Sarah Patterson informs about Lean

#qualitysummit  Another featured speaker at the Saskatchewan Health Care Quality Summit was Sarah Patterson, executive vice president and chief operating officer of Virginia Mason Medical Center, the leading adopter and proponent of Lean (or Toyota Production System) process improvement in hospitals.  Her presentation was a masterpiece of description and discussion of the Lean philosophy.  If it is posted on the web, it will be well worth your time.  In the meantime, as I did for the Jim Easton talk, I am going to post my live Twitter feeds to give you a sense of her major points.

Patterson: Using Lean provides a common language for process improvement. Small size of province offers oppty to experiment.

We understand the important role of leadership, throughout the organization.

Other orgs often talk about inability to sustain progress. Frustration of lack of stability.

Would like Va Mason org to operate like an aircraft carrier. How to run a complex business safety.

Aircraft carrier= an airport on top of a nuclear power plant comprising a bunch of 19 year olds!

Aircraft carrier needs complete alignment with the mission. If not done well, puts others at risk.


Aircraft carrier requires an incredible commitment to adoption of standard work. Relentless focus on training.

Aircraft carrier requires enforcement of accountability.

Create jobs that are doable. Train people to do them. Hold people accountable to them.

Virginia Mason story begins in 2000, looking for way to improve and assurance of accomplishing that.

Adopted TPS=customer first, highest quality, obsession w/ safety, staff engagement, successful economic enterprise

Declaration of zero defects was unheard of in health care. Essential aspect of TPS (Lean).

"Elegant" staff engagement system is inherent in Lean.

Lean 4Ps=philosophy; process; people and partners; problem solving. Not a program! A long-term philosophy.

TPS focus on process, not on the outcomes. Build key features into processes that are waste free, continuous flow.

Grow leaders. Respect, develop, and challenge your people, but also vendors (who are partners.)

Problem solving, knowing what is going on on the front lines, when problems are fresh.

AT VM, still have problem implementing and sustaining standard work, e.g., in primary care.

92% of Rapid Improv. Event results sustained after 2 months. Not good enough. Would drop further after 6 months.

Could this be because of current management system? Too much reliance based on superheroes? Great crisis mgrs?

Sterile processing superhero, knew everything, went on vacation! Surgeons left unserved!

VMason had to go back to TPS training. What did we miss?Hadn't given middle mgrs enough training about new roles.

Middle mgrs viewed TPS as an add-on, additional work with new tools. Need comprehensive mgmt system.Back to school!

Need regular management presence where the work happens. A transparent environment. Clear and complete goals.

Mgmt by policy + daily mgmt + cross-functional mgmt = world-class mgmt system.

Management by policy = long term vision, 5 year plans, annual goals.Reflection.Share environmental scan with all.

Mgmt by policy: One stage is "Catchball." Draft of policy shared deeply in the organization. Get feedback.

Catchball staff engagement, shared with 1000 people last year. Next year, 5000.

Deployment. Need process for negotiating what is effective work, resources required, and people's commitment.

More careful scoping of projects is an imp discussion to have in the organization. Signoff by key people.

Multiple executives responsible for projects. E.g., CFO responsible for safety improvements!

Regular mtg for check and review. Short updates. Who needs our help?

Cross-functional work is essential. Where creativity really happens. Blame for silos lies with the top leaders.


(Me) Review what she says to see a fundamentally different role for leaders.


Daily mgmt: Know at a glance status of work. Satisfying customer demand? Std work being followed? Engaging staff?

If our front line staff are telling us it is bad, do we know this? Are we acting to help fix it?

Leaders' 2 jobs. 1 -- Run your business, while ensuring stability. 2 -- Improve your business.

Start with understanding your demand; and knowing your supply; standard work developed and posted.

Track your business on a HOURLY basis, or you can't understand process flaws and improvement opp'ties.

Everybody on the floor needs visual cues as to status of work and meeting customer demand. In real time!!!

Every hospital needs in-the-room nurse-to-nurse bedside handoff. Every time.

Toyota cord-pulls, happens often. 30 second response by leader to be on worker's side.

In hospitals, too, need real-time ID of problems and responsiveness by leader. At the work station!

Elements of daily management = leader standard work + visual controls + daily accountability process + discipline.

Whoa! Leader standard work, too! What a concept. Can't be "too busy" for this!

With leader standard work made visible, staff now know, "Oh that's what leaders do!"

Visual controls focus on the process and make it easy to compare expected with actual performance.

At Virginia Mason, patients can see the visual controls in the waiting rooms -- e.g., MD-specific delays.

If MD gets behind by more than 10 minutes, resources are brought to bear to provide support and get back on sched.

Other visual cue examples.Note: Not sophisticated computer reports.Just white boards with stickies! In real time!

Gives list of foundational elements of hospital nursing care. Every unit, every day. Auditing process, too!

Choreographed and sequenced system of daily accountability. All units have daily huddle.

Daily accountablity. PeopleLink Board used for 30 minute stand-up meeting once a week.

Senior leader regular gemba rounds to view one aspect of standard work.

"I'd rather have no board rather than an out-of-date board. They have to be real."

Email from Amy, "I'm just a biller, but I look forward to every Thursday morning at 7:30."

Amy, "We have a common purpose and a common language."

Audience Q:  Recruitment. Didn't want people who had all the answers. Looked for curiosity. Learners. Communication skills.

Created leadership development curriculum to develop competencies, but look for innate characteristics.

Audience Q: How to take current work off the plate? A: Take things away (reports) that are needed. But don't wait.

Things that used to take leaders a lot of time don't take time, because of connection to staff, issues tracking.

"Just tell them to do it. Don't be afraid. It won't be perfect. Try it. Fail. Try it. Change. Keep going."