I want to preface this post by saying it's mostly about questions, not answers. I've had many readers and acquaintances ask me about what's been going on at Virginia Mason Medical Center in Seattle.
The short answer is: “I don't know, other than anything I've read in the news.”
I don't have any inside connections at VMMC and I haven't talked to anybody there.
But, I've long had a lot of respect for the Lean journey at VMMC. I've only visited once, as part of an MIT alumni tour group, and I came away with a positive impression. I've met VMMC leaders at conferences, including their long-time CEO and Lean champion, Dr. Gary Kaplan.
I've been a fan of the books written about the VMMC Lean journey and I appreciate them sharing what they've done:
I've never had any formal business relationship with VMMC, but the only conflicts of interest to disclose are:
- Former COO Mike Rona wrote the foreword to the first edition of my book Lean Hospitals
- CEO Kaplan wrote introductory material to my book The Executive Guide to Healthcare Kaizen
So, what's the recent controversy?
Back in late June, we started seeing headlines like this:
The “full accreditation” that was denied (or given provisionally) was from The Joint Commission, the main regulatory agency for American healthcare systems (and increasingly so throughout the world).
“Virginia Mason Medical Center in Seattle was found out of compliance in nearly 30 areas during a surprise visit in May by the Joint Commission, a nonprofit group that accredits hospitals across the nation.”
What were they out of compliance on?
You can see the full list here. “The area is listed if one or more of the specific requirements were determined to require improvement.”
Update: the list of discrepancies is no longer online now that full accreditation has been granted after discrepancies were addressed
Some of the items include things that would be hard to believe are out of compliance for a hospital that has the reputation of having focused on operational details through Lean. The list includes things including (again, these were OUT of compliance):
- The hospital has an infection prevention and control plan.
- Before the hospital discharges or transfers a patient, it informs and educates the patient about his or her follow-up care, treatment, and services.
- The hospital safely stores medications.
- Label all medications, medication containers, and other solutions on and off the sterile field in perioperative and other procedural settings. Note: Medication containers include syringes, medicine cups, and basins.
That issue about labeling is especially surprising, considering the famous and tragic Mary McClinton story, where she died after an antiseptic from an unlabeled basin was mistakenly injected into her bloodstream in the cath lab. VMMC credits her story as a powerful motivator for patient safety improvement.
Their “last full survey date” at VMMC was October, 2014. So, did things backslide since then, in less than two years, or was the 2014 accreditation visit lacking in some way? There are many who complain about The Joint Commission visitors not always following the same standards or interpreting standards the same way.
It's also well known in healthcare that hospitals prepare for The Joint Commission visits by moving stuff out of hallways and creating a somewhat artificial environment to be inspected.
From the article:
“The Joint Commission conducts surveys every 18 months to three years, a spokeswoman said. The organization is the nation's oldest and largest accrediting body in health care.
At Virginia Mason, an unannounced follow-up survey will be conducted within three months to ensure that the deficiencies identified in the original report have been corrected, a Joint Commission document indicated.”
So, even though VMMC can correct the deficiencies and get full accreditation… but the headlines about any problems at a high-profile “Lean hospital” beings out the knives from the critics of Lean… those who claim Lean doesn't work in healthcare.
One of those places is in the politically-charged Canadian province of Saskatchewan, where VMMC's former consultant, John Black, was in the middle of a huge controversy over the past few years (read my blog posts on this).
The one headline was:
“NDP health critic Danielle Chartier said she was concerned Virgina Mason was a “hallmark of the government's Lean learnings.”
She added she continues to hear from health-care workers with Lean-related concerns in the health-care system.
“The reality is, Lean is a tool in the tool box, but you don't use the same tool for every job,” she said.
The province spent $33 million on a contract with U.S consultant John Black to implement Lean.
Black was brought in to make the health-care system more efficient. It quickly became a favourite point of criticism for the NDP. In 2014, the government announced it was ending the controversial contract with John Black earlier than originally agreed.”
The Virginia Mason Institute (the training and consulting arm of VMMC) has been doing work in the British National Health Service (NHS) hospitals and there has also been some controversy and headlines trumpeting the problems at VMMC:
“Veteran health campaigner John Lister said it was “astonishing” that Mr Hunt ever “thought the lavishly-funded – and now evidently not very good – Virginia Mason could be in any way compared with the NHS”.
A spokeswoman for the National Health Action party, set up by doctors, nurses and paramedics in opposition to the Government's health policy, said the report proved the NHS should not be “copying” hospitals in the US.
She said: “The US system is a failing system being brought wholesale into the NHS.
“International comparisons have shown the NHS public service model of care to be a world leader at very low cost. The US system as a whole, not just Virginia Mason, is acknowledged as failing very many of its people and it is very costly.”
There are, in Canada and England, concerns raised about Lean and the “American-ization” of their hospitals. Lean, of course, is about improving healthcare delivery – processes and value streams – not turning anything into an American system (or a Japanese system, for that matter).
Does Accreditation = Safety?
Now, if VMMC critics say that not getting full accreditation immediately means the hospital is failing and isn't a model, does that mean hospitals that GET accreditation are safe?
Case in point is a Kentucky health system discussed here:
As also reported here in the local press:
“Dr. J. David Richardson, a prominent surgeon and current president of the American College of Surgeons, said cuts in nursing and other staff had caused a “major patient safety issue” and were “destroying the hospital.”
It must be pretty bad for a surgeon to speak out like that… and again, from Modern Healthcare:
“The Joint Commission re-accredited the hospital in January 2016 but did recommend it make improvements such as better documentation of infection prevention procedures.”
What's the difference between “failing accreditation” and getting accreditation with the recommendation of making improvements that sound very similar to what needed to be fixed at VMMC?
“Those included problems with infection prevention and transfusion errors as well as in broader categories, such as “the hospital plans the patient's care” and “the hospital effectively manages its programs, services, sites, or departments.””
Keep in mind The Joint Commission accredits most hospitals, yet we still have a huge patient safety crisis in the U.S. (see the various statistics).
But, VMMC Wins Many Awards
So, is Virginia Mason Medical Center a big mess?
Well, they were named one of the “Hospitals of the Decade” by Leapfrog Group, a leading patient safety advocacy group (conflict of interest disclosure: Leapfrog paid me to speak at one of their events in 2015 and I interviewed their CEO Leah Binder).
Leapfrog's “Hospital Safety Score” gives VMMC an “A” grade as of Spring 2016, based on a lot of data:
And yesterday, VMMC trumpeted the most recent US News & World Report rankings:
— Virginia Mason Franciscan Health (@VMFHealth) August 2, 2016
As my friend Paul Levy, a former hospital CEO, has pointed out the U.S. News rankings give a lot of weight to a hospital's “reputation” score, which seems like self-fulfilling prophecy. The best-known hospitals aren't necessarily the safest, if you look at the CMS or Leapfrog rankings.
You can see a summary of independent quality reports on the VMMC website.
So, what's the impact of The Joint Commission situation at Virginia Mason?
Does it mean there are serious problems and they shouldn't be considered a leading “Lean hospital” to learn from and emulate (but not copy from).
Or, does is it just a blip and a hiccup that hurts their reputation a bit and, possibly, hurts the reputation of Lean in healthcare?
What do you think? Are the headlines about Virginia Mason overblown? If you want to leave a comment, you can do so anonymously or contact me through this form anonymously.
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