Tuesday, August 3, 2010

Why Lean works for patients at Rouge Valley

-- And how it can work at your hospital

By Rik Ganderton
President and CEO
This blog appears in the August 2010 issue of
The Hospital News

Constant improvements in quality patient care and the effective use of limited resources have become even more important to hospitals in the last few years.

This is something Rouge Valley Health System started tackling head on in 2007 at its two community hospital campuses, in west Durham and in east Toronto.

After introducing a three-year plan to address years of deficits, our Board, senior management team, physicians and staff needed a framework to work within to plant the seeds for a cultural shift toward:
• Relentless focus on quality patient care;
• Heightened accountability, in achieving quality targets;
• Effectiveness;
• Respect, teamwork.

- Why Lean? -

Selecting a philosophy and management framework to address these issues was a key decision. Two years ago, I chose Lean as our enterprise-wide philosophy and management approach to align all of our transformative efforts.

There were many reasons why Lean thinking became the cornerstone of our transformation strategy including that it:
• Drives operational efficiency and cultural change at the same time;
• Focuses on long-term sustainability;
• Offers a comprehensive approach to change;
• Looks at processes from the patient perspective and flow across departments;
• Involves and empowers frontline staff;
• Establishes specific metrics and targets;
• Emphasizes eliminating waste and quality improvement;
• Works quickly, with process changes beginning in days, rather than months.

- Results -

But none of this would matter if we couldn’t get results.

Using a variety of Lean tools, including kaizen events and value stream analysis, our team of front line staff and physicians has generated tangible results for patients, among them:

• Patients going home sooner thanks to improved patient flow and discharge planning at both hospital campuses;
• Improved communication with patients and families by posting regularly updated patient communication boards in patient rooms on our medical and surgical units;
• Patients and doctors getting lab and diagnostic imaging test results faster;
• Patients spending less time waiting for care in emergency at our Rouge Valley Centenary hospital campus;
• Less walking for patients visiting our pre-admit clinics, at both campuses, by having the patient stay in one place and the professionals coming to them instead;
• Enhancements to our pre-screening process for patients booked for elective surgery, resulting in fewer cancellations because the patient was unfit for surgery; and
• Fewer hand-offs and forms for patients and their families.

What has made Lean work so far, is the fact that front line nurses, allied health, cleaning staff and physicians are increasingly engaged. But why?

Doctors and staff got engaged in small groups, often in kaizen teams, to tackle specific issues. More importantly, they were also the ones who often identified problems and created the solutions. They make it work with support from the leadership team.

- Not easy -

That’s not to say Lean has been easy to implement. It has been and continues to be a challenge to grow a Lean culture. But our results during the last two years have generated growing engagement.

Increasingly, we have departments coming to the senior management team wanting to start their own kaizen events, or visual management boards, or apply value stream analysis, or make use of all of these Lean tools.

This basic Lean framework can work in any hospital provided there is sustained, visible senior management involvement that the front line can see. Our senior management team does monthly transformation rounds, as a group, of various departments where Lean initiatives are in place. We listen and learn about how our staff and physicians are getting patients the care they need sooner, more safely while getting them home sooner as well.

Additionally, as CEO, I do gemba walks – a Japanese term meaning the real place. So I go to the real place of work (whether that’s the OR, the nursing unit, or the maintenance shop) to view improvements that have been made, review where each area is on meeting minimum Lean standards, and what the action plans are to get to those minimum standards.

- Standards -

Minimum Lean standards can be demonstrated through visual management, in the form of:
• Process control boards for at least one key process;
• Evidence of Pareto analysis (demonstrating how you ranked issues in order to monitor and problem solve);
• Action plans to drive process improvement;
• Performance control boards that track progress on key metrics. There should be at least one metric for each of the following dimensions: Access, Service Excellence, Financial Sustainment and Team Engagement;
• Evidence that at least one 6S has been conducted in the department in the last 12 months (6S = safety, sort, straighten, shine, standardize, sustain);
• A3 postings, may be a good means to display this evidence. (An A3 is a gap analysis tool that places an issue on one A3-size piece of paper on which team members list the reason improvement is needed, current performance, target performance, gaps, countermeasures, action plans and reflection on this. The A3s are then posted where all team members can see and update it as the plan is implemented.)

- Tremendous efforts -

The point of the gemba walks and transformational rounds by senior management is for everyone to know how important Lean teamwork is, and to personally acknowledge the tremendous ongoing efforts of our team. It’s how we, in management, show our staff that we care and that their successes matter the most.

Once that senior and middle management commitment and support is demonstrated regularly, buy-in and more success in decreasing wait times, lowering infection rates, speeding up test results and more will be achieved for patients.

Community hospitals tend to have the same types of challenges. Rouge Valley is no different in that regard. If anything, we have had more of them! Lean is working for us and it would work for you in your community hospital.

Lean Facts
* Lean is a management philosophy that focuses on the elimination of waste in various processes. It originated in Japan and is used in corporate and hospital sectors in Ontario and internationally.
* Kaizen, a Japanese word for improvement, is one method used to identify waste, and calls on a team of people to improve service to customers or workflow processes. At Rouge Valley this means putting patients first.
* Rouge Valley’s four transformation themes, driving our Lean management philosophy, are:
* Patients first – the best patient/family experience;
* Earn our reputation as the best everyday;
* No waste;
* One team, inspired and involved.