Kaizen Basics is a mandatory education course for all employees that has been offered throughout the province since 2012. The course has recently been revamped, based on past participant feedback. Most managers, directors and senior leaders in Prairie North have taken an older version of Kaizen Basics - this overview is meant to provide you with an understanding of what is being taught in the new class. Leaders are also encouraged to attend the full session again, if possible.

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Meet Connie.

Connie Guhl is a patient in Lloydminster. She has stage 4 breast cancer, and her husband is recovering from colon cancer. Click here to hear how she describes 'quality health care.'

Connie's story is used as a starting point for discussing the concepts of quality and quality improvement in health care.

"Quality health care means doing the right thing at the right time in the right way for the right person and having the best possible outcome." - Agency for Healthcare Research and Quality

Overview of the Lean Approach

At its core, lean is focused on developing people to be able to improve processes to continuously deliver value to the customer. For us, lean is a philosophy of investing in our people to provide the greatest value for patients, residents, clients, their families and communities. Lean is a way to make care safer and optimize flow.

How is this approach different from past quality improvement projects and innovations in Saskatchewan's healthcare system?

• Improvements are informed by patients and families
• Entire system - clinical, support, community - learning a common "language" for improvement
• All employees in the health care system to be involved
• Involvement and commitment from Senior Leadership
• Infrastructure created to support ongoing improvements
• Collaborative provincial priority setting
• Focus on visibility and accountability

Lean and Patient- and Family-Centred Care strengthen one another.

• The focus of the Lean work in healthcare is to improve the system from the perspective of the patient.
• Lean work focuses on improving the safety and quality of care for patients.

Patient- and Family-Centred Care results in an environment where patients and families

• feel welcomed, respected and supported.
• are offered choices that respect their preferences.
• are informed of their plan of care and given access to information to help them make decisions.
• are clear who is involved in their care and participate with their providers in their care.
• have access to programs and services which promote choice and control.

In this short video, patients share their experiences of being included in improvement work.

Making Improvements Every Day: The Improvement Process

Removing 'muda' or waste from the system is a key concept. Identification of problems and waste is the launch pad for every improvement we do. Lean challenges us to look at processes from the perspective the patient and define waste vs. value from their point-of-view.

The seven types of waste are: overproduction; waiting; transportation; overprocessing; inventory; movement; and defects.

The Improvement Process

Generally speaking, improvement will follow these four basic steps:

1. Identify Improvement Opportunities: What needs to be better for patients and staff?
2. Setting Targets: What does 'better' look like?
3. Testing Changes: What ideas do we have to make things better?
4. Implementing Improvements: How do we ensure the change 'sticks'?

Identify Improvement Opportunities

There are many tools for identifying and understanding the problem you are trying to solve. What they all have in common is that they are about learning from the current state (what is really happening? what does the data show us?) and getting down to root cause (why is this happening? what would really impact this problem?).

Prairie North's Employee Health and Safety team has developed Root Cause Analysis Training.

Setting Targets

Once we know what the problem is, the next step is to set our improvement target. Obviously we want things to be better - but what exactly does better mean? Our target should clearly describe the improvement we are trying to achieve.

Setting SMART Targets

S = Specific
M = Measurable
A = Aspirational and Attainable; Agreed-upon
R = Realistic
T = Time-specific

Testing Changes

Once we know what the current state is and we know what 'better' looks like, we need to generate as many ideas as possible to test ways of getting from here to there.

There are no right and wrong ideas at this point. Because we always test ideas before we implement them, we should try to keep an open mind and flex our creativity muscles.

Some questions to help think of ideas:

• Do other areas have a better way of doing this? Is there anything we could liearn from them?
• What ideas do our patients and families have for improving this? What have we learned from their feedback that we'd like to try?
• What can we learn from the way they do this in other sectors?

Use Idea Summary Sheets to document ideas.

When you have decided which idea to test, use the PDCA cycle - Plan-Do-Check-Act, a method for making small tests of change.

Advantages to using the PDCA cycle:

• Makes processes and learning explicit, which is especially useful for teamwork.
• Enables testing of ideas to customize change; evaluate side-effects; improve the idea based on learning and experience; and reduce risks.
• Promotes making improvements in 'bite-sized chunks'

Steps of a PDCA

We call it a PDCA cycle because one PDCA often leads to another. Depending on what happened in the DO step and what was learned in the CHECK step, the team has a number of options in the ACT step:

• Abandon the idea. Sometimes things just don't work. We call this a fail forward fast, because it gets us to the next good idea.
• Make adjustments.  Sometimes an idea has promise, but needs a few tweaks. Test again with the necessary adjustments.
• Adopt the change. The idea has worked out as hoped and there is agreement that it's a better way of doing things. Now it's about support for learning and following the new process.

PDSA worksheet for testing change

Implementing Improvements

Once we've trialed a change and determined it has had the desired impact, we need to ensure that everyone on the team is aware of this new way of working, as well as the reason for the new way of working. The new process is now the standard - and supporting it likely means the team needs to create standard work.

Standard work is a documented way of doing a process safely and consistently. It helps us see when things are working as expected... or not. Standard work can optimize flow, improve safety, and reduce waste.

Standard work can be improved - but only through the PDCA process with the agreement of the team.

Standard Work Template

Daily Visual Management: Using huddles and daily visual management to support improvements

One of the key lean tools that we use to support the improvement process is Daily Visual Management. This technique brings teams together to continuously improve and:

• provides a space and process for gathering improvement ideas from staff
• helps us incorporate data in managing our daily work, as well as longer term goals
• links our daily work to our overall mission
• improves communication flow with the team
• helps us see how our work connects to broader system goals

The visual management board (vizwall, as you many have heard it called) is only one part of daily visual management. The other key component is huddles - gathering around the boards and actively using the information to improve the daily work.

These are some guidelines for effective huddles:

• Select a consistent time
• Start and end on time
• Keep it to 10-15 minutes
• Take turns leading the huddle (not just the boss' job!)
• Ensure a blame-free culture
• Develop a standard agenda

Watch Lloydminster Hospital's daily facility huddle.

Access the Daily Visual Management library on Prairie North's Kaizen Sharepoint site.

Benefits of Lean - How lean can make care better for patients, families and staff

In this section during the full Kaizen Basics course, we review one example of improvement work from the Saskatchewan healthcare system that illustrates each benefit.

Benefits to patients and families

• Increased safety
• Decreased wait times
• Less walking for patients and families
• Better access to care
• Streamlined processes

Benefits to staff

• Better decisions based on data
• Enhanced safety
• More organized and efficient work spaces
• Empowering staff decision-making
• Visual cues to make it easy to do the right thing
• Reliable, standardized processes
• Better communication
• Ideas and improvement come from staff
• Reliable inventory system

Virtual Tour

The session wraps up with a virtual tour through the province, highlighting three specific case studies.

• Improved Patient Safety - Wascana Rehabilitation Centre

• Improved Staff Experience - E-Health Service Desk

• Improved Work Spaces - Organizing the Nursing Desk in the La Loche Emergency Room

• Improved Patient Experience - Turtleford's Riverside Medical Clinic (Click here to watch a video.)

A shift in thinking...

To make these kinds of changes requires more than just a set of tools or events. It takes a shift in thinking. It's not easy work, but we can make significant, meaningful, and lasting change in our healthcare system.

Lean and Patient- and Family-Centred Care are philosophies that we are using to improve health care for the patients of Saskatchewan.

What's one thing you can do to make things better tomorrow?