In the early 2000s, Virginia Mason Medical Center in Seattle was losing money for the first time in its history. Its new chief executive, Gary Kaplan, went looking for a method and found one in an unlikely place: Toyota’s car plants.
Not everyone liked the idea. In June 2002, as about 30 of the hospital’s top executives prepared for a two-week study trip to Japan, The Seattle Times noted that the hospital had spent the past year cutting costs, and that employees wondered why it was paying for executives to go to Japan “to learn to think lean.”
Late one night on that first trip, Dr. Robert Mecklenburg and some colleagues were in a conference room at one of the factories when a sensei, a master teacher of the Toyota system, came over. The sensei wanted to know the path a patient took to get care at Virginia Mason. Mecklenburg began drawing it on a sheet of paper.
The sensei asked what one of the boxes was. “Well, that’s the waiting room,” Mecklenburg said. What was the patient waiting for? The doctor. For how long? “Oh, 45 minutes or so.” Was it a scheduled appointment? “By this time I was starting to feel bad,” Mecklenburg later told PBS. The sensei went on: patients waited 45 minutes for scheduled appointments, in rooms measuring 25 by 30 feet, and there were at least 40 of these rooms? Then the interpreter turned to Mecklenburg. “Sensei wishes to know, aren’t you ashamed?”
“I had not realized,” Mecklenburg said, that the waits, the rooms with their fish tanks and coffee machines, and the office staff juggling appointments “were all unnecessary costs which are ultimately paid by that patient.”
Back in Seattle, the hospital set out to strip waste from its work. Some resisted. Kaplan told PBS that some doctors said they would change “over my dead body,” and the Virginia Mason Institute’s own account says some staff and physicians left for other hospitals. Charleen Tachibana, the hospital administrator, told PBS that nurses had been spending too much time fetching supplies and drugs, so supplies were moved from a central storeroom to the bedside. Through a variety of changes, by Tachibana’s account, the share of nurses’ time spent with patients went from 35 percent to upwards of 90 percent.
By 2012, PBS reported, the hospital’s Kirkland clinic had no waiting room and offered same-day appointments. Patients checked in and went straight to an exam room. The hospital had cut a backlog of three to four weeks by taking appointment calls as they came in, instead of letting them pile up until the end of the day. Not everyone was persuaded: PBS noted that some traditional health care thinkers accused the medical center of practicing a one-size-fits-all form of medicine.