When Virginia Mason adopted the Toyota “lean” principles and methodology as a management system, executive leadership was immersed in the first wave of training, followed by middle management and physicians, and finally frontline employees.  All staff were trained to “fail forward fast” (that is, to take the risk to create change).

Kaizen office staff and Virginia Mason Production System (VMPS) leaders had significant experience with rapid process improvements in various inpatient and outpatient systems prior to focusing on nursing work processes on patient care hospital units.  Work on the RN model began in 2006 on the Acute Care of the Elderly (ACE) Unit and has been replicated on the Orthopedics and other units.  Rapid Process Improvement teams made up of direct care nurses and their colleagues from other professional disciplines have contributed to the development of the RN care model.

Nursing staff have been recruited both internally and externally to fill new nursing roles created by this care model.

Nursing staff have been actively involved in the redesign and creation of standard work as a result of the recommendations of the Rapid Process Improvement teams.  The Kaizen Promotion offices partner with units on implementation and training.

Many aspects of this transformational RN model have been replicated in other inpatient units at VMMC.  There is some variation (e.g. RN to PCT ratio, dedicated CNL) from unit to unit in response to specific patient population needs. Because VMPS is always looking for process improvements, there has been discussion regarding the opportunity to improve the continuity of care in the outpatient setting.