IHI is an independent not-for-profit organization based in Cambridge, Mass., that focuses on improving patient safety and quality of care by promoting the adoption of best practices and effective innovations.

The Institute was founded by Dr. Donald Berwick, a leading proponent of evidence-based medicine who recently served as administrator of the Centers for Medicare and Medicaid Services for the Obama Administrations.

The Institute has become known as a leader in health-care quality improvement.

Virginia Mason Medical Center’s involvement with IHI began in 1989 – two years before it was formally incorporated as IHI

Over the years, Virginia Mason has participated in a number of IHI projects, including:

• The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement

• The Idealized Design initiatives

• The 100,000 Lives and 5 Million Lives campaigns.

Dr. Kaplan has served as chairman and CEO of Virginia Mason Medical Center and the Virginia Mason Health System since 2000. He received a medical degree from the University of Michigan and is board certified in internal medicine.

The Seattle hospital established a national reputation for quality improvement by adapting “lean” manufacturing techniques to medicine.

These techniques were first developed by the Japanese car maker Toyota and have been credited for making Toyotas some of the most reliable cars made.

The Toyota approach seeks to eliminate all waste in its production system and to “mistake-proof” its processes, cutting costs and reducing errors.

Virginia Mason started its adaptation of the Toyota approach, developing an approach the hospital calls the Virginia Mason Production System, 12 years ago.

In large part as result of that effort, Virginia Mason was named “Top Hospital of the Decade” by The Leapfrog Group, a national organization of insurers, employers, and other groups dedicated to improving health-care quality.

Kenney

The new blog will be written by  Charles Kenney. Kenney is a former Boston Globe reporter who has written three books on  improving quality in health care, including a book about the Virginia Mason initiative: Transforming Health Care: Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience.

Kenney says he hopes the blog will provide a forum for anyone who is interested in making health care safer, more efficient and cost-effective.

The site’s first blog post features Kim Pittenger, MD, a family physician at Virginia Mason Kirkland, who discusses on how primary care doctors can organize their work “in flow” to do a better job taking care of more patients in less time, and get home for dinner with no open charts or left over paperwork.

Kenney writes:

Dr. Pittenger and his VM colleagues “have not only reduced the blizzard of paper, email and phone messages, they have created a system that enables more doctors to go home by 6 o’clock more often with no open charts and no left over paper work.

“How have they accomplished this seeming miracle? In a word, flow. They have created flow stations – and a flow production system – where a doctor works in close partnership with a medical assistant who breaks down the indirect care paper, phone calls and email into small lots that can be handled throughout the course of the day rather than in a batch at the end of the day.”

“We will have a lot of these straightforward, things-I-can-do-right-now kinds of posts, and we want our readers to comment, add links, and contribute their knowledge,” says Kenney. “And we’ll post thoughts on books, conferences and articles – anything we think can be helpful to clinicians and administrators working to improve the quality and efficiency of care delivery.’’

To learn more:

• Visit the Virginia Mason Blog: virginiamasonblog.org

• To learn more about the Virginia Mason Production System go to the Virginia Mason Institute webpage: www.virginiamasoninstitute.org

• To learn about the Toyota “lean” manufacturing approach read the Wikipedia article: Toyota Production System.

• Visit the LeapFrog Group’s website: www.leapfroggroup.org

By Harris Meyer

HILLSBORO, Ore. — Peter Cady, who works 12-hour shifts on his feet at Intel’s plant here, occasionally suffers severe lower back spasms.

But he nearly gave up seeking medical help because in the weeks it took to get a doctor’s appointment and a referral to physical therapy, the pain usually subsided.

These days, however, Cady is much happier with his care.

Rather than waiting to see a doctor, Cady and other patients with routine back pain now see a physical therapist within 48 hours of calling, compared with about 19 days previously, Intel says.

They complete their treatment in 21 days, compared with 52 days in the past. The cost per patient has dropped 10 percent to 30 percent due to fewer unnecessary doctor visits and diagnostic imaging tests.

And patients are more satisfied and return to work faster.

“It’s a real bureaucracy buster that gets you right straight to someone who can take care of the problem,” says Cady, 47. “Before, the doctor wasn’t helping me or explaining anything. But the physical therapist educated me, gave me stretches and exercises to do, and cleared it up.”

The change came about through an unusual collaboration between Intel, two local health care systems, and a health insurer. Based on that success, the partners have developed similar improvements for hip, knee, shoulder and headache treatment.

Intel and its partners say the result has been $2 million in administrative savings this year, from reduced costs for patient scheduling and registration, for example.

The Hillsboro collaboration is one of a small but growing number of voluntary partnerships around the country to tackle the twin problems of unsatisfactory quality and rising health-care costs.

Similar programs are underway in Atlantic City, N.J.; Lewiston, Maine; Muskegon, Mich.; Sacramento, Calif.; San Francisco and Seattle. One is budding in Orlando.

All the efforts draw on quality improvement models developed in manufacturing and other industries. Physicians and hospitals share cost savings with the employers and insurers, and in some cases share losses if savings targets aren’t met.

Medicare has launched a similar program under the 2010 health reform law aimed at developing so-called accountable care organizations.

Tackling a cost crisis

The goal is to carve out health-care spending that’s wasteful and doesn’t help patients. Sometimes there’s an implicit threat that if a provider or health plan doesn’t participate, the large employer will buy health care from someone else.

“It all starts when leaders in a community say the current system is not sustainable and we’ve got to find a different model,” says Joe Damore, a vice president at Premier, a national alliance of 200 health systems focused on performance improvement. “Major employers are jumping on board because they see it as an opportunity to improve their employees’ health and reduce costs.”

Intel asked Providence Health & Services, Tuality Healthcare and Cigna to collaborate in 2009 because its employee health costs were rising by more than 10 percent a year, with costs projected to hit $1 billion companywide.

The Oregon Public Employees’ Benefit Board recently joined the effort, having its members participate in the redesigned Providence and Tuality care models, sharing its data with the collaborative, and working with the partners to come up with new ways of improving quality and reducing costs.

“Health care was the only area where we weren’t setting standards and managing our suppliers,” says Patricia McDonald, an Intel vice president who spearheaded the project. “Our employees were waiting for care and the quality was questionable.”

In Atlantic City, Unite Here Health, a hotel workers’ union health plan, persuaded AtlantiCare, a local health care system, to open a special, jointly funded clinic in 2007 to provide intensive outpatient care to high-cost patients with chronic conditions such as diabetes, obesity and heart disease.

The program, which the union is replicating in Las Vegas, achieved steep drops in patient smoking, blood pressure and diabetic blood sugar levels, according to AtlantiCare.

By keeping patients healthier, it has reduced hospital admissions by 41 percent and emergency department visits by 48 percent.

Collaboratives help physicians and hospital leaders see employers and patients as customers whose expectations, such as rapid access to care, must be met.

“I practiced for 30 years without knowing how long patients waited to see me,” says Dr. Robert Mecklenburg, who led the development of a collaborative effort at Virginia Mason Medical Center in Seattle, which started working with Starbucks and other employers in 2004.

After meeting with employers, he adds, “you realize how important it is to see patients when they need to be seen. Any wait is not OK.”

Roadblocks to collaboration

Some employers are reluctant to get directly involved in how health care is delivered. Critics warn about rationing of care.

And some physicians complain about interference with their professional autonomy, although Mecklenburg says most come around when they see better results for patients.

Perhaps the biggest roadblock is the predominant fee-for-service system, which pays providers to deliver more services, rather than better, more efficient care. Health-care payers, including private insurers and Medicare, have been slow to change their payment models to reward outcomes rather than volume of care. That sometimes puts providers in the position of losing revenue by doing the right thing for patients.

Dr. Donald Storey, who worked on the Seattle collaborative as an Aetna medical director and now is a vice president at Premera Blue Cross, blames insurers’ reluctance to change on their having many different contracts with employers and providers. In addition, not everyone wants a more efficient system. “One man’s waste is another man’s income,” he says.

Some insurers have embraced collaboration. In Sacramento, Blue Shield of California, Catholic Healthcare West and Hill Physicians Medical Group have worked with CalPERS, the state public employee benefit system, to redesign care after they identified quality problems and high costs for 42,000 plan members.

Key areas were obesity-reduction surgery, hip and knee care, hysterectomies, and preventable emergency department visits and hospital readmissions. For example, Hill Physicians persuaded its OB/GYNs to perform more minimally invasive hysterectomies, which are safer and cheaper than open hysterectomies, when appropriate. Catholic Healthcare West hospital staff worked closely with patients on their medication instructions before discharge, to make readmissions less likely.

Redesigning care through a collaborative is “not easy to do. There’s a lot of investment of human resources, and we didn’t know if it would work or not,” says John Wray, senior vice president for managed care at Catholic Healthcare West. “But this was something we thought was important to try to learn from.”

It worked. Hospital length of stay and readmissions both declined 15 percent in 2010. That helped save more than $20 million, exceeding the $15.5 million target and allowing Blue Shield to keep CalPERS’ premiums flat in Sacramento for 2011.

The remaining savings were split among the three partners, who would have lost money if the target hadn’t been hit.

Now Blue Shield is working with its current partners and several additional provider organizations to improve care for 26,000 members of the San Francisco public employee plan.

It’s also starting partnerships in January for 38,000 plan members in California’s Orange and Stanislaus counties.

Mecklenburg hopes this partnership model will spread widely across the country. “We are creating a marketplace based on quality, where employers can use their purchasing power to bring out the best in both providers and health plans,” he says. “But up to now it hasn’t usually worked that way.”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Virginia Mason has established a national reputation for its efforts to apply the super-efficient “lean production” system, developed by the car manufacturer Toyota, to health-care delivery.

The hospital says its application of the Toyota Production System’s approach to health care has significantly improved the quality of its care and the morale of its staff.

Treatment is more timely, delays are fewer and quality has improved, the hospital says.

At the same, time it “has meant less rework and frustration for staff” and helped control the cost of care, the hospital says.

The purpose of the new center is to evaluate the effectiveness of hospital’s improvement initiatives more rigorously and publish the results in medical journals and other publications.

Craig Blackmore, MD, MPH, will serve as director of the Center for Health Services Research.

“The role of the center will be to collect that data, apply the rigor of science and academic peer review, and publish it so that it can be scrutinized and applied by health care providers around the globe,” Dr. Blackmore said.

The Center for Health Services Research will also support the scholarly and publication efforts of Virginia Mason’s education programs that train medical residents, nurses, pharmacists and other health care professionals.

This is the sixth year in a row that Virginia Mason has made the Top Hospital List, and the second year in a row for Swedish First Hill.

This year sixty-five hospitals have earned The Leapfrog Group’s annual “Top Hospital” designation for delivering the highest quality care:

• by preventing medical errors,

• reducing mortality for high-risk procedures like heart bypass surgery,

• and reducing hospital readmissions for patients being treated for conditions like pneumonia and heart attack.

The 2011 Top Hospital list was culled from a field of nearly 1200 hospitals that voluntarily and publicly report their performance by participating in the Leapfrog Hospital Survey, which focuses on three critical areas of hospital care:

1. How patients fare
2. Resources used to care for patients
3. Management practices that promote safety and quality

In each of the three areas, Leapfrog asks hospitals to report on nationally standardized measures so healthcare consumers can compare hospitals in their community and across the country.

University and other teaching hospitals, children’s hospitals, and community hospitals in rural, suburban, and urban settings were all represented in the 2011 rankings.

To learn more:

• A complete list of 2011 Leapfrog Top Hospitals and the survey results for all participating hospitals are posted on a website at www.leapfroggroup.org.