Hospitals without Waiting Rooms: Learning from Toyota

I recently realized that Modern Healthcare releases an annual list of 50 Most Influential Physician Executives–MD’s who have one foot in clinical practice and the other in health care management. I decided to browse through some of the names from 2012, and over the next few weeks I hope to share some of the especially interesting stories through short blog posts.

The first person that caught my eye is Dr. Gary Kaplan, Chairman and CEO of Virginia Mason Medical Center in Seattle. Back in October I had come across an article profiling Virginia Mason for opening a clinic without waiting rooms–a stunt I was admittedly skeptical of at first.

Turns out it’s part of a larger effort since 2000 to apply Toyota’s “Lean manufacturing” philosophy across their health system. Take a look at this 8-minute PBS special for a good introduction. Some highlights and other links across the web:

• Kaplan describes initial reactions to his proposal as: “10% early adopters, 10% that said ‘over my dead body’, and 80% in the middle.” Having the ability to bring that 80-90% on board is likely a core reason Dr. Kaplan made it to a list of “most influential”.
• One of their tactics involves deploying “Medical Assistants” at “flow stations” to monitor flow and direct the doctors, akin to a traffic cop. “The physician takes direction from the MA, and that’s a change for providers to, um, accept direction from an MA,” says Kirkland’s CMO. There’s an understatement–but speaks to the resistance that will have to be overcome to adopt a true team-based approach.
• Speaking of team-based, check out Virginia Mason’s logo.
• For those interested in ways that other hospitals are applying Lean strategies, here’s a 2011 WSJ article that lists a few. They include a “fast track” triage system that relies on physician’s assistants to cut triage time from 10 min to 3-5, and a staffing model that’s designed to match peak-demand periods.

Finally, sometimes you wonder how the impetus for a decade-long undertaking such as this comes about. Here’s an interview with Dr. Kaplan that sheds some light on that: Interestingly, back in 200 when Dr. Kaplan was traveling the states looking for clues from other hospital systems, turns out someone from Boeing was on Virginia Mason’s board. And in the preceding seven years, Boeing had been adopting the Toyota production system right in their back yard.