The element of 'Defective Product' is an interesting approach to viewing Healthcare and is an eye opener in terms of what it means for patients, as it refers to a 3-4% Defect rate. This means that for every 100 patient encounters there were 3-4 defects, which are everything from no record of an appointment all the way through to an avoidable death.
As Dr. Kaplin stated in his address of the St. Luke's Health System Summit in 2013:
"...if the aviation industry had this sort of defect rate, 'planes would fall out of the sky every day; if Flat Screen TVs had these kinds of Defect rates we wouldn't buy them..."
Video: Applying the Toyota Production System to Medicine
In the year 2000, the Board asked Dr. Kaplin and his Management Team: "Who is your Customer?", to which they responded (of course) "The Patient". However, the Board retorted that if that was the case, things wouldn't look like they did:
By facing the reality of the situation they tackled some of the paradigms prevalent in the Healthcare industry and in the video (just short of 15 minutes but well worth your time investment) Dr. Kaplin also talks about a preventable death that had a major impact on their Lean Transformation, even though they were already 3 years into it, which resulted in a single organisational goal for 2004-2006 of protecting patients from avoidable harm.
What I really like about the approach that the team at Virginia Mason have taken is that they have not tried to 'reinvent' Lean for their industry, accepting that they do 'make' things and even calling their Lean System the Virginia Mason Production System (VMPS). This is a mature approach and, in my opinion, a critical factor of the mindset required to be successful in a Lean Transformation.
Virginia Mason have undertaken detailed Value Stream Mapping of their Current States (finding typically 90%+ of the time being non-Value Added) to enable the significant improvements that they've made in their performance and they take a granular approach. However, as Dr. Kaplin states in the video:
"As Leaders there are technical changes, Lean, there's the Toolbox, it's the improvement method ... but you need a critical mass to feel urgency, you need to have visible and committed Leadership; not advocacy leadership; I was a great advocate Leader ... my job was to get all the resources from our department and keep administration off of our backs ... but that's not what we need now; we need leaders who are change sponsors."
As a result of the 14 years of Lean Transformation, they have made a fantastic leap forward in their performance and care for their Patients and in 2010 were awarded the recognition of 'Top Hospital of the Decade' by the Leapfrog Group and have since featured regularly in the 'Top 100 Hospitals in America' list.
The Cultural change in their organisation is tangible and is led from the top, with another great quote from Kaplin demonstrating this:
"... we've got a $2.7 Trillion Industry, we've got enough Money in Healthcare ... We need to change our mindset from Scarcity to one of Abundance. It's what we do with our resources that count."
Virginia Mason have demonstrated that with true Lean Leadership, as I wrote about in my articles 'The Meaning of Lean' and '5X Why most Leaders aren't good enough', a Lean Transformation, linked to the Business Strategy, can Transform the performance of your Business.
"I aim to promote the global sharing of best practices in the application of Lean Thinking."