"The Largest Lean Transformation in the World": The Implementation and Evaluation of Lean in Saskatchewan Healthcare

Kinsman, Leigh; Rotter, Thomas; Stevenson, Katherine; Bath, Brenna; Goodridge, Donna; Harrison, Elizabeth; Dobson, Roy; Sari, Nazmi; Jeffery, Cathy; Bourassa, Carrie; Westhorp, Gill

doi:10.12927/hcq.2014.23880

Cited by 26 publications

(20 citation statements)

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“…This study was conducted within a publically funded health care system in the province of Saskatchewan, Canada (population 1 million), after government implementation of a multimillion‐dollar investment in the Lean management system (Kinsman et al, ). All 13 health regions in the province, comprised of secondary and tertiary hospitals, community health centres, ambulance and emergency services, support care, home care, mental and rehabilitation, were included in the roll‐out.…”

Section: Methodsmentioning

confidence: 99%

“…When transferred to health care, Lean is described as comprising two defining characteristics: (a) philosophies , or a set of principles, aimed at transforming the workplace culture and focusing on continuous improvement by eliminating waste, improving flow of patients, providers and suppliers, and processes; and (b) assessment activities or analytic tools that identify waste and improvement activities (Rotter et al, ). Ultimately, the aim of Lean is to facilitate access to cost‐effective, high‐quality and innovative health care that puts the patients and direct‐care providers at the centre of determining what care is optimal, and what essential resources are required to achieve the best patient outcomes (Kinsman et al, ). However, Hines, Found, Griffiths, and Harrison () suggested the intent, though enticing, was reported by many institutions to be unsustainable.…”

Section: Introductionmentioning

confidence: 99%

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Nurse managers implementing the lean management system: A qualitative study in Western Canada

Udod

Duchscher

Goodridge³

et al. 2020

J Nurs Manag

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Aim This study explores the perceptions and experiences of nurse managers involved in implementing the Lean management system in a Western Canadian province. Background The provincial government of Saskatchewan, Canada, implemented a multimillion‐dollar investment in the Lean management system to transform health care delivery by reducing waste and increasing efficiency of processes and outcomes. Methods This qualitative exploratory study employed semi‐structured interviews with 14 nurse managers in urban and rural health regions in one Canadian province. Results Six themes outline the difficulties nurse managers experienced in juggling role responsibilities alongside a poorly implemented change system with scarce resources. Conclusion The results showed tensions in the implementation of a Lean model adapted in the context of health care organisations. The expectations for nurse managers to be pivotal players in the implementation of transformative health care practices that promote and sustain strategies to reduce waste, improve coordination and increase patient safety require investment in leadership development. Implications for Nursing Management Lean management systems significantly impact the roles of nurse managers who require adequate resources and training to successfully adapt. The results of this study may be used for more effective support mechanisms for nurse managers.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nurse managers implementing the lean management system: A qualitative study in Western Canada

Udod

Duchscher

Goodridge³

et al. 2020

J Nurs Manag

Self Cite

View full text Add to dashboard Cite

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“…The need to simultaneously improve the quality of health care (patient outcomes) and reduce health care costs has been widely recognized nationally and internationally [1–4]. In the United States, a value-based health care delivery system – where payments are based on outcomes rather than the volume of services rendered – is increasingly being pursued as a solution, thanks in part to the passage of the Affordable Care Act [5; 6].…”

Section: Introductionmentioning

confidence: 99%

Second-Opinion Interpretations of Gynecologic Oncologic MRI Examinations by Sub-Specialized Radiologists Influence Patient Care

et al. 2015

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Purpose To determine if second-opinion review of gynaecologic oncologic (GynOnc) magnetic resonance imaging (MRI) by sub-specialized radiologists impacts patient care. Methods Four hundred and sixty-nine consecutive second-opinion MRI interpretations rendered by GynOnc radiologists were retrospectively compared to the initial outside reports. Two gynaecologic surgeons, blinded to the reports’ origins, reviewed all cases with discrepancies between initial and second-opinion MRI reports and recorded whether these discrepancies would have led to a change in patient management defined as a change in treatment approach, counselling, or referral. Histopathology or minimum 6-month imaging follow-up were used to establish the diagnosis. Results Second-opinion review of GynOnc MRIs would theoretically have affected management in 94/469 (20%) and 101/469 (21.5%) patients for surgeons 1 and 2, respectively. Specifically, second-opinion review would have theoretically altered treatment approach in 71/469 (15.1%) and 60/469 (12.8%) patients for surgeons 1 and 2, respectively. According to surgeons 1 and 2, these treatment changes would have prevented unnecessary surgery in 35 (7.5%) and 31 (6.6%) patients, respectively, and changed surgical procedure type/extent in 19 (4.1%) and 12 (2.5%) patients, respectively. Second-opinion interpretations were correct in 103 (83%) of 124 cases with clinically relevant discrepancies between initial and second-opinion reports. Conclusions Expert second-opinion review of GynOnc MRI influences patient care.

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“…As Saskatchewan embarks on a provincial wide implementation of Lean a formal evaluation is ongoing and will consider previous research of Lean [43]. …”

Section: Discussionmentioning

confidence: 99%

One size does not fit all: a qualitative content analysis of the importance of existing quality improvement capacity in the implementation of Releasing Time to Care: the Productive Ward™ in Saskatchewan, Canada

Hamilton

Verrall

Maben

et al. 2014

BMC Health Serv Res

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BackgroundReleasing Time to Care: The Productive Ward™ (RTC) is a method for conducting continuous quality improvement (QI). The Saskatchewan Ministry of Health mandated its implementation in Saskatchewan, Canada between 2008 and 2012. Subsequently, a research team was developed to evaluate its impact on the nursing unit environment. We sought to explore the influence of the unit’s existing QI capacity on their ability to engage with RTC as a program for continuous QI.MethodsWe conducted interviews with staff from 8 nursing units and asked them to speak about their experience doing RTC. Using qualitative content analysis, and guided by the Organizing for Quality framework, we describe the existing QI capacity and impact of RTC on the unit environment.ResultsThe results focus on 2 units chosen to highlight extreme variation in existing QI capacity. Unit B was characterized by a strong existing environment. RTC was implemented in an environment with a motivated manager and collaborative culture. Aided by the structural support provided by the organization, the QI capacity on this unit was strengthened through RTC. Staff recognized the potential of using the RTC processes to support QI work. Staff on unit E did not have the same experience with RTC. Like unit B, they had similar structural supports provided by their organization but they did not have the same existing cultural or political environment to facilitate the implementation of RTC. They did not have internal motivation and felt they were only doing RTC because they had to. Though they had some success with RTC activities, the staff did not have the same understanding of the methods that RTC could provide for continuous QI work.ConclusionsRTC has the potential to be a strong tool for engaging units to do QI. This occurs best when RTC is implemented in a supporting environment. One size does not fit all and administrative bodies must consider the unique context of each environment prior to implementing large-scale QI projects. Use of an established framework, like Organizing for Quality, could highlight the distinctive supports needed in particular care environments to increase the likelihood of successful engagement.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0642-x) contains supplementary material, which is available to authorized users.

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"The Largest Lean Transformation in the World": The Implementation and Evaluation of Lean in Saskatchewan Healthcare

Cited by 26 publications

References 0 publications

Nurse managers implementing the lean management system: A qualitative study in Western Canada

Nurse managers implementing the lean management system: A qualitative study in Western Canada

Second-Opinion Interpretations of Gynecologic Oncologic MRI Examinations by Sub-Specialized Radiologists Influence Patient Care

One size does not fit all: a qualitative content analysis of the importance of existing quality improvement capacity in the implementation of Releasing Time to Care: the Productive Ward™ in Saskatchewan, Canada

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