Virginia Mason has strived to be patient-centered since its inception. In the past 20 years, however, it has increased its dedication to this mission by closely examining its processes and strategizing how to shift them to better serve the people who come to its clinics.
Spearheading this movement has been Dr. Gary Kaplan, who first came to Virginia Mason in 1980, right after he finished medical school at the University of Michigan. After an entire career spent at one organization, moving his way up to his role as CEO for the past two decades, he has seen Virginia Mason undergo a lot of change. And he’s very proud of what he and his team have accomplished.
“Our founders 100 years ago believed in a different way of practicing medicine,” Kaplan said. “And when I look at the last 20 years, probably what I’m most proud of is our willingness to look outside of our industry for solutions that many of us face in health care.”
At the forefront of these changes is the health care systems’ adoption of the Toyota Production System, a management system that organizes logistics and manufacturing for Toyota — and has been used by such companies as Boeing — to help streamline interactions with suppliers and customers. Adopted 19 years ago by Virginia Mason and renamed the Virginia Mason Production System, this approach to management allows the health care system to improve many of its operations to cut waste and costs and turn the focus back to its primary customer: the patient.
“What we have come to realize is that in health care, we make things: We make office visits, we make lab tests, we make bills. And when you think about it that way, it forces you to look at the processes that go into making these things, and when you do that, you begin to see the waste,” Kaplan said. “And that’s what this management system is really all about, is systemically taking waste out of processes. The Virginia Mason Production System gives us a common language and a common method to improve quality, safety, and patient and team member experience. And, oh yeah, by the way, it also lowers costs — making us today the lowest-cost tertiary health system in our market.”
As the organization turns 100 this month, Kaplan reflected back on his 40-year career at Virginia Mason, and how he and his dedicated team continue to try to push the envelope and better serve their patients every day.
Where did the drive to adopt the Toyota Production System as a method of management come from?
I think it was spurred by our new strategic plan. Our board asked me and our team, “Who is your customer?” And, as you would expect, we said, “Our patients.” But we came to realize that our systems were really all designed around us — the doctors, the nurses — and not around the patients. A great example of this is the waiting rooms, where we tell people, “Hurry up and be on time to wait for us.” That’s the antithesis of being patient-driven and patient-centered. And so, at a time when people were focused on growth and market share, we said that our vision would be around quality and being a quality leader in the Seattle area and beyond. How will we do that? By what method?
That’s when we first heard from Boeing about the great work they were doing with the Toyota Production System. We started studying it and realized it could help us create a much better experience for both our patients and for our team members delivering care. So, that’s how it got started. And, you know, we’re still evolving and growing and learning every day.
What does the Virginia Mason Production System look like in action?
To understand what it looks like requires one to understand where all the waste is. We’ve looked at the various flows — the flows of patients, the flows of medications, the flows of supplies, equipment. When you focus on creating flow, that means that people don’t wait. And the objective is to eliminate waiting, whether it’s the patients waiting, or team members waiting for the next process to begin. So, you’re looking to standardize all the variation that adds no value. Waste comes in so many forms — I use the example of waiting rooms. The clinic I’m in at Virginia Mason, where I still see internal medicine patients and have worked in for the last 38 years in the 425 area code, we actually have no waiting rooms. You take away the spaces, then invest in other things that add value instead of those that don’t add value, and look at how we can work together more efficiently. And this mindset touches teaching, planning, budgeting, financing.
Have you expanded the scope of this approach to health care beyond Virginia Mason itself?
For the last almost 12 years, we’ve had an institute, so we’re training people in these methods and tools across the United States and worldwide. We’ve worked with hospitals in the UK, the Netherlands, Denmark, Japan. And we learn when we teach, and it’s a chance to share and help transform health care. That’s what we’re trying to be about. So, there have been lots of changes, but I think despite those changes, we’ve stayed true to who we are while being willing to evolve as an organization.
You wear so many different hats at Virginia Mason — what part of your work do you feel is most rewarding?
I get to help facilitate and coach our team members, which is a critical component of my day. In addition to that, my patient care responsibilities are some of the most rewarding and satisfying parts of my work. As a general internist, I take primary care patients, many of whom I’ve known for well over 30 years. That helps connect me to our roots, and I think helps make me a better leader. I’m the seventh CEO in 100 years at Virginia Mason, and each one of us has been a practicing clinician. I decided early on that I was not going to be the one to break that mold, and I’m glad that is that path I have taken.
In terms of Virginia Mason’s response to COVID-19, what are some features that you feel proud of your team for executing well?
I’m very proud of how we’ve responded to COVID. It’s actually great proof of the concept of how the Virginia Mason Production System works. Feb. 28 is when we had our first COVID patient at Virginia Mason, and we activated our command center — something we set up periodically over the years to deal with emergencies where we need to have an all-hands-on-deck kind of mentality. The Virginia Mason Production System served us well because we had already mapped out all of the flows for all of the different work areas — we understood how things like the supply chain interfaced with our surgical team workflow or primary care workflows. So, we were able to be very fast and nimble and have been able to take great care of patients during this very challenging time, and not just COVID patients, but the other patients that also need us. We have best practices in place, and our team members are really focused on our patient and team member safety.
What does this 100-year anniversary mean to you?
Well, it’s certainly an important milestone, and I have been here for almost half of that 100-year period. It’s kind of daunting. And it’s humbling. I think about how we stand on the shoulders of the giants that came before us. And we have to think about the future, how we take next steps. We want to stay a learning organization — it’s about the continuing, never-ending pursuit of perfection. We need to be willing to open our minds and willing to fail. I won’t be here 100 years from now, but I hope people look back on us in this time and say, you know, they evolved. They weren’t stuck in the past, but they were focused on thriving in the future. It’s exciting to think about.