LEAN: Change in Saskatchewan
LEAN: Change in Saskatchewan
Director, Pharmacy Services
Saskatoon Health Region
Reduce waste and
improve quality and
performance by long
term changes in
• Lean principles profoundly
enhance patient satisfaction
and safety, quality, efficiency
• Improve clinical outcomes by
firmly establishing the
infrastructure necessary for
long term results
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
4. Establish a cascading measurement and reporting
system to support greater system transparency and
Establish organization and infrastructure
Educate organization in basics
Make rapid improvements
Implement management system
Visibility and accountability
Identifying a common vision;
Setting short- and long-term goals;
Tracking progress toward those goals; and,
Changing course as required.
Managers with staff
VPs with Directors
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
• “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
• 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
3. Engages Others
4. Achieves Results
Accountability and performance
5. Develops Coalitions
6. System Transformation
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 2012 2013
• 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
• Tell at a glance what and how you are doing
• Create daily awareness of important areas, e.g. safety
• 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!
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
3. Who is your customer and supplier and what is the feedback
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
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
“In a rapidly changing
environment, it is vital that
team members frequently
resynchronize their efforts,
and flexibly adapt to current
“A visibility wall without gemba walks is just wall
“A gemba walk without a visibility wall is just a
‘Shaking hands and
• What IS your job?
• What are you trying to accomplish today?
• How do you know if you are doing this work
• What do you do if you have a problem?
• What improvements have you made lately?
• Respect to the people who do the value
• Look for signs of disrespect toward workers,
• 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
• 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)