Lean Hospitals – Lean Healthcare

By Errol Black

During the recent discussions on changes to the formula for federal contributions to health care spending, Saskatchewan Premier Brad Wall signalled that his province (which is flush with resource revenues from potash and oil) could live with the new arrangements. At the same time, however, Wall suggested that a Health Care Innovation Fund be created to help fund significant innovations in healthcare in the provinces. A working group was subsequently established by the premiers to work on healthcare innovation. The working group is co-chaired by Wall and Premier Robert Ghiz, Prince Edward Island, and includes health ministers from provinces and territories.

Prime Minister Harper rejected Wall’s proposal to create an “extra fund” but said he would be interested in getting fresh proposals from the premiers on how to sustain Canada’s health-care system.

As it turns out, Wall and his Saskatchewan government are already moving forward with one innovation that could have a profound impact on heatlhcare delivery in that province and perhaps others. It is, moreover, precisely the sort of innovation that would appeal to Stephen Harper.

In recent years, the Wall government has been experimenting with the application of lean-management principles to in the healthcare sector. Early applications in the Five Hills Health Region in Moose Jaw apparently produced some promising results. So promising in fact that the CEO of the Five Hills Health Region, Dan Florizone, was recruited to pave the way for the introduction of lean-management principles and practices across the province to include “all of its 43,000 workers and managers.”

The plan will proceed in two stages. Phase 1 involves “strategy deployment” – or the establishment of priorities. Phase 2 involves getting all healthcare components – agencies, hospitals, councils, etc. – “thinking like a synchronized lean machine. Indentify waste, test a possible fix, evaluate the outcome and repeat. The cycle can, and should, go on forever.” The claim is also made that workers have bought into the process and are contributing input to design of the new Moose Jaw Union hospital and a new Children’s Hospital in Saskatoon.

An American consulting firm, John Black and Associates, is to provide the expertise required to transform the culture and shape the system to the lean philosophy.

All of this has its origins in the example of the lean production/ lean management methods of Toyota (much of which is reminscent of the practices of scientific management from the late 19th and early decades of the 20th centuries). The big push for the adoption of lean management in North America comes, apparently, from the Kaizen Institute, which bills itself as a “Global Leader in Continuous Improvement Strategy”.

It does indeed seem that Saskatchewan is on the “cutting edge” of innovations in healthcare delivery, although we suspect that this approach will have more to do with cutting costs and deskilling hospital workers than it does with enhancing jobs and improving healthcare services. This is a particular concern when American firms are recruited to lead the way in transforming the culture and shaping the system to the lean-management philosophy.

We need to know:

  • how workers and their unions feel about the approach to lean-management in Saskatchewan;
  • if similar approaches are underway or contemplated in other jurisdictions in Canada;
  • and, if the federal government has signalled that this approach is approved as an example of the sorts of private-public-partnerships they would support.

This is potentially the start of a fundamental change in the way our healthcare services are delivered, and we will be keeping a close eye on how things progress in Saskatchewan.

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