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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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?
Lean and Patient- and Family-Centred Care strengthen one another.
Patient- and Family-Centred Care results in an environment where patients and families
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:
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?).
How it helps
Prairie North's Employee Health and Safety team has developed Root Cause Analysis Training.
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
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:
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:
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:
PDSA worksheet for testing change
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:
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:
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
Benefits to staff
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?