Benefits of Lean similar at hospitals around the world

Bangkok Blog#2 – Written on Monday, January 24, 2011

Michele Jordan
VP Quality Improvement and Transformation

Today was the official start to the Seminar on Regional Sharing on Lean in Health Care.  There are about 25 participants sponsored by the Asian Productivity Organization (APO).  I am in awe of the rich diversity.  Participants represent 15 Asian countries:  Cambodia, China, India, Indonesia, Iran, Japan, Korea Malaysia, Mongolia, Nepal, Pakistan, Philippines, Singapore, Thailand and Vietnam.  Each country had to submit a ‘country paper’ describing their health care system and the status of Lean in the health care sector.  I have to read all 15 of them before the end of the week.

Most countries are in their infancy where Lean is concerned but they all see the potential for Lean to improve their health care systems and are anxious to learn more.  The health care challenges faced in Asia are similar to what we face in Canada – quality concerns (i.e. wanting to use more evidence-based practice; need to minimize adverse events), lack of standardization, patient satisfaction, meeting growing public expectations, trying to reduce length of stay and insufficient money to do all the things we want to do.

In Asia, many hospitals are run by doctors who serve as both practicing physicians and CEOs.  Most of the participants at the conference are doctors and all of the speakers today were doctors.

The first presenter was Dr. Anuwat Supachutikul, Chief Executive Officer, Healthcare Accreditation Institute who set the tone for the day by providing an Overview Application of Lean Thinking to Healthcare.  I think it is absolutely brilliant that Thailand’s Healthcare Accreditation Institute had the foresight to invest in Lean and sponsor demonstration projects in several hospitals.  They clearly see the link between Lean and quality!

Next  Dr. Cherdchai Nopmaneejumruslers, Assistant Dean in Quality Development, Siriraj Hospital gave an introduction to the theory of Lean touching on topics such as value vs waste,  the ‘House of Lean’ (similar to our ‘House of Rouge’), common  Lean tools, operational excellence, value stream mapping and visual management.  He also talked about error rates and adverse events.  Did you know that the rate of preventable deaths in hospitals is comparable to the error rate for airline baggage handlers? Dr. Cherdchai is a respirologist who trained in Canada at (U of T, McMaster and UHN). He is the only one I came across so far who can relate to the frigid temperatures in Canada in January.

The third speaker was Asst. Prof. Dr. Roengsak Leetanaporn, Director, Songklanagarind Hospital. He gave a series of small lectures on specific aspects of Lean thinking including: Benefits of Continuous Flow, Cycle Time, Takt Time, Cell Concept, Batching, Workload Leveling, Error Proofing and A3 problem solving. For each topic, he gave an example from his hospital.  His hospital currently has 300 Lean projects on the go of varying size and complexity!

One of the most interactive and enjoyable parts of the day was a Patient Simulation Exercise organized by Dr. Cherdchai and his team from Siriraj Hospital.  It was a fun exercise similar to ones we have used at RVHS but using Lego.  At the end of the exercise we showed how improving processes (without increasing staff or space) could lead to more patients being seen, better quality (reduced defects), improved cost-effectiveness and improved morale.  The results made true believers out of everyone in the room, especially the doctors.  (Look for this exercise at Rouge Valley in the coming months!!)

Two things struck me about Day 1 of the conference. First, the similarities in Lean implementation between the Thailand hospitals and Rouge Valley.  Like us, they are using 6S, A3 thinking, surgical safety checklists, standard order sets, value stream analysis and kaizen events. Their discharge planning whiteboards, complete with “EDD” look exactly like ours! They have even surpassed us in some areas. For example, they have implemented Kanban systems for inventory management.

The other thing that impressed me immensely is that we sat in a room for an entire day and talked about the benefits of Lean.  Yet no one ever mentioned cost-cutting – only improving quality and ‘making patients happier’. No matter what part of the world you live in, that is what Lean is all about. 

Read Bangkok Blog#1 

Read Bangkok Blog#3 

From Rouge with Lean

Bangkok Blog#1 - Written on Sunday, Jan. 23, 2011
By Michele Jordan
VP Quality Improvement and Transformation, RVHS

When we started our Lean journey at RVHS who would thought that a mere two years later, people half way around the world would be interested in hearing our story.  Yet here I am in Bangkok where I’ve been invited to speak at the Seminar on Regional Sharing on Lean in Health Care.

So how did this come about?  In late November I received a telephone call from an individual who works in the Modernization Branch of the Ontario government. He said that he had heard me speak about Rouge Valley and Lean at a conference in Toronto several months prior.  The Ontario government has links with governments in many other countries and he has been doing some work with the Asian Productivity Organization (APO). The APO has existed for 50 years. They have promoted Lean in the manufacturing sector for many years but recently decided to explore the potential to deploy Lean widely in the service sector, including health care. He said the APO was holding a conference on Lean in hospitals and the organization would be interested in having a Canadian speaker.  He recommended me and with the support of our CEO, I was pleased to accept the invitation. All expenses are completely covered by the APO so there is no cost to the hospital for participating in this wonderful educational event. 

The conference runs from Monday, January 24th to Friday January 28th.  The first two days are a standard conference format with some of the best Lean experts in Asia scheduled to speak.  The next two days will consist of site visits to three hospitals in Bangkok that have been participating in Lean since 2008.  Lean was introduced into these hospitals as a demonstration project sponsored by Thailand’s hospital accreditation body and by the APO. I will have a chance to see the improvements these hospitals have made and contribute to an evaluation of their progress.  From the advanced reading materials I received it looks like all hospitals have made impressive progress.

I will speak at the conference on Tuesday afternoon and Thursday night. The week promises to be very busy and a great educational opportunity.  I will update this blog daily to ensure that interested individuals at Rouge can share in the learnings.  So stay tuned.

Read Bangkok Blog#2 
Read Bangkok Blog#3 

Happy New Year: Looking forward to more successes in 2011

By Rik Ganderton, President and CEO

Hello everyone and happy New Year to all!

Thank you to everyone for your dedication to our patients and all your hard work in 2010. The year marked another huge step in our progress to becoming the best community hospital in Canada. We again served and treated more patients than in the previous year.

Our emergency departments (ED) at both hospital campuses — Rouge Valley Ajax and Pickering (RVAP) in west Durham and Rouge Valley Centenary (RVC) in east Toronto — saw and treated record numbers of patients during the year. In fact, December was a record month for both sites. Thanks to all of you — whether in the ED, on an inpatient unit or providing support services — who showed up for work over the holiday season and contributed to managing this record patient load.

From a quality perspective, we maintained or improved our record of making Rouge as safe as possible for our patients, families and staff. We are still challenged to ensure that our hand hygiene habits are the best in the industry, and I look forward to relentlessly pursuing this goal with you in 2011!

Operationally, we had another successful year, and we anticipate — on a financial-year basis — that we will again achieve our budgeted surplus. This will mark the third year in a row of success in managing to a surplus, and will bring to a successful close our three-year deficit elimination plan. Achieving surpluses allows us to reinvest in our facilities and equipment that have been so neglected for so many years (see our previous blog on this). Behind the scenes we have completed major, multi-million dollar replacements of our boilers (at RVC), while more obvious items for frontline staff include new monitors and infusion pumps. At RVAP, our major redevelopment is almost complete and we have opened the new complex continuing care unit; the ED has been open for more than a year; and the new ambulatory care area, lab and diagnostic imaging space are in use.

People development is core to our success. We have been able to invest significantly in training and developing our people. We continue to invest in the Late Career Nursing Initiative, we are expanding our investment in training of frontline nurses and other clinicians, and we continue to provide training for our managers in the use and deployment of Lean tools (read how Lean helps our patients). We have also run a very successful (and ongoing) program for our managers and leaders, called Advanced Leadership Foundations (ALF). This program is aimed at equipping all our managers with the skills and competencies needed to lead our organization. (Read about the ALF program in one of earlier blog posts).

Operating efficiently and delivering on what we commit to also means growing credibility with our funders (the Central East Local Health Integration Network — and through them, the Ministry of Health and Long-Term Care). This translates into real and tangible benefits for our patients, our communities and our staff. Examples include new funding for 20 new transitional restorative care beds at RVAP (read more about this new unit in our December 2010 Echo newsletter), as well as the recent announcement of operational funding for a new MRI at RVAP as well (see news release from CE LHIN). At RVC, we have enjoyed significant funding increases for the Birthing and Newborn Centre; for additional surgical volumes in a variety of specialties; for additional MRI operational funding; for a new coronary care unit bed; and support for the very successful implementation of Code STEMI program, which fast-tracks emergency care for people who experience a heart attack in our communities (learn more about Code STEMI). In fact, as I write this, I am sure there are lots more successes — they are just too numerous to recall!!

I fully expect 2011 to be as busy and successful as 2010. We will publish our new strategic plan early in the new year, and we will be starting an ambitious major capital plan which will see us, amongst other things, replace the Siemens catheterization lab and install a third cath lab so that we can meet our regional commitments to cardiac EP. We will also try to do some visible sprucing up of our facilities, including a "lick of paint" here and there to make the place look better!

Of course, we will continue to drive innovation and operational excellence so that we can continue to benefit our communities, make RVHS a place where all of us are proud to work, and allow us to invest in our people so that we can be the best.

Again thank you all for a tremendous year in 2010, and I look forward to an even more success in 2011.

I wish you all a healthy, happy, safe and successful 2011.

Regards to all!

Reinvesting $2 million in our hospital - Thanks to staff and doctors’ teamwork

By Rik Ganderton, President and CEO

Rouge Valley knows how to close a calendar year on a high note.

In fact, I’d say this is a trend – thanks to not only hard work, but also smart work by our staff, physicians and volunteers.

In the three years since we introduced our Deficit Elimination Plan and then Lean, we have gone from the hospital that “couldn’t” improve, to the hospital that “could” and does improve for its patients – everyday.

Following-up on a blog by my colleague – John Aldis, vice-president of corporate services and chief financial officer – Rouge Valley Health System finds itself in the enviable position of generating modest surpluses. As John said, “Efficiency is contagious.”

As a result, we have some very real reinvestments to make in our existing hospital services and facilities at both campuses.

So the Christmas, Hanukkah and happy holiday gift that our staff and physician team at Rouge Valley have delivered to our patients and community comes in two big packages. This is on top of the $650,000 in recently approved additional capital investments that John talked about.

Gift number one –
$1 million for 2010-11 Approved One-Time Expenditures

Our strong year-to-date financial performance has generated $1 million, which we have decided to invest in 24 important one-time items this fiscal year, including:
• Education and training for staff in critical care, emergency department, diagnostic imaging, labs, paediatrics/neonatal intensive care unit (NICU), labour and delivery, and biomedical engineering;
• Various minor repairs, renovations, and upgrades to hospital facilities;
• Stereotactic (surgical) biopsy supplies;
• Emergency department patient navigator role, for four months;
• And more.

Gift number two –
$1.09 million for 2011-12 Approved Budget Reinvestments

There is also $1.09 million in service reinvestments budgeted for the 2011-12 fiscal year that will go toward additional staff resources in key areas:
• Five medical short stay beds at Rouge Valley Centenary;
• Intensive care unit staffing;
• Pharmacy staffing to support medication reconciliation;
• New manager of quality, who will support implementation of requirements of the Excellent Care for All Act;
• Information technology project management; and
• Patient services representative staffing.

As the year 2010 comes to a close, I want to thank all staff, physicians and volunteers for putting our hospital in such good shape for the New Year and into 2012.