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25th National Forum: ‘Ah-Ha’ Moment: It’s About the Patients − Not Us

By Maureen Bisognano | Friday, November 22, 2013
The following is part of a series of guest posts celebrating the 25th Anniversary of the IHI National ForumGary S. Kaplan, MD, is Chairman and CEO of Virginia Mason Health System and Chairman of IHI's Board of Directors.

Gary Kaplan

I was on the IHI website recently and saw the tagline for this year’s National Forum, “25 Years of ‘Ah-Ha’ Moments.” I think it serves as a great framework. As we look at what needs to transpire to transform health care in our country, it is important to consider our past.

Looking back on my own career at Virginia Mason Medical Center, I have been part of numerous “ah-ha” moments – many coming in the last dozen or so years as we’ve been on our lean journey. But if I were to pick one moment that truly redirected the organization and my role as a leader, it was during strategic planning the year prior to implementing the Virginia Mason Production System (adapted from the Toyota Production System, see below) as our management methodology. The moment I’m thinking of was the Virginia Mason board of directors, essentially my “boss,” asked our leadership team a simple question: “Who’s the customer?”

Of course, our answer was, “It’s the patient.” But the board told us to take a closer look, so we did. We did a deep dive on our processes, and (ah-ha!) we found out most of them were designed around us – the physicians, nurses and other team members – not the patient. And, if you think about it, what are waiting rooms but places for patients to hurry up, be on time and then wait for us? What happens in most hospitals on Saturdays and Sundays? Patients wait for Mondays so things can get done. We really weren’t designing our processes around our patients, our true customers.

The result was a new focus on truly designing all care processes around our patients, not us and this is depicted by our strategic plan “pyramid” that puts the patient at the top. This has served as our true north ever since.

Virginia Mason Pyramid

As Virginia Mason looks to the future, we know we are on the right path because we have the patient as our unquestioned focus and the management methodology of the Virginia Mason Production System as our foundation. This has allowed us to concentrate on improving the quality of care we provide, while lowering costs by removing the wasteful things that don’t add value to the patient experience.

That “ah-ha” moment when we truly recognized the patient as our customer remains the constant for everything Virginia Mason is about. It also continues to be a cue for me, as a leader, when faced with myriad decisions every day. “How does this improve the experience for patients in our care?” is a question I am routinely asking myself and others in the medical center.

Sharing our experiences and learning from others on similar improvement paths is critical as we move forward. That’s why we value the opportunity to participate in the IHI National Forum on Quality Improvement every year. To truly change health care in America for the better, it will take “ah-ha” moments from all of us − working together.

-Gary Kaplan

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