Liz Thiebe: Lessons from Seattle: dealing with the challenge ahead

Every year I lead a group of health care leaders on a study trip of medical and other organisations in Seattle, an American city with a rich and diverse health care economy. This year the trip threw up some interesting comparisons between our two nations’ health systems, and helped to shed light on the current situation facing the NHS.

Our multinational group – five doctors and a mix of senior NHS leaders – were all looking for ways to apply learning from the exemplar sites in Seattle to their own organisations.

On the trip we spent half a day at Group Health, a member-owned, integrated care organisation similar to Kaiser Permanente that successfully commissions and provides services for 600,000 members. We learned how the organisation uses transparency together with strong leadership and support structures to focus on the four ‘pillars’ of patient experience, staff satisfaction, quality of care and financial balance.

Here we learned the value of the daily ‘huddle‘, in which key staff come together for a five minute focus on the goals of the day. This was done every day – and on some wards, every hour. It was amazing to see such a complex organisation manage itself so successfully with very simple routine processes.

At the Everett Clinic, which employs more than 300 primary care and specialty care doctors, we explored how to give feedback and manage clinicians’ variation in practice. The Clinic’s annual appraisal system taught us valuable lessons to take forward with our own GP consortia around feedback to peers. This included peer feedback on working relationships with colleagues, patient satisfaction, and productivity measures based on individual performance and compared to agreed performance targets.

It seems that Seattle has embraced the concept of improving productivity and quality through these austere times. At three different medical centres – the Virginia Mason Medical Center (VMI), the Veterans’ Affairs, and the Harborview Medical Center – we witnessed lean practices being introduced to reduce tasks or remove steps that do not add value. In each case, frontline staff identified work processes that could be standardised across teams and organisations.

For example, in the outpatient clinic at VMI, patients do not sit in waiting rooms, but are greeted by a receptionist, handed a clipboard with the consultation room location and then allowed to walk right in. This approach has enabled the clinic to reduce the time spent taking patients to rooms and to spend more time with the patients who needed treatment.
We found it incredibly valuable to experience these health systems first-hand – and we could dive as deep as we wanted into the organisations, allowing us to test our assumptions and thinking.

In particular, all the organisations we visited showed just how serious they were in keeping the patient at the centre of everything. It is a lesson we would do well to bring back into the UK.

Liz Thiebe is the deputy head of leadership, King’s Fund.

This blog also appears on the King’s Fund website at