Memorial Hospital

An entrance to Virginia Mason Memorial hospital in Yakima. (GORDON KING/Yakima Herald-Republic file)

Virginia Mason CEO Gary Kaplan visited Yakima on Thursday to offer more detail about what the community might expect as the Seattle hospital begins implementing its merger with Yakima Valley Memorial Hospital.

The goal of the affiliation is not to take services away from Yakima, but to improve care and expand opportunities here, Kaplan said.

“Our objective with Virginia Mason is not to create a giant sucking sound to Seattle, but rather to ensure that every patient can get the kind of care that they should be able to get in the Yakima Valley close to home, whenever possible,” he said in a meeting with the Yakima Herald-Republic.

Kaplan and Memorial CEO Russ Myers again declined to list any specific services that might be expanded in Yakima in the near future, saying that teams of specialty providers from both hospitals are working to determine where those opportunities might be.

There are some things that make more sense to go to Seattle, Kaplan said, because of the high degree of specialization required and the relatively low patient volumes seen in Yakima. For example, he said for procedures like pancreatic surgery and esophageal surgery, doctors at Virginia Mason have more expertise.

“There will be times when care in a tertiary facility (Virginia Mason) will be necessary and required,” Kaplan said. “We want to make those experiences as seamless and coordinated as possible, but also make sure the patients have rapid return to their community, where there’s support services, and also rapid return to function in all the things that are important in their lives.”

For the past 15 years, Virginia Mason has been working under a tailored health care approach modeled on the world-renowned Toyota production system, using it to eliminate waste within its medical facilities and ensuring a high-quality, efficient patient experience.

Introducing that model to Memorial is something both sides are excited about, Myers said. In fact, he said, when the two hospitals announced the signing of their affiliation agreement at the beginning of January, one of the first questions from Memorial physicians was when they would start to get the benefits of Virginia Mason’s process.

While acknowledging it will be a significant learning curve to implement those practices, Myers said, “We’re going to take on the journey with energy and intent and the understanding that, (in the health care arena) time is not on our side.”

Those same provider teams will help assess which areas of the Memorial system should be first priority for finding more efficient solutions, he said.

Finding efficiencies doesn’t mean standing behind someone with a stopwatch and a clipboard, tracking their every move, Kaplan said. But it requires a complete understanding of existing practices before beginning to improve workflow.

“By understanding our current processes, that gives you an opportunity to identify the waste,” he said. As a physician himself, “If I’m waiting or the patient’s waiting, that’s the absence of flow.”

Once problem areas are identified, multidisciplinary teams work together to redesign the process.

“So the people closest to the work redesign the work,” Kaplan said. “So it’s a very powerful way to engage the workforce. Frankly, as a chief executive I don’t know the solutions. What I know is, the people who are working in the process — they know the solutions. It’s been far too long that we haven’t asked them.”

Patients and family members have been part of those redesign teams, too, he said.

One area that many physicians would like to see redesigned is the burden of paperwork: Completing charts in the electronic health record to meet “Meaningful Use” and other federal requirements can take hours, often keeping providers in the office long after their last patient appointment has ended.

Part of the solution is deciding whether some tasks could be done by other members of the care team, freeing physicians to care for patients.

“One of our basic tenets is that people operate at the top of their skill set, so that nurses are doing work nurses should be doing; physicians are doing work physicians should be doing; medical assistants are doing work they should be doing,” Kaplan said.

In his own practice, he sometimes completes the chart with the patient sitting side-by-side, he said.

The impact of the affiliation on Memorial’s workforce — as the largest employer in Yakima County — is still unknown, but Myers and Kaplan again stressed that they don’t plan on any staff reductions.

While there’s “waste in everything we do,” Kaplan said, “we do not envision layoffs at this time.”

“We’re looking to expand services here in Yakima,” he continued. “I think when you expand services and hopefully attract more patients ... that there will be plenty of opportunity, plenty of work. And at the same time, we will continue to make things more efficient.”

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