The Blue Yarn

In 1998, Dr. Gary Kaplan, the CEO of Virginia Mason Medical Center in Seattle, received some bad news about his hospital. It was losing money. So Dr. Kaplan started studying how other hospitals were being run to see if there was a better way to manage his hospital. He scoured the country, looking for a hospital with a management system worth adopting, but he never found one. Instead, he ended up in Japan. At a Toyota factory.

When Dr. Kaplan told his staff they would be changing everything about the way they operate, and the changes were based on a car company, and that doctors and nurses should refer to their new teachers as “sensei,” the response was less than ideal.

This entire, multiyear overhaul started with a ball of blue yarn. The staff met with a Toyota Production System sensei and he took out a ball of blue yarn and a map of the hospital and told the staff to trace the path a cancer patient would take on a typical visit for chemotherapy treatment. When they were finished, it was an immensely powerful visual experience for everyone in the room. They all stared at this map with blue yarn snaking all over the place, doubling back on itself and making complicated twists and turns from one end of the building to the other. They understood for the first time that they were taking their sickest patients, for whom time was their most precious resource, and they were wasting huge amounts of it.

This story was produced by David Weinberg who also wrote an article about Virginia Mason adapting the TPS to health care and did a piece for “Marketplace” about its adoption at Barnes Jewish Hospital in St. Louis. David spoke with Charles Kenney, author of “Transforming Healthcare,” and Dr. Henry Otero & nurse Michele Wettland from Virginia Mason.



Blue yarn 6 by PLCMC training accountcc 2.0 license

  1. Charlie

    As a public servant, I really thank you for telling this story.
    I will always keep it in my mind and never forget to make this world better.

  2. My personal favorite so far!

    After your Ted talk I’ve started listening from the first post

    (btw, it’s very hard to get to the first posts)

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