Hoshin Kanri in Saskatchewan, Canada

Bonnie Brossart, Jim Rhode and Suann Laurent

IHI National Forum

Session C14

December 11, 2012

1:30 pm – 2:45 pm

These presenters have nothing to disclose

Session Objectives

• Describe the key attributes of a strategic planning process that

embraces continuous improvement principles and puts those who

use the health system first

• Identify how a specific strategic planning process - Hoshin Kanri

- can be used to build a shared narrative, create inspired

cultures and facilitate health system transformation

• Apply these tools and learnings in other health systems

2

Who we are:

Bonnie Brossart

CEO

Health Quality Council

Suann Laurent

President and CEO

Sunrise Health Region

Jim Rhode

Board Chair

Saskatoon Health Region

3

Some Context

Saskatchewan

5

Saskatchewan's health care system:

• 13 Regional Health Authorities

• 1 provincial Cancer Agency

• 5 hospitals in 2 cities with >

225K pop; 61 other hospitals in

smaller centres

• 156 nursing homes

• 13 home care programs offered

via RHAs

• approx. 2000 physicians

(mostly FFS)

• Aboriginal health services

(federally funded) 6

Key events… Quality as a Business Strategy (2008-2010)

7

Key events…

Patient First Review (October 2009)

• “Patient First” must be

embedded as a core value in

health care

• Health care in Saskatchewan

needs to function as a cohesive

system

• Frontline providers must be

empowered to deliver patient-

and family-centred care.

8

Key events… Strategic and Operational Directions (2010-11)

9

Key events: expression of the health care

system’s strategic intent (2011)

10

Key Events: A commitment to establishing

a World Class Management System (2011)

Hoshin Kanri

Daily

Management

Cross

Functional

Management

Adapted from John Black and Associates, LLC 11

Implementing a

World Class Management System

Daily Management

Cross Functional Management

Hoshin Kanri

Time

Adapted from John Black and Associates, LLC 12

Saskatchewan’s Implementation of a

World Class Management System

Daily Management (Continuous Daily

Improvement using LEAN)

Cross Functional Management

Hoshin Kanri

Time

Adapted from John Black and Associates, LLC 13

What is Hoshin Kanri?

It is an approach to planning that involves:

• Identifying a common vision

• Setting short- and long-term goals

• Executing plans to achieve those goals

• Tracking progress toward them

• Changing course as required

Hoshin Kanri = Management by Policy = Strategy

Deployment = Hoshin Planning

In Japanese, hoshin means shiny

metal, compass, or pointing the

direction; kanri means management

or control.

Purpose: Provide focus and

direction; alignment throughout an

organization

Approach: Requires a high degree

of participation through all levels

of the organization. Operates in

both a top-down and bottom-up

fashion. 15

Hoshin Kanri in Action

Goals were developed from the top down to all levels of the

organization. The goals were few in number, but they enabled

the enterprise to mobilize its total resources to achieve the

desired results. The deployed goals plus the control of daily

work moved the enterprise down the desired path. Each

member of the organization understood the path the

organization was taking.

Bruce Gissing, Executive Vice-President Operations

Boeing Commercial Airplane Group, 1991

Source: John Black and Associates, LLC 16

The straight goods…

The discipline of Hoshin

Kanri is intended to help

an organization:

• Focus on a shared goal

• Communicate that goal

to all leaders

• Involve all leaders in

planning to achieve the

goal

• Hold participants

accountable for

achieving their part of

the plan 17

Hoshin Kanri Characteristics

• Focus on a few key breakthrough improvements (or

hoshins)

• Alignment of the entire organization (or health care

system) around these breakthroughs

• Shared input and responsibility for plan and goals

• High participation throughout the organization

• Equal attention to end results and the methods for

achieving them

18

Breakthrough vs daily improvement

Characteristic Daily Management

Improvement Projects

Breakthrough

Improvement Projects

Performance leverage Continuous improvements

that change performance

over time

Significant leverage

changing performance

Magnitude of

Improvement

Smaller Larger

How many Many, incremental Few, most important

How long? Year after year, ongoing 3-9 months; temporary

Improvement focus Improvements made

within daily work team

Requires changes in cross

functional processes and

service delivery models

Source: John Black and Associates, LLC 19

Breakthrough vs daily improvement

Source: John Black and Associates, LLC 20

Hoshin Kanri in Saskatchewan

21

2013-14 Hoshin Kanri

22

Diagnosis and Review

• Analysis of performance data;

comparison of actual to

expected results

• Joint problem solving and

agreement on follow-up actions

• Determine what needs to

continue, be improved, have

correction action

• Are goals being achieved?

23

Reflection

“Reflect” on the Saskatchewan

health care system environment

and the past year’s performance.

Answer the following:

Where are we today?

What barriers must we overcome?

What opportunities await us?

24

Strategy Development

25

Catchball

• is about dialogue

• involves obtaining input on

plans

• ensures an organization (or

system) has the process

capability to accomplish the

goal(s)

• is a natural, healthy process

of give and take when

setting priorities, assigning

resources, and specifying

targets

• is messy and iterative

process, at least to start

26

Finalize and deploy the plan

Reflect on feedback received from the

system and reach consensus on a final

plan for the entire health system.

Determine accountability for the plan

and a system for course correction and

reviewing progress on system targets

and outcomes.

Throughout organizations, ensure clarity

and understanding of the final provincial

plan, to deselect organizational work

and update project plans accordingly 27

Ongoing monitoring

Ongoing assessment and

monitoring of progress

towards desired results.

Unit level: daily huddles

Organizational: weekly wall

walks

Provincial Leadership Team:

quarterly wall walks 28

What is a

Strategy Deployment Matrix?

A visual tool for outlining an organization’s strategic destination over 3-5 years. It

contains: foundational strategies, 3-5 year outcomes, necessary 3-5 year

improvement targets and 12-18 month breakthrough initiatives 29

Foundational Strategies

Triple Aim Plus: Embracing “The Betters” 30

3-5 year Outcomes/Results

“Big Dot” results the health system is trying to achieve. They

describe the health system we want to see in the next 3-5 years. 31

3-5 year Improvement Targets

Improvement targets specify what specific improvements or things need

to be done to achieve the 3-5 year outcomes. 32

12-18 month Hoshins

These are the short term (12-18 month) improvement projects and

are the most important areas for ‘focus and finish.’ 33

Saskatchewan’s Implementation

of Hoshin Kanri

We are here

34

Saskatchewan’s Implementation

of Hoshin Kanri

Vision without action is just a dream 35

Saskatchewan’s Implementation

of Hoshin Kanri

Our commitment to

and ambition of

“thinking and

acting as one” is

unprecedented!

36

Saskatchewan’s Implementation

of Hoshin Kanri

Working differently

means we are

embracing the

complexity of

Saskatchewan’s

health system and

the challenges we

face.

37

Saskatchewan’s Implementation

of Hoshin Kanri

We are building

and nurturing

strong, respectful

relationships with

each other across

our health system

38

Saskatchewan’s Implementation of Hoshin Kanri

We are cultivating

the discipline

required to stick

to and be

successful in

attaining our

ambitions

39

Saskatchewan’s Implementation

of Hoshin Kanri

We are encouraging and

embracing curiosity

among each other and

throughout our

organizations

40

Some last words from our

colleagues back home Insert video here

Over to you…

42