citizens first: saskatchewan’s “bold...
TRANSCRIPT
Citizens First: Saskatchewan’s “bold experiment” with implementing Lean throughout its public sector Dan Florizone, Deputy Minister of Lean and Education
October 2014
A better understanding of the Saskatchewan government’s commitment to and early journey
with Lean implementation
What I hope to leave you with:
What is Lean?
Lean is…
• A set of operating philosophies and methods that help create maximum value for customers (patients, students, citizens) by reducing waste (e.g., errors, waits, rework).
• This is achieved by engaging employees and customers in identifying issues and potential solutions.
Value Stream Map video – click to start
Lean is…
• A philosophy based on creating a culture of continuous improvement and respect for people.
• It is often referred to as a learning and management system.
• Quality is the goal, savings are a by-product.
Why Lean?
Context: Public Service Renewal
Why Lean? A compelling vision…
• “Citizens First” must be embedded as a core value
• Our government services need to function as a cohesive system.
• All employees must be empowered to deliver citizen-centred care.
• Citizens must be engaged in the changes
And a sense of urgency…
• Growing population with limited government resources
• Growing customer expectations
• Room for improvement: • Graduation rates • Preventable deaths • Workplace injuries • Waits for services
Benefits to Customers
• The benefit to the customer is that they receive:
– Exactly what they need
– When they need it
– In the quantity they need
– In sequence
– Without defects (a high quality, safe service)
– At the lowest possible cost
• Their voices and input are included in the design of services.
• They are engaged in identifying issues and helping to design solutions.
Student First Video – click to start
Patient First Video – click to start
Benefits to Employees
• Time, tools and support from leadership to solve problems immediately
• They are empowered to make changes that improve services for their client
• They are engaged in identifying issues and designing solutions that affect their customers and employees every day
• They feel their work has purpose and see the connection to the organization’s purpose
Employees using Lean – click to start
Benefit to Leaders
• Whole organization alignment to focus and finish priorities.
• Tools and knowledge to lead improvements in their areas.
• More fully engaged teams.
• Proactive identification of issues.
• The leader doesn’t have to know the answers, instead, Lean engages employees and customers (those with more knowledge on the process) to develop solutions
Our Journey
SK’s Lean Journey: Timelines
2006 Five Hills Pilot Project 2008 Ministry of Health Pilot Projects
2009 All Regional Health Authorities & Ministry of Health 2008 – 2009 Some Ministries 2010 All Ministries 2012-13 Select School Divisions & Post-Secondary Institutions 2013-14 Student First Initiated 2014-15 All School Divisions
The Plan
Modeling the approach at Health
1. Set provincial health strategy collectively (Hoshin
Kanri or Strategy Deployment)
2. Develop infrastructure to support and coordinate continuous improvement efforts
3. Build improvement science capability among leaders and the entire health care workforce (40,000 strong)
4. Connect learning and doing with achieving health system priorities via improvement events
It is an approach to setting provincial strategy that involves:
• Alignment to a common vision • Breakthrough Improvement • Executing cascading plans / metrics • Transparency and Accountability • Changing course as required
Hoshin Kanri = shiny metal or compass or “a ship in a storm going in the right direction”
Source: Pascal Dennis
#1 - Set Provincial Strategic Direction
“Think and Act as One”
“Think and Act as One”
“The magnitude of our vision is immense - to better serve citizens,
to encourage innovation and implement tests of change at all levels, and to continually pursue
excellence in public service.”
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Multiple Ministries - Lifecycle of the Offender
Multiple Ministries participated in an event to identify top issues and system gaps for common clients.
Watch Video Clip – click to start
Level 1 - Sector
Level 2 – School Division
Level 3 - School
Level 4 - Classroom
Cascading Data
in Education
System
Develop Infrastructure to Support and Coordinate Efforts
Example - Healthcare: o Central Support in a Provincial Kaizen Promotion Office
o Provincial leadership in a Guiding Coalition
o Quality departments or units transitioned to Kaizen Promotion Offices in all authorities, Cancer, Ministry, 3sHealth, eHealth
o Consistent, standardized approach and use of Lean tools
o Monthly standardized reporting
o Presently over 100 employees dedicated to improvement
o Aim to have 1-2% of workforce with deepened capability to lead
& do continuous improvement
#2 - Develop Infrastructure
• Premier and Cabinet • Minister Responsible for Lean • Deputy Minister Responsible for Lean • Management Services Council • DM Citizen First Committee • Lean Deployment Champions • Lean Leaders • Enterprise Forums • Central support • Multi-Year Lean Plans and Quarterly reporting at wall walks • Annual ministry reporting to DM committee • Annual All-DM progress assessment and refresh • Performance management (DMs, ADMs, Lean Deployment Champions)
Example: Leadership, Governance and Accountability Structures in Government
Building improvement capability among our leaders and workforce (40,000 in healthcare alone).
– Over 18,800 health employees and 4600 employees in government have lean foundational training
– Over 740 healthcare leaders (CEOs, VP, Directors, physicians and improvement staff) currently in Lean Leader Certification (80 days learn / do) and 158 are certified
– More than 300 government employees have completed 3-day Lean Leader training
#3 - Build Improvement Capability
• Learning and applying tools and methods via various improvement events
– More than 1526 lean improvement “events” in healthcare (880) and across government (646)
– Lean facility design in three major hospital builds, , integrated health care facility, primary care clinics, 9 joint-use schools
– Patients, students, families, and citizens participating in improvement events
#4 - Learning through Doing / Achieving Results
Average Improvements from Events in Healthcare (2012-2014)
Space (square feet) -31.1% > Office -20.9% > Clinical -33.7% > Storage -33.0% Inventory -53.0% Walking distance (feet) -48.5% > Patient -60.6% > Direct care -50.6% > Indirect care -52.7% Part travel distance (feet) -76.5%
Lead time (hh:mm:ss) -41.9% > Patient -55.2% > Other -34.3% Quality (defects reduced) -71.2% > Defects -70.4% > Standard Work -83.9% 5S (avg. score improvement) +35.0% Set-up time (hh:mm:ss) -77.4% Cycle time (hh:mm:ss) -64.3%
• A third less space required • Half the inventory
• Half the walking distance • 40% less time
• More than 70% reduction in defects (errors, lack of standards)
• Eliminated backlog of 2,200 out-of-country health claims
• 32% reduction in backlog of labour standards complaints
• Student loans processed in 2-3 days, down from 12 days
• SIAST international applications processed in 15 days, down from 90 days
• Horizontal well applications processed in 1 day, down from 30 days
• Payment process for Public Guardian and Trustee reduced to 1.5 days, down from 5 days
• Crown lands sales down to 76 days, down from 90 days
• Time to staff now 44 days, down from 100 days
• Speech therapy wait reduced from 8 weeks to 4
• Occupational therapy wait reduced from 18 to 7 weeks
Results in Government
To tackle this job, they turned to the 5Ss of Lean:
Sort - Keep only what is required. Set in order - Create a place for everything and put everything in its place. Shine - Clean and sweep the workplace regularly. Standardize - Create a 5S organizational standard. Sustain - Build the structure to maintain the established standard.
Results (cont’d)
• Employee – “This is not about govt. or the union or management. It’s about a person – a person who wants to provide service…this is one of the best things that I’ve done since I’ve been in the public service”
• Employee –” We work smarter, not harder, and the more we work
with Lean, the more improvement we see”
• Employee – “I have been here for 28 years and this is the first time someone has asked me for my ideas on how to make things better”
• Manager - “I am blown away. This work is crucial. It is important for patients to have pain management in a timely way, but it also saves time of doctors and administrators and improves morale. I can’t believe what has happened this week”
Results – Employee Testimonials
Leaders’ Impressions of SK’s Transformation
“I wouldn’t want to be anywhere else…because I want to be part of this; I want to see it succeed. At a very personal level, it is the most satisfying
thing I have ever been associated with.” Maura Davies, CEO, Saskatoon Health Region
"The Saskatchewan Union of Nurses welcomes the opportunity for front-line care providers to have their voices heard…A focus on patient- and
family-centred care using best practice evidence and Lean principles will improve the patient experience and return nursing to a rewarding career."
Rosalee Longmoore, Past President , Saskatchewan Union of Nurses
“I’m a lot less frustrated…I can see things happening in my community which is the whole purpose why I ever volunteered to be in a regional
health authority in the first place.” Tina Rasmussen, Board Chair, Keewatin Yatthe Health Region
Implications for Leadership
From:
• Command & control
• Fire fighting
• Culture of blame
• Hidden problems
• Delegation
• In your office
• It’s your fault
Transition to Lean Leadership
To:
• Coaching & mentoring
• Fire prevention
• Root cause analysis
• Transparency
• Getting your hands dirty
• On the Gemba
• I own this work
Lessons Learned: Transparency and Accountability
• The problem – Requires clear identification of the problem
– Problem becomes transparent, as does reporting of progress
– Lack of skill in using measurement
• The investment – $ and FTEs
• The results – Government must be able to communicate results
including return-on-investment
• Participation of employees leads to engagement and buy-in
• Citizen engagement is a game-changer
• Communicate, communicate, communicate!
• Better Health Care: www.betterhealthcare.ca
• Think Lean: www.thinklean.gov.sk.ca
Lessons Learned: Engagement & Communication
Sustaining Lean
• Moving from doing Lean to being Lean (from project focus to Lean as the way we do business)
• Sector-wide planning – Patient First, Student First, Growth Plan, Child &
Family Agenda, Life Cycle of an Offender – Use of Hoshin Kanri
• Strategic Value Stream Identification • Province-Wide Lean Management • Internal and external communications • Unrelenting focus on accountability and results • Continuous Improvement
Embed Lean in the Culture of the Public Service
Lean Deployment Trajectories
The end game is achieving customer-centric Lean Government
It takes a sustained commitment to stay on Trajectory “A.”
The critical zone of commitment is around the end of year one.
I III IV
0
1 2 3 4 Years
A
B
Critical
Zone
D
X
I
Initial Deployment
III IV
0
1 2 3 4
0
Lean
Benefits
C
Critical
Zone
Leadership
Commitment
Gaining Momentum
Building Commitment
Building a Lean Culture
Customer Centric Lean Government
II V
Sustained Customer Centric Lean Government
We are here
We need to be here
Top 5 Lean Achievements
1. A Service-Wide Approach
2. Sustained Implementation
3. Robust Governance, Support and Funding
4. Ongoing Lean Activity and Training
5. On the path from “doing” Lean to “being” Lean – continuous improvement
Where to start…
• Develop a compelling vision and urgency for change
• Develop and grow leaders for change
• Commit to a consistent, rigorous, disciplined improvement methodology
• Use transparent measurement
• Engage and mobilize people
• Align processes, priorities
• Spread (replicate) innovation
Where to start…
The Commitment to “Thinking and Acting as One” is unprecedented
Lean is the only way to do more with what we have - it is the growth engine we need to improve people's lives …the Saskatchewan experiment is path-breaking and important for the rest of the world Dan Jones, Lean Enterprise Academy, UK
Questions?
• We are focused on our clients
and our customers.
• We engage employees to find
ways to work better and smarter.
• We make continuous
improvements and minimize
waste.
• We produce efficient, just-in-time
processes.
For more information contact: Dan Florizone, Deputy Minister Ministry of Education
Additional Examples
Multiple Ministries - Lifecycle of the Offender
• What: Multiple Ministries participated in an event to identify top issues and system gaps for common clients
• Who it impacts: General public.
• Why it matters: This work will improve quality of life and community safety.
Life Cycle of an Offender
What: Lean tools were used to create a standard, evidence-based process to prioritize, select, set-up and implement large-scale change initiatives in the health sector.
Who it impacts: Patients, families, public
Why it matters: The public will have a health system that can more quickly and effectively change to meet their needs.
Health - Large Scale Change Initiatives
What: Increased the volume of permits issued to companies. An additional 14,000 permits are issued (an increase of 85%).
Who it impacts: Businesses
Why it matters: This allows businesses to transport goods with fewer delays and allows for greater efficiencies that effect their bottom line.
Highways – Bridge Permits
What: Improved service to students who are applying for financial assistance.
Who it impacts: Post-Secondary Students
Why it matters: One agreement for both loans and online confirmation of enrollment has reduced lineups, paperwork and waiting time for loan processing from 12 days to 2-3 days.
Advanced Education - Canada-Saskatchewan Integrated Student Loans
What: 10 licenses and permits have been deleted and replaced with 1 levy. Horizontal Oil Well applications processing time reduced from 30 days to 1.
Who it impacts: Oil Companies – Business
Why it matters: Requests are processed faster and reduced administrative costs (20,000 transactions that did occur have been eliminated).
Economy - Oil and Gas Well Levy
What: Processing time has been reduced by 50% and wait times were eliminated for clients.
Who it impacts: Ranchers and Farmers
Why it matters: Ranchers and farmers receive Livestock Loans more quickly.
Agriculture - Livestock Loan Guarantee
Health: Mental Health Appointments
What: A Mental Health Clinic in Regina Qu’Appelle Health Region has eliminated its wait list of 150 clients, reduced the amount of appointments being rescheduled or cancelled from 42% to 0% and eliminated wait times (previously as long as 47 weeks).
Who it impacts: Mental Health clients
Why it matters: Patients receive service faster without waits or cancellations. An additional 6 patients / day
can be seen with the same resources.
What: Developed provincial guidelines and a monitoring process that optimizes the appropriate, efficient, and safe use of IVIG blood products ($8.4M budget, 2013-14). Results:
– 10 guidelines and 8 physician order forms reduced to 1 standard
– Patient information on safety risks created
– Elimination of 33% of use that was previously outside of guidelines
– Completion of requisition forms improved from 62% to 100%
Who it impacts: Healthcare patients.
Why it matters: Safer, higher quality care for patients.
Health: Intravenous Blood Product Use
What: New regional 115-bed hospital designed with Lean 3P process that included 200 staff, providers, patients and families.
– 100% single rooms – 18 standard rooms designed to be easily adapted to provide more intensive care if needed – 8 standard rooms built to a “Bariatric” standard – comfortably accommodate large patients – rooms are not assigned to specific healthcare services and can easily be converted to meet
different patients’ needs to avoids the waste of beds – Department zones - allow department areas to take more patients into their areas by
expanding into the neighboring zone as needed.
Who it impacts: Patients and families. Why it matters: The hospital will be able to flex to meet community demands, all patients will have private rooms, providers and staff will find standard layouts easier to find supplies, clean, perform services. The health system is expected to achieve operational efficiencies between $85M - $160M over 20 years through the application of Lean to the design of the new hospital in Moose Jaw.
Health: Moose Jaw Regional Hospital