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Thursday Complexity Post
May 22, 2014

Lean and Innovation: Perfect Together  


tree canopy Canopy ecology is about life at the very top of the world's forests, a distinct aerial realm where an estimated 30 million species share their space with leaves, branches, rain, sunlight and wind. Life on the ground is interconnected with life on the top and everything in between. In fact, survival of the whole forest depends on the success of the life at every level. And health care organizations have much in common with forests.


The design team envisioning a new Kirkland Clinic at Virginia Mason Medical Center in Seattle studied rainforest ecosystems as they considered how different teams of specialists, internal medicine and family medicine providers could blend individual design needs for their own patients while working together on whole clinic with core support services. As a result, the Mountain, Meadow and Beach corridors in the clinic allow the teams to share resources and operate autonomously as needed.


virginia mason medical center


In his new book Accelerating Health Care Transformation with Lean and Innovation, internationally renowned consultant Paul Plsek describes Virginia Mason Medical Center's continuing work to integrate Lean and innovation in pursuit of "the perfect patient experience." Learning from analogies in nature is one tool. Word play was another. Participants in a workshop convened for design of another clinic used the word "lagoon" to temporarily sum up a guiding metaphor. A lagoon is flexible because it supports both fresh and salt water and while it looks calm and beautiful it's teeming with life under the surface.


In 2002, Virginia Mason adopted the basic tenets of the Toyota Production System, called it the Virginia Mason Production System, and integrated it throughout the organization in an ambitious program to change the way it delivers health care and improve patient safety and quality. Plsek, a management guru and expert in large scale change in complex systems, served as the center's chair of innovation. He explains lucidly and with dozens of examples why Lean and innovation are complementary. Lean is about standardization that improves flow and removes waste, and it stretches people's thinking by aiming for perfection even when that seems impossible. That requires busting myths, re-thinking basic assumptions, and examining practices in other industries. During various change efforts, staff members were asked to study weather forecasting, air traffic control, and computer virus detection for any key features that might relate to improvement in hospital care. Inspired by the fast food business, Virginia Mason began the first drive through flu vaccine program.


The tools of lean and the directed creativity described by Plsek brought about a clinic operation so well designed that patients were seen immediately, eliminating the need for a waiting room, and an infection prevention and communication system so efficient that time needed to identify a catheter associated urinary tract infection was reduced from seven hours to 11 minutes. Plsek talks about the long commitment to create a learning organization, where all community members are introduced to VMPS, all engaged in improvement, and leaders learn to coach and support learning. Plsek discusses a commitment to andragogy-the education of the adult learner, who unlike the child or complete novice, needs opportunities for application of new concepts, dialogue,  and guided reflection in a safe environment that permits the learner to challenge and unlearn old and deeply held beliefs and assumptions.


As Plsek makes clear, none of this is quick or easy. He quotes reflection by Virginia Mason neurosurgeon Dr. Farrokh Farrokhi who studied the Toyota system in Japan and came come to understand that the Japanese after 50 years are still perfecting their system, and the journey of lean and innovation is infinite. "I now realize that paradoxically, what you need is patient urgency," Dr. Farrokhi said. Listen to tomorrow's PlexusCall with Paul Plsek and Daniel Pesut.



Liberating Structures Workshop 

May 29-30* - Washington, DC 


Why start using Liberating Structures?

We all want to be part, included, listened to, we want to have our voice heard and it doesn't matter which country we come from or what language we speak and people enjoy it. People mostly hate the way work is traditionally organized. It's boring, it's dis-empowering, it's frustrating. Just ask people around how they feel about the next meeting they are going to or the one they just walked out from. So if you create something different that they will participate in and enjoy and feel good about WOW, people will love you. So, just do it.  - Henri Lipmanowicz, PlexusCall 5/9/14


Liberating Structures are novel, practical and effective methods to help you engage everyone and unleash innovation in meetings of any size. During this roll-up-your-sleeves immersion workshop, participants will learn and immediately practice 10-12 Liberating Structures while receiving tips on how to implement them in the workplace and traps to avoid. Event flyer (pdf). *1-day, $150. 1 1/2-day, $200.  



Remember PlexusCalls!



Friday, May 23, 2014- 1-2 PM ET

Improvement, Innovation and Lean 
Guests: Paul Plsek and Daniel Pesut            


Paul Plsek's  latest book, Accelerating Health Care Transformation With Lean and Innovation, describes the integration of creativity and innovation tools into the pioneering work of the Virginia Mason Medical Center in Seattle. Donald M. Berwick, MD, president emeritus and senior fellow at the Institute for Healthcare Improvement, says "If you're in healthcare and this book doesn't scare you, you're not paying attention." Join the conversation with Paul and Dan to learn more.     




Friday, June 13, 2014- 1-2 PM ET

Philadelphia Schools in a Changing Terrain 
Guests: Abigail Perkiss and Susan DeJarnatt             


In her new book, Making Good Neighbors: Civil Rights, Liberalism, and Integration in Postwar Philadelphia, Abigail Perkiss describes historical efforts of the West Mount Airy neighborhood to coalesce around a goal of residential and educational integration, and how those ideals evolved in a turbulent era. Susan De Jarnatt is a professor at Temple Law School whose research includes educational reform and the psychology of parental choice in education.

See more upcoming PlexusCalls on the Plexus Calendar.  

Audio from all PlexusCall series is available by searching the iTunes store for plexuscalls. Or, visit under Resources/Call Series. 


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