In late 2007, St. Boniface Hospital’s executive team recommended a bold, yet simple lean transformation strategy to our board of directors – quality is the strategy.
Previous improvement strategies had had limited success. We were frustrated with our ability to sustain meaningful quality improvements. I was persuaded we could do much better by our patients. The Board overwhelmingly agreed this was the approach we had to take to improve care. This was not to be a project or a trial, but a way of doing business at SBH.
We started slowly. We went to see other facilities engaged in the process to learn from their experiences. We made it clear at the outset: staff, physicians, patients and families would be involved, and no employment would be lost as a result of process improvements. We explicitly stated this was all about delivering better care to patients.
Our goal was to rapidly improve results on SBH’s True North: satisfy patients, engage staff, do no harm, and manage resources.
In the first years we focused on introducing lean tools to senior leadership and managers, and on learning to use them together. However, we were still challenged to sustain transformation gains despite being armed with a fully-stocked lean toolbox.
Today we recognise that in our eagerness to move forward, we were not always practising the behaviours we were preaching, and that tools are only as good as people’s ability to understand them. The answers could not be found in the boardroom. Change could only happen with the commitment and engagement of everyone at St. Boniface Hospital, especially frontline staff. We came to realise communication is about so much more than putting out messages – it is about listening. We learned to engage staff by listening to their feedback and responding to the information we heard.
“Working effectively with leadership and managers is central to our success. To this end, in the past year, we developed a management system to regularly and intentionally hold “catchball” conversations between senior managers and their
One of our most successful transformations involved the surgery programme, one of the first to introduce lean problem solving to several of its units at SBH. Surgery inpatient, pre- and postoperative units and clinics were spread over six floors throughout the facility, causing multiple movements for patients, staff, and families.
After 18 months of extensive lean problem-solving activities, we brought all 19 surgery outpatient flows together on one floor, adjacent to the operating room. This eliminated 15,000 elevator trips and multiple hand-offs, thus improving patient care. The “surgery on the move” project affected where and how staff work and the work they do. This could not have been made possible without early improvement efforts to prepare staff for the bigger changes.
Two years ago we started to notice a culture shift at SBH. All employees – senior executives, directors, unit managers and front line staff – began proposing initiatives to improve care and, most importantly, these initiatives were increasingly focused on improvements linked to our True North.
Individuals who recently joined the organisation have commented on our culture, and on how things are different at St. Boniface Hospital.
Since 2008, more than 1,200 employees and physicians from all departments of the hospital have been involved in transformation activities. Our leadership team has grown to appreciate the benefits of being focused and clear, the rigour involved in addressing the right problem, setting targets, developing and attending to completion plans, monitoring results, and adjusting plans as needed.
We have developed clear mechanisms to hear the voice of patients, through the creation of a Patient and Family Advisory Council, daily leadership visits with patients at the bedside, satisfaction surveys, critical incident reports, and most importantly, patient and family participation during process improvement initiatives. Their voice is essential to our success.
We have accomplished some great things, and we are a better hospital now than we were five years ago. We focus on what matters most, our True North. We have clear three-year goals and annual targets for each. We believe that if we satisfy patients, engage our staff, and do no harm we will manage resources and move closer to our vision of care.
In 2012, 85% of patients rated the overall quality of care they received as very good or excellent (our goal is to achieve a 95% or higher rating). Staff engagement is at an all-time high (scores are 58%, up from 41% before we began our lean transformation; our goal is 65%). Most importantly, St. Boniface Hospital has reduced occurrences of unexpected harm to patients by 30%. The Canadian national average for unexpected harm to patients is one per cent. St. Boniface Hospital’s average is 0.7%. Although we did not embark on our lean transformation journey to save money, thanks to our transformation efforts in 2012 we treated four per cent more acutely-ill patients with the same resources as the previous year.
The SBH board of directors focused senior leadership on sustaining our quality goals in 2012, and spread training and knowledge more deeply throughout the organisation. Working effectively with leadership and managers is central to our success. To this end, in the past year, we developed a management system to regularly and intentionally hold “catchball” conversations between senior managers and their direct reports. These conversations are an opportunity to focus and bring attention to True North, results achieved to date, and the actions and counter-measures to achieve breakthrough results.
Our focus for breakthrough is attending to patient flow throughout the hospital. Managers have identified patient flow is the top priority to positively impact patient outcomes, manage access to beds, and decrease length of stay from admission through to 30 days post-discharge.
Extensive improvement in several units will involve patients, staff, physicians and families and provide insights on the beginning-to-end journey of patients as they flow throughout the hospital. Ultimately, improvements will spread to all clinical areas and involve all areas in the hospital. The goal is to attend to the right steps at the right time, every day, to remove risks, delays and waste, and to provide the best possible outcomes for patients.
Lean is more than just words and a set of tools – it is becoming the way we do business. This journey is not without obstacles. I like to say we make great mistakes, and each is an opportunity to learn and do better. Our members of staff are passionate about patients, and are seizing opportunities to share their ideas and solutions to improve patient care on a regular basis.
When St. Boniface Hospital was established by the Grey Nuns in 1871, they were present in every department, every day. Lean transformation is helping us return to our roots and our traditions.