Archive for July, 2011

Independence and Interdependence

This Monday America celebrates Independence Day, the day she declared independence from the British crown.   America’s founding fathers, of course, knew the importance of independence – that’s why they fought so hard to win it.  At the same time, they knew the importance of interdependence, both the interdependence of forging alliances among the colonies and the interdependence of maintaining alliances abroad.

We would do well to learn from America’s founding fathers and to apply their lessons to our institutions.   How can institutions, and the people who work in them, exhibit both strong independence and strong interdependence?

Virginia Mason Medical Center in Seattle knows the answer to this question.

In 2000, faced with the challenges of spiraling costs and quality control that the entire health care industry was encountering, Virginia Mason Hospital knew that it needed to change or die.  When the hospital created a strategic plan that reached clarity about its customer being the patient, the board responded to the leadership team with a challenge: “If the patient is the customer, why is everything designed around you, the doctors and nurses and staff, instead of being designed around the patient?”

Seeking an answer to this question led Virginia Mason’s leaders to the Toyota Production System, which had masterfully eliminated waste and put the customer first.  Virginia Mason’s leadership began to wonder how Toyota’s system might apply to health care.

Through a long process of exploring similarities and differences between health care delivery and the Toyota Production System, Virginia Mason leaders decided to adapt Toyota’s system to health care.

Central to the Toyota system were Rapid Process Improvement Workshops, in which interdisciplinary teams would observe health care processes from the patient’s perspective, identify ways in which the patient’s time was wasted, and design new processes that eliminated the waste.  Testing and refining the processes resulted in standardization, recognizing the interdependence of care providers and the importance of working together efficiently and effectively.

At first, this standardization and recognition of interdependence clashed with the strong independence of the physician culture.  Physicians, accustomed to autonomy, questioned the validity of standardization, claiming it would bring down the quality of care.  Some ridiculed the application of manufacturing processes to the practice of medicine.  Others left the hospital.

But over time, as physicians tested the new processes and discovered that they could serve more patients more fully, without having to work late or take work home, they began to understand their interdependence with the larger system in a new way.  They began to see with fresh eyes, valuing their independence in such areas as diagnosis and prescribing treatment, and valuing their interdependence within the hospital’s structures and processes.  Independence and interdependence could complement one another, resulting in better care for patients, dramatic lowering of costs, and less wasted time for patients and physicians alike.

When independence and interdependence balance one another within an institution, the institution thrives.  Finding the appropriate arenas for independence, while at the same time recognizing the places of interdependence, can help an institution’s ecology flourish.

This Independence Day, let’s take a lesson from America’s founding fathers and, following Virginia Mason’s example, strengthen both independence and interdependence in our institutions.