When it comes to Lean, Saskatoon Health Region hasn’t even hit kindergarten yet.

According to John Toussaint, former CEO of Thedacare – a world leader in adopting lean – if you have used a lean management system for five years “you have just graduated from kindergarten.” His comment reflects that lean is not a project, rather is a fundamental transformation in organizational culture and operations to add value to the customer, eliminate waste and improve quality and safety.

A gemba walk on the labour and delivery unit at RUH.

A gemba walk on the labour and delivery unit at RUH.

For the Region and the rest of the province, the use of lean methodology may still be in its infancy, but the Region is wholly committed to the endeavour. “In the beginning, the Ministry of Health challenged us to use lean processes for the planning, designing and building of the Children’s Hospital of Saskatchewan,” says Maura Davies, President and CEO. “And while we are still doing that work, lean has enabled us to look far beyond the scope of the Children’s Hospital and apply this approach to improvement into virtually all areas of care and service.”

Staff participate in a gemba walk at the SCH operating room.

Staff participate in a gemba walk at the SCH operating room.

In early November, the Kaizen Promotion Office hosted a quarterly review of the Region’s lean progress to date and the results were worth celebrating. “I am so excited to watch the ‘a-ha’ lights that continue to be ignited as a result of kaizen work,” says Lisa White, Infrastructure Lead with the Kaizen Promotion Office. Kaizen is a Japanese term that means ‘good change’ or ‘continuous improvement.

One of the very first rapid process improvement workshops (RPIWs) created a registration space for pregnant mothers on the fourth floor of Royal University Hospital in Labour and Delivery so that they wouldn’t have to travel to main floor registration and then up to the fourth floor. The walking distance for pregnant and potentially labouring mothers was reduced by 85 per cent but the new registration process initially was not a 24 hour, 7 day a week operation; mothers coming to Labour and Delivery had to register through the Emergency Department after hours. Now, with the hard work of many people in different departments, the registration process on fourth floor is the only registration point for pregnant mothers and is open around the clock. “That RPIW really proved what lean was all about; making small incremental improvements,” says White. “When something doesn’t work, you try a different approach and get expertise from the people at the point of care and service. I love seeing the shared education that happens when we cross pollinate on rapid process improvement workshop teams.”

While a completely defect-free health care environment is still a long way off, the groundwork and foundation for this future state of health care is being laid. The Region has completed 51 rapid process improvement workshops (RPIWs) so far with 256 employees, 51 physicians and 34 patient advisors participating in improvement events. Other kaizen events include mistake proofing projects to make care safer, 5S events to create a more organized work environment and kanban seminars to manage supplies better.

“Our pursuit of lean has certainly been an investment of time, finances and human resources,” says Davies. “From John Black and Associates, we’ve learned that it can take years before lean pays off in the form of substantive financial dividends and we are not expecting big savings right away. It took Virginia Mason in Seattle many years after they adopted lean in 2002 to see major reductions in their overtime and inventory costs.* However, I feel that the investment in reducing waste and improving the quality and safety of our care and services to the patients, clients and residents we serve is worth the investment.”

As the Region continues to pursue a vision of defect-free health care and prepare for the Children’s Hospital of Saskatchewan, more opportunities for lean education and training will be developed. The goal is to provide every single employee and physician working in the Region with some lean training so that they can better understand how to make quality improvement part of their work every day. In addition to the one-day Kaizen Basics course, more than 100 Region leaders are enrolled in lean leader certification and other learning programs are being planned.

Concerns about being able to sustain the changes and not tire of this constant newness and upheaval still remain. “My oldest son started kindergarten this year. Some days he bounds out the door with excitement in his eyes about what he will learn at school that day and some days it is all just too much ‘new’ and he’d rather go back to his regular, old, comfortable day care,” says White. “I think that sums us as a region up right now. That safe secure way we have always done things feels temptingly comforting but we are still learning and we need to recognize that.”

For now, the Region is focusing on sustaining the gains made with lean so far and to keep the momentum of improvement work flowing. “Our patients, residents, clients and families are already telling us they see tangible improvements as a result of the changes we are making using lean tools and methods,” says Davies. “This encourages us to hold the course, even though this is very hard work and takes time. Much of our improvement work will continue to be focused on services that are involved in the new Children’s Hospital. The opening of the Children’s Hospital of Saskatchewan is scheduled for 2017.While that may seem far into the future, we have a lot of work to do to improve our services before we welcome patients to that building.” In the meantime, patients do not have to wait to benefit from the many changes resulting from lean throughout the Region.

*From The Toyota Way to Excellence by John Black, page 163
• 29 per cent reduction in overtime and temporary labour in overhead areas
• 40 per cent reduction in number of products on surgical procedure carts. (inventory).