1. them there will be a significant increase in

1.      What is Gary Kaplan trying to achieve at Virginia Mason?


·       Creating a better work environment:

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Gary noticed that in general the morale of employees was very low and that they needed to infuse a spirit of ownership in them. This was experienced first-hand when over half the employees did not attend the company offsite training module scheduled.

·       Standing out:

There were many different hospitals located close to Virginia mason, Gary was trying to professionalize the operations so that he could attract better talent in the form of doctors and in turn more patients that would use the hospital’s services.

·       Profitability:

As a loss making entity Gary’s focus was to turn the organization around and post profits, the aforementioned points were key in his strategy to do so.


2.                  How does Toyota Production system fit into this strategy?


Given the objectives of Gary- his focus on how to improve morale and profitability would be met through the following:

·       Streamlining systems & processes

·       Reduced Costs

·       Increased efficiency

Overall there is a need to create better processes at the organization to streamline the work of its staff, increase morale and in turn reduce the costs associated with a higher lead time for completion of tasks. If we are able to create better systems & processes for staff to follow and implement them there will be a significant increase in the profitability and efficiency of the organization.  Through the 3 Ps of production, preparation & processes Gary was able to save on cost tremendously and meet his business objectives.



3. What is your view of the “people are not cars” debate?

While it’s true that people need customized care considering each patient has varying diseases and related symptoms, there is also scope for standardization of certain steps in the process, which are common across all patient care processes, particularly the administrative tasks and routine checklist items that are a part of diagnosis, operation, where needed and post-op care.

The argument from certain disgruntled non-supporters within the VMMC that they did not work like a production line and hence they could transfer TPS principles to their medical center is flawed because as per Kaplan, a transformation to operations as streamlined as a production line would in fact free up the staff’s time for more productive work as well as building relations with the patients and their families; this indicates that the current system is disorganized and is not helping the staff function at their productive best.

Another side of this argument is that it would limit autonomy and creativity of the staff because of a high level of standardization. I would like to argue that implementing the new system would ensure that the foundations of medical care and treatment at the center are streamlined and efficient with minimal errors and maximum efficiency in terms of productivity and output. Autonomy and creativity is not as crucial at these steps as it is in more high impact situations such as building a relationship with the patients or diagnosing complex diseases, particularly when the patient needs special care. Under these special circumstances, medical center staff can still exert autonomy and freedom of their creativity based on their instincts and experiences and record them as special cases. This documentation can further be used to account for all the special, one-off cases that occur at the center which can further be standardized and act as a guide to minimize differences and errors for staff who work on similar cases in future. Hence, both in terms of working as a production line as well as limiting autonomy and creativity, while the new system may be limiting, it can certainly be applied to a majority of the process to improve productivity and patient satisfaction.

4. Is Kaplan’s approach transferable to other US hospitals?

There are plenty of best practices that can be replicated by other US hospitals however few of them would require the availability of initial investment for setting up processes, infrastructure as well as trainings.

Ø  Ensured Maximum participation of the staff towards continuous improvement – Kaplan involved its staff and motivated them towards a culture of quality and regular improvement.

Ø  Kaplan concentrated on the very basic issues for any hospital i.e. optimization (cost control), quality, profitability, visibility and safety.

Ø  High autonomy culture- the CEO as well as the board had full authority in making the decisions. As long as the hospitals have the initial investment and money that can take care of the training and infrastructure requirement above processes can be replicated.

Ø  The doctors, specially the physicians followed very critical yet basic elements i.e. patient focus, training, innovations and excellence driven.

Ø  Patient focus – helps in providing great services as the hospital staff is focused and they all work together with one purpose i.e. taking care of the patient.

Ø  Innovation – helps in getting new ideas in terms of profitability and cost effectiveness

Ø  They followed high six sigma techniques and followed the very basic quality measure of 5S in the workplace organization i.e.  Sort, set in order, Shine, standardize and sustain to minimize the defects per given opportunity.

Ø  They not only worked on qualitative aspects but also linked and worked to quantify the impacts and improvements using 3 P initiatives, daily lean, patient safety alert system, along with the standardization of processes which linked to value stream mapping.

These best practices can be transferable to other US hospitals based on the staff’s willingness to change and ability to adapt quickly and efficiently