Things that make me go hmmm...

I just finished reading an article in Business Insider entitled “The Ten Most Annoying Management Terms” and couldn’t help but stop and think about all of the buzz words that float around.  From there my brain carried on to the impact that they must have on people.  And from there I continued on in my mind to the effect words have on people (don’t worry this is normal for me).  Words are so powerful, and can pack an incredible punch to the recipient, sometimes depending on the context in which they are received.  Today’s fast-paced, crazy environment only seems to add to that impact.  It seems like we hardly ever take the time to have that face to face conversation because, let’s face it, it’s so much easier to simply send a text, BBM, email, well…you get the picture.  Long gone for most of us are the days of taking the time to track someone down to have that personal face to face conversation, or at least take the time to pick up and dial the phone.  Now don’t get me wrong, I am no different then the mass majority when it comes to these “quick and easy” ways of communication.  But today I can’t help but stop and wonder about some of the messages that I have sent.  I wonder if any of them were ever put in the wrong context simply because my message wasn’t clear, or there was a tone perceived by the way it was worded.

This whole subject makes me go hmmmm and reminds me of an experience I had not that long ago, and how a few extra seconds out of my day definitely left an impression.  Good or bad I’m really not sure, but an impression nonetheless.

I was in Las Vegas at the end of September, and we decided to have dinner at the Cheesecake Factory.  The restaurant was absolutely packed and there were maybe two empty tables that were simply waiting to be cleared and were then filled with waiting patrons.  We were seated by a hostess, and then greeted by one of the most outstanding waitresses that I have ever come across in my life.  Sara came to the table to take our drink order and let us know the nightly specials as all waitresses will, but there was a difference with Sara.  There was a genuinely caring feeling coming from her, and it seemed that she, in fact, really did want to listen to what we had to say.  I immediately commented to the group I was with that I really liked this waitress.  Anyone that knows me knows that I will never be labelled as someone who is happy to just relax and take it all in.  My brain runs 100 miles an hour and so does the shaking of my right leg as I anticipate what will happen next.  When she returned with our drink order she asked if we were ready to order.  Everyone except me was (I knew looking at the 40 page menu that there was no way that I was going to be able to come up with an answer to that question so I hadn’t even tried).  So she and I went through a series of questions from “What do you like?” to “What would you suggest?”  I couldn’t help but get the impression that she really wanted this to be the best dining experience possible, and was making it her mission to see that it happened.  The restaurant was crazy busy, but whenever she would stop by the table we had her complete and utter attention; not for one second was she looking away or wondering what was next for her.  Every time she stopped at the table, I just felt comfortable.  As we were nearing the end of our meal and Sara stopped by the table, I asked her to please have her manager come out as I would like to talk to him or her.  You could see all expression leave her face so I quickly explained that it wasn’t a bad thing, I just wanted to talk to him.  Surprisingly, her manager did not visit my table.  I think Sara was sure this would end badly for her and chose not to tell her manager I’d requested to speak with him.

Now up until this evening, I was always the guy that requested to speak to the manager if I had a bad experience.  I would go out of my way to find the manager or owner of the establishment and let him know the concern or problem that I had encountered because “if I owned the business I would want to know, so really, it’s my duty” was what I would always tell people.  By the same turn, if the service was better than what I expected, I would always respond with the appropriate gratuity to let the waitress know that I thought she had done a great job.  But this particular time a nagging thought wouldn’t leave my mind.  Yes, me simply giving a larger then normal tip would probably make Sara’s night, but how would the manager ever know that she had gone above and beyond to make these visitors experience a great one?  Also, let’s say for a minute that this restaurant was in transition, or at a time where lay-offs were necessary for some reason, and Sara just happened to be at the bottom of the “totem pole”.  If this was the case, the bigger gratuity wouldn’t do much to help (it wasn’t going to be THAT big), and this to me was unacceptable.

So we settled up the bill at the table, and as we were making our way out of the restaurant, I stopped at the front counter and asked to speak to the manager.  When the gentleman came to the front, it was pretty easy to read the look of horror on his face to see a 6’2” guy standing there waiting for him.  I introduced myself and proceeded to say that I wanted him to know how amazing Sara had been and that I thought he needed to be aware.  He immediately let out a huge sigh of relief and thanked me for letting him know.  I told him that he should take good care of her because if I owned a restaurant in the area, I would most definitely steal her away!

As we walked away, I could not help but wonder if taking the time to seek out the manager personally as opposed to filling out the generic comment card on the table had made any difference.  I know I have sometimes received messages from people that have caused me to shake my head and wonder how I should take what the person is saying.  It is so much easier to see and feel what another person means when you are face to face, as opposed to reading their words.

Well, I returned to Vegas three weeks later (because I just can’t get enough of the city that doesn’t sleep) and on our second night returned to the Cheesecake Factory, but sadly, did not see my favorite waitress.  But just as we were finishing up, the manager that I’d had spoken with on my last visit walked by the table.  I smiled and he immediately stopped, stuck out his hand, and said “Chris, how are you my friend?”  I was speechless (not an easy feat let me add)!  In a restaurant of that size, with that many people moving through and after three weeks going by, I could not believe that he would remember my name.  My question, however, had been answered.  It really does make a difference when we take the time to have a face to face conversation.

We all know that words are powerful weapons, and a word left unspoken can be just as dangerous as a sharply delivered message.  Experts suggest children need to hear approximately four positive statements for every negative comment to counterbalance the impact of that one negative comment.  Sobering isn’t it?  Another point we need to remember, is that we all receive a message through the filter of our personal experiences.  I may interpret or apply a different meaning to a comment because of where I’ve been, who I’ve been influenced by in the past, or the message I received 20 minutes ago.  That filter can often put a spin on a quickly penned message that wasn’t meant to be there.  I’m willing to bet me asking Sara to arrange for me to see the manager was passed through a filter of not so great past experiences, resulting in her being unable to believe there was a positive message at the end of it. All of this to remind us to think twice before pushing send, hitting enter or clicking the mouse.  And better yet, don’t even start letting your fingers do the talking.  Give the recipient of your message the privilege of seeing your face while you deliver it!

I want us all to know the impact of taking the time to stop, smile, and say something positive and empowering to someone else as opposed to rushing through our day to day routine thinking that we could be getting somewhere quicker without taking the time to be human.  It might feel good to “kick the dog” when our day has gone haywire, but 10 minutes later the day is still haywire, and now someone else’s day is too.  The payoff when we do the right thing, isn’t just for the person receiving our message.  I guarantee the thrill will be there for you too!  I walked out of the Cheesecake Factory that night knowing I had made a positive impact, and that is a feeling like no other.  We are so privileged to work in an industry where care is our number one responsibility.  We are rightfully called Healthcare Workers or Healthcare Providers.  Let’s make sure we take the time to be the best we can be and encourage those we meet to do the same.  It’s up to us to keep the CARE in those oh so important titles!!

A Year In Review...

"Coming together is a beginning.

                Keeping together is progress.

                          Working together is success." Henry Ford

It’s hard to believe that 2011 is behind us and there is another year full of challenges ahead of us. The last year has been one of beginnings and successes…I’m going to take this time to reflect on some of the accomplishments every one of you have been a part of in the past year – our progress.

Coming Together

The times we’ve been able to come together this past year has been what provided me with the most satisfaction. The "Walk This Way" training I have had the privilege of delivering to over 20% of the Region in the last six months, always results in lots of good discussion and seems to provide a starting point for making simple improvements from the ground up. The front line perspective I come away with is a huge benefit as I look for ways to improve the training and gain a better understanding of what work still needs to be done in the Region. Coming early in 2012 will be the roll out of "Flight SC201" a second level of Lean Training that we will be rolling out to further build Regional capacity in process improvement!

The Region’s CQI teams continue to meet and focus on improvements that will have huge impacts on the care being provided every day. Teams have been working on projects like VTE prophylaxis protocols, ER patient brochure standardization, LTC admission chart standardization, Failure Modes Effect Analysis (a proactive approach to problem solving), and many more. Without these teams "coming together", there’s no doubt in my mind SCHR would not be where it is today!

Keeping Together

In the last few months, Team CQI has expanded! We have been happy to welcome Niki Rodine, Clinical Improvement Facilitator and Susan Buehler, Administrative Assistant. We are in the process of interviewing for a Quality Improvement/Patient Safety Manager who will be starting in early January.

On a more personal note, as I have travelled across the Region and the province, I have been impressed by the striking similarity in the vision and mission of healthcare workers – no matter the facility, the occupation, or the age and background. The province has been very deliberate in providing a vision of where it wants the province’s healthcare system to end up, and that is why I, as well as the CQI team in SCHR, is working so hard to train, equip, and empower anyone and everyone who will listen. I’ve said it before and I’ll say it again, LEAN is not a magic formula for success, but simply a different and more efficient way of performing the many tasks we do every day. I am always excited by the ways we can fall in line with the provincial vision for healthcare, as well as that of each of us who truly desire a quality experience every time someone needs to access treatment. We really are "keeping together" as we do our jobs each and every day.

　

Working Together

Working together is the key to all of the QI work done in Sun Country. Medication Reconciliation has been a project that has shown the ability of staff across the Region to work together to achieve a common goal. Nursing staff, Physicians, Pharmacy staff and most importantly our customers, have pulled together to provide safer, more efficient care for everyone who receives service in the Region.

Accreditation was another incredible example of Sun Country staff working together to achieve an amazing result. The Region achieved an outstanding compliance rating of 94%, and will continue to work together to see that the standards which were flagged as having room for improvement are followed up, ensuring we are providing the best level of care for our patients.

The Releasing Time to Care project expanded in 2011 to include five more sites: St. Joseph’s ER and OBS wards, Arcola, Kipling, and St. Joseph’s Long Term Care. Added to the first three sites of Weyburn General Medical Unit, Mental Health Inpatient Unit and St. Joseph’s Unit A, the resulting eight units or sites participating are having some amazing results. The goal of Releasing Time to Care is to provide staff with ways to increase the time they can spend with their patients, which not only makes the patient experience a better one, but also increases job satisfaction for all those involved. A huge thank you to everyone who has been "working together" on this important initiative.

I don’t usually spend a lot of time looking back – I am pretty much constantly anticipating, and even though I may not know when I’m going to have the result I want, I am able to look forward to it anyways. Crazy maybe, but it gives me the excitement and love for my job that I hope is contagious! 2011 saw some incredible accomplishments as we came together, kept together and worked together on the sampling of projects above, and many more. I cannot wait to see the many things we can achieve together in the New Year. There WILL be new beginnings, more progress and continued success as we journey on. And what more could we possibly look forward to than that?

See you in 2012!

From My Desk To Yours...

As I sit at my desk (not a real common event) I can’t help but smile and think of a quote that I love that was sent to me from a great friend:

“Teamwork is the ability to work together toward a common vision.  The ability to direct individual accomplishments toward organizational objectives.  It is the fuel that allows common people to attain uncommon results.” ~  Andrew Carnegie

When I started in SCHR I had a huge vision for implementing Lean in the Region.  I still have that vision, and I am humbled that so many of you have felt it was a vision that you could be part of as well.  I am energized every day by the people I work with to achieve our objectives and am so grateful to each of you for the part you have played.  I don't know about you, but I feel pretty common most days - however, there is no doubt our results have been, and will continue to be, uncommon!

I wish each of you a Merry Christmas, a happy and healthy holiday season, and great things in 2012.

A Sure Bet

September and October have seen me jetting off to Las Vegas – TWICE!!  I love the energy and buzz of the city – for those of you who know me, not a huge surprise.  Not everyone’s cup of tea for sure, but the constant bombardment of sights and sounds lets me wind down somewhat from the activities back at home (quite the paradox).  The downside to Vegas is my lack of ability to win at the gambling…I’m either really unlucky or need some lessons on how to win at the games I’ve tried my hand at.  And the lights and bells are so enticing!  Before anyone starts to worry, I do know when to quit…I just would like to quit ahead for once.

I can’t help but compare what I do every day to my experience in Vegas.  The excitement I feel when I am part of that energy on vacation is very much the same feeling I get when I begin training a new group of care providers, or see the enthusiasm in the faces of our staff when they can see improvement they have been a part of.  The positive experiences people have using Lean in their workplaces, and the excitement they share with me, are a way bigger draw than any I’ve ever seen anywhere in a casino!

I recently provided a group with a brief rundown on Lean and its benefits, and was asked if it wasn’t just the “flavor of the month” or some kind of “cult”!  I was quick to reply that Lean would never be the “flavor of the month” because guaranteed results set it apart from other improvement methods.  It is so easy to use in every area of life.  I gave the example of the silverware trays we all use to sort our silverware and how that is a perfect example of 5s and make us realize this is not some new scheme.  Lean isn’t like a craps shoot where you roll the dice and hope for a good outcome.  There is no need to cross your fingers – Lean gets you a good result every time.  We aren’t gambling with our province’s health and resources by using the latest and greatest management philosophy to come out of the head of a hippie in Nevada.  It has proven time and again to be effective in industry, healthcare and life - every one of you use it every day in ways you can’t name!  Next time you see me, I dare you to ask me for five examples off the top of my head…I’ll be ready!

To continue with the analogy, the biggest part of my job is to teach as many people as I can the rules of the game!  No one is going to win at blackjack without a basic understanding of how to place bets and whether to hit or stand.  Lean does have some “rules” so to speak, and basic understanding of the tools and methods that can be used to make amazing improvements, ensures a win for you every time (the silverware tray wouldn’t work if it was upside down). 

No matter what the stakes are, Lean is never a gamble – it’s a sure fire bet that wins every time.  As much as I love the lights and sights of Las Vegas, I am always happy to return to the best place to live on earth, and to work with such a dedicated and enthusiastic team.  I’m “all in” when it comes to whatever I can do to improve the patient experience in Saskatchewan and especially Sun Country Health Region, and Lean is the hand I’m playing to make sure it happens!

Light Camera...QI Action

Quality Corner, the latest initiative from the Sun Country CQI department, is coming soon to a Telehealth near you!  The purpose of the series is to provide some QI education in a fun, interactive way that will apply to everyone in the Region, no matter their position or qualifications.  The great thing about LEAN and quality improvement is that it can apply to every process and position in Healthcare!  The topics we cover every month in the series will provide an opportunity for everyone to acquire some new tools to help them with their everyday work.

As we travel together on this quality improvement journey I get more and more excited!  With every training session or project that we come across, the passion that people in Sun Country exhibit for providing quality health care still blows my mind.  This is another reason why we are launching Quality Corner - to give people a look at all of the incredible initiatives happening in the Region.  One thing that always makes me smile when I talk with people in different facilities is that they are improving their own processes every day, but don’t think to “blow their own horn”!!  This series will also serve to change this reality, because the more we can share the amazing work our coworkers are doing in the Region, the easier it will be to recognize some of the simple ways we can improve our own workplaces. 

I am totally pumped about our inaugural edition of Quality Corner!  In this first episode we are going to take a look at the similarities between quality improvement and the activity in an operating room.  I won’t give away any of the plans for the episode (you’ll have to join us that day), but we will use surgery as a metaphor for a QI process and show how some of the tools and equipment used every day on patients across the province can be compared to LEAN tools and methodologies.  I hope that as we go back to our regular tasks and duties wherever it is that we work, we will remember some of the examples given and look at quality improvement in a new way!

As the series goes on, we will be looking for stories to share with your colleagues, as well as topics that you think can help you with your day to day activity.  Feedback and input are what is going to make this program a success.  No one knows better than the employees on the front lines what Sun Country needs to succeed.  Your CQI department wants your ideas, so please take the time to tune in, gain some new tools, and give us suggestions for topics for the future!

My Northern Adventure

This past week, I had the opportunity to travel to Northern Saskatchewan and help out a sister Health Region with their Quality Improvement Lean journey.  I feel privileged to be able to share with you a rundown of what I encountered, along with some of my reflections on the experience. 

To start off, I’d just like to say that this was definitely one of those times where you ask yourself…is this a good idea?!  You may know that Keewatin Yatthe Health Region is nine hours north of where I live, and I really had no clue what I was getting myself into.  That being said, I had lots of reasons to go!  I am a huge believer in the Province of Saskatchewan working as one, in Regions helping other Regions, and in the fact that we need to build internal capacity to create real and lasting change where needed.  We can not always rely on outside consultants to come in, help with projects, and leave, if we are really going to have a culture shift happen!!  There are 13 different Regions that have the same set of goals in place:  to improve the safety, quality of care, and access to Health Care for the people that we serve.  With that being said, if we ever hope to achieve these goals we are going to have to work together to make it happen by sharing the knowledge, experience, and tools that have been and will be created.

Driving up, I could not help but be in awe of the amazing scenery that I was witnessing – it’s easy to forget how much Saskatchewan has to offer so close to home.  Eight hours of driving also gives you a lot of time to reflect on past experiences, and to wonder about what the future holds.  As I listened to the radio and thought about what the next few days had in store for me, I couldn’t shake the nagging feeling that I was about to experience things that I had never come across before.  I certainly did not expect that in this case, I was about to learn as much from the group as I had to offer them. 

When I consider that I have only been in this field for a little less then three years, I could not be more fortunate.  The staff, customers, and processes that I have been able to work with, as well as some first hand experience, have given me an unwavering passion and knowledge of what our Healthcare system has to offer.  When I am introduced to something new, I always try to look at it from a 30,000 foot level, and keep emotions and feelings out of the big picture.  At the same time, I am trying to deliver my message at a level that anyone can understand without effort or interpretation.  As a facilitator, I never set out a rigid agenda and look to the group that I will be working with to set the pace and the tone of our time together. 

Upon arriving in Buffalo Narrows, I was greeted by people jumping off of a huge double arch steel bridge into a crystal clear river and I could not help but think…now that would be a great way to spend the next three days!  But, I reined in my sense of adventure and looked forward to what was coming, aware that it would likely be an adventure as well.  I pulled up to the motel that had been booked for me, unloaded my gear, and was invited to supper with two of the Executive of the Region.

Over supper they gave me the background and history of the organization, and only heightened my excitement for the days to come.  We met up the next morning at the office and set out on the hour drive north to La Loche, which is the site of one of the Region’s facilities where we would be spending the next three days working to educate the Senior Leadership team, and also take a look at the patient flow through the facility.  After arriving and setting up for our session, I was greeted by one of the most dynamic and diverse Leadership teams that I have had the pleasure of working with.  There were people sitting around the table with diverse backgrounds, some born and raised in the area, one from India, and another from Jamaica.  There was an individual who had received their education in the Asian panhandle and there were people who had worked in other Regions around the Province and across Canada.  We had people from all aspects of the Healthcare continuum able to attend, and I knew we were set up for success right out of the gate.  The first day and half, I simply provided a background of what Quality Improvement and Lean are all about, discussed the basic tools that we would be using, and gave a lot of opportunity for the team to get to know each as many were relatively new to the organization.  Excellent discussion took place relating to some of the challenges being faced by Keewatin Yatthe and their customers.  This resulted in the expression of a lot of new ideas as to how instant changes could be made to improve access and patient flow in La Loche!  At the end of day two, the team had identified the five ways customers enter into service at the facility.

The start of day three was excitement filled as we started to map out one of the pathways through the facility.  The process the team decided to start with was the patient experience as they go through the Emergency Department.  As we worked through the various steps trying to piece together exactly what people would experience as they are seeking care, it became very obvious that none of this mapping process would have been able to take place without everyone there that day.  It is so important to have a cross functional team in place to make sure that there is a perspective from all spectrums.  Without this crossfunctionality, there is a very good chance that the results are not going to be the whole or most accurate picture.  As we were completing the ER flow and were asking ourselves if this was in fact what patients would experience, a few minor tweaks were made and we were ready to move onto our second stream. 

The second stream the team identified, was the patient flow through the clinic located right in the La Loche Health Center, as this process is highly tied into the ER flow.  Since there are no dedicated Emergency Room doctors, the Physicians from the clinic are on call to deal with any situations that may arise in ER during clinic hours.  We mapped out the first portion of this process, and I stopped the group. We had covered the majority of the two major processes and this is where I like to break and take a few minutes to debrief.  Then I join them in walking through the processes that we have been working on, or “Walk the Gemba”.  A lot of people that work in Quality Improvement will often walk the process before starting.  Those of you who know me, know that I like to do things a little bit different, so I like to show the group the difference between what we perceive and what the actual reality is, and so far, it’s worked every time!  As the group Walked the Gemba, it became very clear we would be making some changes to the maps we had worked on.  These changes would be necessary to ensure we had laid out exactly what takes place and would be critical to ensure we had set up a great baseline to gauge our progress as we worked through improvements.  We made our changes and finished up the second process map shortly thereafter.  

Now was the time for next steps.  Ownership of what I had started with them would be critical for success and I was excited to see people step up to the plate to become the process owners for the two streams that we had been working on.  I vowed to continue to help them as they work on this, and hopefully many more great initiatives.

As we were wrapping up our three days together, there was time for reflection and comments as to what we had all just been through.  The consensus of the group was that at the end of the day, we are all here for the people we serve.  For those of you who have worked with me before, or who have been through any of the Lean training I provide, you would know how I felt when I heard that.  I could not have asked for anything better to come out of the three days!! 

As I drove home after all that had transpired up north, I couldn’t help but smile.  What an inspiration it is to me every time I go through this process with a group.  Everyone likes to feel like they can make a difference and that change is possible.  And I know that in three days, the group of leaders in La Loche I’d been able to interact with were able to believe it and were going to achieve it.  Credit needs to be given to each of them for working hard for those three days to dream and believe big!  All in all, an amazing group of people had been met, an amazing task of seeing the big picture present and future was completed, and an amazing opportunity for excellence has been started for those involved and those they serve!!

Deep Water

Sun Country Health Region has had, and is still having, some challenging days with deep water and its effects this spring.  Clean water and dry homes are some of the things we take for granted in this part of the world.  But no one was taking it for granted this year.

·        As of Monday, June 20, Estevan had received 287 mm of rain since May 1 making it the wettest May-June period since records began in 1945. 

·        A State of Emergency was declared in Weyburn, and there were hundreds of displaced Sun Country residents, with a precautionary boil water advisory being ordered.

·        Ongoing challenges with flooded land, haying operations, crops behind in development, disease, and aphids continue for agricultural producers.

Nothing about the weather this spring was normal, and the results were completely out of anyone’s control.  What we could control, was how we reacted.

The similarities to healthcare are very real.  An influx of patients, the severity of an illness, or the timing of a complication is almost always completely out of anyone’s control.  But just as with the flooding this spring, how these issues are managed is completely within our hands.

LEAN tools are used all the time as we react to these types of uncontrollable situations.  Patient flow in an ER, discharge planning, even the  method of cleaning a room for the next admission can all have links to LEAN methodology.  MedRec is based on LEAN principles and provides instant information to physicians and staff when patients are ill.  The pre-op surgical process has roots in LEAN, and not only does it assist in the event of a complication, but it works beforehand to ensure one doesn’t take place.

I’d like to say LEAN has all the answers to the unpredictability of healthcare.  But that, of course, isn’t true.  We all happily rely on the quick action and years of experience of the professionals who are there to care for us when we need them most.  LEAN tools can, however, make their job simpler and less taxing because it can take away a few of the unnecessary wrinkles and bumps in the processes that are consistently the same.

There is nothing simple about 24-7, and in most cases, that’s what healthcare is.  That’s one of the reasons why it is an industry unlike many others.  But efficiency and preparedness can provide us all with some control of the situations that seem overwhelming.  Sun Country’s QI team will continue to work at providing you with ways to become more efficient at how you have to react when called upon.  We can’t control what gets thrown our way, but deep water is doable with the right reaction!

Let's Get Ready To Rumble

In June I was able to spend two days in Estevan at St. Joseph’s Hospital meeting with staff and sharing a little bit about where the QI journey is taking us in Sun Country Health Region.  As different groups came with their questions and ideas throughout the day, I was able to learn from them and hopefully they went away with a better grasp as to what LEAN is and how it can help them with where healthcare needs to go.

The name given to the one hour sessions was “What Would Thor do with this Healthcare System?”  I have to say definitely not what I had been tossing around as a potential label for the sessions, but we went with it!

My message to each group those two days is one for every healthcare worker in our Region and across the province.  There is no need for a superhero or a mythical powerhouse to whip Saskatchewan’s healthcare system into shape.  The fact is, the power to alter what we all know needs to be changed lies within each and every one of us – there is nothing mythical or magical about it!  Every healthcare worker who is there for the good of the client they greet and care for every day, is a superhero.

Sun Country’s QI team wants to be able to equip you with some “thunderbolts” so to speak, so you can better fight the battles you face every day.  LEAN is at first a new set of ideas that will ultimately provide you with endless opportunities to improve your patients outcomes, and therefore your job satisfaction!  And who doesn’t want that?!

Thor was the Greek god of thunder which is perfectly appropriate for the rumblings starting in our Region as we all start working together to “fix” our systems.  Who needs Greek mythology when we have the right team in place already?  Thank you to St. Joseph’s for having me for two days and to all of you who attended for the opportunity to share some of my dream and vision for the healthcare system.  Keep up the good work and I look forward to the chance to provide more of you with LEAN tools for our work together.

Full Speed Ahead

As we sailed through March and April, the CQI department vowed to ensure the great work going on in the Region continued!  MedRec was rolled out in Filmore, Stoughton, Arcola, and Carlyle, and the Walk With Me…An Intro to Lean training took place at St. Josephs in Estevan.  We were also fortunate to be able to attend the first Saskatchewan Quality Summit in Regina, with amazing presenters and activities showcasing the Healthcare Quality Improvement journey taking place not only in our province, but all over North America.  To wrap up April, we all prepared for, and took part in, the Accreditation survey that took place the first week of May, with outstanding results.  Hats off to all the staff of Sun Country for all of the great achievements.

One of the Accreditation Required Organizational Practices (ROP’s), is that an organization complete a Client Safety-Related Prospective Analysis.  There are numerous tools and techniques available to organizations to assist with conducting a prospective analysis.  One tool is a Failure Mode Effect Analysis (FMEA), which is a team based, systematic, proactive approach.  It identifies the ways a process or design might fail, why it might fail, the effects of that failure, and how the process can be made safer.  The CQI department was already involved in looking at some of the processes taking place at St. Joe’s, and one area identified as a potential process needing improvement was the nursing hand off process between ER and Unit A.  So an FMEA was started.  This tool breaks down and analyzes all steps in a process.  It also identifies the areas that require attention the quickest, and will result in the biggest impact.  The area needing attention that was brought to the forefront was definitely the communication that takes place between staff during the transfer itself.  A communication tool has been designed, and is already being trialed that will hopefully address the gaps identified that could lead to a possible miscommunication.  The end result will be the safest care possible for our patients, and an easier and more reliable process for staff.  Great work by the team and staff involved in making this process possible!

Everyone will be seeing a lot more of the FMEA analysis process in the very near future as we are going to strive towards completing one with every CQI team.  By completing the prospective analysis we can ensure that goals are identified and improvement areas are dealt with in a proactive manner.  This in turn will ensure that we have the patient’s needs at the forefront of all that we do.  I look forward to the days, weeks and months to come!

Dirt and Green Stuff

The farm boy in me is itching for the smell of dirt!  Spring has been slow in coming this year and I am going crazy for the chance to give my boys a ride in the tractor and watch for the sure signs of growth that come a few weeks later.  Farming can be one of the most rewarding occupations that exists simply because the fruits of your labor are so quick in appearing.

I am equally excited to see Spring because I know it is going to bring growth of another kind.  There has been a lot of QI work going on in the Region and I know that the fruits of that labor are soon going to be popping up too!

There have been a number of staff trained in “Walk This Way – An Introduction to Lean” including Community Health Services, Estevan Hospital Management group.  Still to come is a group including all Sun Country HR staff on May 11.  I continue to be excited about the potential of this training for SCHR.  Stay tuned for your opportunity to take part!

Another big QI Initiative has been the rollout of Medication Reconciliation (MedRec) across the Region.  MedRec falls under the QI umbrella because of the incredible potential it has to improve the patient experience.  The statistics surrounding medication errors and adverse events that involve medication administration all point to opportunities for improvement.  MedRec focuses on obtaining a patient’s current medications and creating the “best possible medication history”.  This in turn will reduce medication errors and potential for patient harm, become a key component of seamless care strategies, and save time for nurses, physicians, and pharmacists.

I have worked on the MedRec project with staff at St. Josephs’s Hospital, Weyburn General Hospital, Kipling Hospital, Filmore LTC facility, Stoughton LTC facility, Arcola Health Centre and Carlyle Health Centre as well as our SCHR Home Care Team, and have a huge amount of respect for the work that is done every day to care for our clients and family members.  MedRec is going to be an incredible tool that will ensure care is provided safely and efficiently.  Thank you to all involved for their enthusiasm and hard work on the roll out!

This spring as you see machinery like this in the fields, I would encourage you to think not only of the growth that will follow on the land, but the growth that is taking place in SCHR.  It is going to produce some amazing results as well.

Walk This Way…An Intro To Lean

The month of March has come in like a lion for Sun Country Health Region and the Continuous Quality Improvement Department -  and we have no intention of letting it go out like a lamb!  As of March 21, we have started the Region wide training roll out of Walk This Way – An Introduction to Lean.  The possibilities that will result are endless, and excite me to no end. 

The training kicked off with Community Health Services on March 21^st and 22^nd and was followed closely by the training of a selection of management and staff at St. Josephs in Estevan on the 24^th.  Participation was enthusiastic and everyone went away with a better understanding of how lean thinking and methodology can assist them be more productive and more satisfied with their day to day activities. 

The training is a one day course that provides a comprehensive understanding of Lean tools.  Participants are given tools that assist them with such things as being able to identify a process that requires improvement, understanding and identifying waste, and understanding and implementing 5S.  Participants worked through simulations to drive the tools home, as were engaged in practical conversation as to how these tools can be applied to individual situations. 

The benefits of the continued rollout of the Walk This Way training are endless as staff throughout the Region begin to speak a common language and work together towards a common goal.  It won’t be long before transformational change begins to happen and we see the benefits not only in the way we are able to do our jobs, but in the improvement of the patient experience within the Region. 

I am encouraged by the incredible potential in each and every participant to affect real and critical change to the processes they work with every day.   As Lean Champions are trained and prepared to assist their colleagues, I know we will be able to keep this ball rolling.  I am looking forward to being able to share Sun Country Success Stories as we continue on this Lean journey!  Stay tuned…

Value Stream Mapping

As 2011 began so did an exciting project for the CQI Department in Sun Country Health Region! 

At the end of February, a team came together to examine the Patient Pre-Operative process from Doctor referral to entering the Operating Room.  All of the steps were identified using a Value Stream Mapping exercise.  Value Stream mapping takes a look at every step of a process, and breaks it down into intricate detail, revealing all of the areas where there are opportunities for improvement.  The other huge benefit of a Value Stream map is how it allows everyone involved to “see” exactly what is actually taking place in the process on a day to day basis. 

Participants that took part were from both Weyburn General Hospital and St. Josephs Hospital in Estevan.  Combining the two facilities allowed each group to have a look at what the other is doing as well as standardize some of the practices that go one in the same region.  Everyone involved was amazed by just how different the processes were, and yet, at the end of the day patients are receiving the exact same service.  The group was careful to remember that this is about a process, not the people who are involved in making that process happen! 

When the five day Value Stream mapping came to an end, we had identified many opportunities for improvement which will go a long way in ensuring our patients experiences are the best possible.  Teams are now holding weekly huddles to give each other updates and keep the project on track!  I’d like to thank the team that came together to make all this possible and look forward to seeing the future state Pre-Op process!!

Musings From the Other Side of the Fence

I can honestly say that in my 30 years I have been very fortunate not to have experienced the “other side” of the Health Care system.  I have been working long and hard to try to change the way the Health system does business from a management/administration side of the fence, and the only resource I have used to be aware of what needs improving has been the experience of others.   I have always used someone else’s (our customers) perspective to look at the way we do business and to start the change in processes which have been in place since the dawn of time.  Well that lack of first hand knowledge of the “other side” was all about to change January 1st and I had no idea...

I woke up that morning with a pain that I have never felt before, and later found myself waiting in a packed Emergency Department waiting room.  After five and a half hours, six vials of blood taken, two x-rays and a CT scan, I was told I was being admitted to a larger hospital an hour away.  There was a bed waiting for me and I could expect to have surgery later that night as I had an 8mm kidney stone creating a blockage.  So off I went home to pack an overnight bag before returning to the Emergency Department to pick up my file and DVD of my diagnostic images.  Upon arriving at the next hospital, I was welcomed by a sign that alerted me to the fact that the hospital was experiencing an overcapacity situation.  I wondered if this would affect me as I made my way to the admitting desk, but I was quickly told that it didn't, and I was admitted.  A cheery Porter then appeared and led me to a bed which was one of four in a shared room.  He assured me that someone would be with me soon.  Approximately 15 minutes later I was greeted by a very cheery nurse who conducted a quick interview and started an IV of a saline solution in order to make sure I would be hydrated for surgery.  Before going any further I should mention that it was about 5:30pm by this point and "lucky" for me I hadn't eaten all day, as you must fast prior to surgery.  My wife and two boys showed up approximately a half hour later to visit, and at about the same time a Lab Tech came to take some more blood from me.  After a couple hours of watching my boys amuse each other, I began to wonder if this procedure was actually going to take place.  When I left the other hospital I had been given the impression the urgency of my situation was quite high.  Around 9:30 a nurse came in to tell me that I had been cancelled for the day and that I could eat and drink now, but nothing after midnight.  So I was given half an egg salad sandwich, a little container of apple juice, and a granola bar.  For a little perspective, I'm 6'2 - 245lbs and as lovely as the box lunch was, it was far from filling my hunger gap but I resolved that I would not think about it and try to get some sleep.  I quickly found out that sleep with three other men in a shared room in a hospital wasn't going to be as easy as first thought; but I decided one night with not much sleep wasn’t going to be a big deal and my bed at home the following night would make up for it. 

Around 11 the next morning I was greeted by a doctor who was there to give me some news.  The news was that I had Mononucleosis and he would have to notify the Anaesthetist about my condition.  My shock and inquisitive nature immediately kicked in and I subjected him to a barrage of questions.  First, I asked him who had ordered the test for Mono, to which he responded he had no idea.  Next, I asked why if I have such a virus there were no symptoms whatsoever being experienced.  I was promptly told that I probably did have symptoms and that regardless of how I felt, I had Mono.  At this point I decided any further questions would be futile and let him do his thing.  A couple hours later my surgeon arrived to let me know the details of what was going to take place.  After he had explained the kidney stone removal procedure I proceeded to ask him about the Mono diagnosis delivered to me earlier that day.  He responded with he wasn’t sure who had ordered the test but it appeared that I in fact did have Mon.  He assured me I did not need to worry - he was confident it wouldn’t affect anything.  He also explained that I was fourth on the "list" and, fingers crossed, would get done today.  Skipping ahead a few hours filled with a lot of mundane waiting, at 11:30 pm a nurse came rushing up to my bed with sandwiches and juice and told me to “eat,eat,eat!!”!!  I had been cancelled for the day but should eat all I could before midnight when I would need to begin fasting again. 

That night and the following day were a repeat of those previous, and I was beginning to wonder if this surgery was ever going to take place.  Mid afternoon of day three, my surgeon arrived again to tell me that I was number 6 on the “list” and, fingers crossed, would be done sometime after 4 pm that day?!  Well 4 pm came and went and I was preparing myself again for my 11:30 gorging and gluttony before the fast.  At 9 pm I was surprised to see a nurse at my bed telling me to get ready - they were coming to get me.  This was followed shortly by the same friendly porter arriving with a stretcher and off I went.  In what seemed like a matter of 15 minutes, I was put under and was waking up from the anaesthetic.  When I woke up, I was immediately told that I had really scared them in the OR.  Apparently, my blood pressure hit the floor and they had to give me “fluid” to bring it back up.  But since I was awake and feeling good, no harm no foul I thought.  Apparently they felt it was a little more serious then I did and were on my vitals every 20 to 30 minutes.  My blood pressure finally came back up to around normal about 3 am.  I was discharged the next morning around 10:30 am and sent on my merry way.  I have been informed since that blood pressure drop was a lot more serious then I ever imagined and feel lucky to be writing this!!

Throughout the whole ordeal, I can say that my interactions with health care workers were positive, and I never felt like any of them were not doing their job.  I appreciated their smiles and humour when I felt like I had been forgotten.  What caused the most stress and discomfort was the system and its lack of respect for the needs of the “customer” and the resulting disregard for what we assume is our right – timely, efficient service.  In the end, I was provided with the service I had needed – my kidney stone was removed.  But the disheartening fact remains that the experience caused me and those who care most about me to have doubts about the system and its ability to look after me at a time when we needed it desperately!

Needless to say, after experiencing the Health Care System from the other side of the fence I have a whole new outlook on things, and a new invigorated passion to make it the best system possible, for my generation and those to follow!