Thread by @DBadenoch

In a few minutes I'll be starting my coverage of @VM_institute CEO Gary Kaplan's #Quality2021 talk about a comprehensive management system built on "people principles".

Here's a bit of background:

A bit more about Gary.

He has held the role of CEO, Virginia Mason Franciscan Health and SVP, CommonSpirit Health since 2021 and was CEO and Chairman, Virginia Mason Health System from 2000-2020. He is also a practicing internal medicine physician.

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We're hitting the ground running here.

Project-based approaches to safety and quality are rarely sustainable

System science offers huge opportunities for improving health and wellbeing.

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Gary's expanding on his organisational story here.

Central is the desire to improve people's health.

The challenge at board level came from realising systems were designed around doctors instead of patients.

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Virginia Mason were "in the market" for a comprehensive management system.

This was informed by their granular definition of #quality.

Note A for Appropriateness! (Phew!)

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Gary's learning took his team to other sectors, notably manufacturing.

Looking at Toyota's production line, where quality was embedded in the front line. QA is online, rather than retrospective.

For example, from this came their patient safety alert system.

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Another key learning was being transparent when things go wrong, including when a patient dies.

We have an obligation to learn from failure.

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So far, so mechanistic, you might think.

No. None of this would work without co-production, with staff and patients. Processes, communication tools, priorities are produced together.

This represents a shift in mindset for the whole organization.

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Can you answer YES to Gary's three questions testing how well we respect people?

Mandatory training, at all levels of the organization!

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If we do not embrace the human aspects of change, we will not succeed:

- Create a sense of urgency
- Visible leadership
- Shared vision
- Aligned expectations.

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Now onto the improvement methods

I think we're seeing the biggest challenge now: managing across functions.

Patients don't care what "department" they're going to.

Unlike manufacturing, in health care we have less defined systems and unpredictable inputs.

What else is holding us back?

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So, really, we're looking at whole system redesign.

Perhaps counterintuitively, this is collaborative rather than hierarchical.

See how the VM nurses redesigned care processes to use "cells" - shortest distance to walk, line of sight etc.

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Similar examples from redesigning bedside handoff, daily rounds, outpatients services. All co-produced by staff and patients.

Outcome data captured the improvements from the changes made. Here, reduced time spent walking between patients.

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This approach has put Virginia Mason at the top of regional health system performance.

Gary Kaplan's approach is sustainable:
- Based on systems thinking
- Facilitate problem framing
- Be visible

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On to questions now.

1) How do you make all this sustainable?

Gary observes that managerial turnover can be a problem. So engage the executive board. New managers will then know we're serious. Also, train them! I'm struck by the level of investment here at VM.

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2) How do you deal with, er, less enthusiastic managers

"Not everybody needs to be a champion, but nobody can opt out."

Also see 1) above - transparency at the outset about expectations.

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3) How do we sustain people's enthusiasm through failure?

"Failure is part of innovation."

It's what happens after failure that matters.

"Fail forward fast" is the mantra, as part of a learning organisation.

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4) How do you halt the flow in an acute setting where patients are deteriorating?

We standardise those things that add no value by variation. This yields more time for individual needs of the patient.

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5) How do you break down the silos?

Gary emphasises the importance of cross-functional management.

It seems that patients are an ally here - most of this stuff baffles us already.

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Many thanks to Gary Kaplan for providing so many practical examples of real-world benefits from strategic alignment around patient flow.

I think it's time to sally forth and smash some silos.

Hope you enjoyed this #Quality2021 session.