Podcast | Lessons from SuperVax with Dana Nelson-Peterson

00:09

Thank you for joining us for Better Never Stops our podcast for healthcare leaders and anyone and everyone committed to transforming healthcare. We’ll be interviewing leaders from our partners around the world, including leaders right here in our Seattle home, where they are doing the work day in and day out sustaining a culture of learning and improvement. And each episode, we hope to explore our philosophy of go see, ask why, and show respect. We’ll cover observations we’re seeing from the frontlines, share how decisions were made, and outcomes we’re seeing and explore the leaders role in this work and maintaining a culture of learning and respect. My name is Melissa Lynn, senior partner at Virginia Mason Institute, where I get to work with healthcare organizations around the world to coach and guide them through their own cultural transformation journey. Today, I’m excited to introduce you to a phenomenal nurse leader who will share an incredible story about what happens when you trust the process by giving their all to the Virginia Mason production system philosophy to help solve the biggest problem of 2021 in the middle of the COVID pandemic, and why their innovations and lessons learned have such a massive impact on how they look at the health care challenges of the future.

01:30

I’d like to give a warm welcome to our guest today. Dr. Dana Nelson Peterson is vice president of nursing operations at Virginia Mason Franciscan health. Dana has worked as a registered nurse at Virginia Mason Medical Center for more than 36 years most recently as Virginia Mason Medical Center’s vice president of nursing. She spent the last 20 years in leadership positions including managing inpatient nursing units, directing hospital-based programs and building programs like the transition support center and care management services. Dana is a graduate of the 2007 Virginia Mason production system fellowship and has led numerous improvement initiatives. Welcome Dana, thanks for joining me today. Thank you very much for having me.

02:16

I’m so excited to have you on our podcast, you are just infamous at Virginia Mason for all the incredible work that you’ve done, certainly with your leadership and nursing, but more so just your advocacy and cheerleading of the Virginia Mason production system. So, we’re glad to share you with all of our colleagues around the world and some of the insights and lessons that you’ve learned over the past few decades at Virginia Mason and beyond your BIOS kind of given us a little bit of their professional background. But I’d love to share with the audience, if you don’t mind about your role at Virginia Mason specifically as it relates to your experience with vmps. In particular. Sure, as you noted, I’ve been around Virginia Mason for a long time. And I like to think of myself as one of those early adopters of the production system.

03:09

And I was one of the in one of the early cohorts, I’m getting my original certification and BMPs. And I was loving life out there and operations I was helping. I was at the time overseeing hospital operations. We were in the process of building our new Jones tower on the Seattle campus. And one of the first or the first unit that was going to go over was the emergency department which I was the was under my purview. And I was so looking forward to and looking forward to moving the ER from their cramped, confined space into this beautiful new space that I actually had the opportunity to use my VNPS skills to help design the different the different flows and layouts of the building. When I was approached by my boss at the time, Charlene Tachibana, asking me if I would like to rotate, do a rotation through the Kaizen promotion office. And the first time she broached it to me, I actually said, No, I really didn’t thank you for the offer. But I don’t really care to do that. Because I was just having so much fun in operations and applying vmps with my teams. A little later, a few weeks later, she came back and asked again and I was like no, I really don’t I am so excited to see this EDT move into K po and I just want to see that through to the you know, through that transition. And then she came back to me a little bit later and told me I was going into K Po.

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And it was like no, no, you’re going and so I reluctantly transitioned into K PL and it was really, really difficult for me to leave these teams that I had cultivated and worked with that I loved and to leave them in the day.

05:00

The operational leadership into que Po, where you had to learn a different type of leadership, it was no longer having my hands on the levers so to speak. But I had to learn how to lead to influence. And

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I thought originally that I was only going to have to stay there for two years. Note the word have to. But I actually pretty quickly realized what a wonderful gift it had been given to me to get the experience and the exposure, leaving the hospital cousin promotion office in conjunction with Charlene. And

05:34

I ended up staying there for almost four years. And during that time when I went back to school, I took advantage of not having day to day operations, and went back to school to get my doctorate degree. When it was finally time for me to rotate out of kpl. I was getting antsy, I was ready to do something, I thought I was gonna get to go back into the hospital and lead lead to hospital operations again. But that I was dropped another little bomb on me so to speak, that there was a new position created that they wanted me to go out to and that was to go into ambulatory care, and explore ambulatory nursing, find out what nursing was doing, use my vmps skills to really elevate the practice of nursing across the ambulatory and create structure and processes for nursing. And at first to get I was just like, oh my god, they’re putting me out here.

06:25

Because I had my I had my own mental valleys about what working in ambulatory care was all about. And within the first couple of weeks of starting to explore what was going on in ambulatory care, because my entire life had been based on the inpatient setting, I realized how fascinating ambulatory care is. And

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in my opinion, amatory nursing is really the key to the future of healthcare, because more and more care delivery is going to be happening in the ambulatory space. And it was just ripe for development and creating structure and processes. So, then I spent that time in ambulatory nursing,

07:05

before being moved up into a vice president position, overseeing nursing at VA Medical Center. So the presenting waste and production system journey has really taken us to so many different parts of the organization and just seems to widen your eyes and your perspectives on how it can be applied. Absolutely. Absolutely. I’m one of the, I think a handful of very fortunate people that have been able to work on the inpatient setting and understand how a hospital works and all the flows in the hospital, and then get to work on an ambulatory environment and understand the flows through an ambulatory environment, and really be able to see across the continuum, because our patients experience us across the continuum. And they think that we know them, and we talk to each other. And that was one of the realizations very quickly is that even with our electronic health record, we still haven’t hardwired how that ambulatory setting talks to the patient setting when patients cross our paths. So just really, really fortunate to be able to look and be able to work in this more of a system level.

08:16

And then I’ve had an opportunity when I was still with Virginia Mason to work at a higher-level system when we were working with Yakima over at Virginia Mason Memorial over in Yakima, Washington. I got an opportunity to spend about a year and a half over in Yakima, halftime, helping them with learning BMPs and creating structure and process with regards to nursing over in Yakima as well. And that all led me and set me up really nicely to now work at Virginia Mason, Franciscan health, where I’m working across all of our facilities, partnering with our leaders and all of those sites at looking at opportunities for improvement of the care delivery.

08:56

We certainly have Charlene Tachi vana to thank for her persistence and maybe the gentle or not so gentle nudge to get you to go to the Kaizen promotion office, because what an incredible gift that we have to, for you to really support these new teams as they’re starting their own transformation journeys, wherever that beginning may be for them as it I’m sure it’s been different for each of them. Yeah, it certainly is. And, yeah, it was it was a gift. In retrospect, I was provided just the most wonderful gifts from a career development perspective. At the time. It felt it didn’t feel like a gift that I was being given.

09:37

It was being given an assignment that I really didn’t want, but I grew to love. So

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that’s its benefit. It’s benefited me well. And I think it’s benefited the organization and most importantly, our patients and our team members. Well, I suspect a number of our audience members will know about, you know, that story that we talked about all the time of the talent belongs to the organization.

10:00

Chun and being able to utilize that Kaizen promotion office as kind of a staging area to really develop up and coming leaders who can, we can see the potential for them to really think, at a system level to really appreciate that it’s not about the people in the whether or not they’re doing their jobs well, but whether or not the processes and the systems that are designed around them are supporting them to do those Well, or we’re setting them up to fail. So, I just really love that you were able to take that opportunity and get on that platform and figure out how to influence not just about via authority, but through that different way of thinking using BMPs. Yes, fantastic. Well, today’s episode, we wanted to dive in a little bit deeper with our go see, ask why, and show respect, you know, the original phrase that came from Toyota as Chairman. Mr. Chou, we talk a little bit more about what we call Super Vax. At Virginia Mason, some folks know a little bit about that out there in the world. And I know, we’re about to two and a half about to hit our three-year anniversary, it almost feels like with our COVID pandemic. So, we’re still in the midst of it, and felt like there were still some good lessons that we could learn from it. So I wanted to have you share the story, Dana, if you don’t mind about what exactly the Super Vax initiative is, and what exactly it entailed. During that time. Sure. Divided is put in an elevator speech Super Vax was accumulation of a group of likeminded people that were focused on doing what we could for our communities in getting vaccine into arms in the most efficient, rapid manner possible. And doing so in combination with a likeminded partner with Amazon. So, two years ago, when COVID hit in the vaccine first started, we got vaccine allocated through the Department of Health through the state. And we did a soft launch of trying to do vaccines for our team members, as well as our local community members. And if you remember, it was tiered. Not every vaccine wasn’t available to everybody. There were very specific tears of who was able to get the vaccine. And first and foremost, it was our elder generation and our health care workers. And so we stood up a clinic in one of our old buildings, one of our oldest buildings on the Seattle campus,

12:41

and tried to put patients through there. And it was just a vaccine clinic. We didn’t call it Super Vax.

12:48

We had look at, it’s really something and but we were able to do about 300 people a day through the that clinic. And we were using primarily our we put a call out to our advertising providers. So, we had several physicians wanting to come back into

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service to help vaccinate our community members, and our team members. And then we also put a call out to nursing schools to get nurse techs to

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help our vaccination efforts. So, combination of old retired providers and brand-new nursing students ready to enter into health care. And we ran the clinic. And we just you know, as I said, we got it through about 300 a day, it was a very arduous process, very labor intensive in the electronic health record. Average cycle time was like 10 minutes per person, for the vaccinator to go into the different screens and the electronic health record, etc. Documented give it so we were just time limited, because it took so long as well as space limited. And one afternoon, we got a phone call from a leader down Amazon who was looking to partner with a healthcare entity to help How could the Amazon help in our response to COVID. And the following day, we went down as a small group of us went down to Amazon and met with their global team. And they she took us around a little bit on a little mini bus and showed us three different sites that they could offer up that because all of their people had been furloughed. There was nobody in their buildings. And when we entered into the last one, it’s the was the Amazon Meeting Center down in South Lake Union district. And it was just this huge building,

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building and it was just like the typical Greenfield and everything about vmps in my head started working on how we could set a clinic up in there and literally flow patients in like a production line in the front, out the back and within four days so

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or days, we took an idea. And we ran our first clinic four days after going and seeing that site visit. So it took a huge team, as I said, a very likeminded people

15:14

putting together if you think about all of the flows, we had to think about, what did the layout of the room have to look like? How can we optimize the number of stations? How could we get the vaccinators in there to do the vaccinations? How would we manage the drugs and medication flow, and at the time, the medication the COVID vaccine was just like a very much wanted

15:39

in a product, so it was like guarded with your security would accompany pharmacy. It was signed by as they escorted the

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the drug from our deep freeze and VRI down the Amazon, because you know, somebody could potentially steal it, get it on the black market, our vaccination cards were showing you it was a black market thing. Those had to be guarded with security. It was just crazy at the time, when I think back about it.

16:12

It took our leaders from our registration,

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areas of our finance registration people, it took our electronic health record. clinical informatics leadership, took our nursing leaders, it took our pharmacy leaders, it took our

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partners at Amazon with as far as they were able to provide he’ll parking, the parking lot had like over 700 cars could be in the parking lot. At any given time. It took partnership with the City of Seattle for trafficking, traffic control.

16:49

And we ran our first clinic four days later, and we put through a couple 1000 patients. Again, we’re looking at tears, right. So again, the vaccine wasn’t available for everybody, it was still very stringent on who you could deliver. And if you gave a vaccine to somebody that didn’t meet that tier, they the state would pull the vaccine from you. So there was huge scrutiny. In fact, some organizations not us

17:14

did have their vaccine pool because they gave it to VIPs people that didn’t meet the criteria. So we were really, really particular and we had to have security lot what we call on line patrol, because there were people trying to cut into lines that didn’t meet the criteria.

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It was just really something. And it was a beautiful opportunity to as I said, look at a Greenfield and start to build it using BMPs. And so that first day was just kind of like a it was a bit every week actually. So we ran it every Saturday and Sunday. And

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we use volunteers from across our originally from across our system because people were clamoring, wanting to volunteer to do something to give back. And then we were able to open it up and use the city volunteer pool as well as as time went on. But

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it was true Greenfield the first day was just a PDSA, we huddled we started tweaking things. And every single week, things got better and better. We would try new things, we would identify opportunities to eliminate barriers to try to try to get to a pole type of system. So at first it was very much pushing, wanting to get to a pole and be able to sit back and actually watch a continuous flow. We introduced Leader Standard Work as far as standard heddles huddle times where we would all come to the different point people would come together throughout the course of the day, we would we introduced volume so that we could track where we were based on anticipated volume at every two hour increments to see where we ahead are we behind production, which then would allow us to either open more stations up or we could close it down. And then the first wave of Super Vax, it was all about never ever wasting vaccine. We never want to do because it was like liquid gold, you couldn’t waste the vaccine. So it was

19:24

really fine tuning how many vials to open and repair and draw based on how many patients were left in the queue. So a lot of reconciliation, especially that last half hour of every day. It was all about utilizing the concept of setup reduction, how we introduced a roll of syringe prep, and then we even went up set up reduction even further where we would get packs from the government of syringes, and then with needles. So part of what you had to do was you had to open up the syringe open up the needle put the needle into the syringe, so I’m a syringe

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was the actual physical syringe prep. And then it was getting a cohort of nurses and pharmacists that would actually pull and prep the syringe. And at the beginning when we just had the Pfizer vaccine, it was really it was much easier. But then when we introduced additional vaccines, then we had to really double down on our visual control. So we actually created visual control and different lines. So we actually it was pretty clever. We had the syringes had different, the way the vaccine would come as in a little vial, and you could pull like, five or six doses of each vial. The vial tops had different colors. So Maderna was red, Pfizer was purple. And then when we introduced it later, when it was available for kids, the pediatric Pfizer was orange. So we have visual control based on who was coming in downstairs. When they were checked in. Are you getting Pfizer Maderna if they’re getting Pfizer they got a purple armband, if they were getting Maderna, they would get a red armband. As they came up, they would queue into a purple line, where we had all of the station signs were

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in purple for Pfizer read for Maderna, they would the flags that the vaccinators had as visual control that they will hold up that they were ready, were color coded to the vaccine that they were given. So that as we stood at the back in pharmacy prep area, we could look up and we could see from a visual control perspective, you know, all the purple people were purple banded, we’re in the purple rows of the red in the red. But as we which was really important because as more and more people started to transition over to Moderna, then Pfizer or they wanted when the second wave came and we got people could get a follow up Moderna they got Pfizer, because he some people like to mix and match, we would we would ebb and flow our lines based on our volumes that were coming through the line. So we wouldn’t we would very quickly do that rapid changeover kind of like single minute exchange of dye the s&s Minute, it would be the single minute exchange of station. So we would flip a purple station to a red station and make sure that the vaccinator knew that they were down giving the Maderna because it mattered as to how it was being registered by the state.

22:28

And then our informatics people just did an absolutely phenomenal job in continuing to streamline the process. I

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think early into it, they introduced the idea of barcoding, rather than seems to make sense. Yeah, rather than manually putting in the writing into a dose, what type of drug it was, they would just be able to bar screen, bar scan, excuse me, a QR code from Maderna QR code from Pfizer that would then auto populate the medical record. And that medical record then fed to the state database. So with all of the different enhancements, you remember, in the beginning, in the old HRB building, we had a cycle time a little over 10 minutes at the end of our Super Vax. After all of the different PSAs and improvements, we got it down to a two minute cycle time. So we were able to actually time patients. And the only originally, let me just back up a little bit. Originally, there was that mandatory 15-minute wait period because it was still investigational. So we would give it would take like 10 minutes for them to do the vaccination from the time the patient sat down to the vaccine was administered and document patient done, the patient would still have to go back and wait for 15 minutes, make sure there’s no adverse reaction, and then go at the end, after we did the second wave of boosters. They had lifted that 15 minutes, it was not mandatory anymore. So you could actually watch the patient flow through the entrance of the Amazon clinic, come sit down in station and go walk out the back. And it was truly like watching a continuous line. It was like it was I’ve had the opportunity to go to Japan a couple of times and it was just like watching the movie line at one of the factories at Toyota with to just you know, pick a patient.

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You know, somebody that might be I would oftentimes just pick somebody that was just maybe outrageously dressed or was just sparked my curiosity. And all right from the time I saw them enter the doors downstairs because the second story is where the Meeting Center was. So you can watch the line if it was moving or not. And just follow that patient through the flow. And it was just really something Yeah, we talked about continuous flow being like the Nirvana, the perfection and how hard it is for you for

25:00

Are any of us to get there, particularly in health care, we, we understand the complexities of medicine and, and everything else. But just you can’t help but just see that beautiful symphony of actions and processes and all of the tweaks that you made along the way that just allows for that patient to just goes through every step of the process without any delays. And it’s like, Oh, right. This is the pinnacle of how VR works. And for those of us that, you know, because we were all pretty, pretty nerdy and kind of geeky,

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that when we saw it, when it happened, it was so cooled watch. So we did all very early on, you know, we did many of the just basic BMPs principles, like kidding, of supplies, making sure that we could, that was actually another big thing. The setup for the first clinic took several hours, as we because we were scrambling to get all the supplies, we needed for the actual vaccinator to have everything they needed. What we did, then, was externalize that setup by actually having little caddies that we prepped for prior to even taking the caddies down. So that that was a kind of an interesting

26:16

revolution of what we did. So, we bought little, like dish caddies. And we would, the supply chain would all would set up upstairs or up at the campus, take them down, and then distribute them to each station. So we were talking 36 stations we add,

26:35

then, we got smart and say, well, we’re not going to be carrying these back and forth. That’s wasted movement, wasted transportation, we actually then did the restocking, and the supply chain would restock at the end of every day, inside the venue. And then we’ve got we don’t even need to have the supply chain to this. This is something our bit our vaccinators can restock after they’re done with their shift, they can restock their own caddies. So it’s just those types of things that we were able to do in every little nuance of how we, again, it was.

27:11

When you think about the flows of medicine, we touched every single one of those flows, and continuously improved, and were challenged by Amazon, who are all about logistics. So, they saw things that we didn’t see, you know, it really got out. I always remember sensing the cow. And one of the trips back to Japan, we were the factory, and it was trying to shave off seconds. And never thought it was like seconds of looking at like a drill bit. How far would you have to raise the drill bit, you know, could you decrease the amount of distance and still get the same quality product and fine tuning to that level. And you never thought you would ever be looking at shaving seconds off. But that’s where we ended up is we were really trying to save shave seconds off of our process. And we I think it’s fair to say, We thrilled and delighted our patients, they just couldn’t believe what a seamless process it was for them.

28:13

The alkaloids that we got from our patients was, you know, just really outstanding, to make it as easy as possible for them. No one could say that what would make it easiest would be like the people say, Well, you know, the drive-throughs are the easiest. It’s like,

28:28

I think we had to drive through the drive thru to beat on our cycle times in our experience. Oh, absolutely. I really do think we did wasn’t because there’s different logistical and infection control issues that come with the drive throughs. But I think the point being is the opportunity for us to just think outside the box and figure out what could we do? Or how can we do this differently to solve a massive problem, which is how do you know, vaccinate a massive amount of people in a very, very short amount of time. Yeah. And even just thinking like, oh, and on. So usually, you think of the visual control that we had. We also introduced auditory and on. And that is, every once in a while, you’d get a patient that would come through that would go do what’s called basal vagal. They would like faint, they sat in the chair, you’d see somebody slide off the chair onto the floor, and we introduce handbells because sometimes with the music in there, and just

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the sound of people interacting in a large venue like that. We introduce camera, but yeah,

29:40

we try out the music.

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We always like to have the music going, kept us going but they were very long days, but we introduced handbells. So every station had a little handbell that they had a patient that either they needed to clinical

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intervention support

30:00

If the patient had questions that the vaccinator couldn’t answer, myself, the pharmacist would go, they would ring the bells so that there was an auditory because it was so unusual to hear bells ringing in that environment. So, we added a clock. At the beginning, this was brilliant, to beginning and one of the most difficult things for the vaccinators was we would give the vaccine and then they would put a sticker on the patient,

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going 15 minutes ahead of how long they needed to sit back in the observation area. So, say if the patient got it’s easy, if it was 11 o’clock, it’s 1115. But when it was 1050, to the vaccinated, you’d have to manually take a moment for your will 1050 to plus 15 minutes, you know, what does that equal? So, Amazon actually said, Well, why don’t we just get little clocks for each desk and set each of them 15 minutes ahead, so that the vaccinator can just look at what the clock says and write that down on their little sticky. Then you know, just eventually that went away when we didn’t have to do the observations. But that shaves seconds off the vaccinator cycle time. You know, it’s just little point improvements like that, that we continuously look at trying to improve. That’s your Japanese factory drill, but millimeter or micrometer at a descending moment that you had there. That was actually one of my favorite stories, when I first heard about the incredible work that you’re all doing in Seattle is a lie based in Boston, I did not have the opportunity to raise my hand and said, I will go there and support you all and volunteer every single time that you’re doing this. And I just love that it’s such a simple innovation of just setting the clock 15 minutes ahead. And yet, you know that that’s probably 30 seconds for some of us that are just Yeah, it’s a long day, you know, you are my 300th vaccine of the day, and I’m starting to be cross-eyed. And now you’re asking me to do some, you know, simple math fine, but it’s this is this is not this is not what I need right now.

32:12

I just need to take care of my patients. So, we were really, you know, just we would watch the vaccinators we would look at opportunities to try to relieve the burden of work on them. And so if you think about it in the beginning, you know the first time we actually gave you the sort of pharmacy mix the vials in the back, we actually gave the vaccinator a vial and the syringes and had them drop their own syringes. And by centralizing that externalizing set up to that and centralizing it, it also allowed us to do quality control, because there were times unfortunately, you know, things happen, that a syringe would be very, you know, you’re doing Milam milliliters, or millimeters of

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fluid. So it was point two, or point three depending upon the vaccine. And sometimes from a quality control perspective, especially our older vaccinators that didn’t have really good eyesight, to be able to look at that level of syringe.

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It allowed us to do quality control and make sure that the syringes were accurately filled with the correct amount of vaccine. And that, you know, the vaccinators loved it not having to deal with pulling up their own vaccines. Yeah, absolutely. So, you mentioned a couple of the results of their private work. I mean, I think noticing that the cycle time of the vaccination process going from the original 10 minutes in our old HRV building, if anyone’s visited Seattle and seen it before to this beautiful Amazon Greenfield space that allowed us to get it down all the way to two minutes that those are huge gains. Clearly quality controls while getting as close as possible if not hitting 100% on the mark on that. Were there any other results that you wanted to share? There was another one we had we actually had a target progress report that we populated with the vetrix Our baselines, just because we were really focused on wanting to make sure we were seeing improvements. Another one was the time spent setting up so in the beginning, we would go down there this cohort is going down they would go down Friday afternoon and get into the space and set up the space so that comes 7am Saturday morning it was ready to rock and roll.

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And that would take us hours to get all of the sites all you’ll get everything. The Amazon did a great job once we had a template arranged of how we want the tables and chairs set up. But then to set up each vaccine station with the sharp’s containers, the caddies etc. Make sure the caddies were had all the supplies and everything

35:00

Seeing all the signs are set up correctly, flags were there, it took us about three hours. And what we were able to do, by the end of it, it was a 30-minute setup. So, we left everything there.

35:14

We were able to leave everything there except for the drug, and the sharps. So, every at the end of every clinic, the sharps would all be taken away. Any drug that wasn’t cracked, would be taken backups to the main campus, we were able to decrease that from three hours down to 30 minutes, which was pretty phenomenal. Yeah, I mean, you’re talking about your team, a team of people having to do that. So it’s not just, it’s not just their three hours, but three hours, it was three hours of like seven people

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the setup for every day,

35:45

meal that Amazon loved it, so they didn’t have to have their people there on Friday afternoons.

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Yeah, we just wouldn’t meet all of these Amazon shoot, they would start, their team would start like at five in the morning, getting all the signage up the parking, it was all, you know, handicap parking, you know, each they had, they had people at each level of the parking lot so that it was really a concierge type service, from the time that a patient would pull into the parking lot to go get it spot. And then we added what’s called mobility assist for those patients that had mobility issues. We had a fleet wheelchairs staffed by volunteers that we would go down into the parking lot and get them out of their car, bring them up, escort them up in through.

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We’re really trying to focus on the patient’s experience as well. Oh, absolutely. Absolutely. So, um, you know, it has been over a year and a half since the times of the mass vaccination that we saw around the world and, and yet, I’m curious to know, from your perspective, why do you think this work? You know, what you learned from that experience is still relevant to health care leaders today or why it shouldn’t be relevant to us today. I think what we’ve learned how to stand up something incredibly quickly and take our knowledge of BMPs and continuously improve and look for opportunities.

37:19

It’s going to it’s going to happen again, we don’t know what’s coming down the pike as far as infectious disease or communicable disease if we’re going to have to, to provide mass vaccination attempts with

37:32

the oh, now we’ve done is we’ve been able to permeate all of the local pharmacies and vaccine is widely available for COVID right now. But again, it’s like with monkey pox, a very coveted vaccine held very tightly, certain organizations are going to be allocated to be able to vaccinate the Absolutely. Now, I understand that the Super Vax team, one of the most recent Mary McClinton, patient safety award. Can you tell our listeners about the significance of who misses? Oh, yeah, hopefully I can do it without why this, this support. This award is so important to the team. Yeah, I can hopefully I hope they’ll do it without tearing up.

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The Clinton was a patient of ours who experienced a medical error of primary preventable medical error and died in the care of our care. And in recognition of that it actually was a real it was a sentinel event that was really a bellwether event for Virginia Mason, and really strengthened our commitment to absolutely focus on the patient first and safety, safe delivery of care.

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And, in recognition of her we had we established the annual Mary McClendon Patient Safety Award, it was a while ago, and yet for those of us that were here, then still feel the impact when you hear her name.

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We were nominated and received the Mary McClendon Patient Safety Award this past year. And I don’t know who wrote to apply for the award. There’s quite a robust application process that you have to fill out and I have helped fill out applications for teams through the past and teams that have received the award and none of us that I that I am aware of lead this work. Even thought about submitting it for the Marion McClinton award, but apparently many people did. And somebody out there wrote the application. I never got to see the application. And we were notified that we were going to win the award. It was incredibly humbling

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humbling to myself, and I think humbling to all of us leaders that were so instrumental in getting Super Vax up because we never did it.

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Thinking of winning an award, we did it because it was the right thing to do and what we can do and using our skills to really reach 10s of 1000s of people in our Seattle Community and get vaccines into arms. So it was really quite something to be recognized for that work this past spring. Very, very, very, very humbling,

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filled with gratitude that we were recognized for that it was also fun to bring our Amazon partners along with it. So Katie Hughes, who is

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leader down at Amazon was there on site with us join us on site to be recognized and received the award as well, because it was something that we couldn’t have not done it without the fabulous partnership with Amazon.

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Every single year that I’ve been able to attend the Clinton Patient Safety Award ceremony, and just the powerful stories that you hear about this team of incredible people who just understood the problem at hand, the challenges that we’re experiencing, trying to keep our patients safe, and then their ability to overcome them, really think outside the box using VNPS. To really strengthen that experience, and the safety of our patients. And it just really comes back to patients who are always at the top of everything that we do, and how we make decisions or how we make changes. Because, you know, as you’re saying it standing at the back, you could see the whether or not there were blockers in that patients’ experience as they were trying to check in or get their vaccinations. You could see the vaccinators and maybe if there was something that was creating a little bit of a delay. And you all as a team that just the continuing thread of the theme was, how can we make it better? What’s the next thing that we could do? And you could have easily just said 10 minutes is pretty good. Right? I mean, that that doesn’t seem like much in the grand scheme of healthcare, I feel like and yet he’s like, no, no, we know we can do better. But let’s take a look at that. That’s just such a powerful moment. It truly was well deserved. Thank you. It was, it was it was it was very humbling to stand up and represent the team. Because it took it truly took a team it took a village it took in total, there was over 2000 volunteers that helped Super Vax happen every week through that time. And I also I didn’t touch on. One of the other things I’m very proud of is that we, when we think of the Seattle Community, the Seattle Community is so diverse. And we actually focused on making sure that we had good representation from a diversity and equity perspective. So we purposefully reached out into those lower socio economic

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communities, communities, where English was the second language to work through our community partners to get those patients in

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and get them vaccinated as well. That was quite something to see these literally busloads of people coming in and coming through the flow and having to manage that language barrier, and the important role interpretive services played and how we could bring that in without slowing it down. So that was the other it got to be like the challenge was, what else could we do? Who else could we serve? How else can we serve without slowing down our line? Get keep bringing in, people keep bringing in improvements. At the meeting center, they actually have a catwalk up in the air where they would take the like the photographers from the different news agencies would come in the local news agencies and they would take them up top and that’s where they would take their pictures. And from up there, you could watch the mind move. It was just it was just so cool. Just like those catwalks it to be with it. Right? Right. Or any of our listeners who are fondly aware of standard worksheets or spaghetti diagrams are probably feeling the gears turning in their head or they was as you’re talking about that catwalk and that drone view of it or just watching the flows of medicine of all the things that are happening. Yeah. And we were fortunate we had to actually gave us the CLK Pio loaned us, Nate Higby, who’s one of the specialists. So, Nate actually would come down and spend a few hours and do observations and timings. So, we could actually, you know, we would try to do it, but we were actually doing the operations of it. So, it was hard just to stand back and be an observer.

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But So Nate actually provided us our data. So, we had things down to the minutes and seconds of the different cycles. So we

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would have been focused on different cycles. So, we could look at the data and understand where we had room for improvement?

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Well, that’s a really great question for us to end on as it relates to super vaxis. I, but a number of people are wondering, was it the Kaizen promotion office that was leading this work? And just now you’ve already that have busted that myth a little bit? Because the archives and promotion office out of Seattle loan one person to help with the work? So, who led the work? Who and how did you engage with the team? And because I just feel like there is you’re talking a lot about this respect for people? And how do we let the people do the work and prove the work? But can you just share a little bit of behind the scenes on what that was about and how people led? Well, you were forged, the people that ended up stepping up into the roles of the different leads or were people that have you ever been in to, than rotations through KBO or just have just embraced vmps. So, the Shawn Farley’s of the world, Sean Farley, is our now our Vice President of supply chain. You know, he was just like, just a phenomenal partner, Jessica Dunn, who is now our Director of Patient Experience. She was spent a couple of years in kpl, as a director in Kate the KBO.

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Roger Wolf and Laurel Brown from pharmacy with Craig Peterson, we are very vmps minded. So, it was those of us that had the training in VNPS. That literally, Stephen Emery, if you ever read from finances and vice president in finance, a vmps fellow so former fellows, sort of former certified leaders, former K po people who have done their rotations and are back out in operations, gravitated towards helping lead this body of work county Condor who’s a project manager, project director of programs and projects. Instrumental was never missed a weekend

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in her process, improvement brain. So it was those of us that knew the NPS and those that gravitated towards it. And it was really fun working with the Amazon teams, because while they don’t use vmps, they lose. They use Lean, and they were so eager to learn with us in ways of improvement. Well, it really just goes to show what happens when an organization invests fully in itself to embed a continuous improvement culture. And for us, it was in Virginia Mason production system. And it’s not just a group of experts that are tucked away in a single office. The idea is that it should be everyone it should be everyone from every level of the organization, starting from the very top with your chief executive officer, down to the people who are at the front lines, doing the work transporting the patients cleaning, cleaning the beds, you know, taking care and triaging folks left and right, that they would still have some level of BMPs knowledge and just love that you all at the operational level was like, yeah, it obviously we have to go with it. Go with a vmps mind to solve this mass Max. Yeah, how can we work? Well, we were really cognizant of the impact. So, you know, we were there for several months, we spent every weekend there. And we worked our full-time jobs. So, we were cognizant for each other to make sure that we were being respectful to ourselves, trying to take time off during the week, because we were there, you know, 1214 hours a day, Saturdays and Sundays.

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It was a labor of love, it truly was a labor of love.

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Wow. Well, on that note, I think that’s a great way for us to wrap up and thank you for helping us to go see what it was like on the front lines with all of you who were there and, and to help us ask why and continue to ask why and always, always show respect. I’m going to wrap up our session here today and ask you just a handful of questions because I feel like the audience would love to know a little bit more about you and not just about this amazing Super Vax. So let’s talk about looking back and looking ahead. So you’re thinking back on all the work that you’ve been involved in not just with the Super Vax but your rich experience and things that you’ve been seeing now at Virginia Mason, Franciscan health. Is there anything in particular that as you’re looking back, you want to celebrate shout out specific when there’s so much opportunity. I’m eager, I’m really eager to continue to spread VNPS across Virginia Mason

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Franciscan health, division, there’s so much opportunity for improvement. There’s so many wonderful things that are happening across the Franciscan health side of our business, just as there’s wonderful things happening in Virginia Mason. And it’s the sharing it’s with what’s been wonderful is getting outside the walls of VM. And across all of these different organizations, and seeing such wonderful care, wonderful practices and opportunities for improvement. And how do we work collectively as a large division now to identify and prioritize where we need to come together to standardize? What can we standardize? What needs to be customizable?

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There’s a lifetime’s worth of work out there, that I’m excited to continue to help identify and drive improvements for. I feel like you’ve just asked for both the looking back and the looking ahead, because I have the same level of excitement and optimism for our new partnership. And under Virginia, Mason, Franciscan health 11 member hospitals learning from each other, sharing what we’ve learned in our 20 years of vmps, as well. So, I completely agree with you. Last two questions is a bit of a lightning round here. What’s your favorite example of vmps? In the wild, not in healthcare, just things that you might see in the shopping malls or in the airports? Or suddenly you’re like, oh, yeah, that’s the OVS right there.

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Well, kind of a different, maybe a different take on that. And go back when I was learning about vmps. And I, so I learned from John Black, who was our original trainer from Michigan jujitsu. And I was going through the,

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the education where we were prepping, prepping for having to stand up and explain the house, that production house to John, and I was doing that I was working full time, I was going to school, I think I was in my master’s program at the time. And my youngest son who was by like five years old, four or five years old, was home. And mom was busy multitasking. And he wanted me to come out and play. And I was just kept putting him off. I remember I’m standing at the sliding glass door to the backyard. And finally, he got so frustrated with me. And out of the mouth of a five-year-old no grant you this is the same little boy who created his own shadow board. When I was learning about shadow boards in vmps. And it was we were doing I was doing Christmas cards and he wanted to do Christmas cards with me. I still have this picture today of his shadow board with his tape and his bows and his markers and stuff. Oh my god. Anyway, he was standing at the sliding glass door. And he stomped his feet and had his hands down like little fists. And he said, Mom, why don’t you come now don’t you know everything you need to know you can learn from nature. And it was just like,

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blew me away. Because that’s syncing the cow teaches out to go to look like nature. And it’s like, I just dropped everything and went out and I played in the sandbox with him. And just listen to the birds and look at the trees. And like he’s so right out of the mouths of babes. Everything you need to know, because nature is nothing but systems. They’re systems that are intricately

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designed together that work. Now that young man, he turned out to be an engineer, when I got in as an engineer, which is not a big surprise, given the way he was when he was a little bit. But that’s kind of been my mantra, everything you need to know. You can learn from nature. And so, when you do get into a place

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where you don’t see a solution, you don’t see a path out. Going to nature, even if it’s just going and sitting somewhere silent, and listening and looking around you. You think kind of wait, you can figure things out. I love it. That’s a great other great way for us to add anything you needed to know you can learn from nature. That’s right. We’ll give the club to your son on that one. That’s right. Well, Dana, this was such a wonderful conversation. I wish we could spend some more time geeking out over everything in anything under the sun when it comes to the Virginia Mason production system. But I really enjoyed this conversation. I hope you had some fun sharing all the great successes and stories. So, thank you so much, Dana for your time. Thank you so much.

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Wow, what a wonderful conversation with Dana exploring what happens when leaders and Frontline members work together with a clear mission to serve their patients during the pandemic and with a common continuous improvement philosophy.

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to iterate and redesign a process until they’re celebrating down to mere seconds of improvement. I love how much you encourage us to embrace being geeky about continuous improvement, and having fun, creating and innovating, especially when it means a better, safer patient experience. Whether it’s COVID, monkey pox, or big important challenges coming down the pike in healthcare and life. Dana really brought it home for us how we can take these lessons forward. A big thanks again to Dana and the whole Super Vax team, for sharing their wonderful, wonderful work.

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Stay up to date and enjoy more conversations like this one by subscribing to our podcast on Apple, Spotify or wherever you get your podcasts. You can get in touch with us and submit any questions on social media like Twitter and LinkedIn. Or you can email us at podcast at Virginia Mason institute.org. Thanks again for listening. And remember, transforming healthcare isn’t just about a pursuit of perfection but a mindset that we can always do better because better never stops.