There are some new terms being used throughout the Region and province lately. You may be hearing words such as lean, kaizen, hoshin kanri, strategy deployment and value streams. They’re all part of a provincial approach to changing the way health care is provided in Saskatchewan based on a Japanese production system now being used by other North American health care providers.

Phyllis Goertz, Marianne Maiboll and Ron Balezantis design a value stream map.

The lean and continuous improvement approach is not new to Saskatoon Health Region. The purpose is to examine the value-added and non-value-added processes in health-care from the perspective of the patient, and design new value streams – or ways of providing that service – to eliminate wasted time, inventory, errors and movement.

Many of the challenges in health care today are found in the large and complex processes, not the talented people who provide health care.

Several Region departments have already used lean philosophy to redesign their space and processes. The Children’s Hospital of Saskatchewan project team used a lean methodology tool called 3P (production, preparation, process) to recently transform how care will be delivered in the new hospital, and develop a design to support that care. Now Saskatoon Health Region and others in the province will begin applying the continuous improvement philosophy to additional care groups over the next year.

“This is transformational,” said Dan Florizone, Deputy Minister of Health in a recent article. “No state or province that I’m aware of in the world has attempted it on this scale.”

“It’s going to take a hell of a lot of leadership to be able to convince people this isn’t a fad,” Florizone added. “There’s only one way to convince the skeptic and that’s the way I was convinced – let’s do it.”

Click here to learn more about Children’s Hospital continuous improvement.

Better care, better health, better value, better teams

Better care, better health, better value and better teams are the themes of a new game-changing health-care planning process in the province and the Region known as strategy deployment. This is a method for setting breakthrough priorities to transform health care, and then getting feedback from people closer to the work on how to prioritize and implement them. The process started with the Ministry of Health and region CEOs in 2011, and continued in Saskatoon Health Region in January 2012.

“This was an opportunity for senior leadership to reflect on the strategies for Saskatoon Health Region in the context of the provincial plan for developing and taking health care really to another level,” says Dr. Alan Casson, physician Vice-President of Acute Care.

The process included three levels of catchball – or feedback and discussion – including Ministry of Health representatives, region CEOs, Saskatoon Regional Health Authority board members, senior leaders, operational leaders and physicians. The feedback from each Region has now been provided to the Ministry of Health, who will provide a provincial priority plan in spring, to provide a clear direction for the health sector.

“I think the most exciting thing for me was that when we left here at the end, it felt like we are going to create a different way of serving people in our community, and for the people who serve,” said Bonnie Blakley, Vice-President of People Strategies. “I came out thinking we could be a world class organization. We can do things that no one else is doing, and we have the people and the resources to do it, if we just do it in a different way.”

Click here to watch senior leaders provide an overview of strategy deployment.

Value streams help understand the flow of patients and supplies

More than 60 Region leaders, employees, physicians and union colleagues gathered at Royal University Hospital in January to learn how to create a value stream map – a visual tool to help see and understand the flow of the patient through the health-care experience, including supplies and information.

“The workshop was a mix of senior leadership all the way from the CEO level down to the frontline managers and consultants, physicians, nurses,” said Jon Schmid, Manager of Nursing for Saskatoon City Hospital Emergency Department. “I think that is what we need to move forward.”

With the help of consultants and teachers from John Black and Associates, who work with health-care clients throughout North America, teams visited various areas of the hospital to study their processes and use stopwatches to determine where waste could be eliminated for the patient, including time spent waiting, unnecessary movement of staff and patients, or possible defects in the system. The purpose is not to time the people doing the work, but to see where the process itself can be improved across the system.

“We don’t come here and give the solutions to people,” said Tina Hallberg with John Black and Associates. “We as consultants do not have the answers. The answers lie with the staff themselves – the people that are doing the work. So our approach is to put those folks out on the gemba – or the place where the work is being done – and have the staff determine what the solutions are in order to fix the work in their area so that these patients get the quality care they deserve in the safest and most efficient manner possible.”

After mapping out several processes in Sterile Processing and Distribution, Diagnostic Imaging, Pediatric and Adult Outpatients, Operating Room Holding and the Emergency Department, the teams created future value stream maps designed to remove the waste and improve the patient and employee experience.

“SUN’s perspective has always been patients and families first,” said Mark Henderson, SUN President Local 75 at RUH, “and when we started this workshop, one of the first things that we discussed was that the whole focus is around the patient and not around the rest of the caregivers.”

This is the first wave of value stream mapping and lean leader training in Saskatoon Health Region. Education, continuous improvement projects, and involvement of care and support providers will continue throughout 2012 as part of the provincial health-care transformation plan.