Virginia Mason Medical Centera. What is Gary Kaplan trying to achieve at Virginia Mason? – KumareshThe company had made double digit millions losses by 1998 and 1999. Combined with the financial loss were reports that talked about the increasing cost of medical errors. This led to staff morale declining. This presented Kaplan a major challenge as he took on the CEO post from Lindeman. Kaplan wanted to turn the hospital profitable and also be the quality and safety leader in the healthcare industry. Kaplan took multiple measures to help the hospital see the light of the day. Within 6 months after Kaplan took responsibility he made the following attempts towards recoveryTrimming costs e.g cutting academic spending for travel time, research etcConsolidate less profitable business lines Grow highly profitable linesNew physician Compact: move from a implicit medical compact to explicit medical compact. New goals for the organization: becoming the quality leader by focusing on the patient, working together and embracing change. The new goals were tied into the performance review and incentive compensation systemTPS system to achieve the strategic plan of quality and safety. b. How does the Toyota Production System (TPS) fit into this strategy? MansiThe Virginia Mason Production System fit into TPS’s strategy by aligning with Toyota’s core principles. Following points detail as to how were they able to align with TPS.1) Value – Stream Mapping – This scheme enabled them to understand the steps properly and identify the waste. It entailed the processes, flows and inventory and thus was in line with Toyota’s principle especially waste reduction i.e. Muda.2) RPIW – RPIW was an event specifically designed to improve process efficiency and eliminate waste and hence enhance the productivity of the system. This technique catered to specific and standardized tools and looked at specific metrics to measure the performance of the system. This scheme of continuous improvement and identify issues at every step, hence, aligned with Kaizen and Jidoka..3) 5S – Another waste elimination technique, in line with Muda and was 5S which basically aimed at improvising and de-cluttering the work space and hence standardize the same. A cleaner and well kempt place enabled the staff to search for tools easily while reducing time for insignificant activities.4) Every day lean – Adopting the principle of Kaizen, VMPS aimed at identifying areas of improvement opportunities specifically pertaining to process efficiency and innovative solutions. Employees were asked for their innovative ideas and were thus rewarded for providing ideas aimed at process excellence and continuous improvement.5) Patient safety alert system – This system alerted the staff in case of any hazard by pulling the cord. This ensured that the root cause was identified and the problem was solved then and there. This was exactly similar to pulling the andon cord in Toyota Production System which is well aligned with the Jidoka principle.6) Kaizen Promotion Offices (KPOs) – The KPOs oversaw, led and coached various units to implement RPIWs while looking at everyday nuances and facilitation of the process. As the name suggests, it was aligned with Kaizen – Continuous improvement. In addition to this, VMMC organized two annual trips to Toyota’s factories and Head Office where in they observed the employees of Toyota following the TPS in a Gemba Kaizen workshop.7) Zero Defects – To seek zero defects, VMMC followed Jidoka which was in line with identifying the problems and root cause while immediately looking at their solutions and eliminate the possibility of repetition of such mistakes. c. What is your view of the “people are not cars” debate? SonaliThe People are Not Cars Debate We agree with the statement that ‘People are not cars’ and that interaction between doctors and patients is unique and extremely personal. One cannot streamline or standardize this interaction or the way someone is diagnosed or treated. However, in our view, those opposing the VMPS system basis this stance were missing an important aspect of the system – That being the fact that the VPMS system was implemented to streamline and standardize the processes ancillary and complementary to the patient doctor interaction, diagnosis and treatment. For instance, if one were to take the example of the wrong chrlorhexidine injection administered to a patient it can be clearly seen that there was an impending need to correct processes surrounding a patient’s treatment, which included something as basic as labelling the medicines / injections correctly. Ultimately, however unique the interaction between a patient and doctor may be (including treatment), if the tools used for the interaction (medicines / tests / monitoring) are unclear, unorganized and unavailable, the diagnosis and treatment holds no good and could turn fatal for the patient. This in some way could be likened to the need to create a streamlined process for manufacturing cars, since any defective / missing piece in the configuration could lead to a faulty car which either might not work or may end up in an accident. Thus, in our view VPMS was more about the processes surrounding treatment and diagnosis of patients, rather than the patients themselves. The facts highlighted in the case regarding reduction of staff walking distance, more free time for doctors to pursue academic research and focus on personal activities clearly outline how VPMS aided a better patient-doctor interaction. Reduction in time wasted on walking the floor, identifying medicines / equipment, find records etc. could be used in arriving at a more conclusive and accurate diagnosis and providing more focused treatment. Moreover, free time by doctors could be devoted to medical research, thereby aiding better treatment for patients through the discovery of more medical conditions, cures etc. Thus, yet again, while patients cannot be likened to cars in any sense or reasoning, the processes used in hospitals can be likened to a production process in a car factory in terms of the accuracy, speed and detailing required. d. Is Kaplan’s approach transferable to other US hospitals? Kaplan approach aimed to address basic issues such as resource utilization, profitability, quality, safety, etc. which were faced by most of the hospitals. Kaplan’s measures to encourage maximum participation of the staff in implementing a mind-set for continuous improvement and quality were the key for its success.Further, in Kaplan’s approach considerable autonomy was given to the board and the CEO for taking several decisions, thus making it essential for hospitals aiming to replicate these processes to have initial capital in order to fulfill the infrastructure and training requirements.However, if the above mentioned concerns are catered to, the other quality initiatives started by Kaplan can be completely replicated to other hospitals.The elements of the explicit compact for the physicians, which revolved around patient focus, fostering excellence, training, educating and taking initiatives, would be beneficial in all settings. The idea of focusing primarily on the patient imparts a sense of purpose within the staff which is very important in order to impart best in class servicesFinally, the documentation and standardization of procedures which are part of value stream mapping, everyday lean, 3P initiatives helps the hospital to understand status quo of their operations and device ways of improving it further.Hence, if the issues mentioned are taken care of, Kaplan’s approach can not only be replicated in other hospitals but also be very beneficial to other hospitals.