If you want to learn more about how and why Saskatchewan is using Lean in health care, join us for this introductory session. During the Quality Summit, you will hear about various Lean tools, concepts and principles, and this session will serve as a quick primer for you, covering some “lean essentials” to enhance your Summit experience!

1. The “Low Down” on Lean
Bonnie Brossart, CEO, Health Quality Council
Debra Jane Wright, Executive Director, Learning and Implementation,
Provincial Kaizen Promotion Office, Health Quality Council

2. What we hope to leave you with:
A better understanding of the
Saskatchewan health care system’s
commitment to and early
implementation of Lean methodology
An increased familiarity with some of
the most common Lean concepts and
methods we are using in Saskatchewan

3. What is Lean?
• Lean is a set of operating philosophies and methods
that help create maximum value for patients by
reducing waste including the waste of time waiting
for service. It is often referred to as a learning and
management system.
• Way of managing and delivering health care, and a
new way of relating to and working with patients as
partners in their care.
Source: www.betterhealthcare.ca

4. Why Lean, Why now, Why at
such a scale?

5. A burning platform…
• Unsafe health care
– Estimates of one to two avoidable deaths per day
in health system (extrapolation from Baker and
Norton 2003 study)
• Long waits for services
- over 15,000 waiting more than 3 months for
elective surgery in 2010
• Unrelenting expenditure growth in health care
costs
– Greater than 7% per annum from mid-1990s to
late 2000s

6. a compelling vision…
• “Patient First” must be
embedded as a core value
in health care.
• Health care in
Saskatchewan needs to
function as a cohesive
system.
• Frontline providers must
be empowered to deliver
patient- and family-
centred care.

7. …and disquiet with the status quo.

8. • Jönköping County (Jönköping, Sweden)
• Southcentral Foundation (Alaska)
• Virginia Mason Medical Center (Seattle, Washington)
• Intermountain Healthcare (Salt Lake City, Utah)
• National Health Service (England)
• Veterans Health Administration (USA)
• Kaiser Permanente (USA)
Learning from high-performing, innovative
systems greatly influenced our approach

9. • Develop and grow leaders for change
• Commit to a consistent, rigorous, disciplined
improvement methodology
• Transparent measurement
• Engage and mobilize people
• Align processes, priorities
• Spread (replicate) innovation
Key “take aways” from these systems and their
transformation efforts…

10. 2012: a new partnership emerged

11. Patient First Review: “Keep the Best, Fix the rest”
“Fix” = Eliminating waste; waste is anything that does not
add value in the eyes of the patient = LEAN
Reducing
walking
Reducing
waits
Reducing inventory
Eliminating
defects

12. Our approach to making care safer and
better
• Set provincial health strategy collectively (Hoshin Kanri or
Strategy Deployment)
• Develop infrastructure to support and coordinate
continuous improvement efforts
• Build improvement science capability among our leaders
& our entire health care workforce (40,000 strong),
• Connect learning and doing with achieving health system
priorities via Improvement Events
• Working in partnership with patients and families

13. Hoshin Kanri: Key characteristics
• Focus on a few key breakthrough improvements (or
hoshins)
• Alignment of the entire organization (and health care
system) around these breakthroughs
• Shared input and responsibility for plan and goals
• High participation throughout the organization
• Equal attention to end results and the methods for
achieving them

14. Our approach to making care safer and better
• Developing Infrastructure to Support and Coordinate
Efforts (Establishing infrastructure)
– Quality departments or units transitioned to Kaizen
Promotion Offices in all RHAs, Cancer Agency, Ministry
of Health, 3sHealth, eHealth
– Presently over 100 employees in the health system
dedicated to improvement
– Creation of Provincial Kaizen Promotion Office (housed
at HQC)
– Consistent, standardized approach and use of Lean tools
– Aim to have 1-2% of workforce with deepened capability
to lead & do continuous improvement

15. • Building improvement capability among our leaders
and health care workforce (40,000 strong)
– Over 600 leaders (CEOs, VP, Directors, physicians
and improvement staff) currently in Lean Leader
Certification)
• 83 certified to date
• Over 40 physicians in training
– Over 16,000 staff have completed Kaizen Basics
course (on track to reaching all 40,000 by 2017)
Our approach to making care safer and better

16. • Learning and applying tools and methods via various
improvement events
– From January 2012 to March 2011: more than 300
improvement “events” engaging thousands of staff (e.g.,
207 Rapid Process Improvement Workshops (RPIWs), 15
3Ps, dozens of 5S events, 28 Kanban teams, 88 Mistake
Proofing projects)
– Lean facility design in two of our three major capital
projects (MJUH, SCH)
– Lean “design” applied to Primary Health Care sites, staff
scheduling and provincial laundry services
– Patients and families participating in improvement
events
Our approach to making care safer and better

18. Lean is about learning to see

19. A snapshot of our work
• Built from direct observation on the Gemba
• Identifies the steps in our work
• Highlights where things tend to run amuck in the process (Starbursts)
Value Stream Map

20. The Waste Wheel
• Identifies opportunities for improvement
• Generated by direct observation and by the staff who do the work
Types of Waste

21. Making too much
Doing too much
Time on Hand
Stock on Hand
Movement of Things
Movement of People
Broken or defective
Products/ Equipment
All of which can be
deemed as
unnecessary
distractions in our
everyday work

22. Understanding Movement and Flow
• Built from direct observation – by following patients, families, providers,
medication, supplies, information and equipment.
Spaghetti Diagram

23. Visual Controls
Signals in our System
• How can we make it easy to know what the right thing is every day
Visual Controls

24. Mistake Proofing Devices
Preventing errors and eliminating defects
• Making it difficult to do the wrong thing and even better, making it impossible
to do the wrong thing.

25. Mistake Proofing
Understanding our Roles, Responsibilities & Tasks
• Having clarity in who does what is helpful to ensure we are all working to our
best ability to provide care for our patients.
Standard Work (SW)

26. Daily Visual Management BoardsDaily Visual Management (DVM)
Understanding our Collective Work
• Making information visible
• Identifying , talking about and testing ideas to improve your work on a daily basis

27. Personal Production Board Team Production Board
Unit Level DVM Board Service Line Visibility Wall
Cascading Communication
• Making work visible across the multiple levels in our system

28. Regional Walls
Provincial Walls
Communication Cascades continue
• To regional and organizational walls and up to a provincial walls on a
quarterly basis

29. Lean is about learning to do

30. RPIW
Try-storming change on the Gemba
• Senior Leaders, managers, point of care staff from the area , and patients come
together to test and implement improvement ideas over 5 days.
Rapid Process Improvement Workshop (RPIW)

31. RPIW
Eliminating Defects in our Work
Senior Leaders and managers working together to identify and redesign mistake-
prone situations, to ensure safe care for patients and providers.
Mistake Proofing Project Team

32. RPIW
Building, designing or redesigning a better future
• 3P stands for Production Preparation Process and is a Lean method
• Highly engaging and creative workshop to rethink what’s possible
3P Workshop

33. Managing Inventory
• Built on the concept of just in time and visual cues, to make it easy to find, fill
and reorder materials and supplies.
Kanban Seminar

34. A well organized work place
• Organizing and sustaining the orderliness of your workplace, to allow you to do
your best work everyday.
5S Campaign

36. Leaders’ Impressions of SK’s Transformation
“I wouldn’t want to be anywhere else…because I want to be part of
this; I want to see it succeed. At a very personal level, it is the most
satisfying thing I have ever been associated with.”
Maura Davies, CEO, Saskatoon Health Region
"The Saskatchewan Union of Nurses welcomes the opportunity for
front-line care providers to have their voices heard…A focus on
patient- and family-centred care using best practice evidence and
Lean principles will improve the patient experience and return
nursing to a rewarding career."
Rosalee Longmoore, Past President , Saskatchewan Union of Nurses
“I’m a lot less frustrated…I can see things happening in my
community which is the whole purpose why I ever volunteered to
be in a regional health authority in the first place.”
Tina Rasmussen, Board Chair, Keewatin Yatthe Health Region

37. Staff’s experiences with Lean
“That RPIW really proved what lean was all about; making small
incremental improvements…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.”
 Lisa White, Kaizen Promotion Office, Saskatoon Health Region
“Each potential and true injury is treated and addressed as an
opportunity for learning and prevention with frequent team
huddles and transferring/lifting/repositioning (TLR) audits…This
has been effective and inspired everyone to be more aware.
 Marie Legault Lalonde, Unit 3-2 Manager, Wascana Rehabilitation Centre

38. Saskatchewan’s Implementation of Lean
We are cultivating
the discipline
required to stick to
and be successful in
attaining our
ambitions

39. Saskatchewan’s Implementation of Lean
Working differently
means we are
embracing the
complexity of
Saskatchewan’s
health system and
the challenges we
face.

40. The commitment to and ambition of the
health system to “thinking and acting as
one” is unprecedented.

41. “When it comes to
Lean, Saskatchewan
hasn’t even hit
kindergarten.”
Maura Davies,
President & CEO,
Saskatoon Health
Region
And probably the most important lesson
learned so far: Humility

42. Want to learn more?