• Because of inclement weather tied to Hurricane Sandy, the Advisory Board's office in Washington, D.C., is closed on Tuesday, October 30. Other Advisory Board offices are following normal work hours.

Seattle-based Virginia Mason Health System over the past decade has phased out waiting rooms at its medical facilities, a move inspired by a Toyota "Sensei."

More than 10 years ago, Virginia Mason physician Robert Mecklenburg met a Japanese "Sensei"—or master teacher—who worked at Toyota's headquarters. Mecklenburg and several other Virginia Mason physicians had visited the car manufacturer to examine its waste management and assembly-line system.

The Sensei inquired about patients' "pathways" to health care and was surprised to learn about the backlog in Virginia Mason's waiting rooms. According to Mecklenburg, the Sensei asked the physician whether staff felt "ashamed" that patients had to wait 45 minutes to see physicians for scheduled appointments.

Mecklenburg describes this as an "Ah-Ha" moment. " He explained to PBS, "I had not realized that [the] waits and delays and these rooms with the Internet access and the fish tanks and the coffee machines, and the cubes of office staff keeping people waiting and trying to get them in for new appointments were all unnecessary costs which are ultimately paid by that patient."

"This is a moment I'll never forget," Mecklenburg told PBS.  "I was ashamed."

Mecklenburg and Virginia Mason's CEO Gary Kaplan—who was also on the Toyota trip—subsequently began an 11-year effort to eliminate waste, improve the quality of care, and prioritize patients throughout the system. As part of the initiative, the hospital has re-designed its medical clinics, eliminated waiting rooms, and streamlined waiting times.

At Virginia Mason's Kirkland Clinic, there now are no waiting times. When patients arrive, they are immediately ushered to an exam room, an improvement made possible through collaboration between physicians and nurses using medical assistants to manage care delivery.

Kaplan says before the restructuring, the health system was a top-down organization designed around allowing each physician to do things his or her own way. By making teamwork the foundation of the organization, doctors and nurses deliver better, more efficient care by putting patients first, according to Virginia Mason officials (Bowser, PBS, 10/25).