Responding to Crisis at Virginia Mason

A Message from Our Executive Director, Sarah Patterson

You are in our thoughts as we hear about the incredible efforts that are underway in your organizations in response to the COVID-19 virus. These unusual and challenging times are causing us all to think differently about how we do our work. Several of Virginia Mason Institute team members are actively involved in Virginia Mason Health System’s response so we are also seeing it up close on a day-to-day basis. At Virginia Mason Institute, the health and safety of our clients, staff and community is our top priority, and we are taking steps to ensure a healthy and safe working environment for our staff and those we work with.
 
To promote health and safety and based on input from our clients, we have made the decision to postpone our upcoming public trainings and to move to virtual services wherever possible. We’ll continue to update anyone affected by further scheduling changes and we look forward to working with you using virtual technologies to conduct assessments, coaching, advising, trainings and more over the coming weeks.
 
We have been asked by some of you how Virginia Mason is using our proven improvement and innovation tools and the Virginia Mason Production System (VMPS) in leading through crisis. We have been gathering those examples and talking to Virginia Mason leaders about what has been most effective. Some of our early learnings are:

Leadership:

• A Command Center was immediately established and continues to operate with dyad leadership – a physician and administrative leader are paired for a week at a time to lead the center and to be responsible for all communication and updates. Command Center priorities include:
  • Rapidly allocating resources to areas of higher priority – leadership makes decisions on what is the most important work and communicates this to the organization.
  • Creating a frequently updated, clear source of truth for patients, families and staff is one of the most important roles for leaders. The communications team is critical to this effort.
  • The Command Center communicates with all external authorities and other hospitals to ensure that Virginia Mason’s response is coordinated with the overall response.
• Friday Report-Out (weekly presentations of improvement work) is continuing but is being done virtually – we want to continue our daily and weekly routines that create the discipline and accountability that allow us to move forward despite the immediate crisis.

Daily Management Routines:

• Daily Huddles – There are multiple 30-minute huddles throughout the day, seven days a week in the Command Center that involve representatives from key impacted areas and support departments, e.g., hospital wards, clinics, supply chain, I.T., pharmacy and communications. There is a standard agenda with reports from all key areas.
• Production Boards – The Command Center has a production board with information including the number of patients who are infected and the number being tested.
• Real-time updates are being fed into the daily huddles that occur elsewhere throughout the medical center to communicate essential information related to the medical center’s status and requests for each unit.

Using VMPS Tools and Methods:

• Teams have used value stream mapping to understand flows for patients who are presenting with COVID-19 symptoms.
• A new unit to care for COVID-19-positive patients was designed using the flows of medicine.
• Greeting stations have been opened at all entrances to the medical center and standard work has been developed for new roles at these greeting stations. Existing staff from other parts of the medical center are being trained rapidly in these new roles.
• Standard work has been developed for PPE – when and what to use in various situations. This has required rapid redesign and training based on changing availability of PPE.
• Speed kaizen events held to define critical provider crisis levels and coverage.
• Frequent leader genba rounds particularly in areas where there are new processes to continue to identify improvements needed.

Innovation:

• Clinic teams rapidly expanded and deployed virtual visits to care for patients – leaders and providers moved quickly to put this in place ensuring that patients could get the care they needed.

Overall Reflection:

• The urgency of this situation has stretched us in ways we could not have anticipated, and our team has done a remarkable job responding. We have also made improvements faster than we could have imagined, and we hope to carry these improvements forward around developing shared urgency, sharing clear priorities across organizational silos, removing artificial barriers, moving rapidly from ideas to implementation, and frequent collaboration across teams.  

Our medical center’s response is rapidly evolving, and we look forward to sharing more with you about how they are using the methods and tools of VMPS along with innovations. We are also humbled to know that many of you are already hard at work implementing your own responses and innovations to address this crisis. This includes many of our clients that are implementing new measures around daily management, visual controls, standard work and process redesign. Eli Quisenberry, Senior Director of VMPS at Virginia Mason’s Kaizen Promotion Office, challenges us all to consider the changes we are making to determine what elements of our work we want to maintain as we return to our new normal. How will you maintain a sense of urgency, clear priority across groups, agility with implementing new ideas and more?

We thank you all for your contributions and dedication to providing care during this difficult time. If you have any questions or concerns, please contact us at info@virginiamasoninstitute.org or (206) 341-1600.

Sarah Patterson 
Executive Director
Virginia Mason Institute

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