Turning St. B into a lean machine

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Dr. Bruce Roe (left) and Dr. Michel Tetreault have embraced lean initiatives at the hospital.

When the doctors in charge of St. Boniface Hospital wanted ways to provide better health care and ultimately reduce mortality rates, they turned to local aerospace firm Standard Aero.

Who else?

While it might seem incongruous, there are actually many similarities between repairing airplane engines and healing patients. In both cases, specialists won't know exactly what they're working on until the "patient" comes through the door. The problems have to be diagnosed quickly, a plan of action needs to be developed, the necessary skills must be marshalled and performed and the handiwork sent out the door.

St. Boniface Hospital president, Dr. Michel Tetreault, said bottlenecks have long occurred in the health care system because hospitals "give great people broken processes and expect them to do good work."

So, St. Boniface has adopted lean manufacturing, which essentially reverts back to the basics of a process and eliminates all of the unnecessary steps that have been added on over time. While making such adjustments seems the obvious thing to do, it wasn't always smooth sailing. Tetreault said some health care workers resisted changing things they had been doing a particular way for many years. But once they saw how the streamlined processes made everything more efficient and boosted the level of patient care, they quickly became "big fans."

For example, a pair of nurses who gave a demonstration of the new bedside shift report, whereby a departing nurse updates her replacement at the patient's bedside, rather than dictating into a tape recorder in a back room, said this and other lean initiatives help reduce errors, such as when patients receive their medication or how much.

The new reporting method was initially introduced on one ward but when word spread of its success, it was quickly adopted throughout the hospital.

St. Boniface, a member of the Healthcare Value Leaders Network, a group of medical experts from around North America committed to a "full organizational transformation" using lean principles, hosted 15 others members from the group for two days this week.

Dr. John Toussaint, president of Wisconsin-based ThedaCare Center for Healthcare Value, said many of the processes hospitals have used for many years are "defective and wasteful." By removing the waste, hospitals are able to "collapse" time and improve quality, he said.

One of the lean success stories at St. Boniface has been time-saving practices for nurses. After tracking nurses on the job, hospital staff found they spent an average of 45 minutes per shift "looking for equipment and other stuff." Using a lean principle, supplies were moved to a specific area, complete with labels and regular restocking from another employee in the supply area, and the amount of wasted time was reduced to 15 seconds per shift.

"The improvement has been put back to patient care. There's more time at the bedside," Toussaint said.

"These are all manufacturing principles, they've been applied to health care and they work. Patients are more satisfied, they don't wait as long, they spend more time with their nurses and the quality (of service) is better."

Internal processes aren't improved by external experts, according to Brian Lanoway, a former Standard Aero executive who provided lean consulting services to St. Boniface for two years. Instead, they're improved by the people involved with them every day, such as nurses, orderlies, clerical staff and patients.

Bringing the process out in the open is often another way of improving matters. He cited the discharge process, which has historically been a great mystery to patients, as a prime example.

But after putting the process up on white boards in the wards, which let patients and their families keep track of their status and when they might be going home, rather than keeping it hidden in binders, the mystery has been removed and patients are happier.

"For any patient, their prime concern is 'Where am I in the process, what's next and am I receiving the right care at the right time?' The patient is a key part of this and if they participate in the process, it reduces anxiety and stress," he said.

geoff.kirbyson@freepress.mb.ca

Republished from the Winnipeg Free Press print edition April 28, 2010 B1