Janet Harding Director, Pharmacy Services Saskatoon Health Region June 2013

Reduce waste and improve quality and overall system performance by long term changes in behaviour

Lean principles profoundly enhance patient satisfaction and safety, quality, efficiency and profitability Improve clinical outcomes by firmly establishing the necessary organizational infrastructure necessary for long term results John Black

1.Support the strategic alignment of health system priorities across the province 2.Boost health human resource capacity and capabilities related to quality improvement (skills, dedicate resources, leadership commitment) 3.Foster a culture of safety with the goal of zero defects 4.Establish a cascading measurement and reporting system to support greater system transparency and accountability

1.Establish organization and infrastructure 2.Set direction 3.System leaders 4.Educate organization in basics 5.Make rapid improvements 6.Implement management system 7.Visibility and accountability

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

 Diagnosis & Review Managers with staff Directors with Managers VPs with Directors  Reflection  Strategy Development Provincial Leadership Team  Catchball Vice Presidents Directors  Finalize the Plan Provincial Leadership Team  Finalize Region Plan  Deploy Plans Vice Presidents Directors Managers Is an annual learning cycle of review, adjust, implement and learn (aka PDSA)

A way of thinking about value Change management to promote behaviours with employees that are conducive to improvement “Too often management doesn’t get involved. They think they can pass it off to someone else – they see it as just those tools”

Over 4 years, 800 Saskatchewan health system leaders will receive in depth Lean training 55 days over a period of 18 months 11 days of classroom learning / seminars 3 Books, 10 modules Quizzes / Presentations 8 days of learning and implementing improvement as part of North American tours Virginia Mason, Seattle Children’s and AutoLiv 36 days in rapid process improvement Ongoing file, Report card

Assess the SHR structure and leadership based on value added criteria Create a health system around service lines rather than functional silos while ensuring that SHR’s structure is as flat as possible to ensure decisions are made as close to the point of care and service possible To 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 chart

1.Patient First Focus on patient safety Focus on value add for patients 2.Leads Self Demonstrates character and values Manages self Develops others 3.Engages Others Succession planning Communication 4.Achieves Results Financial stewardship Accountability and performance management 5.Develops Coalitions Teams Influence 6.System Transformation Lean training Lean modeling Daily management Champions and leads change

A 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

Mistake Proofing Examines 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, Act Stop the Line Anyone can recognize that there is a potential for harm or injury and can signal their concern STOP and RESPOND

16 Performance Metrics Gemba Walk Daily Visual Management

Tell at a glance what and how you are doing Create 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 issues Enables the manager to act proactively → Less firefighting ‘The pulse of the unit’ What you cannot see, you cannot manage! 17

1.What primary or support process are you part of? What is the purpose of this process? 2.How does your process create value for patients/clients/residents? 3.Who is your customer and supplier and what is the feedback process? 4.What is the rock in your shoe? What about your daily work keeps you up at night? 5.What are the safety risks for patients/clients/residents and staff? 6.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? 7.How do you know when things are not running the way they should be? 18

“In a rapidly changing environment, it is vital that team members frequently resynchronize their efforts, coordinate, communicate, and flexibly adapt to current situation.“ 19

“A 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’ 20

What 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?

Respect to the people who do the value creating work Look for signs of disrespect toward workers, especially overburden Look for signs of disrespect toward customers, poor quality or poor delivery Steadily take away each and every bit of non value creating “work”

Don’t 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, 2013

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)