One Cultural Shift, Two Safety Improvements

Chelsea Rice, for HealthLeaders Media , March 11, 2013

The report was the result of a similarly titled NPSF roundtable discussion of hospital and health system executives last year. Gary S. Kaplan, MD, FACP, FACMPE, FACPE, the chairman and CEO of the Virginia Mason Health System in Seattle, WA, was a part of that discussion and building the report.

The health system was highlighted specifically in the NPSF report for its culture, which emphasizes workplace and employee safety through mutual respect.

In a phone conversation with Kaplan, we discussed how Virginia Mason's adoption and implementation of Toyota's Lean Process improvement model in 2002, which the health system tailored for healthcare, known as the Virginia Mason Production System, has shifted the culture from physician-centered to patient-centered.

Kaplan says this shift to a culture of mutual respect is imperative for transforming not only patient safety, but employee safety as well.

"In many healthcare organizations, staff are not treated with respect—or, worse yet, they are routinely treated with disrespect," reads the NPSF report. "Emotional abuse, bullying, and even threats of physical assault and learning by humiliation are all often accepted as 'normal' conditions of the health care workplace, creating a culture of fear and intimidation that saps joy and meaning from work."

The journey to patient-centered care and building a culture of mutual respect at Virginia Mason began in the early 2000s. "We had many elements of the traditional, hierarchical culture that exists and is so prevalent, even today, in medicine—with doctors at the very top of the hierarchy. I used to be very proud to say that we were a physician-driven organization," says Kaplan.

"But we were really coming to understand the importance of change, and I realized that unless we really examined kind of the old deal, and really sat down and made a compact of new expectations together, we would not be able to move forward."

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