Although Kaplan was elected CEO of Virginia Mason Medical Center (VMMC) when everything was in a downturn, I believe it created a tremendous opportunity for him to make a difference in the hospital. As illustrated in the reading, the hospital was losing in the double-digit millions. This, in addition to the fierce competition in Seattle, caused morale to be extremely low in the office. As a CEO, Kaplan truly had to do something in order to survive. Initially, Kaplan initiated the change with regular cost cutting policies. He cut down on less-profitable branches, renegotiated contracts, and did a general overview of costs incurred within the hospital. However, even with his cost cuts, he realized that he needed a more deep-rooted solution to come out of this alive.

                The combination of creating the explicit physician’s compact and the implementation of the Toyota Production System was what really helped VMMC become a champion in the health industry. This not only allowed the hospital to cut its cost, but also improved quality and safety of its patient care. First, the explicit physician’s compact helped doctors align their goals on focusing on the customers. As it was mentioned in the article, the general problem that the hospital was having was that doctors felt entitled to their patients. This meant that doctors did whatever they wanted as they were the ‘professionals’. By creating a new compact, Kaplan was initiating a change in this attitude by encouraging doctors to work together for a common goal, which was a more quality and safer service to its customers.

                To aid this new compact launch, Kaplan also brought on the Toyota Production System and rebranded it as the Virginia Mason Production System (VMPS). It is crucial to realize how VMPS and the physician’s compact go hand-in-hand. Although it was first seen as not very applicable to a health care industry, the VMPS definitely helped bring about incremental changes to the medical center. Out of those mentioned in the article, I think the most basic one that every type of industry should start implementing is value-stream mapping. This truly allowed the staff and administrators of VMMC to figure out where the non-value added steps were occurring.

                Another very effective new policy was the Patient Safety Alert System that was modeled off of the andon cord used at Toyota. This is a good change to see in a medical facility as it is widely assumed that hospitals rather try to hide their mistakes than let the public know about it. Also, with so many patients and problems going on in a hospital environment, it would be tough to fully implement this type of policy. Thus, it is very respectable to see senior leaders to be able to stop what they’re doing to analyze the root cause of the issues.  The incident that the article brings up regarding a patient’s death is a great example of how the hospital admitted its mistake and took actions right away so that it would never happen again.

               Not only the previously mentioned efforts, but policies such as the Rapid Process Improvement Workshops (RPIW), 5S, and 3P all helped make VMPS a great success. The best example with the 3P (Production, Preparation, Process) was the redesign of the hematology and oncology units. With the circular layout, everybody was able to reduce the distance they travel while maximizing communication.  This seems like a fascinating concept how a new layout in a hospital tremendously helped improve efficiency. This helped me think back to all the different hospitals I went to while living in Korea and how annoying it was to navigate through the facility. The adoption of this type of concept to other health care facilities will greatly improve customer experience.

                The Virginia Mason Production System did facilitate a lot of the processes, but it is true that it can’t be implemented in everything. I believe that was the biggest concern that some of the doctors had who ended up leaving the medical center. Their argument was that they disagreed trying to implement a manufacturing production system into a hospital, where each customer should be considered as a unique case. Having a manufacturing system was pretty much saying that customers were products that were part of a huge process flow. However, I agree with the article in that this argument is flawed. By reducing the distance that a nurse or patient has to walk, it reduces the over time wasted on non-productive activities. This allows physicians to focus more time on the patients while allowing patients to quickly get their treatment when they visit the facility. Thus, although VMPS cannot be implemented to activities such as a surgery, it helps facilitate the processes before or after so that it is easier for the doctor to purely focus on the patient.

                Overall, the implementation of the explicit physician’s compact and VMPS changed the physicians’ role tremendously. Doctors were discouraged from working alone on patients and doing whatever they want. Every practice and flow was becoming standardized that no error could happen in a treatment or surgical procedure. The escalation policies such as the patient safety alert system required physicians to take full responsibility in solving problems by analyzing the root cause. Over time, I believe this type of system will allow physicians to go back to their old state like when VMMS was first founded back in the 1920s. When the facility was run through a partnership, physicians felt the responsibility of their actions since they shared the debt burden and they were financially liable of mistakes that could happen at the workplace. That is what allowed the medical center to flourish. With the new policy, I believe physicians will feel the same type of responsibility, mainly due to the policies that were enacted. Although they are not financially liable, they do receive incentive in getting a good performance evaluation, which is directly correlated to proper usage of VMPS.