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Why Virginia Mason Chose Lean Transformation | Virginia Mason Institute™

Virginia Mason Institute — Fri, 20 Mar 2026 07:00:00 GMT

How Virginia Mason became one of the first hospital systems to use the Toyota Production System for healthcare

Welcome to our blog miniseries: Transforming Healthcare, featuring some of the biggest takeaways from the book Transforming Health Care: Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience.

Change or Die

In the early 2000s, Virginia Mason was in a financial crisis. They weren’t alone – the whole industry was struggling. Hospital leadership was also increasingly concerned that quality of care was not at the level they wanted it to be. Something was going to have to change…but what?

Dr. Gary S. Kaplan was the new CEO. He and others in the organization had always thought of itself as patient-centered, but as Kaplan began to deepen his understanding of how the organization was operating, he realized that it simply wasn’t true.

“The natural trajectory of the profession and the industry, first of all, was not one to look outside of itself,” says Kaplan in Transforming Healthcare. “So one construct is all we really had was ourselves to benchmark against and when you don’t look outside, you don’t necessarily see what’s possible….And if you don’t understand the current state and, even worse, you don’t know that you don’t understand the current state, it becomes limiting and you don’t think about something that ties it all together.”

Kaplan wanted to learn from other hospitals. Perhaps other systems had built a model that Virginia Mason could adopt to truly serve its new mission, which put patient care above all else.

“We were looking for ideas around innovation, around quality, safety and economics,” he says in the book. “I wanted ideas that we could steal, shamelessly, that would help us. But what I found was that there was no method to get there. We realized that nobody had a management method in health care to achieve this.”

The Airplane Conversation / Airplane Serendipity / Serendipity on an Airplane

But then Mike Rona, then president of Virginia Mason, happened to meet John Black on an airplane. ‘Lean’ manufacturing was gaining in popularity in many industries in the early 2000s, and Black told Rona about the Toyota Production System (TPS) and the transformational effect it had had at Boeing.

Assembly time for the 737 had been cut in half – from 22 days in 1999 to 11 days in 2005. Defects in production had been reduced 35 percent. Lean manufacturing had dramatically reduced the floor space needed for operations and reduced the amount of inventory kept on hand.

These are impressive improvements, to be sure, but what did auto manufacturing have to do with healthcare? Mike Rona and Gary Kaplan started to learn more.

Eliminating waste is the basis of the Toyota system. But it’s not just about wasting physical items. There are seven different types of waste: of time, motion, inventory, processing, defects, transportation and overproduction. In healthcare, “waste of motion” might happen when a nurse has to go off in search of supplies that could be kept readily at hand. “Defect waste” can happen when faced with doctors’ famously illegible handwriting. “Processing waste” might mean generating a report that has become obsolete.

‘“By eliminating waste, you improve quality, safety and reduce cost,” Kaplan observes in Transforming Healthcare. “When you eliminate waste, you create repetitive processes that can easily be standardized.”

Eliminating waste maximizes the value of every dollar spent on care.

Another core principle of the Toyota system is standardization, which can lead to a reduction in defects. Dr. Kaplan was beginning to see that, if TPS could effectively be applied to healthcare, it could offer the chance for Virginia Mason to improve quality and cut costs – an exciting possibility indeed.

Kaplan assigned a couple of teams to engage in Rapid Process Improvement Workshops, one of the key TPS tools.

They were thrilled with the immediate results: reducing the number of surgical instruments on the laparoscopic setup from 74 to 58, and cutting patient wait time by 69 percent. They achieved an annual savings of $26,880.

Kaplan was convinced, and began encouraging other members of his team to study the TPS. As they deepened their understanding of the model and began to comprehend how it could apply to Virginia Mason, a major insight became crystal clear: the challenges the hospital system was facing were not about commitment, competence, or resources. They were process problems. And they were starting to see how to address them. But in order to truly understand what might be possible, they knew they needed to see TPS in action. It was time to visit Japan.

A Study Trip to Japan

As plans took shape for a group of 30 top executives from Virginia Mason to take a two week long trip to Japan to study the Toyota Production System, many were skeptical. In June of 2002, The Seattle Times wrote, “for the past year, Virginia Mason Medical Center has been nipping and tucking to cut costs, so employees wonder why the hospital is paying for executives to go to Japan to learn to think lean.”

But Kaplan believed the trip would be more than worth it. And almost immediately, the executives were deeply inspired by what they witnessed. In their first dispatch home, they wrote:

“Toyota has perfected a set of tools and techniques that are applicable to any industry. There is not a single principle utilized to produce the highest quality automobiles that could not be applied to health care and to our processes at Virginia Mason”

One remarkable observation was that even the Virginia Mason team, medical professionals with no experience in industrial manufacturing, were immediately able to contribute to process improvement. Their dispatch continued:

“What impressed us was the ease with which we could understand a totally ‘foreign’ process, implement changes right away and see them work. We were stunned at the willingness of management to apply changes within minutes. Our teams would show the workers how we thought the work should change; they would retrain on the spot if possible and try it ….In one situation, the suggestion of placing parts on a higher platform eliminated bending over and picking up heavy parts hundreds of times a day for just one operator!”

The team came to understand that manufacturing and healthcare had more in common than they’d first thought. In another letter home they wrote: “Each of the products they produce has thousands of processes involved and many are very complex. Many of these products, if they fail, can cause fatality. They are in many ways, just like us.”

But this work did not ‘just happen.’ The executives came to understand that continuous improvement must be infused into every element of process, operations, and organizational culture. They observed that supervisors worked right on the genba (the shop floor), alongside line workers so they could communicate directly rather than via email or telephone. Team meetings happened at tables and chairs on the factory floor – not far away conference rooms.

The Virginia Mason group was able to witness what it looked like for kaizen – continuous incremental improvement – to be the fabric of every aspect of the work. As Kenney writes of the trip: “Toyota had succeeded in fostering a corporate culture that enhances individual creativity and teamwork while honoring mutual trust and respect between staff and management.”

The team returned to Seattle invigorated by the possibilities, but for some, it was simply too much change. While many embraced the change, some staff and physicians left for other hospitals, and others wanted to ‘wait and see.’ But as Kinney reports, Kaplan did not want anyone to ‘wait it out.’ He insisted on active engagement.

“If you want to be a senior leader here,” Kaplan told colleagues, “you have to be certified, which means you have to go through the certification training, take the exams, and continue to be certified to hold your job as an executive.”

Certification required a serious investment: seven days in the classroom and plenty of additional study – in addition to existing responsibilities. But the resistance soon gave way, as managers were able to almost immediately apply the learning to their everyday work – and get results.

An idea began to take shape: an adaptation of the Toyota Production System could become the Virginia Mason Production System. The idea was not to adopt the TPS wholesale, but to gain a deep understanding of its principles and apply them to healthcare. They knew the work would not happen overnight.

“Everyone was telling us that this takes twenty years,” says Kaplan, who was under pressure to make improvements immediately. But, he said, it was not long “before you realized that this is incremental and really a long-term strategy. So early on you’re hopeful that you’re going to see some really significant wins, but people said you’re going to be in it for the long haul. Given the unacceptability of the status quo in terms of quality, safety, cost, workforce satisfaction … there was no better option.”

With their work cut out for them, Kaplan and the Virginia Mason team embarked on what would become a new era of sustainable improvement – and transformation.

This post is based on the book Transforming Healthcare: Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience. You can find the book online https://a.co/d/09nWpGo

Healthcare Improvement With Kanban Systems | Virginia Mason Institute

Marlon Borbon — Tue, 25 Mar 2025 07:00:00 GMT

Defining kanban

In Japanese, the term kanban means “visual signal” or “card.”

At first glance, it’s hard to believe that a process perfected in a supermarket chain would have implications for health care. In the 1940s, employees from Toyota observed the way that U.S. supermarkets consistently provided their customers with the food they wanted at the time they wanted it — without holding on to massive amounts of inventory. The supermarkets stocked their shelves and coolers with a first-in-first-out (FIFO) system, stocking supplies from the back instead of the front, and placed visual signals in their stockrooms to let employees know when and how much to order as the stock was depleted.

Toyota successfully applied this kanban system to the manufacture of automobiles, to increase the organization’s efficiency. Much later, Virginia Mason applied a similar kanban system to make health care processes much more efficient and cost-effective.

How does it work in health care?

Before implementing the kanban system, Virginia Mason was like most health care systems — relying on the employee in charge of ordering supplies to operate on gut instinct, with no data. The result was that for some supplies, availability was scarce, and many employees felt the need to hoard supplies so they could access the items they needed to care for their patients. For other supplies, the stockrooms were overflowing, taking up space that could have been used for patient care.

Since the kanban system was implemented, however, Virginia Mason employees have learned to find what they need, just when they need it. In the supply cabinets in orthopedics, for example, there’s a two-bin system. Items are consistently stocked from the back, using the FIFO approach. When the first bin runs out, the employee who uses the last item places the empty bin in a common area. Then, because Virginia Mason has developed a very effective replenishment process with its supply-chain vendors, the card on that bin is scanned the same day, activating a new order of supplies that will fill up that bin. While the team waits for the new supplies to arrive, there’s already a full bin on the shelf — it’s been there waiting behind the previous bin — and it’s ready for the next employee who walks in. When the new supplies arrive, they’re placed in the empty bin, and the bin filled with new supplies is stocked behind the current bin.

With such a system, the supplies don’t run out, and because supplies are stocked from the back, the supplies are not on the shelf long enough to expire. This not only makes the organization’s system more efficient, but it also drastically reduces the inventory, saving costs. Even more, employees now have trust in a system that gives them what they need, when they need it.

“What if there’s a better way? What if you can trust a new system to give you what you need, when you need it?”
– Marlon Borbon

What is the biggest barrier to creating a kanban system?

In a system that is chaotic, employees have learned not to trust that they will have the supplies they need to do their job. If you ask them why they hoard supplies, you’ll hear, “I remember when an item ran out 10 years ago, and I can’t let that happen again.”

But then ask them this question: “What if there’s a better way? What if you can trust a new system to give you what you need, when you need it?”

What’s the best way to successfully implement kanban in a health care system?

Changing a health care supply system to a kanban system takes work. It’s a system that needs to be created by the frontline employees in collaboration with the purchasers and vendors. At Virginia Mason, our supply-chain vendors even participate in our improvement events to help us create and sustain reliable kanban systems that keep getting better year after year.

Keep in mind that there’s no one easy formula for all supplies, and different suppliers have different response times. For example, it may take seven days to receive a box of gloves but only two days to receive a box of masks. For these two items, assuming a similar consumption rate, the amount of items on hand in the supply closet will be different as the team waits for the new items to arrive.

When choosing which employee should work with the purchaser to make the kanban system a success, choose someone who knows the process, has experience ordering supplies and is open to change. For some employees, it is hard to let go of a process that is based on years of experience and gut instinct, but letting go of an unreliable process is the best way to start creating a process that will improve care for patients and improve job satisfaction for employees.

What’s the best way to get started?

Step back, and keep it simple. Try it first with noncritical items — ones that don’t pose a safety issue — in a small, controlled area. For example, start with an office supply like paper. If during the testing, the paper runs out, you can borrow some from another department without a problem.

To prevent running out of an item during the testing of more critical items, you can use safety stock — a minimum amount of an item to keep on hand in order to accommodate for variation.

After you test the process and refine it, then you can create standard work and get everyone on the same page. After that, you can spread the system to different departments so that the whole organization benefits from improved efficiency, lower costs and reliability that providers and staff can depend upon.

What’s stopping you from trying a kanban system today?

Listen to the full podcast episode hosted by Brenda McLeod:

Brenda McLeod — Fri, 21 Mar 2025 07:00:00 GMT

Is your team of great leaders a great leadership team? In the latest episode of Better Never Stops, join VMI’s Associate Executive Director Brenda McLeod and three guests for a fascinating conversation about the Leadership Emotional Intelligence Performance Accelerator (LEIPA®), a proven pathway to strengthening your leadership team. Read on to learn more, or listen to the full episode here.

LEIPA is not your typical team or leadership analysis. It’s a development tool for leaders that’s rooted in emotional intelligence and leadership styles, and it’s a pathway for transforming that team of excellent leaders into an excellent leadership team.

“ What makes it unique is that it doesn’t compare people to a norm or a band of averages,” says Greg Young, CEO and Co-founder of LeaderShape Global. Young is a co-developer of the LEIPA model.

“What it compares is observed behavior, and that gives a really comprehensive picture that the facilitator can use as a coaching tool, as a development tool, to help feedback or to generate from the candidate the insights that inform their own development program,” says Young.

LEIPA is rooted in the Emotional Intelligence and Leadership Style Framework created by Richard Boyatzis, Daniel Goleman, and Annie McKee. They brought the concept of emotional intelligence into the business world, and their research showed that leaders who possess high emotional intelligence are better at managing teams, handling stress, and creating a positive workplace culture.

The LEIPA questionnaire uses the framework’s six leadership styles (visionary, coaching, democratic, affiliative, pace setting, and commanding), five domains of emotional intelligence (self-awareness, self-regulation, motivation, empathy, and social skills), and three additional emotional intelligence competencies: trustworthiness, conscientiousness, and communication. The model asks the candidate and a group of ‘raters’ – their supervisor, colleagues, direct reports, peers from outside the organization – to rank the order of importance of the leadership style that they believe should be correct in their context, and to reflect on what they expect from the candidate as well as what they see demonstrated in working with them.

Young says that the LEIPA looks to help leaders detach from their egos – the goal is to develop “transpersonal leaders.”

“A transpersonal leader is somebody who’s reached a level of leadership maturity, where they recognize the benefits of setting aside their ego in their leadership practice. So they have a strong sense of personal purpose in service of a greater good, rather than that power, prestige, recognition, reward.” Young says this is an integration of rational intelligence, emotional intelligence, and spiritual intelligence – that is, qualities pertaining to the human spirit such as compassion and tolerance. “So these people no longer have the fear of being judged for making the right decisions. And because of this, they can be radical while also being ethical and authentic as leaders.”

The Team LEIPA Experience

Adam Sewell Jones is Chief Executive East and North Hertfordshire, NHS Trust. Through partnership with Virginia Mason Institute, Sewell-Jones and his leadership team recently participated in a Team LEIPA process, supported by Greg Young.

“At first it was a hard sell,” says Sewell-Jones – not because he doubted the model, but because time is such a precious resource. “We were concerned about the busyness that we all have.” The process does take time. Each participant must recruit several raters and complete their own questionnaire, and then participate in multiple workshops to review the results and create an action plan. But, Sewell-Jones says, his team managed to find the time. “I think the team were able to move forward in part because the cultural shift we’re seeing in the organization from our bigger partnership of implementing a management system and the learning culture that sits alongside it. So although it would be more work, I think the team were really quite excited about doing it.”

After the questionnaires are completed, each team member has an individual workshop to learn about the results and receive coaching about how to take action. Then it’s time to come together as a team. Adam’s team is one of the first to experience LEIPA through the Virginia Mason Institute. Greg Young led the group workshop.

“Probably the most exciting bit was when we did this as a team and Greg came in and we were lucky to have him with us to facilitate and he took us through the science behind the method.”

Sewell-Jones says the workshop helped the team look at the real scores rather than focusing on the gaps between expectations and reality.

“It’s great to do a bit of navel gazing and think about what it’s telling us,” he says. “But the change only happens when we actually work on an action plan.” The workshop concludes with building that action plan, and it’s yet another thing that sets this model apart.

“As you can imagine,” says Wendy Korthuis-Smith, Executive Director at Virginia Mason Institute, “we have a long history with leadership development tools, models, assessments, as well as what we call leader standard work.”

But she says LEIPA is by far her favorite leadership development approach and experience, because “it’s so aligned to our principles, our concepts and beliefs. And it provides the depth needed from a competency, capability, and behavioral perspective. It really brings that rigor, clarity, and actionable development opportunities for individuals and teams.”

Korthius-Smith and the Virginia Mason Institute leadership team recently underwent a Team LEIPA as well: as VMI considered adopting the practice, she knew it was crucial to experience it directly. “The journey has been really rich so far. We’ve identified our own target areas for greatest impact, both individually and collectively.”

For Associate Director Brenda McLeod, there’s an important benefit to connecting emotional intelligence and leadership styles. Perhaps even more powerful is knowing what to do next. “LEIPA enables individuals and teams to create an accountable action plan to address the gaps between observed and desired behaviors.”

Ready to Transform Your Leadership Journey?

Effective leadership is the cornerstone of any successful organization. LEIPA offers a comprehensive, evidence-based approach to developing leaders who can drive continuous improvement and foster a positive organizational culture. By enhancing emotional intelligence and aligning leadership styles with organizational needs, LEIPA helps leaders unlock their full potential and achieve remarkable results.

The Virginia Mason Institute is dedicated to supporting leaders like you. Reach out to us to discover how LEIPA can accelerate your leadership performance and drive meaningful change within your organization.

Listen to the full podcast episode hosted by Brenda McLeod:

Why is A Cultural Shift Important in Healthcare?

Virginia Mason Institute — Wed, 12 Mar 2025 07:00:00 GMT

When we think about what leads to positive patient outcomes, we often focus on medical advancements, skilled providers, and cutting-edge treatments. But one of the most influential factors in a patient’s outcome is often overlooked—health system culture.

Culture encompasses a team’s shared values, communication styles, and approaches to collaboration. A strong, patient-centered culture ensures that healthcare teams work together, driving innovation, trust, and efficiency. Without a focus on culture, even the best clinical practices can fall short. So how can organizations shift toward a culture that drives excellence and improves healthcare?

How Culture Affects Patient Outcomes

The culture of a healthcare organization directly influences patient outcomes and shapes overall care quality in several ways:

Trust: Patients must trust their healthcare providers to feel comfortable discussing symptoms and concerns. A lack of trust can result in non-compliance with treatment plans and poorer outcomes. Similarly, when care providers lack trust in their systems and colleagues, collaboration is hindered, potentially leading to avoidable patient harm.

Communication: Effective communication is critical to ensure patients receive the right treatment at the right time. When trust and collaboration are lacking within an organization, poor communication can lead to errors, misunderstandings, and inefficiencies in care delivery.

Innovation: A culture that values continuous learning and technological advancement promotes a proactive approach to adopting new digital health tools like telemedicine and improving patient care.

Safety: In organizations where safety is not prioritized as part of their culture, both patients and staff are at risk. A lack of emphasis on safety can stem from a culture that fails to value error prevention, learning from past mistakes, and implementing standardized procedures, which ultimately hinders efforts to achieve zero avoidable harm.

Cultural Sensitivity: A workforce that reflects the broader community it serves enhances patient-provider relationships, improves patient satisfaction, and promotes health equity.

5 Key Benefits of a Patient-Centered Culture in Healthcare

Improved Quality and Safety of Care
- Reduces preventable harm and enhances patient outcomes.
- Ensures standardized processes for better efficiency and reliability.
Stronger Trust and Communication
- Builds confidence between patients and providers, leading to better compliance in treatment plans.
- Encourages open dialogue, reducing misunderstandings and improving patient satisfaction.
Respect for Cultural Preferences
- Creates personalized treatment plans that align with patient values and beliefs.
- Encourages diversity and inclusion, leading to better equality in healthcare.
Embracing Innovation
- Supports integrating new treatments and advanced medical technology.
- Nurtures a learning culture where new ideas drive continuous improvement.
Employee Engagement and Retention
- Facilitates staff collaboration and input, making them feel valued.
- Promotes a positive work environment, reducing burnout and increasing job satisfaction.

Defining the Cultural Shift in Healthcare

The healthcare industry is at a crossroads. Moving away from traditional, hierarchical models and embracing dynamic, patient-centric systems is not only a trend, it’s a necessity. These systems prioritize collaboration, quality, and safety, placing patients at the heart of care delivery.

But transformation doesn’t happen without change. Healthcare organizations must not only adopt cutting-edge technology and innovative processes but also reshape how teams communicate and connect. Empathy and clear communication are crucial for building trust between providers, patients, and staff – leading to better care and outcomes.

Investing in the growth of healthcare professionals is equally essential. Continuous learning, upskilling, and empowering staff help strengthen expertise and sustain long-term improvements. Ultimately, a culture of respect is vital for lasting change, one where staff feel valued, patients experience better care, and systems run more efficiently.

The Barriers to Change: What’s Standing in the Way?

Shifting a system’s culture is not without its hurdles, and healthcare organizations must face these challenges head-on if they want real transformation.

Talent Retention Crisis: High turnover rates are more than an inconvenience, they disrupt care continuity, exacerbate staffing shortages, and breed burnout. If healthcare organizations don’t address this, they risk falling into a cycle of instability.

Leadership Resistance: Not all executives are on board. Whether due to financial concerns or a fear of disrupting the status quo, a lack of leadership support can quickly stall any cultural shift. Without strong, committed leadership, meaningful change is nearly impossible.

Training Gaps: The gap in training at all levels can cripple progress. Healthcare organizations need to invest in continuous, relevant education to ensure that their staff can execute on the new cultural vision effectively.

How to Drive Meaningful Change

A successful cultural shift isn’t automatic – it demands a strategic, concerted effort. Here’s how to make it happen:

Leadership Commitment: Transformation begins at the top. Leaders must set the tone by creating a clear roadmap that outlines core values and long-term objectives. This roadmap should reflect both immediate needs and a long-term vision, with feedback from frontline staff to ensure it is actionable and relatable.

Ongoing Education: Training should never be a one-off event. Regular, targeted education is critical for reinforcing patient-centric values, improving communication skills, and introducing innovative practices that drive progress. This continuous learning approach is essential for building a resilient and forward-thinking workforce.

Data-Driven Feedback: Actionable feedback from both staff and patients provides insights into what’s working and what needs improvement. Collecting this data helps leaders make informed decisions and create a culture that’s responsive and evolving.

Encourage Collaboration: A culture of collaboration doesn’t only improve team dynamics; it directly impacts outcomes. When employees feel heard and valued, job satisfaction improves, burnout rates drop, and patient care is more effective.

By embracing these strategies, healthcare organizations can build a culture that doesn’t only focus on operational efficiency, but also elevates the quality of care and the well-being of both staff and patients. The question is, will your organization make the shift?

The Future of Healthcare Starts with Culture

Healthcare isn’t just about treatments and technology; it’s about the relationships between providers and patients. A patient-centered culture isn’t a luxury – it’s the foundation for improved health outcomes, higher job satisfaction, and restored trust in the system.

As the industry evolves, those organizations that invest in cultural transformation will be positioned to lead the way. By prioritizing communication, trust, and continuous learning, we can create a healthcare future where both patients and professionals thrive together.

At Virginia Mason Institute, we help healthcare organizations worldwide to implement a proven, patient-centered management system. Our approach enhances quality, safety, and efficiency, while strengthening the effective elements of existing frameworks to create lasting, meaningful change.

Ready to learn more?

Download a self-assessment tool to identify strengths and opportunities to support a culture of improvement at your organization.

Download a case study about our partner using strategies to pursue patient safety and other goals.

Striving for Zero Preventable Harm in Healthcare | Virginia Mason Institute™

Virginia Mason Institute — Thu, 30 Jan 2025 08:00:00 GMT

Globally, about 10% of patients are harmed during the process of receiving healthcare, according to the World Health Organization (WHO). If that statistic isn’t alarming enough, its estimated that for roughly half of those patients, the harm is entirely preventable. Even one instance of preventable harm is too many. Consider this: how would you feel if you or someone you loved were the one effected? This is why healthcare organizations must strive for zero preventable harm – a vision that aligns with the very foundation of patient care.

For healthcare organizations, patient safety is not only a moral responsibility but a strategic priority. The stakes are particularly high in low- and middle-income countries, where up to 4% of patients die due to unsafe care. Regardless of income levels, healthcare systems worldwide share a common challenge: ensuring that care delivery is safe, effective, and reliable. This issue directly impacts organizational performance, patient trust, and long-term sustainability.

At its core, healthcare is built on science and the pursuit of knowledge. However, the reality at the front lines is that whether or not a patient is harmed often comes down to critical thinking and human judgment. Unfortunately, even well-meaning, and highly skilled healthcare professionals often face systemic barriers that make it difficult to ensure patient safety. Addressing these challenges is essential for healthcare leaders aiming to create resilient organizations that consistently deliver on their promise to patients.

Key Challenges Threatening Patient Safety

The root causes of patient safety hazards are often systemic and multifaceted. From our experience, two primary breakdowns frequently threaten patient safety:

1) Communication Breakdown

Communication failures are one of the most common sources of preventable harm. Critical information can be miscommunicated or omitted at various points, such as:

Transitions of care: Miscommunication between providers during handoffs can lead to incomplete or inaccurate information transfer.

Patient interactions: Failing to gather comprehensive patient information or ensuring patients understand their care plans can lead to errors.

Team collaboration: Misaligned communication between administrative staff, providers, nurses, and specialists can result in delays or mistakes.

2) Resource Limitations

Resource constraints – whether related to staffing, space, technology, or funding – can significantly impact patient safety. Examples include:

Space and infrastructure: Inefficient use of hospital space or overcrowded facilities can hinder safe patient care.

Staffing and training: Insufficient staffing or lack of access to ongoing education for healthcare professionals can exacerbate risks.

Technological gaps: Limited access to up-to-date technology or poorly implemented systems can impede decision-making and care delivery.

Strategies to Improve Patient Safety

Healthcare executives play a critical role in creating environments where safety is prioritized and embedded into the organizational culture. Here are four actionable strategies to consider:

1) Cultivate a Culture of Continuous Improvement

Encourage leadership and frontline staff to actively identify and address problems, establish a mindset of ongoing improvement.

Empower staff to speak up about safety concerns, creating an environment of psychological safety where issues can be resolved proactively.

Simplify and encourage patient communication channels, ensuring patients can easily provide feedback and ask questions.

2) Implement Structured Safety Systems

Conduct regular audits of existing safety protocols to identify gaps and areas for enhancement.

Establish clear systems for reporting and addressing safety concerns, such as the Patient Safety Alert System at Virginia Mason, which empowers staff to take immediate action to prevent harm.

3) Invest in Learning

Provide regular training on safety protocols and best practices for all levels of staff, from leadership to frontline teams.

Keep up-to-date with emerging research and innovations to improve patient care and adapt protocols accordingly.

Be transparent about safety incidents and responses, treating these as opportunities for organizational learning and improvement.

4) Recognize and Celebrate Success

Track patient safety metrics to monitor progress and identify patterns that can inform future strategies.

Celebrate wins, both large and small, to reinforce a culture of safety and motivate staff to maintain high standards.

The Strategic Case for Patient Safety

Improving patient safety has far-reaching benefits that extend beyond clinical outcomes. These include:

Enhanced staff well-being: When systems support safe care, healthcare professionals experience less stress and burnout.

Increased operational efficiency: Streamlined processes reduce waste and free up resources for patient-focused care.

Stronger organizational reputation: Demonstrating a commitment to safety builds trust with patients, regulators, and the broader community.

Reduced costs: Lower liability premiums and fewer avoidable complications contribute to financial sustainability.

By focusing on patient safety as a strategic priority, healthcare organizations can achieve a virtuous cycle of improvement. Safer systems lead to better outcomes, which in turn drive further efficiency, staff satisfaction, and patient trust.

Ready to Transform Patient Safety in Your Organization?

As healthcare providers, ensuring patient well-being should always be the top priority. If your organization is ready to take concrete steps toward zero preventable harm, Virginia Mason Institute can partner with you to achieve your goals. Contact us today to learn how we can help you create safer, more efficient healthcare systems – for every patient, every time.

LEAP: Designed for Healthcare Professionals | Virginia Mason Institute™

Virginia Mason Institute — Wed, 16 Oct 2024 07:30:00 GMT

Virginia Mason Institute’s mission is to help healthcare organizations create and sustain cultures of high reliability and high performance. LEAP (Learn, Experience, Apply, and Perform) methodology is the Learning Experience taught through Virginia Mason Institute. LEAP is a comprehensive learning experience that focuses on the application of knowledge and skills in the workplace. It emphasizes experiential learning and hands-on training. Often, these methods are more effective than traditional didactic methods. This is because experiential learning allows learners to engage with the material meaningfully and develop a deeper understanding of the concepts.

About LEAP

The LEAP learning experience is unique as it is specifically designed to be scalable for healthcare professionals. As an acronym, each letter in LEAP specifies a way of learning. L stands for Learn, which is about learning at your own pace using real-life examples to understand key principles, methods, and tools. LEAP includes mobile-friendly lessons in multiple formats including text, audio, and video to make training as accessible as possible. E stands for Experience, which provides hands-on learning exercises with reflection and collaboration to experience the concepts truly. Learners can engage in online discussions and additional opportunities to network. A is the next step standing for Apply. Applying learning is a way to integrate new knowledge with personal work and daily challenges. LEAP uses worksheets, projects, and more to provide a space for feedback. The final step in this system is the Performance of skills and new knowledge. Within this final step, growth is evident in how the staff applies the learnings to daily work. With the learning, experience, exercise, and application, the result improves patient performance, team performance, and the organization.

LEAP training demonstrates the following principles: one, Learning is a lifelong process; two, Experience is the best teacher; three, Application is essential for learning; and four, Performance is the ultimate goal of learning.

Aiming to improve employee engagement, retention, and performance is the goal of LEAP. It is a powerful tool for improving healthcare culture and training teams. It is a strategic method for helping organizations to achieve their goals and to create a better future for all.

How does LEAP work

LEAP is a nontraditional way of approaching learning holistically. Didactic learning has limits and often does not help an entire team with unique learning needs thrive. LEAP encompasses critical Virginia Mason Institute principles, methods, and tools. These are used to learn through exercises, reflections, and collaborations. Providing the environment to use these new principles in daily work and challenges is crucial to delivering value for patients, the team, and the organization. LEAP is cutting-edge training that combines innovative technologies, clinical expertise, and evidence-based methods to create a scalable healthcare education space.

What is unique about the LEAP learning experience is that it allows for personally paced learning through real-life examples. This engaging approach enables learners to progress at their own speed, fully grasp each concept, and retain information. With this learning method, collaboration with experts and other learners in similar positions fosters a supportive environment for asking questions, gaining insights, sharing ideas, and building a professional network. The LEAP method pushes learners to apply concepts to embed principles and procedures while reflecting on their work’s current state and potential impact. This unique approach to learning develops a sense of ownership and responsibility. By becoming teachers and coaches, learners can pass on their knowledge and skills, creating a culture of continuous learning and improvement within their organization. This continued learning ensures that the team’s new knowledge and experience with the methodology benefits the organization and are sustained over time. This learning experience gives healthcare professionals fundamental training to improve patient care, efficiency, and overall culture. It equips them with the skills and knowledge to deliver high-quality care, enhance productivity, and foster a collaborative and continuously improving healthcare environment.

Final Thoughts

LEAP from Virginia Mason Institute offers a transformative approach to learning. Focusing on healthcare professionals, this method prioritizes hands-on experience, collaboration, and the application of knowledge in real-world settings. By guiding learners through the stages of Learn, Experience, Apply, and Perform, LEAP cultivates a deeper understanding of essential principles while fostering personal growth and professional development. Learners are able to apply concepts quickly to embed the principles and methods while reflecting on the current and potential impact of the Learning Experience. This Virginia Mason Institute learning experience equips healthcare professionals with the tools to enhance patient care, improve talent retention, and enhance organizational performance. Additionally, this type of learning instills a culture of continuous improvement. Through LEAP, teams become more engaged, better prepared, and more committed to delivering high-quality care. Learning this way creates a lasting impact on both their personal practice and the broader healthcare environment. LEAP functions as a vital tool for organizations striving to meet the challenges of modern healthcare with agility, innovation, and a commitment to excellence.

A Guide for Leaders Implementing NHS Impact | Virginia Mason Institute™

Virginia Mason Institute — Mon, 13 May 2024 07:00:00 GMT

Originally published on NH S Providers.

NHS IMPACT articulates a detailed vision for quality improvement across the NHS. The task of mobilising that vision, however, falls to leaders.

As a result, leaders at many of our England’s health system’s 200+ trusts are looking for help — a partner organisation to guide the transformations in culture, management practice and improvement capabilities that are necessary to bring NHS IMPACT to life.

How do you find the partner you need? Look for these five qualities.

1. Someone who meets you where you are

Every trust is complex and unique. So each one will follow a unique path of transformation, with a unique starting point. Leaders should seek a partner that respects those differences and takes time to understand them.

When looking at potential partners, be sure to ask:

How they determine what each client needs
How they adapt their services based on those needs
How they would assess the needs of your organisation in particular

Virginia Mason Institute (Virginia Mason) thoroughly analyses an organisation to figure out the ideal starting point for its transformation. We call this process our ‘readiness diagnostic’. It includes site visits, interviews, focus groups and surveys that document the ‘current state’ in various areas, from workforce engagement to how the organisation measures performance and improvement.

We then place your organisation on a continuum that visualises your readiness for change — and goes far beyond the simple grade or ranking established by other maturity models. First, it reveals your immediate needs and helps you chart a strategic path forward. Second, it provides a baseline for tracking progress and updating strategy over time. Organisations can update their placement on the continuum as they evolve and repeat the diagnostic process.

Adam Sewell-Jones saw the readiness diagnostic applied in multiple trusts while serving as NHS director of improvement, and more recently at East and North Hertfordshire NHS Trust, where he is now chief executive. He says, “This diagnostic not only gauges your readiness for change but multiplies your odds of succeeding. Even if a leader can’t undertake a full partnership with Virginia Mason Institute, the diagnostic alone is very powerful.”

2. Someone who takes a holistic management perspective

For improvement to persist as an organisational priority, it must be part of a broader management system that touches everyone ‘from board to ward.’ Look for a partner who will help you make improvement part of your trust’s DNA and part of everyone’s job.

We worked with a large academic medical system in the U.S. that learned this lesson the hard way. Leaders cycled through many improvement methods that failed to take root because each one was a special initiative, separate from the daily work of patient care. Eventually, leaders collaborated with us on a more comprehensive change. They established a single management system that spanned the entire organisation and empowered everyone to contribute to the mission of improvement. While that required considerable groundwork, it paid off magnificently. The organisation reduced patient harm incidents by half and positioned itself to tackle numerous other challenges.

For a holistic management system like that to work, leaders must change the way they lead. For example, they need to do less directing (‘Here’s what you should do …’) and more framing (‘It sounds like this is the problem …’) That way, frontline workers can do their part as problem solvers.

I recently met with an executive whose trust had adopted a new improvement method with disappointing results. The method was solid, and frontline workers were highly engaged. But they weren’t able to follow through because — the executive eventually realised — leadership behaviour remained unchanged. The trust had built a state-of-the-art plane but provided no runway for it to take off.

3. Someone who approaches equity at the systems level

Advancing diversity, equity and inclusion in healthcare has become a strategic imperative for all of us. But to make lasting progress, we can’t just treat the symptoms. Leaders today need a partner who can help them address the underlying condition: systemic inequity.

A systems approach to healthcare equity is one that embeds equity concepts in improvement methods, staff and leadership training, and daily practices. Virginia Mason Institute has developed practical ways to do this, based on the experience of systematising equity in our own medical system. These include tools such as:

The Inequity Waste Wheel, which consists of a visual aid and questionnaire that help teams recognise different types of inequities. Inequities range from the omission of certain voices to the barriers to access faced by some people. These cause harm in various ways, from depriving patients of opportunities to preventing staff from contributing at their fullest, which translates to waste for the organisation — value that can be realised if we interrupt and question certain mindsets and habits.
Equity Pauses can be added to meetings of all kinds, from daily huddles to executive planning sessions, to step back and evaluate decisions and activities through an equity lens. They include questions like ‘Does everyone benefit equally from this?’ and may be guided by the Inequity Waste Wheel or tailored to the work at hand. At Virginia Mason, equity pauses have helped teams remove eligibility barriers for potential transplant patients and remove bias from our diagnostic algorithm for kidney disease.

Tools like these provide a clear and methodical way of prioritising equity. They comprise part of a pervasive effort to centre the experiences of historically marginalised and underrepresented communities and support safe, culturally responsive care.

4. Someone who has their own experience in clinical settings

The closer a professional services organisation is to the daily realities of leaders, workers and patients, the more relevant and up-to-date its services can be. Look for a partner whose expertise comes not only from working with healthcare but also from working in healthcare themselves.

An organisation with boots on the ground in real healthcare settings is better positioned to:

Keep pace with the rate of change in healthcare.
Work with you like a peer, with a deep understanding of your needs and circumstances.
Help you avoid missteps and accelerate your transformation.

Virginia Mason has been on its own improvement journey for 20+ years. As a result, we know what happens every day in the operating room, lab and exam room. We see firsthand what helps and hurts an organisation’s transformation efforts. And we bring these lessons to every partnership.

5. Someone who has previous experience with NHS trusts

The NHS is a unique ecosystem. Trusts must pursue their own goals while also satisfying national goals and mandates. How can you take on large-scale transformation at the same time?

The right partner will have experience helping leaders join organisational and national goals together with transformation activities as one complementary effort.

For example, Leeds Teaching Hospitals NHS Trust (LTHT) held a ‘requires improvement’ Care Quality Commission (CQC) rating in 2014, before its five-year engagement with Virginia Mason. But rather than view improvement as ‘one more thing’ to take on in a difficult time, leaders embraced it as their way through a difficult time.

LTHT developed a new trust-wide management system and used it to improve not only its quality rating but also its finances and staff morale. Sir Julian Hartley, the chief executive at the time, told researchers from Warwick Business School, “The trust overall has moved in terms of the absolute measures from a £100m deficit to a £19m surplus, from a position of ‘poor quality’ through ‘requires improvement’ to ‘good’ CQC, from one of the worst staff surveys to one of the best.”¹

Professor Phil Wood, the current chief executive at LTHT, has continued the Leeds Improvement Method journey. He commented, “Working with Virginia Mason Institute has allowed us to systematically embed a quality improvement approach as our management method and ensure improvement activity across the trust delivers against our most important strategic priorities.”

The right partner will also include experts with experience inside the NHS itself. At Virginia Mason, leaders from LTHT and two other trusts serve as valuable members of our delivery team. They conduct trainings and perform other services, right alongside our own experts, to help leaders at other trusts make the same leaps they did at theirs. It’s true peer-to-peer engagement, ensuring that trusts build capacity that is unmistakably for the NHS, by the NHS.

Learn more about what leaders at other trusts have learned about transformation and how Virginia Mason Institute helps leaders pursue the changes their organisations need.

The Crucial Role of Psychological Safety in Healthcare | Virginia Mason Institute

Virginia Mason Institute — Tue, 19 Mar 2024 07:00:00 GMT

Article originally featured on HSJ.

By Wendy Korthuis-Smith, Ed.D.

Psychological safety holds unparalleled significance in healthcare. It is the shared belief that one can take interpersonal risks without fear of reprisal or judgment. In an industry where lives are at stake, we simply cannot fulfill our duties without that sense of safety and empowerment.

Psychological safety is the bedrock upon which a culture of trust, collaboration, and innovation can flourish. Its impact extends beyond mere organizational dynamics to profoundly influence patient outcomes and the overall well-being of healthcare professionals.

Building Trust among Healthcare Teams

Trust enables healthcare teams to collaborate and provide optimal patient care, and trust grows strongest in a psychologically safe environment.

When team members feel secure voicing concerns, sharing ideas, and admitting mistakes, it fosters transparent communication and effective problem-solving. It removes the doubt and other barriers that inhibit cooperation and reassures teams that they are truly “in this together.”

Improving Patient Safety

Psychological safety acts as a safeguard against medical errors by encouraging an open dialogue about mistakes, near misses, and areas for improvement.

For example, imagine a nurse notices a potential dosing error in a patient’s IV orders. In many settings, they might avoid speaking up for fear of being reprimanded. But in a psychologically safe environment, they would feel empowered to voice their concerns, potentially preventing a serious adverse event.

When we can discuss errors without fear of blame, the focus shifts from assigning fault to identifying systemic issues, learning from them, and implementing preventive measures.

Enhancing Staff Well-Being

The demanding nature of healthcare places immense strain on the mental and emotional well-being of practitioners. High-pressure situations and the weight of responsibility contribute to burnout and mental health challenges.

Psychological safety becomes crucial in mitigating these issues, by fostering an environment where professionals feel comfortable seeking support and discussing their challenges.

Promoting a Culture of Continuous Learning and Innovation

A culture of psychological safety propels healthcare organizations into the forefront of innovation by encouraging continuous learning and the pursuit of creative solutions. When we feel safe to experiment, share unconventional ideas, and challenge existing practices, the potential for breakthroughs in patient care significantly increases.

Establishing Psychological Safety for Your Teams

Leaders who are looking to foster a culture of psychological safety can begin with equity pauses. These are moments dedicated to evaluating discussions and decisions through an equity lens, through questions like “Does everyone benefit equally from this?” and “Whose perspective haven’t we considered yet?”

At Virginia Mason, equity pauses are one way we have created a safe space during team huddles, project meetings, and decision-making. Use this simple toolkit to do the same at your organisation.

A Vital Thread for Teamwork and Outcomes

In the intricate tapestry of healthcare, psychological safety emerges as a critical thread. It runs through a team’s sense of trust, collaboration, and innovation, and leads to the compassionate, high-quality care we all aspire to. Embracing and championing psychological safety will not only fortify the resilience of healthcare professionals but also enhance the overall effectiveness and humanity of our healthcare ecosystem.

Andons - A Tool to Improve Patient Safety | Virginia Mason Institute

Virginia Mason Institute — Sat, 17 Feb 2024 08:00:00 GMT

An andon — introduced by Toyota and used with great success in manufacturing, health care, retail and other industries—is a tool that signals a person or a team that there’s an abnormality or defect in a process. It can be a visual cue, an auditory cue or a process. It’s one way to gain immediate awareness of a problem and fix it in real time.

Preventing defects from reaching the patient

At Toyota, the original andon was a cord that any employee could pull to signal that he or she had found a defect in an automobile. When an employee pulled the andon, the manufacturing line slowed and a manager rushed to the employee to investigate the defect together and fix it in real time. If they couldn’t fix it in a specified length of time, the manager stopped the line completely, and other employees rushed to collaborate as a team and fix the problem. This process not only prevented a defect from reaching the customer but instigated a process to prevent the same defects from being repeated. Today Toyota’s andon is a button instead of a cord, but the culture that empowers all employees to use it remains the same.

At Virginia Mason, we use andons throughout the organization to help us prevent defects before they affect a patient. They alert us to abnormalities in a process, a need for resources, status changes and equipment availability. They also support compliance with Joint Commission standards, National Patient Safety Goals and the IOM’s Crossing the Quality Chasm report’s rules and focus on transparency.

Different types of andons

Examples of our visual andons, the most common, include lights on Code Blue carts to indicate they need to be checked for the day and intrusive computer screen alerts for pharmacists that indicate a patient allergy or contraindicated medication. A more complex andon is the VTE Clinical Andon Board, which is visible to employees, patients and families in the acute care units and signals that preventive measures need to be taken with specific patients to prevent hospital-acquired venous thromboembolism.

Examples of auditory andons are the beeping alarms on our infusion pumps that signal that a medication is nearly gone or there is defect with tubing and the audible alarms indicating acute medical emergencies such as patient falls, stroke and sepsis.

The best example of a process andon is our Patient Safety Alert System™, inspired by Toyota’s process, which enables any employee to send an alert — in person, by phone or through a website form — whenever there’s an object, person or process that could potentially cause harm to a patient. Creating this process and sustaining it wasn’t quick or easy; it required a radical shift in our culture, and we had to learn to blame processes, and not people, to convince employees to trust the system and always act in our patients’ best interests. Today, more than ten years after its implementation, our leadership team and our safety and quality experts take action and seek resolution and prevention by continually applying the Plan-Do-Study-Act (PDSA) model to be sure all employees are not only vigilant about safety but also feel empowered to use the PSA andon at any moment to keep patients safe.

“The most important aspect of an andon is not the light, the sound or the tool — it’s the response to the andon.”
– Megan McIntyre

How to best implement an effective andon

The most important aspect of an andon is not the light, the sound or the tool — it’s the response to the andon. An organization can’t simply put an andon in place and expect it to work. At Virginia Mason we use six steps to implement and sustain an andon that produces the response we need to protect patients:

Define the goals. Be sure the team members understand why they are creating the new process or alert and are clear about the result they want.
Determine potential problems and establish the checkpoints.
Determine the type and method of andon. Decide whether it should be a visual, auditory or process andon — or even a combination. For example, our andon for Code Blue emergencies is both an auditory alert (a loud alarm and page) and a visual alert (flashing light or staff member directing to a location) to be sure that the appropriate people in and out of the patient’s immediate vicinity are alerted to respond.
Develop standardized responses to the andon. Brainstorm, define and get consensus on the processes you’ll use.
Implement the andon and the responses. Training is key to be sure that each agreed-upon response best protects the patient. In the Code Blue response we have routine scheduled drills to practice responses and train.
Evaluate the effectiveness by using the PDSA process. Be ready to use root-cause analysis and discover ways to fine-tune the process and make it better. Andons are frequently reevaluated for effectiveness, continued need or refinement.

Some final words on andons

For an andon to be reliable and meet an organization’s goals, all team members need to know exactly what to do at the moment the andon alerts them. This takes an alignment of individual goals to team goals and organizational goals — all of which need to include patient safety at the top of the list.

What is Virginia Mason Production System | Virginia Mason Institute

Virginia Mason Institute — Thu, 18 Jan 2024 08:00:00 GMT

NHS Impact is taking root across the nation’s trusts and practices, with many executives both eager to do their part and unsure of where to start.

A few months ago, I joined a panel — including Professor Andy Hardy, Chief Executive, UHCW; Adam Sewell-Jones, Chief Executive, ENHT; and Dr. Gary Kaplan, former Virginia Mason Chairman and CEO — to share insights with 150 leaders from across the NHS England system and learn more about their challenges.

Chiefly, they wanted to understand:

The role of a leader in delivering a Quality Management System
How to create psychological safety for all their people
How to stay resilient and motivated over the long term

Seizing the opportunity to lead differently

Adapting new Leadership Behaviours is a focus of NHS Impact, but most leaders feel so busy and exhausted they can’t fathom taking on new responsibilities or unlearning disabling legacy approaches.

When we as leaders are “too busy,” it’s often with tasks to which we don’t truly add value. What if we excused ourselves from those tasks? Historically, that hasn’t been allowed — but we’re in a new paradigm. NHS Impact is your green light: Reorganise your job to spend time on what matters most.

To counter exhaustion, leaders can surround themselves with fellow champions of change. When the Virginia Mason Institute supported five NHS trusts in creating new management systems, we gathered monthly with their chief executives and NHS officials to share stories, challenges and advice. Executives found the group so invigorating that we’re resurrecting the idea this year with a larger international cohort.

Paving the road to psychological safety

With staff burnout and shortages fueling each other and holding everyone back, healthcare teams need a workplace that feels safe and rewarding. Now is the time for executives to seed a healthier culture through civility, empathy and respect.

How? By defining the values and behaviours that enable constant improvement and making them part of daily interactions and conversations. Words on a poster aren’t enough. Values come alive when we’re committed to talking about them, celebrating when they’re upheld, and acknowledging when they’re lacking.

Sparking big changes with small improvements

No one expects the entire NHS to change overnight — but no one has to wait years for results either. Find small things you can improve now, and use that progress to inform and inspire further improvement.

For example, the fracture clinic at Surrey and Sussex Healthcare NHS Trust addressed one of the U.K.’s biggest healthcare challenges — appointment backlogs — by converting more than 60% of emergency department referrals from in-person visits to virtual care plans. Patients were satisfied, wait times went down and quality didn’t suffer a bit.

Remember: You’re building something special

NHS Impact is the blueprint for an astonishing transformation. Keep that in mind when the going gets tough.

By prioritising quality, safety and improvement across the entire system — 1.6 million patients per day — you’re not just making an impact. You’re making history.

To learn more about bringing NHS Impact to life, explore this case study of real-world examples.

Contact the Virginia Mason Institute.