About a year ago the good citizens of Moose Jaw—Saskatchewan’s fourth largest city—were thrilled by news that a new hospital would be built to replace the city’s aging Union Hospital.
The new facility is tagged at $105 million, of which 80% will be paid by the province and 20% will be funded locally. Construction will begin in 2013 with completion in 2015. The new facility is part of a larger package of provincial healthcare infrastructure investments that total over $700 million since 2007 (News Release, Government of Saskatchewan, September 26, 2011).
End of an Era
Union Hospital is a historical mainstay of the city. Built in 1947, the facility is 65 years old. It underwent expansion and renovation in 1956 and again in 1976. According to news reports published at the time the decision was announced, the province had decided that building an entirely new facility was the way to go since any major renovation, retrofit, or rehabilitation of the existing facility would cost just as much as starting from scratch (Global News, April 13, 2012).
That reasoning—while simple to frame, articulate, and communicate—should never drive such decisions. In all likelihood, neither was it the primary motivator. Why? Well, there is more to this story than haggling over the initial capital cost. The real policy plot revolves around innovation in design and construction, and the operational savings, enhanced efficiency, and improved outcomes that will hopefully flow from them.
Cut Fat and Go Lean
Moose Jaw’s new hospital is being touted as the first of its kind in Saskatchewan. It might also be a first in western Canada, and maybe the country. That title is being bestowed on the facility because its design, layout, and construction are to be based upon the Leanmodel. According to the Lean Construction Institute (LCI), the Lean approach amounts to a fundamental re-think about design, production, and delivery processes in both manufacturing and construction to improve on value provided to a customer. LeanConstruction is all about maximizing value and minimizing waste through specific techniques applied across a project delivery process (Lean Construction Institute).
Now, I have to admit that when I first ran across that description of Lean, it amounted to little more than gobbledygook. My eyebrows only furrowed deeper when I learned thatLean was supposed to “support positive iteration” within a process and “reduce negative iteration.”
Because the theory and concepts of organizational behaviour have always been personally elusive, my understanding was only slightly enhanced by David Chambers, aLean practitioner and consultant for the new hospital project, and Cheryl Craig, the CEO of the Five Hills health Region. They say that Lean sees value as defined by the customer—in this case the patient—and that is then pulled down in the search of perfection. “That’s the definition,” says Chambers (Times Herald, January 12, 2012).
Huh?
Beyond the Lean Lingo
At this point, I abandoned all attempts at definition, and began the hunt for something a little more practical of what Lean might mean.
What I learned is that Lean is all about a facility designed in such a way that it operates well. In short, the facility is not simply seen as a roof supported by four walls. Rather, the facility must, well, facilitate.
The building helps serve a more efficient operation and improve the interaction of those in the building—those providing services and those receiving the services. The facility helps simplify things, eliminate potential errors and mistakes, and keep matters focused on the needs of clients.
The result is a new model of care that sees health professionals and support staff serving patients in facilities designed to bring services promptly and effectively. It’s about having the facility built in such a way that time management of health care providers is maximized and the flow of patients in the hospital is improved. It’s about efficiency, thinking outside the box, and making patient comfort a top priority. It’s about uncovering the waste and inefficiencies in a hospital and getting at strategies to eliminate them.
Former Saskatchewan Health Minister Don McMorris, says it’s all about “More time with the patient…We’re making sure that the facility is designed properly so we can spend more time in front of the patient.” (Global News, April 13, 2012).
Cheryl Craig offers a great example. “Right now, patients wait, answer questions, get transferred to a different ward, wait some more, and then answer the same questions again” “It’s a waste of time.” At a luncheon meeting of the Moose Jaw Health Foundation, Craig said that things like this just won’t happen in the new hospital. (Discover Moose Jaw, April 13, 2012).
In the Lean model, Chambers says that outcomes will improve. The goal is improved outcomes for both patients and staff.
The new hospital facility should not only see patients receiving better care in a more timely and efficient manner, but the hospital facility should be a more engaging and fulfilling place for health-care staff to work.
As part of the Lean process, almost four dozen people involved with local heath care—physicians, nurses, support staff, patients—met for four days in April 2012 to discuss, debate, develop, and devise various models and three-dimensional life-sized mock-ups for the new hospital project. This comprised the first phase of a three step process to design a better facility. Architects and engineers then took the data and from that are creating the blueprint of what the hospital should look like.
The Point
David Chambers says that when Lean has been applied to other hospitals in North America, there were significant improvements in patient care. Assessed across a wide variety of metrics, outcomes were improved by upwards of 45%. “That’s 45% better outcomes with the same staff,” says Chambers. (Discover Moose Jaw, January 25, 2012).
Whether the new Moose Jaw hospital can deliver on all of that does remain to be seen. But the point of the story is clear. Innovation in infrastructure is more than just lowering initial capital costs, as important as that might be. But, innovation is also about lowering operating expenditures, enhancing productivity, securing efficiencies, and at the end of the day, providing better services and yielding better outcomes. All of that should always be the overarching goal for any private enterprise or public service endeavour.
But, you can’t always get that without making the required investment and pursuing the required innovation. At the end of the day, it is more than just addressing the infrastructure need, but improving upon the services for which taxpayers pay and receive.
By: Casey Vander Ploeg, Senior Policy Analyst