PowerPoint Presentation

LEAN: Change in SaskatchewanJanet HardingDirector, Pharmacy ServicesSaskatoon Health RegionJune 2013janet.harding@saskatoonhealthregion.ca

1Dan Florizone, Deputy Minister of HealthDetermined to bring Better Health, Better Care and Better Value to Saskatchewan residents

Reduce waste and improve quality and overall system performance by long term changes in behaviour2Lean principles profoundly enhance patient satisfaction and safety, quality, efficiency and profitabilityImprove clinical outcomes by firmly establishing the necessary organizational infrastructure necessary for long term results

John Black3SASKATCHEWAN LEAN MANAGEMENT SYSTEMSupport the strategic alignment of health system priorities across the provinceBoost health human resource capacity and capabilities related to quality improvement (skills, dedicate resources, leadership commitment)Foster a culture of safety with the goal of zero defectsEstablish a cascading measurement and reporting system to support greater system transparency and accountability4Saskatchewan Lean Management SystemEstablish organization and infrastructureSet directionSystem leadersEducate organization in basicsMake rapid improvementsImplement management systemVisibility and accountability

Hoshin KanriIdentifying a common vision;Setting short- and long-term goals;Tracking progress toward those goals; and,Changing course as required.

6Hoshin Kanri Diagnosis & ReviewManagers with staffDirectors with ManagersVPs with DirectorsReflection Strategy DevelopmentProvincial Leadership Team CatchballVice PresidentsDirectors Finalize the PlanProvincial Leadership Team

Finalize Region PlanDeploy PlansVice PresidentsDirectorsManagersIs an annual learning cycle of review, adjust, implement and learn (aka PDSA)7Lean LeadersA way of thinking about valueChange management to promote behaviours with employees that are conducive to improvementToo often management doesnt get involved. They think they can pass it off to someone else they see it as just those tools8LEAN Leader CertificationOver 4 years, 800 Saskatchewan health system leaders will receive in depth Lean training

55 days over a period of 18 months11 days of classroom learning / seminars3 Books, 10 modulesQuizzes / Presentations

8 days of learning and implementing improvement as part of North American toursVirginia Mason, Seattle Childrens and AutoLiv 36 days in rapid process improvementOngoing file, Report card

9

Lean Depth StudyAssess the SHR structure and leadership based on value added criteriaCreate a health system around service lines rather than functional silos while ensuring that SHRs structure is as flat as possible to ensure decisions are made as close to the point of care and service possibleTo develop leaders to lead in a lean organization today and into the future

In depth evaluation of both job functions and leadership skills throughout the organizational chart11Leadership MaturityPatient FirstFocus on patient safetyFocus on value add for patientsLeads SelfDemonstrates character and valuesManages selfDevelops othersEngages OthersSuccession planningCommunication

Achieves ResultsFinancial stewardshipAccountability and performance managementDevelops CoalitionsTeamsInfluenceSystem TransformationLean trainingLean modelingDaily managementChampions and leads change12

13RPIWA team of people fully engaged in a rigorous and disciplined 5-day process using the tools of LEAN to achieve immediate results in quality, safety and efficiency.

Greater than 500 staff participated in RPIWs to advance improvement efforts in 2012 2013

14Zero DefectsMistake ProofingExamines the root causes for mistakes and aims to prevent them before they create defects (harm to our patients)Takes place over 5 months: one month of data collection, a trip to Virginia Mason to learn how to mistake proof processes, and 4 months to implement solutions through Plan, Do, Check, ActStop the LineAnyone can recognize that there is a potential for harm or injury and can signal their concernSTOP and RESPONDVISUAL MANAGEMENT16PerformanceMetricsGemba WalkDaily Visual Management16Visual ManagementTell at a glance what and how you are doingCreate daily awareness of important areas, e.g. safety concerns,Timely information, Ensure nothing important is missed,Make it easier to prioritize work,Prevent people from reacting to every little thing,Enable synchronization of work,The abnormal becomes visual Allow rapid resolution of conflicts and issuesEnables the manager to act proactively Less firefightingThe pulse of the unit

What you cannot see, you cannot manage!1717Questions to ask your staffWhat primary or support process are you part of?What is the purpose of this process?How does your process create value for patients/clients/residents? Who is your customer and supplier and what is the feedback process?What is the rock in your shoe? What about your daily work keeps you up at night?What are the safety risks for patients/clients/residents and staff?How do you know when you are doing well? If you came back from holiday, what would you want to see on the wall to know the health of the process?How do you know when things are not running the way they should be? 1818The Power of the HuddleIn a rapidly changing environment, it is vital that team members frequently resynchronize their efforts, coordinate, communicate, and flexibly adapt to current situation.

1919Visual ManagementA visibility wall without gemba walks is just wall paper

A gemba walk without a visibility wall is just a social visit

Shaking hands and kissing babies

2020GembaWhat IS your job?What are you trying to accomplish today?How do you know if you are doing this work correctly?What do you do if you have a problem?What improvements have you made lately?

21GembaRespect to the people who do the value creating workLook for signs of disrespect toward workers, especially overburdenLook for signs of disrespect toward customers, poor quality or poor deliverySteadily take away each and every bit of non value creating work22What If My Employees:Dont have any ideas?Have bad ideas?Just ask me to buy stuff instead of fixing processes?Have selfish ideas?Come up with sub-optimizing ideas?Come up with ideas that violate rules or regulations?

Mark Graban Lean blog March 21, 201323CHANGE A single methodology (to learn) Visible leadership (on the gemba) Ongoing communication (more, more , more) Doing, not just planning (it may not be right the first time) Resource improvement efforts (can get things done when it comes to you) Expect surprises (enthusiasm and resistance) Measure change management and hold people accountable (uncomfortable at times)

24