Physician leadership in changing times.

Today, hospitals and physicians are reorganizing themselves in novel ways to take advantage of payment incentives that reward shared accountability for the total health care experience. These delivery system changes will take place with our without physician leadership. To optimize change on behalf of patients, physicians must play a conscious role in shaping future health care delivery organizations. As physician leaders of three of the nation׳s largest integrated health care delivery systems - Kaiser Permanente, Virginia Mason Medical Center, and the Mayo Clinic Health System - we call on physicians to view leadership and the development of leaders as key aspects of their role as patient advocates.

Nurse practitioner-staffed clinic at Virginia Mason improves care and lowers costs for women with benign breast conditions.

The implementation of a breast clinic based on the use of an advanced registered nurse practitioner at Virginia Mason Medical Center in Seattle, Washington, substantially improved care timeliness and efficiency for women with symptomatic benign breast conditions. Women received their final benign diagnosis in an average of four rather than sixteen days, with fewer imaging studies and physician visits, when compared to a control group. Savings to the employer were estimated at $316 per woman, primarily from increased work productivity. Direct care costs decreased an estimated 19 percent, to $213 per woman. By decreasing both direct medical costs and indirect costs such as work absenteeism and presenteeism, the Virginia Mason Breast Clinic has created substantial savings for providers and employers while delivering care that patients rate highly. This model demonstrates the feasibility of achieving higher quality at lower cost through integrated care.

At Virginia Mason, collaboration among providers, employers, and health plans to transform care cut costs and improved quality.

Virginia Mason Medical Center in Seattle has worked in collaboration with health plans and employers to facilitate development of standardized approaches to care of patients with common conditions. These efforts have eliminated unnecessary treatment and decreased costs to employers, health plans, patients, and providers. We describe our collaborative approach and illustrate it with the example of improved treatment for patients with uncomplicated headache, for which we have achieved 91 percent patient satisfaction, decreased use of advanced imaging by 23 percent, and provided same-day appointments in 95 percent of cases. As a model for improving quality while reducing cost, the Virginia Mason experience demonstrates that a multispecialty group practice, hospital, employers, and health plans can define quality and align performance and payment along common goals.

Seeking perfection in healthcare. A case study in adopting Toyota Production System methods.

Virginia Mason Health System's vision to be the quality leader in healthcare means continually adopting new ways of thinking. One change has been shifting from believing defects are to be expected to believing zero defects in healthcare is not only possible, but also necessary. Generally, healthcare has advanced in technology and understanding of disease, but its business and management systems have changed little since the 1950s. Virginia Mason realized it needed a management method to help make real and measurable improvements in safety, quality, service and staff satisfaction.