The Institute of Medicine's 1999 report, To Err is Human: Building a Safer Health Care System, had just come out, which established patient safety as a national priority and broke down that a safer healthcare workplace translates to improved patient safety.
"It was apparent to us that we needed to really examine some of the deeply rooted assumptions that had been imbedded particularly with physicians over the decade, and how they needed to change if we were to really become a safer, and stronger organization," says Kaplan.
Shortly after Kaplan became CEO in 2000, he appointed a committee of front-line physicians to work on putting together a "physician compact"—a mutual understanding between the physicians and the organization about expectations and obligations.
These physician compacts specifically addressed an emphasis on collaboration and teamwork as a direct line to patient-centered, quality care. Its elements are still being used actively 12 years later. The compact idea expanded to executive and even board member levels. Each group has its own compact with the organization, all highlighting similar themes of collaboration, mutual respect, and making explicit the expectations of mutual obligations.
"I think that one of the reasons that there's not a lot of joy and meaning at work in places is that expectations are not aligned," says Kaplan. "People come into organizations and into their careers with certain expectations and they may, particularly in healthcare say, 'Gee this is what I signed up for?'"
Virginia Mason pursued Toyota's Lean Process improvement and then eventually created its own specialized model, dubbed the Virginia Mason Production System. Kaplan says this model, which is based on transparency, wouldn't work in a hierarchical culture.