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"Lean sounds mean; innovation sounds risky. But both are at the heart of what people do every day at VMMC. With lucid descriptions and riveting examples, Paul Plsek tells us how this top-rated health care organization created the culture and provided the tools so that everyone can innovate and learn. A treasure trove of insights for all who, like VMMC, strive to provide a ‘perfect patient experience’."—Lucian L. Leape, MD, Harvard School of Public Health"Health care organizations are being asked to do the seemingly impossible: become defect-free by standardizing core processes and reducing waste, while nurturing a culture of innovation. In this superb and highly readable book, management guru Paul Plsek describes how one US medical center – Seattle’s Virginia Mason – managed to achieve these twin goals. He argues convincingly that the goals of "Lean thinking" and innovation are not in tension; rather, when approached the right way, they are highly synergistic. Plsek writes with insight, experience, and clarity, and the book is chock-full of inspiring examples and practical tools. If I were leading an effort to improve the care delivered by my organization, this would be the first book I would distribute to all of my clinicians, staff, administrators, and board members."—Robert M. Wachter, MD, Associate Chair, Department of Medicine, University of California San Francisco"The practical tools and approaches Plsek offers are helpful for health care providers at all levels. This book demonstrates, through the remarkable journey of Virginia Mason Medical Center, what can be accomplished when leadership, Lean thinking, and creative innovation all align."—Maureen Bisognano, President and CEO, Institute for Healthcare Improvement"Few organizations in health and medical care have created a learning system aimed at achieving performance that is better everyday than it was the day before. The system involves every employee, every board member, every patient, and ideas and practices from every industry and geography. Virginia Mason is not a finished product, but if you are interested in learning how to pursue excellence in a non-random way.....you should read this book."—Paul O'Neill, Former Chairman and Chief Executive Officer Alcoa and the 72nd Secretary of the US Treasury"Health care is in the midst of a massive transformation – a true ‘100 year storm’ that will thin the weak but leave the strong standing even taller. This volume outlines the deep roots, based in Lean quality theory, that can anchor a care delivery group to withstand the blasts and thrive in the gale. It comes from one of the few whole truly know – a rare organization that models the principles, and harvests the results, that will form the next generation of health care delivery. Most important, it addresses fundamentals – the core infrastructure from which any world-class organization grows – at a level of sufficient practical detail to actually be useful to others striving for excellence in the field."—Brent C. James, MD, M.Stat, Chief Quality Officer and Executive Director, Institute for Health Care Delivery Research, Intermountain Healthcare "This is the ‘must-read’ text for anyone in healthcare who is interested in improvement and innovation. It is easy to read, provides lots of stories, and describes how evidence can, and has been put into action through real world examples. Many people will recognise that Virginia Mason has been successfully using Lean methods but most will be surprised by their clever use of both innovation and Lean methods together thus creating significantly more value than using either alone and dispelling the myth that Lean and innovation methods cannot work in harmony. There is a clear message that patients are the number one priority. We see how they actively seek to deeply understand patient’s experiences and how they engage both patients and staff to create innovations that make the biggest difference. To achieve innovation leaders cannot rely on tools and techniques alone, they have to create the conditions that support staff to excel. Rather than putting this into the ‘too difficult’ list we see how Virginia Mason leadership teams have committed to achieving conditions within which innovation can flourish. As you travel through this book you will recognise some of the struggles that healthcare teams from around the world face, read on and you will learn valuable lessons about how you too can overcome these to create a thriving organisation that provides an excellent service for patients and an excellent workplace for staff."—Dr. Lynne Maher, Director for Innovation, Ko Awatea, Middlemore Hospital, Auckland, New Zealand

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Hunters of the Dusk

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