Case Studies

Case Study | FHP Wildly Important Goals

Virginia Mason Institute — Mon, 23 Mar 2026 07:00:00 GMT

In 2019, FHP’s CEO Shelley Ebenal had a wildly important goal: for every department in the hospital system to create their own Wildly Important Goals and use them to improve care. She’s modest about her vision. “ No vision here,” Shelley laughed, “I read a book, somebody else’s vision. I just liked it. Jen [Schuler, Director of Quality at Foundation Health Partners], on the other hand, has taken it to a whole new level.”

Case Study | How Leeds Teaching Hospitals Workshopped Its Way to Financial Sustainability | Virginia Mason Institute

Virginia Mason Institute — Wed, 27 Nov 2024 08:00:00 GMT

At a Glance

Achieve Zero Preventable Hospital-Acquired VTE | Virginia Mason Institute

Virginia Mason Institute — Sat, 15 Jun 2024 07:00:00 GMT

Saving lives, eliminating defects and improving processes

The problem

Venous thromboembolism (VTE) is the third most common cardiovascular illness¹ — and the most common preventable cause of hospital-related death.² In the United States alone, approximately 1 million patients experience VTE events. Nearly two-thirds of these events occur because of hospitalization, resulting in approximately 300,000 deaths.³

Case Study | Improving Patient Flow in Primary Care | Virginia Mason Institute™

Virginia Mason Institute — Wed, 07 Feb 2024 08:00:00 GMT

“I used a leadership stipend to attend the Optimizing Flow in the Ambulatory Setting course at Virginia Mason Institute’s Seattle training facility. I was so inspired by the course that I asked our medical director if I could send the whole team. He agreed to have Virginia Mason Institute come to us at WakeMed to facilitate additional training.”
– Dr. Theresa Amerson, Executive Medical Director of Primary Care

Background

In an effort to better deliver timely patient care, foster more efficient stewardship of clinical resources, and effectively address ongoing staff burnout, WakeMed Health and Hospitals tested and implemented ambulatory flow training across 11 primary care clinics in North Carolina. Executive Medical Director of Primary Care, Theresa Amerson, spearheaded the work and shared her experience, lessons learned and positive outcomes.

Problem

Of the patients seen each day, 20 percent of patient notes regularly went unfinished each day.
44 percent of administrative emails went unread.
Morning schedules routinely ran into staff’s lunch by an hour leaving only 30 minutes for a desk lunch and in-basket processing.
Afternoon schedules ran late by 20-30 minutes.
Staff left the office after 5:00 p.m. without completing all the work for the day.
An additional 1.5 hours of charting and paperwork remained for providers to complete in the evening.

Approach

WakeMed included 100 primary care staff members in four Optimizing Flow in the Ambulatory Setting training sessions, facilitated by Virginia Mason Institute lean experts, each two-and-a-half-days long. Four clinics (Downtown Raleigh, Cary Parkway, Knightdale, and Brier Creek) in the WakeMed Health and Hospital Systems were fully trained and successfully implementing flow concepts and tools at the time of this case study. Seven additional clinics were at least 50 percent trained.

Foundational Elements of Flow

“Foundational to the process was the infrastructure building component. We needed to get the operational pieces in place – or Nemawashi – creating standard work.”
– Dr. Theresa Amerson

Progress and milestones during implementation included:

Standard Work: Operations Huddle
Operations-specific huddles take place daily involving the practice manager, clinical staff, front desk staff and providers at the clinic production board. Huddle boards are in use, and notes are being taken and kept on file in the office as part of the practice manager standard work.

5S: Exam Rooms
A 5S agreement is in place for exam rooms. 5S is a strategy used to keep a workplace safe and organized that is the foundation of improving patient flow. All clinic exam rooms now meet Level V, the highest standards distinction in WakeMed’s new flow progress metrics system, to include items kept in the cabinets, drawers, exam tables and desktop areas. Practice manager standard work includes routine 5S agreement audits of these areas and re-education.

5S: Main Supply Area
A 5S agreement is in place for all supply areas and stock rooms. All supply areas and stock rooms meet Level V standards. Practice manager standard work includes routine 5S agreement audits of these areas and re-education occurs regularly, as needed to maintain Level V standards.

Standard Work: Restocking and Ordering Supplies
Room supply restocking in exam and procedure rooms now occurs “just in time” using Kanban, or scheduling, systems. All supply levels are appropriate to ensure zero defects (no supplies are missing when needed). All clinical staff and providers are educated on the restocking and ordering system and participate in maintenance of appropriate par levels. Practice manager standard work includes routine audits or restocking and ordering standard work and par levels.

5S: Workstations
A 5S agreement is in place for all shared workstations and flow stations. All workstations meet Level V standards. Practice manager standard work includes routine 5S agreement compliance checks.

5S: Clinical and Point-of-Care Areas
A 5S agreement is in place for all clinical and point-of-care areas. All clinical and patient care areas meet Level V standards. Practice manager standard work includes routine 5S agreement audits of these areas, and re-education occurs regularly as needed to maintain Level V standards.

Standard Work: Paper Management
Standard work for management of tasks originating on paper are followed to include forms, faxed Rx requests, faxed results, etc. All clinical, non-clinical staff and providers have been trained on the appropriate standard work for paper management. Practice manager standard work includes routine audits to ensure the standard work is utilized and to inquire about any “rocks in shoes” related to this standard work.

Mistake-Proofing: Waste Walks
All team members and providers are engaged in periodic waste walks to evaluate all types of waste in a clinic area or with a clinic process. Information gathered during the waste walk guide the idea forms and plan-do-study-act (PDSA) cycles on the genba.

Setup Reduction: Weekly Improvement Huddles
Improvement-specific huddles take place weekly involving the practice manager, clinical staff, front desk staff and providers.

“Flow has taught us that effective team-based care can restore joy to the workplace.”
– Dr. Theresa Amerson

Outcomes

Implementation and consistent practice around 5S, standard work, and mistake-proofing has resulted in the following performance improvement metrics:

100 percent completion of medical notes for all patients seen and walk-in patients are accommodated within 15 minutes
All in-basket items are processed in flow
All administrative emails are answered
Staff enjoyed a full one-hour for lunch without work to do
All work was completely done by 4:30 p.m.
Real-life scenarios were collected to create a Practice Manager's Playbook to enable greater ease coaching others through flow implementation

Building a Patient Focused Care Center | Virginia Mason Institute

Virginia Mason Institute — Tue, 12 Dec 2023 08:00:00 GMT

At a Glance

The Organization

The Orthopedic Outpatient Center is a state-of-the-art facility in southwest Oregon, operated by the Southern Oregon Orthopedics group. The group followed a Lean approach to designing their new facility, in order to control construction costs and optimize care delivery.

Case Study | Bringing Impact Within Reach | Virginia Mason Institute

Virginia Mason Institute — Tue, 26 Sep 2023 07:00:00 GMT

How hospitals, practices and leaders can implement NHS Impact

NHS Impact provides the blueprint for organisations throughout the system to create lasting solutions to their most painful challenges. It consists of five core components based on time-tested improvement strategies used by leading healthcare organisations around the world.

But bringing the blueprint to life is a big job, and many in the NHS are unsure how to approach it. The Virginia Mason Institute has partnered with organisations of all sizes, in more
than 20 countries, to develop the components that comprise NHS Impact. The insights below offer a glimpse of how leaders, teams and organisations like yours have used these components to reduce backlogs, reverse burnout, and provide the quality of care they aspire to for their patients.

Case Study | GP Practice to Improve Patient Access | Virginia Mason Institute

Virginia Mason Institute — Thu, 22 Jun 2023 07:00:00 GMT

At a Glance

The Organization

Lincolnshire is a large rural county on the eastern coast of England. It contains 86 general practitioner (GP) groups and three National Health Service (NHS) trusts, which provide acute care, community care, and mental health care.

Digital Workflows to Improve Healthcare | Virginia Mason Institute™

Virginia Mason Institute — Mon, 23 Jan 2023 08:00:00 GMT

Organization

Surrey and Sussex Healthcare NHS Trust (SASH)

Case Study | Error Sparks Innovation | Virginia Mason Institute

Virginia Mason Institute — Fri, 16 Sep 2022 07:00:00 GMT

In many hospital pharmacies today, the pace is hurried. Staff rush to fulfill complex orders for waiting providers with patients’ health dependent on their accuracy. With so many urgent patient needs, staff changes, increasingly complex medications, direct patient care responsibilities and the inevitable influx of new team members who need to be mentored and trained — all in the setting of evolving federal and state medication regulations — how can a pharmacy team prevent errors before they’re passed on to patients?

UW Health Cultural Healthcare Transformation | Virginia Mason Institute™

Virginia Mason Institute — Wed, 31 Aug 2022 07:00:00 GMT

At a Glance

The Organization

UW Health is a large system tied to the University of Wisconsin School of Medicine and Public Health, encompassing 21,000 employees across multiple hospitals.