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Expanding the Virginia Mason Production System to New Corners of Virginia Mason Franciscan Health

Virginia Mason Institute

The Virginia Mason Health System earned a reputation for quality and safety thanks to our management method, the Virginia Mason Production System® (VMPS®), which seeks to achieve zero defects in healthcare by empowering those who do the work to improve the work. Virginia Mason Franciscan Health (VMFH), the regional health system formed by the recent merger between Virginia Mason and CHI Franciscan, now faces a new test: spreading and sustaining its management method and a culture of learning and improvement across all corners of the health system.

 “The Virginia Mason Production System® is more than a set of tools. It is a management system that involves so many things—from culture to our patient’s voice, to our team’s wellbeing. All of this is what we are spreading across Virginia Mason Franciscan Health,” says Ingrid Gerbino, MD, Vice President and Chief Innovation Officer of VMFH.

VMFH leadership, alongside improvement teams and Virginia Mason Institute (VMI) transformation partners, have been actively collaborating in the process of spreading the VMPS® management method throughout the larger system of nearly 300 care sites, 11 hospitals, and 5,000 physicians and providers. This includes simultaneous system-level strategic alignment work and training all leaders in core principles and practices, with the goal of:

  • Helping staff communicate with a common language to enhance patient safety, patient outcomes and a healthy workplace culture​.
  • Supporting teams and departments to leverage improvements across the system and achieve universal status as a high-performing organization. ​
  • Guiding the entire organization to build a foundation that enables accelerated results and long-term adaptability.

As Chief Executive Officer Ketul J. Patel told the blog, “We have created this new health system knowing full well that we want to scale the production system; we want to scale the quality and safety and patient experience outcomes that CHI Franciscan was building, and that Virginia Mason became legendary for.”

Launching a new journey

Our management method, VMPS®, includes a host of concepts, tools and behaviors that are meant to be carried out every day by team members across the health system. Only by being adopted by all levels, from executives to frontline team members, can VMPS® truly fuel a patient-focused culture of learning and improvement, and ensure that everyone is benefitting from the management system rather than it simply supporting siloed pockets of innovation. Fully integrating VMPS® throughout the larger health system and ensuring sustainability will take time.

To begin developing the foundation for system spread, an executive-level guiding team was formed including the CEO and senior leaders.

The guiding team is responsible for system-wide oversight and accountability for VMPS® as our single management method. This includes three key roles:

  1. Oversight, accountability, and alignment for system wide VMPS® implementation and results
  2. Prioritization of strategies and resources for VMPS® deployment throughout VMFH
  3. Identification and breakdown of system barriers

Early guiding team agreements:

  • We will have one management method across Virginia Mason Franciscan Health
  • We will use the management method to improve all VMFH goals and strategies
  • We will have one set of management method policies and expectations
  • We will use the same tools, concepts, documents, training, etc. to ensure the same version of the management method
  • We will have one health system Kaizen Promotion Office (KPO) to be the keeper of the methodology, standards, tools, and policies with a distributed KPO model
  • A governance structure for the system’s management method will be approved by the CEOs, including system-wide oversight as well as local responsibility

Focusing on both the system level and front lines

To progress with implementation, VMFH leadership and improvement leaders are pushing forward in two critical areas: system-level strategic alignment and management system training for all leaders.

Strategic alignment on the system level

A crucial component of sustaining a culture of learning and improvement is aligning with a unified strategy and vision. VMFH leaders are working to refresh strategic goals and align teams — and, eventually, all staff members — with those updated goals. This work is particularly vital now as VMFH takes its first steps as a new integrated health system.

During a process to create strategic alignment, leaders and board members decide on key priorities, set targets, and empower all teams to achieve them by engaging everyone from the board room to the frontline. Leaders must agree to listen to the people who do the work to ensure the focus remains on the patient experience. Otherwise, it’s all too easy for the shakeup of the merger to distract from the ultimate purpose of reliably providing the highest-quality care.

Strategic alignment is all about building from the health system’s vision — our True North. This vision must provide direction at all levels, from the board to the front lines of care. As VMFH is now part of CommonSpirit Health, one of the country’s largest nonprofit healthcare systems, we are now using processes to build alignment between the CommonSpirit system, VMFH, and each of our front-line teams.

One recent example was a “Roadmapping Innovation Event,” an improvement event focused on developing strategic alignment conducted in partnership between CommonSpirit, VMFH and VMI. This event was held to connect a specific division’s strategic roadmap with the larger health system’s goals – to create meaningful alignment from the national system level all the way down to individual team priorities.

Creating system-level strategic alignment with a Roadmapping Innovation Event:


  • Amidst a rapid pace of ongoing IT initiatives, Virginia Mason Franciscan Health’s IT division needed a vision and framework to prioritize work and create system-level alignment



  • New guiding principles for this division’s work
  • A new roadmap structure:
  • A new “Roadmap Development Approach” for use by other divisions – An approach to help teams facilitate an innovation event that helps them achieve an aligned 3- to 5-year roadmap

Key elements for the new “Roadmap Development Approach”:

  • Prework
    • Prepping sponsors
    • Project scoping and initial documentation
    • Defining roles and responsibilities
  • Innovation event preparation
  • Innovation event facilitation
    • Facilitation by innovation expert (trained in 3P, Directed Creativity Cycle, VMPS®)
    • Sponsor kickoff – support by cross-functional leaders
    • Alignment to vision, strategy, personas
    • Developing the vision, roadmap, and timelines
  • Reporting out (sharing back with the organization)
  • Celebrating the wins

“The most powerful work the team did over the course of these two days was deriving these aligned objectives. . . . We know that we need to hit on all of these items for the health system to hit its goals.”
– Innovation Event Co-Sponsor

Management system leadership training

While strategic alignment sets the foundation, leadership training is what begins to drive a direct impact for patients. “Leadership alignment is critical to supporting having our people trained, and having people trained is critical to how we deliver high-quality care,” says Gerbino.

VMI transformation partners alongside VMFH improvement leaders are rapidly moving forward with training all leaders in the VMPS® management system – with a focus on both the technical and human dimensions of change that provide a foundation for modern healthcare leadership. This training aims to help leaders develop and sustain a culture where staff are directly involved in improving their work — which, in turn, feeds a team’s performance in quality and safety.

“This is really about the power of one language, one management method,” says Eli Quisenberry, Division Director for VMPS®.

Based on decades of application and the combined expertise of VMI and VMFH leaders, the core elements of the training include fundamentals of:

  • Executive engagement, alignment, accountability, and reliability
  • Both human and technical dimensions of change
  • Adapting and shifting priorities during crisis
  • Increasing engagement through a culture of learning, improvement, respect, and transparency
  • Incorporating the elements of daily management
  • Identifying waste to give valuable time back to our patients and teams
  • Value from the patient experience perspective
  • Embedding quality and systematizing equity into all healthcare processes
  • Developing a deep understanding of process and measurement versus assumption
  • Creating a safe, defect-free environment
  • Understanding that quality improvement is everyone’s responsibility

As with all our training programs, in addition to a didactic component, a primary focus is immediate practical application. Once their training is complete, all leaders will “report out” their learnings and improvement applications with their team, executive leaders, and learning cohort using the following questions:

  • What was the current state before improvements?
  • What is your leader standard work?
  • What were your observations about how this affected your leadership?
  • How are you ensuring reliability?
  • What are your key learnings, barriers, and advice to give?
  • What are your wins and next steps?

Applying training at new sites across the health system: 

St. Anne Hospital in Burien, Washington began a journey of adopting VMPS® at the end of 2017, partnering with Virginia Mason Institute to begin building an improvement office and training all hospital and clinic leaders in the VMPS® management method. By 2018 the improvement office was established and by October 2019 all leaders had been trained in the methods and tools of VMPS®.

The improvement team and team members across St. Anne were energized by the management method and how it was utilized to launch “value stream” improvement work across primary care, inpatient care, imaging, and perioperative services. Sustainment of the new management method and culture of learning and improvement now includes a focus on Daily Management and improvement planning for all teams, along with continued training.

Results from a recent primary care improvement workshop focused on improving the patient experience, by increasing access, yielded the following results:

  • A new appointment scheduling process with zero defects, which means front desk staff are correctly scheduling 16,000 more patient visits per year than before.
  • The addition of 8 more primary care providers, enabling 40,000 additional patient visits per year.
  • Estimated $7 million increase in annual net revenue.

The role of internal communication

Making progress comes down to our team members and the care they provide, so robust and consistent internal communication is essential. It helps our team members understand each step of this journey and how it connects back to the “why.” It ensures we remain patient centric and focused on providing the highest levels of quality, safety, and patient experience.

Says Gerbino, “It’s important to remember we are doing this for our patients and to serve our community. We as leaders have to remind our teams why we’re here and connect those dots to our management system and tools.” A strong partnership between leadership and internal communications teams is necessary to ensure that not only are teams hearing the right messages, but that leadership is playing a direct role in articulating the “why.”

Identifying guiding principles is also critical when it comes to internal communications related to this work. Reflecting on Virginia Mason’s experience in spreading VMPS®, Quisenberry says, “It’s different for every organization, but for Virginia Mason this meant focusing on quality, ‘patient first,’ and full organizational transformation. Not every organization will have these specific aims but consistency in communicating them is key.”

Scaling towards one future

Looking forward, as the VMPS® management method is scaled across the health system, we know that shared values will help this work succeed. Values with clearly expressed behaviors foster a patient-first culture of learning and improvement in every care site and team.

In spreading and sustaining the Virginia Mason Production System®, Virginia Mason Franciscan Health will maintain its ultimate goals:

  • Remember the patient is always first​
  • Focus on the highest quality and safety
  • Engage all employees
  • Eliminate waste
  • Strive for the highest satisfaction
  • Maintain a successful economic enterprise

We look forward to sharing more progress as the journey continues.

Originally published February 23, 2022, updated March 24, 2022

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