring costs, only to succumb to perverse incentives, infighting and an entrenched status quo. Virginia Mason offers a different path forward, by showing what happens when all of health care's stakeholders -- doctors, employers, insurers -- align themselves behind pursuing the best care for the patient. It's a potential model precisely because its leadership medical staff had to overcome the same challenges that affect hospitals and clinicians across the country today. -- Vanessa Fuhrmans, The Wall Street Journal Congratulations to the Virginia Mason team for being another great example of committing to a compelling vision and to continuous quality improvement ! . Thank You! -- Alan Mulally, former President and CEO, Boeing Commercial Airplanes; current President and CEO, Ford Motor Company Health care transformation is a process not an event. This book richly describes this process at Virginia Mason -- not just the principles but all the challenges along the way and how they were overcome. It is a textured account of an ongoing journey and as such is an invaluable aid to anyone serious about transforming their own organization. -- Richard Bohmer, MBChB, MPH Professor of Management Practice, Harvard Business School This is the story of a journey. It's a journey that began almost a decade ago, that continues today, and that will likely continue for the foreseeable future. Through a number of powerful case studies, this book illustrates how Virginia Mason Medical Center has steadily improved the safety, quality, and efficiency of its patient care -- one process at a time. But more importantly, it is a study in leadership and cultural transformation in one of our nation's most important industries -- health care. That transformation has made patient-centered care much more than a slogan at Virginia Mason; it has become a way of doing business, each and every day. The beneficiaries of that transformation, first and foremost, are the patients Virginia Mason serves. But of equal importance is the new-found sense of accomplishment and satisfaction that these changes have engendered among the Medical Center's physicians, management team and employees. This book is inspiring must reading for anyone who leads, or aspires to lead, any health care organization. -- William F. Jessee, MD, FACMPE, President and CEO, Medical Group Management Association If you want to understand what health care can become, you need to know about Virginia Mason Medical Center. This book gives you the complete story. It is essential reading. -- David Cutler, former Senior Health Care Advisor, Obama Presidential Campaign An inspiring tale of leadership, discipline, and persistence by an organization committed to excellence in patient care. VMMC has redefined patient-centeredness as the core of process change. By so doing, not only has it transformed its culture and dramatically improved outcomes, it has set new standards for quality and efficiency. Must reading for all health care leaders who are serious about quality. -- Lucian L. Leape, MD, Harvard School of Public Health This remarkable story of Virginia Mason's journey to Lean offers hope that America can achieve the high-quality, affordable care we all deserve. -- Ceci Connolly, Freelance Writer How does a hospital change the very culture of medicine? By abandoning the philosophy that says This is the way we've always done it! That's the essence of the amazing story of true change told by Charles Kenney in Transforming Healthcare: Virginia Mason Medical Center's Pursuit of the Perfect Patient Experience. But hold on: This is not a cold chronicle of good people moving deck chairs around on the deck of the Titanic. This is genuine course-changing, history-changing work born of steely determination to stop hurting patients by finding ways of practicing medicine that tradition never taught. How does one transform to an idyllic hospital where errors never hurt patients and people are happy? By breaking the molds and infusing a common vision and by starting down the path Dr. Gary Kaplan and Virginia Mason were courageous enough to blaze ten years ago - when no one else was even peeking outside the box. If you intend to keep your patients safe - if you intend to improve the working environment, the bottom line, and the camaraderie of your hospital - you cannot ignore this story! This book isn't about Lean, Toyota, or any single methodology as much as it's about a refusal to maintain the terrible status quo documented by the Institute of Medicine in 1999. This book is the foundational element of understanding what it takes to really change a moribund culture. -- John J. Nance, author, Why Hospitals Should Fly Virginia Mason Medical Center is widely recognized as the pioneer in applying the disciplines of the Toyota Production Systems to improve the delivery of health care. Now, with the publication of Transforming Health Care, we have a first-hand account of what they did and what they learned: the steps they took to make the concept of Team Medicine a reality; the struggles and successes in moving from physician-centric to patient-centered care; and the projects they have undertaken to redesign clinical pathways to eliminate waste and error, reduce scientific uncertainty, and promote patient preferences. An easy read, but also an in-depth account of Virginia Mason's effort to transform itself. This book is a must for students of organizational behavior as well as for those who aspire to improve health care. -- John E. Wennberg, MD, MPH, Peggy Y. Thomson Professor Emeritus (Chair) in the Evaluative Clinical Sciences & Founder and Director Emeritus, The Dartmouth Institute for Health Policy and Clinical Practice

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