This time of year is usually a period of graduations and children enjoying a break from school. But, as part of Lean Leader certification, I am “back to school” with other Saskatoon Health Region colleagues. We have been studying Virginia Mason Medical Centre and Seattle Children’s Hospital, which are recognized as world health-care leaders in adopting a lean management system based on the Toyota Production System.

These two high-performing health systems have achieved remarkable results. They have created care environments characterized by a sense of calmness, order and teamwork. Staff truly put patients first. Care and services are done using “standard work” – documented, consistent, reliable methods, with variation only as required by the unique needs of the patient. Virginia Mason and Seattle Children’s illustrate the opportunities we have to create a care environment that is truly focused on the patient and family, to eliminate waste such as waits, duplication and rework, and to engage every person in continuously improving what he or she does, every day, everywhere.

As I mull on these learnings, I have a sense of urgency for us to accelerate our improvement efforts. Every day, some of our patients, clients and residents are harmed as a result of the care they receive. Sometimes the harm is minor, such as a fall that does not hurt the resident or client. Sometimes the harm is very serious, such as an infection that results in pain, prolonged hospital stay or even death. Last year 31 critical incidents were reported in our Region and we know that this number does not fully capture the number of times our care caused serious harm to our patients, residents or clients. It is estimated that more than 300 patients die every year in Saskatchewan as a result of errors or defects in the care they received. No harm is acceptable. Our target is and must be zero. “First, do no harm.”

The urgency is also driven by the fact that every day we spend more money than we have available to operate our Health Region. This is not acceptable or defensible. We can solve this problem in one of two ways. We can cut jobs and reduce services. Or we can work together to aggressively eliminate the waste and inefficiency in our system. But we must live within our means.

A significant part of this waste is in our scarce human resources. Last year our Health Region spent $20,673,474 of taxpayer money on sick time and $16,653,620 on overtime. In 2011-12 we had 2,651 work-related injuries. This is not sustainable. We are closely tracking these numbers and have made our sick time, overtime and injury rate reports by each director area available at Our year to date results are not acceptable and we are putting actions in place to better manage these costs and improve our results.

Some sick time is unavoidable. Care providers are prone to the same illnesses that our general population experiences. We know, however, that some sick time use is excessive and not related to illness. We need to work together to promote health in our workplace and have staff healthy and safe while at work to provide the care and services our patients need. Our goal is to eliminate workplace injuries – Mission Zero. There are many factors which influence overtime costs but improved scheduling and patient flow can significantly reduce the need for overtime.

In many ways, we all need to go back to school together. We need to learn new ways of solving problems and making decisions. We need to find ways of improving care and reducing costs. We need to eliminate waste, while achieving better care, better health, better teams and better value. If we don’t do it, who will?

Maura Davies
President and CEO
Saskatoon Health Region