Virginia MasonA Study in Transformation

Robert S. Mecklenburg, MD

AAPMROctober 2, 2015

© 2014 Virginia Mason

Virginia Mason Medical Center

1. Seattle-based integrated system

2. 450 employed physicians

3. 800,000 outpatient visits; 17,000 hospital visits

4. Graduate medical education

5. Research Center

6. Virginia Mason Institute

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The First Board Meeting

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Two Circles and a ChoiceProactive or Reactive?

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Influence

Concern

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Circle of Influence for ProvidersRemove Waste From Health Care Delivery

1. Produce appropriate, quality health care2. Eliminate needless variation 3. Eliminate waits and delays4. Reduce cost of producing health care

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© 2014 Virginia Mason

A Decade of Change at VM

1. Physician compact and reorganizationto ensure accountability

2. Strategic plan to define ourselves and our decision rules

3. Reliable systems to reduce variation in care

4. Marketplace Collaboratives to redesign care with customers

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Physician CompactMutual Accountability

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Organization’s Responsibilities

Foster Excellence• Recruit and retain superior physicians and staff• Support career development and professional

satisfaction• Acknowledge contributions to patient care and the

organization • Create opportunities to participate in or support

research Listen and Communicate• Share information regarding strategic intent,

organizational priorities and business decisions• Offer opportunities for constructive dialogue• Provide regular, written evaluation and feedbackEducate• Support and facilitate teaching, GME and CME• Provide information and tools necessary to improve

practice Reward• Provide clear compensation with internal and market

consistency, aligned with organizational goals• Create an environment that supports teams and

individualsLead• Manage and lead organization with integrity and

accountability 

Physician’s Responsibilities

Focus on Patients• Practice state of the art, quality medicine• Encourage patient involvement in care and treatment

decisions• Achieve and maintain optimal patient access• Insist on seamless serviceCollaborate on Care Delivery• Include staff, physicians, and management on team• Treat all members with respect• Demonstrate the highest levels of ethical and professional

conduct• Behave in a manner consistent with group goals• Participate in or support teachingListen and Communicate• Communicate clinical information in clear, timely manner• Request information, resources needed to provide care

consistent with Virginia Mason goals• Provide and accept feedback Take Ownership• Implement Virginia Mason-accepted clinical standards of care• Participate in and support group decisions• Focus on the economic aspects of our practiceChange• Embrace innovation and continuous improvement• Participate in necessary organizational change

© 2014 Virginia Mason

Strategic Plan

1. Who we are.

2. What we do.

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Path Toward a Management System That Works

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New Attitudes and New Tools To Achieve Zero Defects

VM Board Member at Hitachi

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The Sensei and the Waiting Room

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Reliable Systems Eliminating Wasted Time and Content

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Standardize Processes

Build in Pace Only what is needed when and where needed

Build in QualityEvidence-based, patient centered care

LESS WASTE

LOWER COST

BETTER - FASTER - MORE AFFORDABLE

Cost of care

Cost of absences

Cost of variation

© 2014 Virginia Mason

Reliable Systems“Best Doctors” Not Sufficient

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Safe Medication Ordering

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Jan-

05

Feb-0

5

Mar

-05

Apr-0

5

May

-05

Jun-

05

Jul-0

5

Aug-0

5

Sep-0

5

Oct-05

Nov-05

Dec-05

Reliable System Installed

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The Medical Assistant’s Question

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Reliable Systems Flu Shots

2002 2003 2004 2005 2006 2007 2008 20090%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

38.0%

54.0%

29.5%

97.6% 98.5% 98.7% 98.9% 98.9%

Influenza Immunization Rates

Year

Em

plo

yee

s Im

mu

niz

ed

(%

)

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The Nightmare

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Mary McClinton“Hands that make dreams come true”

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The Customer

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Affordability: Three Challenges

1. Failed process for delivering quality

2. Failed process for paying for quality

3. Failed process for purchasing quality

Affordability requires correcting all three.

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A Marketplace Collaborative

1. Employer uses purchasing power to define products and quality specifications.

2. Provider produces product to quality specs.

3. Health plan pays for delivery of quality specs.

4. Employer purchases product.

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Employer Defines Products Doing the Right Thing: High Cost Conditions

1. Screening and prevention

2. Back pain

3. Joint pain

4. Headache

5. Upper respiratory infection

6. Breast symptoms

7. Diabetes

8. Depression/anxiety

9. Asthma

10. Abdominal pain

11. Chest pain

12. Bladder infection

13. Dyspepsia

14. Hypertension

15. Hypercholesterolemia

16. Total joint surgery

17. Spine surgery

18. Coronary artery bypass graft

© 2014 Virginia Mason

Employer Defines Quality SpecsDoing Things Right

1. BetterEvidence-based care: what works

100% patient satisfaction

2. FasterSame-day access

Rapid return to function

3. More Affordable Affordable price for employer and provider

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© 2014 Virginia Mason

Will it Work?

1. PM&R underwater financially

2. 12 professionals leave section

3. Major changes across medical center4. New Section Head

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There is no security on this earth;there is only opportunity.

-MacArthur