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!