On the blog today, I want to mention the recent announcement of Susie Creger’s retirement from Rona Consulting. I echo all the complimentary words written by Rona about Susie. Susie’s outstanding service to healthcare improvement will not be forgotten.
I’d like to give you the background story to the series of remarkable events that led to Creger’s role in Lean transformation.
I’d like to give you the background story to the series of remarkable events that led to Creger’s role in Lean transformation.
Creger and King with me in Japan 2002 attending the first of many Virginia Mason 14 day Japan Gemba Kaizen Study Missions. Kaplan continues to lead these important missions to Japan, maintaining the rigor needed to craft meaningful study missions.
1: A chance meeting
Let’s go back 15 years. When I met with Mike Rona, president of Virginia Mason Medical Center and his boss Dr. Gary Kaplan in early January 2001, I realized the depth of their interest and their willingness to take a tough approach to changing the way VMMC did business.
The date was October 17, 2000. I was on my way from Seattle, Washington, to Madrid, Spain, to meet with the minister of health to discuss how Spain could improve its healthcare system through the application of Lean. My presentation to him was on my laptop computer.
As I settled into my seat, the businessman beside me introduced himself as Mike Rona, president of Virginia Mason Medical Center.
What an opportunity! Someone intimate with the healthcare field was right next to me—someone on whom I could try out my presentation. As we leveled out at 37,000 feet, I pulled out my laptop and said, “You really need to see this.”
When we headed for different connecting flights in Atlanta, I gave Rona a copy of my first Lean book A World Class Production System which the Boeing Company had sponsored. I figured I’d probably never hear from him again.
To my surprise, while still in Spain, I received an e-mail from Rona with more questions about Lean. Then I received a phone call asking me to meet with Rona and his boss, Dr. Gary Kaplan, Virginia Mason’s CEO.
The date was October 17, 2000. I was on my way from Seattle, Washington, to Madrid, Spain, to meet with the minister of health to discuss how Spain could improve its healthcare system through the application of Lean. My presentation to him was on my laptop computer.
As I settled into my seat, the businessman beside me introduced himself as Mike Rona, president of Virginia Mason Medical Center.
What an opportunity! Someone intimate with the healthcare field was right next to me—someone on whom I could try out my presentation. As we leveled out at 37,000 feet, I pulled out my laptop and said, “You really need to see this.”
When we headed for different connecting flights in Atlanta, I gave Rona a copy of my first Lean book A World Class Production System which the Boeing Company had sponsored. I figured I’d probably never hear from him again.
To my surprise, while still in Spain, I received an e-mail from Rona with more questions about Lean. Then I received a phone call asking me to meet with Rona and his boss, Dr. Gary Kaplan, Virginia Mason’s CEO.
2: A culture open to change
Lean leaders must be open to change to achieve success. My chance meeting only set transformation in motion because of Rona and Kaplan’s willingness to change. When I met with Rona and Kaplan in early January 2001, Rona and Kaplan were all ears, enthusiastic about Lean and obviously committed to changing how Virginia Mason operated. At that time, they were under pressure from the surgeons to build eight more operating rooms (ORs) at a cost of millions. One of their challenges was to increase OR capacity, but they didn’t have the money to fund what was thought to be needed.
They kept asking me, “How can we do it?” I told them capacity could be increased without a big expenditure, but only if they agreed to my plan.
The plan I had in mind for Virginia Mason was similar to the one we’d applied at Boeing. First, start by focusing at the point most vital to serving the patient. In the case of VMMC, that meant the OR. Second, define the value stream, and designate a portion of that value stream as a model line—that is, an area of surgery where you could drill down a mile deep and an inch wide. Third, create a Kaizen Promotion Office (KPO) and establish the infrastructure to support kaizen.
They kept asking me, “How can we do it?” I told them capacity could be increased without a big expenditure, but only if they agreed to my plan.
The plan I had in mind for Virginia Mason was similar to the one we’d applied at Boeing. First, start by focusing at the point most vital to serving the patient. In the case of VMMC, that meant the OR. Second, define the value stream, and designate a portion of that value stream as a model line—that is, an area of surgery where you could drill down a mile deep and an inch wide. Third, create a Kaizen Promotion Office (KPO) and establish the infrastructure to support kaizen.
Creger and King (Nurse Kaizen Leaders whose OR expertise and nursing skills helped shape the first KPO), receiving their certification with Smith and Miller.
3: A fight for great talent
In order to execute the plan, we needed to build a solid team. That’s when I told both Rona and Kaplan and Ruth Anderson, Administrative VP that we needed to populate the Kaizen Promotion Office (KPO) with two nurses from OR operations. I asked who their best and brightest nurses were and was told about Susie Creger and Rosemary King who worked in the OR as special OR supply leads. Then I was told they were too valuable to take out of those positons I scheduled a time to meet with them, but let the issue rest for the moment.
The first thing I did was to walk the route patients took from where they parked their car to where they entered the flow of perioperative services, gastroenterology and the ED and then were discharged. I walked with Dr. Steve Rupp, the Chief of Perioperative Services at my side as we created the first value stream map at Virginia Mason. Obviously we ended up value streaming the OR and the turf of Creger and King. I interviewed them on the spot. I then told Anderson and Rona they had to be reassigned immediately as we needed them in the first group to start certification. A good consultant identifies the expertise needed to achieve success, and then fights to bring that talent together.
Identifying talent: what made Creger and King so special?
The pair:
1. Were highly competent in their field
2. Were respected by surgeons and their peers
3. Had a strong work ethic
4. Always put the patient first
5. Never said "I can't," "We don't have time," or "That won't work." They were willing to innovate.
Only later did I find out that Creger and King were pulling double duty, going through certification and still working in the OR, a testament to their commitment to improvement. I got them changed to full time KPO leaders, a team which then included Virginia Mason’s Diane Miller and Danielle Smith. Miller is now the VP of the Virginia Mason Institute.
4: Results
The first year is always difficult, and the experience at VMMC would be no exception. The first Rapid Process Improvement Workshop, held the week of April 23 to 27, 2001, involved four teams with aggressive targets, all achieved. The results were excellent for the kickoff effort, but the real learning of the week, as reported by VMMC, was “that teams of process-knowledgeable people could make a major change in a one-week period.”
Creger and King were absolutely integral to the improvement effort. Their willingness to work double-time, their agility in switching on to the KPO team, and their invaluable years of experience as OR nurses helped catapult VMMC to successful implementation. I wish Creger the best in her retirement, and will always remember the combination of circumstance and determined commitment to change that brought together such a dynamic team at Virginia Mason.
Creger and King were absolutely integral to the improvement effort. Their willingness to work double-time, their agility in switching on to the KPO team, and their invaluable years of experience as OR nurses helped catapult VMMC to successful implementation. I wish Creger the best in her retirement, and will always remember the combination of circumstance and determined commitment to change that brought together such a dynamic team at Virginia Mason.
On the far left are Rona, Creger and King posing with first group of VM Kaizen Fellows attending 14 day Japan Kaizen Fellows Training in 2005. Rona and Kaplan and VM’s leadership immediately embraced the Kaizen Fellows program and Rona led many of the Kaizen Fellows trips. I required this first group of Kaizen Fellows to prior to the trip to review each value stream map for every sentinel event over the last 5 years, noting changes that had been made, possible changes they would pursue upon their return, and areas for which they were seeking insight as they went though our 12 days together. Others presented major inpatient and outpatient value streams as well as plant layout opportunities. Each Kaizen Fellows trip included not only rigor but rigorous documentation with a continuous feedback loop during the trip back to VM leaders and then a final report presentation when the team returned home. Those initial Kaizen Fellows trips produced significant turns of the PDCA wheel.
RSS Feed