Loretta Hrenyk says she is excited about making changes, and the Lean Improvement Leadership Training (LILT)* program has given her the tools and capacity to engage other staff members in identifying and solving problems.
“I love change. I’m always thinking, is there a better way to do something?” says Hrenyk, a Nurse Educator on the Victoria Hospital’s Level 4 (Surgical Unit). When she saw the results of rapid process improvement workshops, and how those changes were made, she was excited by how this might make a difference.
“Before Lean, I think lots of people wanted to make changes, but there was no standard way to do it. Now there is a process to identify problems, discuss them, and figure out ways to make improvements.” (Loretta Hrenyk)
While she was somewhat surprised to have her name put forward for the LILT program, Hernyk said her only apprehension was the time commitment. “Like anything in your learning, there are quite a few tools. It can be challenging to go back to the student role,” Hrenyk said. “Understanding the tools and how to use them takes time. I was a little overwhelmed by the papers.”
With several modules and project work for each of them, Hrenyk wondered how that would be managed; however, now that she has completed the program she is excited about how she can use what she learned to improve patient care.
Cathy Suchorab also had her own doubts about taking the LILT program. Her hesitation had more to do with her own experiences as a manager, and wondered what value the time commitment would add.
“I had managed before, so I felt like I knew how to manage,” said Suchorab, a Nursing Unit Manager at Herb Bassett Home. She acknowledges that the training changes how she approaches managing.
“One of the important things I learned is the visibility of going on to the gemba and talking with your staff and getting their input. It has helped in terms of staff morale, because I get their feedback about what they want to see.”
One of her key learnings occurred when they did a value stream map of the admission process at Herb Bassett Home. They identified that it was taking a long time to complete the admission after the resident arrived, and that there were often gaps in communicating among the care team about the residents’ specific needs.
“I was surprised that we were not organized ahead of time on admissions,” Suchorab said. Charts were not always ready, equipment was not in the room, and many trips were made to get things during the admission meeting with the resident and family.
After the changes, everything that is normally needed – from clinical information to equipment – is now in the room 30 minutes prior to the resident/family arrival. The key information is going into the care plan, and it is documented and other staff members (especially the continuing care aides) can more easily know what is required when working with the new resident.
One of the key improvements Hrenyk has seen on the surgical unit is the use of visual daily management boards. It includes a white board behind the nurses’ station, where they can post memos, and the information is constantly updated so that staff members know it is important to review it. Hrenyk said it helps her as an nurse educator ensure all staff have the opportunity to review new information on a timely basis.
An improvement project she worked on during the LILT training was to address challenges for identifying specific patient needs, including food restrictions, fluid restrictions, risk of falls, etc. The notices were not easily obtained, and were not always posted or easy to find. Hrenyk said it took a lot of time and effort to make sure notices were posted.
“We asked staff for advice and we created a sign system that is on the doors and sticks with magnets,” Hrenyk said. “The signs are right there, and you just turn it over if you need it, and if you don’t you just flick it back and it is blank. That was a real good time saver for the nurses. You don’t waste time looking, and the signs are always in the right place for the right patient.”
Hrenyk said she is starting to see a change in culture from staff members on her unit. “I love to hear the staff, some of them identify something that is not going well, they say: ‘That’s not lean.’ The next part is getting them to take the ownership, and say: ‘I can do something about it.’ We need to develop that in them.”
Suchorab said that changing how people look at their daily work, including her own, has been one of the most important improvements – including getting daily feedback from staff members. “I like to think that I did that before, but now I’m consciously doing that to make sure that I’m getting their feedback,” she said. “This is a more detailed and structured report, which is better.”
Suchorab said some staff members have started doing 5S, identifying areas that need attention. She is pleasantly surprised to seeing initiative being taken by staff members she was not expecting it from – people who may have been reluctant before they say saw other results.
“I tell them you don’t have to wait for me. They know what is safe or not, or things we don’t need. Let’s just do it,” she said, noting that the improvements are focused on resident care, but also make a difference for the employees.
“If you are going to improve resident care, you are going to make it better for the staff as well.” (Cathy Suchorab)
* What is LILT?
The Lean Improvement Leaders Training (LILT) is an applied learning program created by Saskatchewan’s Health Quality Council. It is designed to develop improvement leaders who manage and direct care, services and processes, and help them learn to use Lean tools and philosophies in their areas. The program covers core concepts in the Saskatchewan Healthcare Management System that the learner can apply to both daily continuous management and improvement, and their roles as process owners, content experts and sponsors in kaizen events such as Rapid Process Improvement Workshops.
By the end of the program, learners will be able to:
- Use Lean tools to identify key improvement opportunities for staff and patient experience;
- Improve safety and quality, optimize flow and reduce waste;
- Use data to understand current state, guide improvement work and monitor and sustain unit/area progress, while maintaining focus on patient / client needs; and,
- Demonstrate continuous improvement as part of daily practice.
All PAPHR managers are expected to complete LILT or Lean Leader Training. Participants attend an in classroom workshop where key concepts for nine modules are reviewed. There are hands-on assignments to practice using the skills and concepts in their work areas. For each practical component there is a report out and evaluation, where participants share what they have learned and receive feedback.