I receive a lot of questions and comments about lean. So let’s talk about it.

Why are we doing lean?
In 2011, informed by the Patient First Review, government and health system leaders concluded that we needed a different approach to achieving better health, better care, better value and better health care teams in Saskatchewan. Simply continuing to spend more money was not getting results and was not sustainable. When we looked at high performing health systems elsewhere, we saw that many of them were using lean thinking, tools and methods to improve. We committed to “think and act like one” and develop the Saskatchewan Healthcare Management System, which is what we call our lean management system.

Is this just the latest “flavour of the month?” I will just wait until it goes away.
Lean is here to stay. The province is making a large investment in building lean knowledge, skills and behaviours across the province. All 13 health regions, the Cancer Agency, 3S Health, eHealth, Health Quality Council and Ministry of Health are on the same journey together, with accountability by all organizations for demonstrating our commitment to and progress in applying lean principles and methods. Dan Florizone, former Deputy Minister of Health and now Deputy Minister of Education, is leading the adoption of lean across all government departments.

Maura Davies President and CEO Saskatoon Health Region

Maura Davies
President and CEO
Saskatoon Health Region

Is this just another way to cut jobs and save money?
First and foremost, lean is about adding value to our customers, improving the experience of our patients, clients, residents and families. It is about improving the safety, access, coordination, and efficiency of our care. One of the pillars of our lean management system is eliminating defects that could result in harm to our patients, making it easier for care providers to do the right thing, and harder for errors to occur.

Another fundamental principle of lean is respect for the people who do the work and the people whom we serve. Lean is not about cutting jobs. It is about enhancing value to those who use our services, eliminating waste and making the best use of time and skills of everyone working in health care. Some jobs will change as a result of the improvements we achieve with lean. Where this happens, we will work closely with affected staff to help support them to succeed in their new roles. The mix of care providers may also change. We will free up more time for health professionals to spend time with their patients, clients and residents, rather than on things such as hunting for supplies and duplicating the work done by others.

Improving quality and safety and eliminating waste will help us “bend the cost curve,” and ultimately improve sustainability of our health system. We are tracking the financial savings that we are starting to achieve. But we also recognize that it is early days and that it will take several years before we will see significant savings in addition to the improvements in quality and safety.

Being lean is extremely hard work. It requires a very different way of thinking, working and leading. Many organizations that have tried to adopt a lean management system have failed, often because they gave up too soon, did not have committed leadership, or did not have the discipline to change the way they operate. Even organizations such as Toyota that have a long history of lean sometimes fail in maintaining the discipline of lean and their processes to eliminate defects. Each system failure in a lean organization is an opportunity to further improve.

Where is the evidence this works?
The experience of successful implementation of lean is well documented in books such as Leading the Healthcare Journey (Wellman et al, 2011), The Toyota Way to Healthcare Excellence (Black, 2008), and On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry (Toussaint and Gerard, 2010). It is one thing to read about lean but it is even more convincing to visit lean organizations such as Virginia Mason, Seattle Children’s Hospital, Thedacare and Ascension Health, as I have done, to see where patients do not wait, staff use data and daily huddles to improve their care every day, patient safety has dramatically improved, the cost of care has been reduced allowing organizations to invest in infrastructure, and patient and staff satisfaction levels are extraordinary.

As we track results across the province, we are beginning to see similar outcomes. As of February, 2014, 160 rapid process improvement workshops (RPIWs) across the province have resulted in savings of $1.4 million, reduced inventory by 45 per cent, eliminated 122,694 feet of walking distance by care providers, and reduced the time to carry out the improved processes (lead time) on the involved work areas by 30 per cent. On March 7, five RPIW teams in Saskatoon Health Region reported how they had:

  • reduced by 12 hours the time of patient transfer from an observation unit to a ward bed at St. Paul’s Hospital;
  •  increased the amount of time social workers at RUH 6200 will have to spend with patients;
  •  increased timeliness and safety of cleaning surgical instruments;
  •  improved communication with patients before their day surgery; and
  • eliminated waste of food trays.

How can I get involved?
Lean requires openness to working differently, humility and involvement by every single person. That is what Better Every Day is all about.
Employees and physicians can help improve our care and services every day by participating in daily huddles and making suggestions. Many employees are involved in 5S, a process of creating a more organized workplace by sorting, simplifying, sweeping, standardizing and sustaining. In 2014, we will conduct more than 60 RPIWs involving employees, physicians and patient advisors and depending on other staff to give advice, test new processes and provide feedback. We need your patience. Our ambition to fundamentally transform health care in Saskatchewan is a never-ending journey. We are continuously looking at how we can improve how we teach lean, communicate what we are doing and engage staff and physicians. I would love to hear about your experience with lean, what has worked and what we need to do better. I can be reached directly at maura.davies@saskatoonhealthregion.ca or 306-655-7720.

Employees can also register for several different learning opportunities on the Training Registration System (through your Saskatoon Health Region account) or contact the Kaizen Promotion Office at certandtraining@saskatoonhealthregion.ca.