Health Care Improvement Research Focus Areas

Center for Health Care Improvement Science

The Center for Health Care Improvement Science was initiated in 2012 with the goal of supporting Virginia Mason’s vision to be the Quality Leader and transform health care by:

  • Disseminating the results of Virginia Mason quality, safety, and improvement initiatives through publication in the medical literature.
  • Fostering a learning health care system by investigating ways to improve Virginia Mason Production System (VMPS) at Virginia Mason and other institutions.

The Center functions as a collaborative enterprise, leveraging the research expertise of the core faculty with the content and quality improvement expertise of investigators from throughout Virginia Mason, including physicians, nurses and institutional leadership. Central to the functioning of the Center is the Lean Quality Improvement Publication (QuIP) pathway. The Center also has a major role in training investigators, through the CHCIS Fellowship, and through partnerships with the GME and CME departments. The CHCIS works closely with Virginia Mason's Kaizen Promotion Office (KPO) and the Virginia Mason Institute to improve and spread the VMPS methodology.

Research Focus Areas

Patient Safety

The Institute of Medicine's 1999 report “To err is human: Building a safer health system,” heightened awareness of the extensive quality challenges in health care.  At Virginia Mason, patient safety has been a major focus for more than a decade. At CHCIS, we have multiple research projects studying successful VMPS interventions to improve medication and surgical safety.

Selected publications:

  • Ching JM, Long C, Williams BL, Blackmore CC, Using Lean to Improve Medication Administration Safety: In search of the perfect dose,” Jt Comm J Qual Saf 2013: 39; 199-204
  • Blackmore CC, Bishop R, Luker S, Williams BL, “Applying Lean methods to improve quality and safety in surgical sterile instrument processing” Jt Comm J Qual Saf 2013: 39;99-105
  • Idemoto LM, Williams BL, Ching JM, Blackmore CC. Mistake-proofing to prevent medication timing errors induced by computerized provider order entry,” Am J Hosp Pharm 2015: 72;1481-1488
  • Kaplan GS, Gandhi TK, Bowen DJ, Stokes CD, “Partnering to lead a culture of safety,” J Healthc Manag 2017;62:234-237

Quality of Care

At Virginia Mason, we have implemented standardized clinical value streams across a range of health conditions, designed to prevent unnecessary care while supporting delivery of evidence-based, appropriate care. Quality of care also encompasses developing tools to measure quality from the perspective of the patient and health care system. CHCIS research has demonstrated improved outcomes and efficiency from Virginia Mason care improvements.

Selected publications:

  • Blackmore CC, Edwards JW, Searles C, Wechter D, Mecklenburg RS, Kaplan GS, “Nurse practitioner-staffed clinic at Virginia Mason improves care and lowers costs for women with benign breast conditions.” Health Affairs (Millwood) 2013;32:20-26
  • Pittenger K, Williams BL, Mecklenburg RS, Blackmore CC. “Improving acute respiratory infection care through nurse phone care and academic detailing,” J Am Board Fam Med 2015, 28:195-204
  • Bradywood A, Farrokhi F, Williams B, Kowalczyk M, Blackmore CC, “Reduction of hospital length of stay in lumbar fusion patients with implementation of an evidence based clinical care pathway, Spine 2016;42:169-176

  • Blackmore CC, Watt D, Sicuro PL. The success and failure of a radiology quality metric: The case of OP-10. JACR 2016; 13:630-637

Patient Centeredness

Health care exists to serve patients. Too often, however, the needs of the patient can get overwhelmed by the health care system itself. At Virginia Mason, we have pioneered Experience Based Design methods to understand and incorporate the patient care experience while redesigning the health care enterprise. CHCIS is engaged in validating and studying the application of Experience Based Design.

Selected publications:

  • Russ LR, Phillips J, Brzozowicz K, Chafetz LA, Plsek PE, Blackmore CC, Kaplan GS. “Experience-based design for integrating the patient care experience into healthcare improvement: Identifying a set of reliable emotion words,” Healthcare 2013:1; 91-99
  • Kaplan GS, “Pursuing the perfect patient experience,” Front Health Serv Manage 2013;29:16-27
  • Blackmore CC, Kaplan GS, “Lean and the perfect patient experience,” BMJ Qual Safe 2017;26:85-86
  • Hagensen A, London AE, Phillips JJ, Helton WS, Picozzi VJ, Blackmore CC, “Using experience-based design to improve the care experience for patients with pancreatic cancer,” J Onc Practice 2016;12:e1035-e1041
  • Kamo N, Bender AJ, Kalmady K, Blackmore CC, “Meaningful use of the electronic patient portal-Virginia Mason’s journey to create the perfect online patient experience,” Healthcare 2017;5:221-226

Health Care Policy

The Virginia Mason Vision is to be the Quality Leader and transform health care. Sharing our success with the broader health care audience to inform policy makers is a critical component of transforming health care.

Selected publications:

  • Blackmore CC, Mecklenburg RS, Kaplan GS, “At Virginia Mason, collaboration among providers, employers, and health plans to transform care cut costs and improved quality.” Health Affairs (Millwood) 2011;30:1680-1687
  • McDonald PA, Mecklenburg RS, Martin LA, “The employer-led health care revolution,” Harvard Business Review 2015: July-August; 39-50
  • Kaplan GS, Lopez MH, McGinnis JM, eds. Transforming health care scheduling and access: Getting to now. Institute of Medicine. National Academies Press, Bethesda, MD. 2015
  • Kaplan GS, Blackmore CC. The irrational physician defense of fee for service medicine, NEJM Catalyst, epub: 3.27.2018

Organizational Transformation

Adoption of VMPS at Virginia Mason and other institutions is neither simple, nor linear. Understanding Lean organizational transformation is the newest research focus area for the Center. We are engaged in emerging research focused on understanding the process and outcomes of institutional Lean transformation.

Selected publications:

  • Kaplan GS, Patterson SH, Ching JM, Blackmore CC, “Why Lean Doesn’t work for everyone,” BMJ Qual Saf 2014;23:970-973
  • Blackmore CC, Kaplan GS, “Lean and the perfect patient experience,” BMJ Qual Safe 2017;26:85-86