The province of Saskatchewan has gone further than any other Canadian jurisdiction in implementing health system process improvements using Lean, a production line discipline that originated with the automobile industry. These reforms involve just-in-time inventory managements, waste reduction and systematic quality improvement techniques that rely on behavioural changes in the health workforce.
Influenced by similar reforms in the United States (e.g. Virginia Mason) and the National Health Service (NHS) in England, Lean process reforms have been scaled up to include virtually all health organizations and providers in a province of 1.1 million people distributed over a large land area. The reform was led by the Saskatchewan Ministry of Health, which is responsible for funding almost all public health care services, although most are delivered by regional health authorities and other arm’s-length health organizations.
Lean continuous improvement offices – known as Kaizen Promotion offices – have been established throughout the province. The ministry, through the consultant John Black & Associates, is conducting an extensive suite of training for health care managers, staff and clinicians including physicians, most of whom work as independent contractors. A larger number of health system “leaders” are currently undergoing provincial Lean certification, with 250 managers having already received their certification by 31 March 2013.
Lean methods have now been applied to numerous units and departments in all of Saskatchewan’s larger hospitals as well as the majority of its medium-sized facilities. The ministry is currently working with the province’s regional health authorities and physicians to spread Lean to community care and primary care organizations and facilities. The 2012-14 collective agreement between the Saskatchewan government and the largest union in the provincial health system – the Saskatchewan Union of Nurses – explicitly stated that the union would co-operate with the government on Lean initiatives.
Lean became a policy priority for the provincial government for two main reasons. First, it fits well with the provincial government’s stated desire to bend the cost curve in health spending. Second, Lean provided a tool to implement the patient-centred reforms recommended in the Patient First Review, an arm’s-length advisory body that issued its report in 2009. The provincial government was also highly influenced by a 2008 study tour to England that focused on Lean initiatives, including a sessions led by the NHS Institute for Innovation and Improvement.
An independent evaluation of the province’s Lean initiatives is being managed by Saskatchewan’s Health Quality Council, in a partnership with academics at the University of Saskatchewan and other universities.
For an analysis of this reform, see: https://escarpmentpress.org/hro-ors/article/view/1180