Dr. Joy Dobson has been called a Lean enthusiast.
“The reason Lean methodology is my favourite tool for fixing problems is its unique ability to make the problem visible,” says Dobson, a physician consultant with 3sHealth. “It allows us to measure what is actually happening, and track our performance over time to see that we have made – and are sustaining – an improvement.”
Recent headlines suggest the return on investment for Lean is non-existent or is too costly. Dobson disagrees.
We are caught up in this cycle of demonizing Lean. I would argue it is having a positive impact and the potential for future improvements and savings is mind-blowing.” – Dr. Joy Dobson, physician consultant with 3sHealth
Lean is not unproven, she adds. Toyota, Virginia Mason – a Seattle-based health care organization – and General Electric have used it.
“It is helping us to bend the cost curve – we just haven’t been used to measuring the right things in the right way,” she says. “For example, let’s talk about dark green and light green dollars. They both matter.”
Bending the cost curve
Dark green dollars are the tangible savings; the reductions in spending that are visible in budgets. Light green dollars are the ones you free up and can redirect to other priority areas, or the amount of time saved when staff efforts are spared non-value added tasks and instead can do other work that is meaningful to patients.
“I’ll use transcription as an example of light green dollars savings,” she says. In the current state, some of the doctors are hand-writing the notes – a very time-consuming method of updating a patient record. In other areas, a dictated note may wait for transcriptionists to type up each word of a dictated report. These delays in the process mean the right information doesn’t get where it needs to be.
“The new transcription process allows the clinician to speak into the phone, have their words appear as a transcribed report, make any needed edits, and then push a button to have it appear everywhere it has to be. How much time would be freed up in their day to see the next patient or make the next improvement in their work? We struggle with how to capture that but it is a real quality improvement that impacts patients and caregivers directly and immediately.”
Dobson has always been passionate about quality improvement and it goes hand in hand with cost savings.
Measuring for success
“When you measure for quality improvement, it is critical that you track results over time; you can’t use a randomized controlled trial because it asks you to manipulate a single variable in a select population. In a real life, complex environment where work is actually done, you can’t control everything that way. That’s the key distinction when trying to prove that a complex culture and business approach and a management methodology has impact – you can never control for a single variable.”
Dobson believes the health care management system adopted by Saskatchewan is finally allowing the sector to behave as one and move together in the same direction – putting the patient at the centre of every single improvement.
“For the first time in my 30-plus years in health care, we have a way to tackle big, systemic problems,” she says. “We have a business mindset to focus on providing great value to our customers – the patients and taxpayers of this province. We have a way for frontline staff to see and know – in real-time – how we are doing. They already live the problems along with the patients and have ideas about the solutions. Lean and the continuous improvement approach let them test them immediately to see if they work.”
Success and failure are part of the process
Many Lean transformations will fail as we learn and test the methodology but Dobson believes we are getting better together every single day.
“Failures don’t mean the tool doesn’t work. I can’t run a marathon if I say I’m going to train and then only do it for two months and say it’s too hard and I’m quitting or I don’t like the route or my clothes aren’t pretty enough or you’re making me wear green and I only like red. Sorry, we’ve said we’re running a marathon; let’s train together and let’s do it. And when there comes a hard part, I want you to hold my hand when I run up the hill and maybe we even stop and say we’re going to pause and catch our breath here but we are not turning around and going backwards.
“We’re doing it. We have the leaders who say this is the way we’re going to work; we’re going to focus on what the taxpayers in this province truly value and need. And we’re going to find a way to deliver that reliably and in the right way the first time, every time.”
Photo: Dr. Joy Dobson using new voice recognition technology for physician dictations.