lean thinking - provincial health services authority · lean thinking: less is more a spaghetti...

LEAN THINKINGFostering innovation in BC

OCTOBER 2012

“Every system isperfectly designed to achieve the results it gets.”

Edward Demming

ABOuT THE PROvINCIAL HEALTH SERvICES AuTHORITy (PHSA)

How we serve BCThe first organization of its kind in Canada, PHSA plans, manages and evaluates specialty and province-wide health care services across BC. Collaborating with the five geographic health authorities, PHSA works to ensure that everyone in the province has access to the kind of specialized health services they need, when they need them, wherever they happen to live. PHSA achieves this goal by providing leadership to agencies, services and projects under its jurisdiction.

PHSA Agencies• BC Cancer Agency• BC Centre for Disease Control• BC Children’s Hospital & Sunny

Hill Health Centre for Children• BC Mental Health & Addiction

Services• BC Provincial Renal Agency • BC Transplant• BC Women’s Hospital & Health

Centre• Cardiac Services BC• Perinatal Services BC

PHSA Divisions• BC Emergency Health Services• Health Shared Services BC

PHSA provides a number of pro-grams and services directly, includ-ing the BC Autism Assessment Network, and the BC Early Hearing Program. Through the Lower Main-land Service Consolidation Initiative, PHSA has assumed accountability for Interpreting Services and Pathol-ogy & Laboratory Services across the Lower Mainland, and Information Management & Information Technol-ogy Services for Vancouver Coastal Health and Providence Health Care.

PHSA also plans, coordinates, evaluates and, in some cases, funds specialized services delivered by the regional health authorities, including thoracic surgery, to ensure accessi-bility, quality, efficiency and effective-ness of province-wide delivery.

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Edward Demming

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Lean Thinking

Health expenditures have grown at a rate more than twice the rate of growth of GDP over the past 20 years and at nearly quadruple inflation rates in this decade. Increasing demand for services coupled with waiting lists and budget constraints are threatening the sustainability of our health care system and creating stressful work environments. At the same time, health care is under increasing scrutiny from the public and politicians to increase its focus on the quality and safety of patient care.

There is a growing realization in Canada that in order for the system to stabilize and become sustainable, the focus needs to be on value, defined as health care outcomes per dollar spent and the balance between cost and equality, rather than focusing solely on the numerator or the denominator, like many past attempts at health care reform. Or, to state it in its simplest terms, we need to specify value from a patient’s perspective.

In a patient-centric system, sometimes, more value means “less”. For example, the Lean case studies like those above that cut wait times enabled PHSA to increase the numbers of patients who receive service, using the same resource base.

THE HEALTH SySTEm – SHIFTING TO A LEANER PARAdIGm

Lean means more. More quality outcomes, a more engaged workforce, more focus on client needs, more effectiveness, more sustainable processes.

Lean means less. Less human effort, less inventory, less processing time, less space, less cost, less waste.

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An 84% reduction in the time a patient with an eating disorder waits from referral to receive treatment; 86 days to 14 days.

A 78% reduction in wait time at the Cardiac Services Pre-admission Clinic (which prepares/assesses a person’s ability to withstand surgery) from 71 to 15 minutes.

A 32% reduction in the length of time a sick child spends in BC Children’s Pediatric Intensive Care Unit (PICU) from an average of 5.5 to 3.7 days.

Quality improvement research has proven that the average large organization wastes 70 – 90% of its available resources.

LEAN THINKING: LESS IS mORE

A spaghetti diagram is a simple tool commonly used in Lean methodology to trace the “flow of medicine”; for example, flow of patient, providers, supplies, equipment, information, food during the course of a work process. This visual representation can be quite revealing often resulting in a streamlined work flow that cuts wasted time and energy and allows people to work “smarter”.

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Before

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LEAN 101: wHAT IS IT?

“Lean thinking” is derived from the Toyota Production System. It is an innovative approach to the systematic elimination of waste in every process in an organization. Its goal is to be highly responsive to customer needs and demand by enhancing the quality of products or services (i.e. ‘outputs’, or outcomes in health care terms) and providing them in the most cost-effective manner possible with less human effort, less inventory, less processing time, and less space (i.e. less ‘inputs’). Lean has been widely adopted in the manufacturing industry over the past two decades and more recently across other industries. It has transformed organizations having a dramatic effect on quality, productivity, and cost.

best practices in health careThe application of Lean principles to health care is relatively new and showing great promise as an innovative approach to addressing the challenges and increasing pressures facing the health care industry. Lean examines every component in the patient’s journey focusing on those that add value to the care process and eliminating

those that do not. Standardization and minimization of variance in the value-added components are key themes in Lean that, when applied to health care, lead to improvements in the quality and safety of care.

Lean promotes the evaluation, uptake and dissemination of best practices and standards so that patients receive safe, high quality care and the best health outcome possible. Through the elimination of non-value added components, i.e. ‘waste’ from workflow, such as waiting, inventory, overproduction, etc. Lean redirects time and energy not only sustaining but also enhancing programs and services while managing within a fiscally-constrained environment.

Furthermore, Lean creates improvements by putting problem solving into the hands of those who do the work and encouraging teams to work together in a collaborative way to find solutions. Having staff and physicians meaningfully involved in the improvement of the system not only taps their intelligence and expertise, it also the increases morale by creating a more engaged workforce thereby enabling better retention and attraction of scarce health human resources.

Lean examines every component in the patient’s journey focusing on those that add value to the care process and eliminating those that do not.

Lean creates improvements by putting problem solving into the hands of those who do the work.

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Lean 201

phsa pioneers leanPHSA was one of the first health organizations to adopt Lean as the “way we do business”. The Lean journey began in 2005, when Lean was first introduced as a process improvement methodology. The greater potential to make a significant difference within the health system was soon recognized. In early 2007, PHSA made a bold commitment to adopt Lean thinking as a key organizational strategy. The name “imPROVE” was adopted to reflect PHSA’s unique approach to Lean. It is an acronym based on the organizational values which have guided the implementation:

• Patients first• Results matter • Open to possibilities• Best value• Excellence through knowledge

imPROVE is a management system that empowers employees at all levels to remove waste and maximize value for the patient. Over the past five years, Lean has been strategically and systematically implemented throughout the PHSA not only to improve organizational performance, but also to foster a culture of innovation and continuous improvement throughout the organization.

LEAN 201: PuTTING LEAN INTO ACTION

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A 75% improvement in the turnaround time in accessioning in labs at BC Children’s Hospital and BC Women’s Hospital – from 96 hours to 24 hours, meaning that specialty physicians in the hospital receive information they need to make critical diagnoses 3 days earlier.

An 83% improvement in the turnaround time from referral to the booking of an appointment at the BC Cancer Hereditary Cancer program. Wait time for a patient visit went from 42 days to 7 days.

A 65% reduction in the time from court referral to admission in the Forensic Psychiatric Hospital, which went from 10 days to 3.5 days.

A 50% reduction in the time a patient waits to get a diagnostic breast image after a referral (from 14 to 7 days) while at the same time increasing the capacity/ number of patients seen by 30%.

a 30% increase in the capacity at the TB clinic (from 250 to 325 patients) at the BC Center for Disease Control.

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imPROVE

LEAN 201: THE imPROvE PROGRAm AT PHSA

patients FirstThe first step in Lean is to specify value from the patient’s perspective. This is done by mapping the patient journey through the health care system. A ‘value stream’ mapping exercise examines not only our own care and processes but also studies the interfaces with our care partners so that an integrated system is created along the continuum of care. This process creates inter-disciplinary, cross functional teams who discover previously unexplored synergies and solutions.

best ValueOnce the patient journey or value stream has been mapped, the components are analyzed to identify those that add value to the patient care process and those that don’t, to eliminate waste from workflow. This is the basic premise of Lean – better efficiency and therefore stewardship of taxpayers’ dollars, by optimizing value within available resources.

Waste is eliminated through rapid cycles of improvement, one week in duration (“Rapid Process Improvement Workshops”, or RPIWs”) that deliver tangible results, where staff are empowered to seek improvement by redesigning, testing and implementing the new process within that week. Similar, but smaller in scope are “Kaizen” events that last 2-4 days and focus on a smaller process.

excellence through KnowledgeThe RPIWs are led by leaders within PHSA with the greater purpose of creating a culture shift where doing things better, faster and without error becomes the only performance standard – in other words, a way of life. In order to support this, PHSA has created an extensive Lean education program comprised of a technical component and an applied component that requires leaders to become certified in lean thinking.

results MatterThe key to Lean transformation is its management system that provides infrastructure and standard work to regularly track key metrics, improvement progress, and staff

suggestions all aimed at providing the safest and best possible care. At PHSA, Performance Walls are being established where leaders review progress in achieving the value stream and associated RPIW goals in weekly stand-up meetings. Formal quarterly reports are presented to the agency executive teams to track progress and identify areas needing support to adjust course.

open to possibilitiesA Lean culture means that the organization encourages employees to actively seek and act on solutions to problems; that it’s open to possibilities and to challenging the status quo. Since the goal of Lean is to uncover problems and inefficiencies in the current system, people can often feel that their job security is threatened. To give staff the space and security to think differently and encourage innovative ideas, PHSA has made an Employee Promise that no one will lose employment as a result of participating in lean and creating “efficiencies”.

imPROVE is framed by the organizational values at PHSA.

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LEAN 201: mEASuRING OuR SuCCESSPHSA LEAN HIGHLIGHTS 2007 – 2012 CHART 1 PHSA now has several years of cumulative data related to its experience with applying Lean methodology. Close to 200 RPIWs have been conducted. Shorter kaizen events were also introduced in late 2011. The charts on the following pages highlight some of the more recent results and areas of improvement.

Key Result AReA

Agency leAn ImpRovement objectIve bAselIne ActuAl Result

ImpRovement

QualityBCCA Reduce the number of hand-offs for

abnormal mammography result entries from 4 to 1

4 hand-offs 0 hand-offs 100%

Quality

BCCA Increase percentage of new breast tumour patient referrals that meet the processing lead time target of 4 days (or less) from 30% to 70%

31% 100% 223%

QualityBCCA Reduce percentage of physician orders

incorrectly completed on the 2nd floor from 69% to 0%

69% 1% 99%

QualityBCCH Reduce interruptions during Morning

Rounds to the Pediatric ICU Clinical Nurse Coordinators

18 interruptions 5 interrup-tions

72%

QualityBCCH Reduce percentage of defects in the

use of the Pain and Sedation tool and discuss in Pediatric ICU rounds

74% 2% 97%

QualityBCCH Reduce defects per week in sterile

package failures in the OR Core19 defects per week

2 defects per week

89%

Quality

BCCH Decrease number of defects per day in collecting and transporting lab specimens from Pediatric ICU to BCCH Labs

15.9 defects per day

0.6 defects per day

96%

QualityBCCH Reduce percentage of incomplete

orthopedics sets reaching the OR Core from SPD

28% 12% 59%

Quality

BCWH Reduce the number of visits by post partum women to the Assessment Room for pain management from 10 to 8 per period

8 visits per period

5 visits per period

38%

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LEAN 201: mEASuRING OuR SuCCESSPHSA LEAN HIGHLIGHTS 2007 – 2012 CHART 2

QualityBCWH Reduce lead time (hours) for results

received to clinician for review in Medi-cal Genetics Clinic

80 hours 28 hours 65%

QualityBCWH Reduce percentage of untabbed results

in Medical Genetics charts100% 16% 84%

QualityBCWH Reduce time for routine basic IV

change by two RNs from 27 minutes to 8 minutes in the Neonatal ICU

27 mins 9 mins 67%

QualityBCWH Reduce percentage of defects (missing

information) at Diagnostic Ultrasound patient visit from 25% to 0%

25% 8% 68%

QualityBCMHAS Reduce percentage of PreSentence

Reports not completed within five days of court date

10% 8% 20%

QualityBCMHAS Reduce defects in compliance with

guidelines for content of PreSentence Reports

18% 6% 67%

QualityBCMHAS Reduce defects in the Eating Disorder

Care Paths being utilized for inpatients100% 2% 99%

QualityLabs Decrease Quality Control failure rate

for Serology Labcell5% 1% 80%

QualityBCCDC Decrease defect rate for contact tracing

of an index case and all related Type 1 contacts from 100% to 35%

100% 29% 71%

QualityBCCDC Decrease defect rate (% of required

items completed on time during orien-tation period) from 48% to 10%

48% 24% 50%

SafetyBCCA Reduce defect rate for medication

reconciliation at discharge100% 0% 100%

SafetyBCCA Decrease patient wait time in the Am-

bulatory Care Unit from 14 minutes to 7 minutes for patients on active treatment

14 mins 5 mins 64%

Key Result AReA


ImpRovement

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Safety BCCA

Reduce number of charts leaving Am-bulatory Care Unit with unprocessed orders for chemo patients from 5 charts per day to 0

5 charts per day1 chart per day

80%

Safety BCWHReduce defects in medication reconcili-ation at hospital admission to 0%

70% 40% 43%

Safety BCWHReduce patient lead time (minutes) from decision for Urgent AVD or C Sec-tion to patient ready for the OR

27 mins 15 mins 44%

Safety BCWHReduce percentage of Neonatal ICU patients where systems not presented in sequence from 60% to 0%

60% 10% 83%

Safety BCWHReduce defects (missing information) during nurse to nurse handover from 100% to 0%

100% 3% 97%

Safety BCWHReduce lead time of Priority 1 Patient from decision made to OR arrival from 34 minutes to 25 minutes

34 mins 28 mins 18%

Safety BCWHReduce percentage of physician orders not transferred to the Bedside Informa-tion Tool (BIT) from 100% to 0%

100% 0% 100%

Safety BCWHEliminate defects in Patient Bed Board Information - Discharge Goal and Acu-ity Status

100% 1% 99%

Safety BCWHReduce the percentage of charts without a complete oxytocin safety checklist from 66% to 0%

66% 10% 85%

Safety BCCHReduce defects in patient handover during Cardiac transfer from OR to Pediatric ICU, relating to role crossover

22 defects 0 defects 100%

Safety BCCHReduce defects in Inter-Hospital Trans-fer of Care process

38% 10% 74%

Safety BCCHReduce defects in Pediatric ICU RN shift to shift handover process

44% 0% 100%

Key Result AReA


ImpRovement

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Safety BCCHReduce the number of duplicate Pedi-atric ICU tests performed from 0.67 per patient per day to 0

0.67 per pt per day

0.02 per pt per day

97%

Safety BCMHASReduce lead time (mins) for initial shift assessment completion on Eating Disorders inpatient unit

348 mins 7.5 mins 98%

Safety BCMHASReduce lead time (minutes) for morn-ing medication set-up and administra-tion at Psychiatric Forensic Hospital

99 mins 65 mins 34%

Safety BCMHASReduce defect rate of internal Eating Disorders transfer of care process

53% 32% 40%

Safety LabsIncrease percentage of confirmatory serology samples tested within one day

7% 37% 429%

Safety LabsReduce lead time (hours) to report Tuberculosis molecular results

51 hours 38 hours 25%

Safety BCCDC

Increase percentage of medication reconciliation processes in compliance with Accreditation Canada standards from 0% to 100%

0% 99% % Change N/A

Safety BCCDCReduce the number of patient falls or near missed falls from 4 per month to 0

4 falls per month0 falls per month

100%

Safety BCCDCIncrease percentage of health care providers (physicians) checking for two client identifiers from 0% to 100%

0% 98% % Change N/A

Satisfaction BCCAReduce difference between scheduled appointment time to actual appointment time from 18 minutes to 0 minutes

18 mins 8 mins 56%

Satisfaction BCCAReduce patient waiting time at Am-bulatory Care Unit Reception from 30 seconds to 5 seconds

30 secs 5 secs 83%

Satisfaction BCCAReduce the number of voice mail mes-sages on the appointment line from 100 per day to 50 per day

100 messages per day

55 messages per day

45%

Key Result AReA


ImpRovement

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Satisfaction BCCAIncrease the response time by the nursing help line to less than 60 min-utes for symptom-related calls

120 mins 20 mins 83%

Satisfaction BCCA

Streamline and standardize nurses’ work to be able to staff the Radiation Therapy patient nursing help line with a full-time nurse (from 0)

0 nurse 1 nurse % Change N/A

Satisfaction BCCHReduce lead time (minutes) for Pediat-ric ICU post-operative communication between surgeon and family

20 mins 3 mins 85%

Satisfaction LabsDecrease average wait time (seconds) for clients calling in to the Serology call centre

137 secs 34 secs 75%

Delivery BCCAReduce the turnaround time (minutes) in Operating Room (time patient leaves OR to time next patient enters)

17 mins 16 mins 6%

Delivery BCCAIncrease total number of procedures booked in OR1 from 3.1 to 5 every second Tuesday (target = 4.5)

3 procedures 5 procedures 67%

Delivery BCCAIncrease total number of surgical procedures booked on Tuesdays and Thursdays from 20.6 to 26 procedures

21 procedures27 proce-dures

29%

Delivery BCCAIncrease number of CT scans per-formed per day in Radiology

32 scans per day

37 scans per day

16%

Delivery BCCADecrease time from new patient ap-pointment to Oncology consult from 10.8 days to 5 days

11 days 7 days 36%

Delivery BCCADecrease percentage of patients not pre-registered one day prior to clinic appointments from 51% to 25%

51% 21% 59%

Delivery BCCAReduce percentage of clinics with physicians not arriving on time from 95% to 75%

95% 32% 66%

Key Result AReA


ImpRovement

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Delivery BCCAIncrease percentage of physicians’ leave with more than 90 days notice from 34% to 90%

34% 59% 74%

Delivery BCWH

Reduce Post Partum patient wait time (minutes) for discharge from when nurse deems patient ready to leave to actual discharge time

30 mins 24 mins 20%

Delivery BCWHReduce lead time (minutes) for booked C Section patient preparation


Delivery BCWHReduce lead time (minutes) within As-sessment Room


Delivery BCWHReduce lead time (minutes) for non-laboring APH patients < 32 weeks in the Assessment Room

176 mins 125 mins 29%

Delivery BCWH

Reduce patient admissions per day shift to Assessment Room for fetal as-sessment by improving utilization and capacity in the DAP NST clinic.

11 admissions per day


64%

Delivery BCWHIncrease labouring patient admissions per day to Single Room Maternity Clinic from 5 to 7.


6.6 admis-sions per day

32%

Delivery BCWHReduce percentage of defects of patients not being flagged for discharge from 100% to 0%

100% 1% 99%

Delivery BCWHReduce Neonatal ICU patient lead time (from bed availability to call ITT) on day of discharge from 180 minutes to 90


Delivery BCCHIncrease 5S score for Pediatric ICU large storage room

1.26 3.5 178%

Delivery BCCHReduce percentage of first case delays in Operating Room due to Pediatric ICU reasons

20% 0% 100%

Key Result AReA


ImpRovement

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Delivery BCCHDecrease the lead time (days) from referral to triage for Neurology outpa-tients

19 days 1 day 95%

Delivery BCCHReduce the backlog of referrals waiting to be booked (not requiring MRI)

493 referrals 49 referrals 90%

Delivery BCCHDecrease the percentage of defects in Pediatric ICU bed readiness to admis-sion

30% 5% 82%

Delivery BCCHReduce percentage of no shows in Neurology outpatient clinic

5% 3% 40%

Delivery BCCHReduce patient lead time (minutes) from arrival to Surgical Day Care Unit to completion of patient prep by RN

37 mins 22 mins 41%

Delivery BCCHIncrease percentage of occasions that patient goals and care plans are avail-able within 48 hours of Sunny Hill visit

1% 70% 69%

Delivery BCMHASReduce lead time (days) for PreSen-tence Reports from referral to case assignment

10.2 days 3.5 days 66%

Delivery BCMHASReduce lead time (days) from referral to initial assessment in Eating Disor-ders

65 days 8.5 days 87%

Delivery BCMHASReduce lead time (days) from initial assessment to treatment for Eating Disorders outpatients


Delivery BCMHASIncrease total number of Eating Disor-der outpatient clinic visits per week

9 visits per week16.5 visits per week

83%

Delivery BCMHASIncrease percentage of patients screened for Family Based Therapy suitability in Eating Disorders

3% 100% 3233%

Delivery BCMHASReduce lead time (days) from initiation of Inpatient Eating Disorders Care Plan to update


Key Result AReA


ImpRovement

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Delivery BCMHASReduce lead time (minutes) for meal set-up in Eating Disorders inpatient unit

22 mins 18 mins 16%

Delivery BCMHASIncrease percentage of patients and families that receive pre-admission care on Child Psychiatry inpatient unit

18% 100% 456%

Delivery LabsIncrease percentage of Serology samples accessioned by 10 am

19% 20% 5%

Delivery LabsReduce accessioning time (minutes) for Histopathology samples


Delivery LabsReduce pre-analytical lead time (min-utes) for Tuberculosis sputum samples

216 mins 168 mins 22%

Delivery LabsIncrease percentage of Histopathology H&E slides assigned before 2 pm

95% 99% 4%

Delivery LabsReduce number of Histopathology transcriptions left to complete at 4 pm

21 transcriptions

7 tran- scrip-tions

67%

Delivery LabsIncrease percentage of IHC slides ready for pathologist review within one day from sectioning

93% 100% 8%

Delivery LabsReduce ECG turnaround time (days) from time of tracing to upload in CAIS at BCCA site

38 days 21 days 45%

Delivery HRReduce lead time (days) from hiring package in outbox to package return to inbox at HR

32 days 21 days 34%

Delivery BCCDCDecrease time required (days) for new and refill prescriptions from order to shipping

12 days 2 days 83%

Delivery BCCDCDecrease overall client lead time from 30 days to 8 days from the date of clinic visit to final report printed

30 days 8 days 73%

Delivery BCCDCStreamline clinic schedule to increase overall client capacity from 250 clients to 325 clients per week

250 clients per week

69 clients per week

72%

Key Result AReA


ImpRovement

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Delivery BCCDCDecrease Pharmacy processing time for dispensing TB Field Operations medication from 3 days to 1 day

3 days 1 day 67%

Delivery BCCDCIncrease percentage of reports accu-rately completed and returned on time

75% 95% 27%

Delivery BCCDCIncrease Tuberculosis Clinic capacity from 300 clients per day to 325 clients per day

300 clients per day

325 clients per day

8%

Delivery BCCDCReduce number of unknown Tubercu-losis patients arriving at TB Clinic from VGH from 2 per week to 0

2 patients per week

0 patients per week

100%

Cost BCCHDecrease percentage of direct pur-chase items ordered by OR staff instead of Supply Chain

30% 4% 87%

Cost BCCHReduce percentage of overstocked locations within the OR Core

51% 16% 69%

Cost BCWHReduce set-up time to increase capac-ity for one additional surgery per day from 24 minutes to 20

20 mins 17 mins 15%

Cost BCWHReduce number of interruptions per hour in Oak Tree Clinic

9 interruptions0 interrup-tions

100%

Cost BCWHReduce number of Unit Clerk trips to the bedside to deliver lab results from 70 to 24 per day shift.

70 trips per day shift

17 trips per day shift

76%

Cost BCWHReduce lead time for Neonatal ICU patient Ward Rounds from 180 minutes to 150 minutes


Cost BCWH

Reduce Sonographer cycle time (from patient chart pick-up to patient dis-charge) from 58 to 40 minutes in DAP Ultrasound

58 mins 21 mins 64%

Key Result AReA


ImpRovement

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Cost LabsDecrease lead time (minutes) from Serology sample open and match to build to batch


Cost HISReduce number of loose filing pieces per day produced by Balsam Unit

3 pieces per day0 pieces per day

100%

Cost HISImprove accuracy of Winrecs (da-tabase) to decrease search time for charts by HIS staff

69% 85% 23%

Cost HISDecrease number of charts per day left in Return Cart at 8 am by Neurology Clinic from 10 charts to 0

10 charts per day

2 charts per day

80%

Cost HISReduce pieces of loose filing per day filed by HIS Clerks

14 pieces per day

0 pieces per day

100%

Cost BCCDCIncrease number of IGRA blood tests collected in Vancouver TB Clinic from 5 to 25 per week without adding staff

5 blood tests per week

22 blood tests per week

340%

Key Result AReA


ImpRovement

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“Together, we create a mosaic of the patient’s journey, carefully adding in all the pieces that make up the big picture of the patient’s journey.”

PHSA is also learning to apply Lean to facilities design with the site redevelopment of BC Children’s and BC Women’s Hospitals. This is the first health care organization in Canada to take on this approach to a major capital project.

Instead of the traditional approach to building design that has architects create concepts and renderings based on our assumptions at the outset of the project, we are using Lean principles and tools to assess our current state and reinvent our services. This new concept is a fiscally responsible use of tax dollars in that operating costs are 30 times higher than capital costs. Once a facility is built, 80% of the workflow is set and unlikely to be changed in the future.

The first of these tools is the “3P” workshop (production, preparation, process) that identifies ideal, efficient and waste free flows for our patients and their families, providers and staff, medications, supplies, equipment, and information.

The second is “Integrated Facility Design” (IFD). Using a massive, 140,000 square foot warehouse space, staff and patient representatives test several patient care scenarios and provider flows using full-floor mock-ups of the acute care centre. Spaces are created using eight-foot high cardboard walls which help teams better understand the physical space and bring two-dimensional drawings to life. Hands-on exercises allow event participants to rapidly lay out physical spaces, eliminate barriers and make adjustments to flows with the goal of continually improving the patient care experience. The new facility is scheduled for completion in 2017.

MoVing ForWard

As a learning organization, PHSA is committed to imPROVE /Lean as an innovative way to strive for and achieve organizational excellence in keeping with our values. Adopting this long-term, core management strategy requires both education

and a cultural shift that takes place year over year. We are moving toward adopting a formal Lean Management System (LMS). Our goal is to promote a culture where people are empowered as problem-solvers, working within teams with managers as on-site coaches, so we have added a coaching component as a co-requisite to Lean Leader Certification.

Components of LMS include “strategy deployment” to focus business goals and breakthrough objectives for improvements to care by ensuring they are actionable and understandable by all levels of staff; “cross functional management” for moving priorities horizontally across PHSA and encouraging systems-thinking; and “daily management,” to shift operations from fire fighting, to a systematic, fact-based, goal oriented style of leadership that works with staff to manage, sustain, and improve daily operational performance.

In doing so, we empower health care professionals to become increasingly patient-centric while driving waste from the system and making the best use of our scarce resources.

LEAN 301: FOSTERING INNOvATION IN BC

seven Flows of Medicine• flow of patient• flow of providers• materials• flow of information• flow of equipment• flow of process

engineering• flow of nutrition

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