Improving Quality and Reducing Waste: The Virginia Mason Production System
The Virginia Mason Production System (VMPS) is a management method that seeks to continually improve how work is done within the medical center. Using this method, Virginia Mason (VM) identifies and eliminates waste and inefficiency in the many work processes that are part of the health care experience, making it possible for VM staff to deliver the highest quality and safest patient care. By streamlining repetitive and low-touch aspects of care delivery, staff members are freed to spend more time talking with, listening to and treating patients. Using this methodology, VM has successfully implemented many improvements in their medical center.
The patient safety alert system at Virginia Mason, for example, has created a culture in which safety problems are quickly identified and addressed, increasing patient safety at the medical center and decreasing medical claims.VM nursing teams used VMPS to redesign their flow of work so they could focus more on patient care, and hospital emergency staff created a process that allows the team to treat more patients faster and with more efficiency.
Adopting VMPS in 2001 required a paradigm shift from thinking errors, inefficiencies and defects are to be expected, to believing that achieving zero defects in health care is not only possible, but also urgently necessary. VMPS uses a variety of strategies to accomplish the elimination of defects and waste, but all begin with an understanding that the medical staff who do the work know what the problems are and have the best solutions. Staff work together in one- to five-day workshops and events to brainstorm, test and implement improvement ideas. Long-term follow up ensures that changes are ingrained into the work and are actually used by the staff. Successes include:
Patient Safety Alert System.
VM used VMPS principles to develop a Patient Safety Alert (PSA) system requiring all staff who encounter a situation likely to harm a patient to make an immediate report and “stop the line” (i.e., cease any activity that could cause further harm). Since the PSA system was implemented, patient safety at VM has increased, and medical claims have dropped.
Getting Back to Nursing.
VM nursing teams used VMPS to redesign the flow of work so they could focus more on patient care. Instead of caring for patients throughout a unit, nurses now work as a team with a patient-care technician (PCT) in “cells” (groups of rooms located near each other). The cell model made it easier for nurses to monitor patients and quickly attend to needs, and communicate with each other. This reduced the number of steps walked per day from 10,000 to roughly 1,200.
Express Treatment in the Emergency Department.
Emergency departments are a major entry point for hospitals and can be a bottleneck. ED patient care is typically more expensive and involves longer wait times. Using VMPS, the ED team at Virginia Mason learned to predict appropriate staffing levels for times of greatest demand. A “team sort” process using standard clinical assessment tools to quickly identify and sort patients’ care needs was implemented. Those requiring minimal services receive express treatment and are discharged without going to patient-care beds, creating capacity for patients who require more extensive services. This work helped Virginia Mason decrease the number of hours the ED was closed and unable to receive new patients by more than 90 percent over two years. In 2011, VM will move its ED into more efficient space and the team sort process will allow the team to care for more patients.
Keywords: Care teams, ED care, eliminating waste, emergency room care, patient safety alert, prevention, safety, value, Virginia Mason Medical Center, Virginia Mason Production System, work process improvement, zero defects
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Director, Communications and Public Relations
Virginia Mason Medical Center
100 Ninth Ave, MS GB-ADM
Seattle, WA 98101