In what other industry besides health care would the customer be forced to wait time and time again? With the risk of harm so high, what other industry would get away with it?
With those two questions, Saskatoon Health Region Chief Executive Officer Dan Florizone launched into an explanation of the Lean system of health care management in Saskatchewan. He was speaking to staff at the Sun Country Health Region’s annual Quality Summit this spring.
“If airlines shared the level of harm caused by health care systems, airplanes would go down constantly,” he said. “And, for staff, it’s safer to work in construction or the mines, any industry other than health care in Saskatchewan.”
Florizone said he’s worked in health care a long time and the old system of cutting costs behind closed doors was heartless and difficult. “We were cutting things we needed; we reduced programs and services that patients needed. But we didn’t know what else we could do.”
Then, in 2005, facing similar pressing budget issues, Florizone went to Virginia Mason Hospital in Seattle to examine the Lean system in a health care setting.
“I thought I knew what was going on in health care from the number of statistics I received regularly. But the truth is different on the Gemba. The truth is learned on the floor, where the evidence and experience is. The picture is far more complex and diverse than any briefing materials had ever indicated. It was the first time I had walked in the shoes of a patient.”
Florizone says Lean seems to be all about saving money and efficiencies but what he found was that it was about putting the Patient First through incremental improvements.
“Before the experience at Virginia Mason, I didn’t know we could measure value and waste.”
“The real key is these every-day improvements that are inspired by thousands of people working in the system. The ideas don’t come from administrators or doctors and nurses but from ward clerks and housekeepers and maintenance people.”
“We found that as soon as we broke down the hierarchy in the teams working on solving problems, the ideas came. And as soon as people had the ability to ask the right question, idea-generation went way beyond what it was before. “
“The group can achieve far more than any individual working alone. A CEO can do a lot but doesn’t know a lot. Front line staff members know a lot but can’t do a lot. As soon as value to the patient became central to the question, waste was reduced and then we saw we could save money at the same time. Creating a patient-centred system is a better alternative than cost-cutting.”
Health care systems have always done improvement projects, said Florizone. The difference using Lean is that Saskatchewan health care has gone back to the fundamentals.
“We’re creating learning organizations that work through problems. We’re not trying to change health care people into manufacturers or health care settings into factory hospitals. Those already exist: patients walk from room to room or sit in a waiting room waiting for service. That’s the Henry Ford design. That’s how health care has been designed in the past, around wasting time and resources.”
“We are going way beyond that,” says Florizone. “ We can learn things from other service sectors. If the hotel industry has a system that knows when its customers are coming in and whether they need a parking space, why can’t the health care system do the same?”
Florizone says forget about saving dollars; think about how much waste you can eliminate. Waste can be time, resources, materials, anything that’s used to provide health care services. Think about what you do that is waste, he advised, and continue to ask why it’s done that way.
That’s the way the system will change.