Book Review

“Transforming Health Care” by Charles Kenney

Virginia Mason medical center in Seattle is ranked in among the top 1% of hospitals in the United States, but it wasn’t always that way.

Starting in 2002, delegations from Virginia Mason travelled to Japan to study the principles associated with the Toyota Production System (Lean) and learned how to apply them to improve the quality and safety of their health care delivery at the same time as reducing cost.

At its core is the philosophy that patients, not the service providers, must truly be at the centre of all decisions for any health organization that pursues excellence.

The status quo can never be good enough. Everyone must support a culture that isn’t satisfied with doing things the same way because “that’s the way we’ve always done it.”

Health care transformation, private or public, is a journey not a destination. To successfully achieve positive transformation an organization must have the personal commitment of the CEO, an expert teacher, and the commitment from all involved “to a long-term slog through the swamp of waste and defects that lies hidden beneath the surface of your daily operations.”

A catalyst for change that is more present in American health care than ours north of the border is the reality that in the U.S. it’s possible for hospitals to fail. They must change to attract patients or face the consequences of reduced revenues, higher costs, and eventually job losses and closures. 

Even those who had operated with a sense of entitlement are quick to learn that team-based care with patient quality at its core is not only the best path forward, it can be in many circumstances the only viable path forward.

Part of the transformation for Virginia Mason was to adopt continuous incremental improvement where all staff could make quality and efficiency improvement suggestions that were seriously considered and that anyone could call out an action if they felt it would compromise patient safety or quality of care.

Some resistance from physicians needed to be overcome as the culture changed to include standardization and measurement of clinical performance, but overcome it was with peer leadership. 

Transformation wasn’t easy or fast. For example, it took nine months to eliminate completely their backlog to see a primary care physician.

Once they started matching physician schedules with predicted patient demand, they were able to open up half days for last-minute appointments. Using a combination of improvement ideas and team-based care, they saw their satisfaction scores rise from 40 to 85%.

Changes resulted in nurses now able to spend 90% of their time with patients compared to previously spending two-thirds of their time away from patients. This was well received by patients and especially nurses, who got to do more of why they became nurses.

Shorter lengths of stay, fewer mistakes, happier more fulfilled staff, fewer unnecessary and expensive tests, same-day appointments, no more back-logs, and gone is the perverse system of pay that rewards doctors and hospitals for how much they treat patients instead of how well.

Can we learn from this American example? Yes, but putting patients first will need to mean more than it does now in our Canadian system.

Change will be difficult, but readers of “Transforming Health Care” will be rewarded with the knowledge that while difficult it’s not impossible.

Norm Letnick is MLA for Kelowna-Lake Country and the B.C. Liberals’ health critic.