ROUGE VALLEY FIRST WITH SMALLER AND IMPROVED DEFIBRILLATORS

ROUGE VALLEY FIRST WITH SMALLER AND IMPROVED DEFIBRILLATORS

Why Lean works for patients at Rouge Valley

-- And how it can work at your hospital

By Rik Ganderton
President and CEO
RVHS
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.

Working together to create leaders in health care

Advanced Leadership Foundations (ALF)
The ALF acronym is a catchy one, which many were quick to liken to the 1980s TV show. But there’s nothing alien about ALF to the management teams of Rouge Valley Health System (RVHS) and Lakeridge Health (LH), who have jointly rolled out the program. ALF team members, from left, are: Bill Hamilton, learning consultant, RVHS; Kathy Gooding, director, human resources, RVHS; Wanda Leach, director, human resources, LH; Darrell Sewell, joint vice-president, human resources; plus the ALF stuffies! (Absent are: Rahim Moledina, learning consultant, RVHS; Petra Bingley, learning consultant, LH; and Marguerite O’Neal, learning consultant, LH.)
___________________________________________
Blog by Darrell Sewell
Joint Vice-President, Human Resources
Rouge Valley Health System and Lakeridge Health

Great leadership is not about any one outstanding individual. After all, how could leadership happen if there were only one person? Rather, leadership is defined by the act of working with others.

Bearing that in mind, it seems quite fitting that Rouge Valley Health System (RVHS) and Lakeridge Health (LH) have been delivering a comprehensive leadership training program to our management teams by doing just that—working together. Now at the mid-way point of the program, we can’t help but step back and take a celebratory look at what we have collectively achieved.

In January 2010, our two hospitals jointly launched the Advanced Leadership Foundations (ALF) program. This program was designed to help our over 250 managers build a strong foundation of leadership skills and to keep them on the cutting edge of leadership fundamentals within Ontario health care.

The ALF program is based on a set of 12 leadership competencies established by the Ontario Hospital Association’s Leadership Development Institute, in collaboration with the Hay Group. These competencies define the skill sets and qualities that all health care leaders in the province should have. Building on the 12 leadership competencies, RVHS and LH developed an additional 12 management competencies focused on operational knowledge. And all twenty-four competencies were the basis for the creation of the training modules that make up ALF.

Between January and June 2010 we have delivered 12 training modules—six leadership and six management competency modules. Delivering two modules per month, we started off in January with Visionary Leadership (leadership competency) and Role of the Manager (management competency) and we recently wrapped up the first half of the program in June with Business Acumen (leadership competency) and Managing Finances (management competency).

We could not have gotten this far without three important groups. First, there’s the team of staff who worked so diligently to build the curriculum for the program and coordinate its delivery. As joint vice-president of human resources for both RVHS and LH it has been an absolute pleasure to guide this initiative and participate with the following ALF Team members who have been key in putting ALF into action:

• Kathy Gooding, director, human resource, RVHS
• Rahim Moledina, learning consultant, RVHS
• Bill Hamilton, learning and media consultant, RVHS
• Wanda Leach, director, human resource, Lakeridge Health
• Marguerite O’Neal, learning consultant, Lakeridge Health
• Petra Bingley, learning and media consultant, Lakeridge Health

The second group that has been instrumental in the success of ALF is the guest presenters who have been responsible for delivering some of the core training. This group of professionals—from administrative areas of both hospitals (i.e. CEOs; human resource; finance; labour relations; occupational health, safety & wellness; decision support)—has worked closely with the ALF Team members to provide training on their particular areas of expertise. They have done an exceptional job, and we wish to thank them for their commitment to ALF and our management teams.

Finally, we need to congratulate all of the management staff, who have participated in the first six months of the program. ALF is a mandatory program for management staff and leaders, and we are happy that everyone is making the time to take part. Thank you for your commitment to your hospital, the work you do, and ultimately, to the patients we care for.

This has been an extraordinary experience for everyone involved, and it is a true success story for Rouge Valley and Lakeridge Health. The development and rollout of ALF reflects leadership at its best. It demonstrates what can be accomplished when two hospitals take the initiative to come together and make something happen. We were not discouraged by a limited budget. Rather, we used our resources wisely, and took advantage of some or most valuables assets: our expertise, our innovation, and our teamwork.

The result has been a top-quality product, which is unique in many ways. With 12 leadership modules and another 12 management modules, ALF has certainly got to be one of the most robust leadership training programs delivered within hospitals in Ontario. Matching this comprehensiveness is the program’s intensiveness. In six months, we delivered 12 training modules to more than 250 managers across two large community hospitals.

And of course, by delivering the program jointly, we have afforded our managers with a number of opportunities to develop relationships with colleagues across the two hospitals. The training modules were offered at RVHS and Lakeridge sites in Scarborough, Ajax and Oshawa, allowing staff and presenters to learn together and from each other.

Another unique aspect of ALF is its evaluative component. At both hospitals, we have introduced Halogen Software systems to evaluate managers specifically on the leadership competencies introduced in ALF. This closes the loop on their training, and helps to ensure that managers are applying in their work what they have learned in ALF.

It has truly been a thrilling start to this program. During the summer, we have taken a pause, but ALF will get going again in the fall. Between September and March, we will complete the program with the remaining 12 competency modules. I am looking forward to the second half of this program. In fact, we have a really exciting kick off planned for September, so stay tuned!

This kind of learning isn’t just about building leaders for our two hospitals. We are creating leaders for our future health care system, and you can’t help but to want to be a part of that.

President’s Blog: Time to map our future

By Rik Ganderton
President & CEO

We’ve come a long way since we introduced and implemented our Plan-On-A-Page.

In the almost three years that we have been working from this strategic plan our world has changed. Changes in health care have included the tightening of available funds, largely thanks to the great recession of 2008-09, and other changes including in how we are governed, which come into effect in 2011. (Read my future blogs on topics such as the Excellent Care For All Act -- and more.)

The new strategic planning process was launched by the Board of Directors in late April. Vice-President of Quality Improvement and Transformation Michele Jordan is leading the process and working with a Strategic Planning Operations Committee and a Strategic Planning Steering Committee, which is chaired by new Board chair Jay Kaufman. The new planning process is our opportunity to renew our focus.

A strategic plan spells out where an organization wants to go, how it’s going to get there and helps us decide how and where to allocate resources. It’s a way of mapping our future. Rouge Valley has started the process of developing a new strategic plan to guide us during the next three years.

Essentially, this plan will be our corporate document that will help us skate to where the puck is going to be, rather than where it is now. Ultimately the hospital Board of Directors will approve and refine our draft of the new plan-on-a-page by January 2011.

But your input is needed to truly get this plan rolling. We don’t simply want to push this information request out, we want you to be part of this important process and to help shape the future directions of your hospital. The core information we gather for input to the process must come from you — our staff, physicians and volunteers. You know what has been working and what has not been working for our patients. Your views are vital.

So for starters, please visit our brief online public survey. (Staff, physicians and volunteers have already completed a survey.) Please click on this survey link before the end of the day on Tuesday, July 13, 2010.

We are also seeking the views of our key health system partners (e.g. other hospitals, CCAC, family physicians, long-term care homes), our Community Advisory Group, community agencies/groups, and political leaders. We are doing this through surveys, face-to-face meetings, focus groups, our electronic newsletter and publicly via social media such as blogs.

This fall, after we have analyzed all of the information and feedback collected, we will bring concepts and drafts to all staff, physicians and volunteers through our many internal forums: Town Hall; Leadership Forum; the Medical Advisory Committee; the Medical Staff Society, our two strategic planning committees and other groups.

Surveyors from Accreditation Canada last year found that we had an extraordinary number of internal and external people knowledgeable about our Strategic Plan On-A-Page. And we want even more of you in the know and actively participating this time please. For a refresher, here’s a link to our current plan as posted on our hospital’s public website.

- Rik