Lean Leader Certification and Maintenance - Physician Track Frequently Asked Questions (FAQs) What is Lean? Lean is a set of operating philosophies and methods that help create maximum value for patients by reducing waste including the waste of time waiting for service. It is often referred to as a learning and management system. Lean eliminates wastes or lack of efficiency in processes, such as patients waiting, duplicating tests or multiple forms requiring the same information, or staff time spent searching for supplies. eliminates defects which include errors such as harm to patients and opportunities for defects that could lead to patient (and staff) harm or dissatisfaction; removes activity that doesn t add value as perceived by our patients; and, applied correctly, Lean is not about cutting jobs. That said, Lean is based on the premise that we can continuously improve health care without adding more money, staff, space, or inventory. As a physician, what are the benefits of me getting Lean training? Lean offers many benefits to physicians and other health care providers. Some of the ways that Lean can improve the daily work in a clinic include: Improving flow. Lean can help you identify ways to optimize how staff, information and patients flow through your clinic. For example, using Lean tools to improve the way requisition forms are managed. Lean reduces time wasted re-inventing the wheel for common problems and processes, by creating standard work. Reducing unnecessary walking and waits. Lean helps you see where you can make changes to ensure you have everything you need, when you need it. Less time spent searching means more time on patient care. Clinics are better able to manage the daily work during clinic hours. For example, clinics are using an approach called 5S to move things to point of use and reduce inventory costs. Improving chronic disease care. Lean can help you deliver the right care, consistently, to achieve optimal outcomes for your patients. At Park Nicollet Health System, in Minneapolis, Lean was used to achieve a 75% increase in the number of optimally 2
managed diabetes patients at one clinic, and shortened from days to minutes the time from when blood is drawn to when results are available to the clinician at a patient visit. Mistake proofing to improve safety. A key focus of Lean is to mistake proof processes reduce the opportunities for errors to happen and find ways to catch errors before they reach the patient. Examples of mistake proofing projects include: ensuring the right lab result is attached to the right patient chart; improving infection control during room turnover; improving labelling of specimens, etc. This is an unprecedented opportunity for Saskatchewan physicians to acquire knowledge and skills for delivering better, safer health care to patients. It also enables you to learn alongside your colleagues, and be part of a community of other leaders working to improve our health care system. Why is there a different Lean training program for physicians? We heard loud and clear that time is a big barrier for doctors. We recognize that, while Saskatchewan physicians are committed to learning about Lean alongside their health system colleagues, many find it difficult to participate because of the heavy time commitment required in the regular program. We have created this special track as an alternative for physicians. How is the physician track different from the original program? This new option is very similar to the regular program. The major difference is that physicians taking this track are only required to fulfil the Participant role in Rapid Process Improvement Workshops; participants in the original program are also required to play the Team Lead and Sub-Team Lead roles, both of which require a significant time commitment. As well, participants in the Physician Track will serve as content expert only on a Mistake Proofing project (MPP), rather than a full participant. Physicians in either track will take part in the North American Tour of Lean health care systems and industries. 2 What does the Lean training include? Kaizen Basics Workshop. This one-day workshop covers the fundamentals of Lean such as understanding the 7 wastes and 7 flows, using visual management, and mistake proofing. Value Stream Mapping (VSM) Course. In this workshop, you ll work with a team to learn how to value stream map how to observe and document an existing process to identify opportunities for improvement. Lean Leader Training (LLT) Course. During this 3 day in-class workshop, you ll explore a broad range of Lean topics 24 modules in total. Modules cover concepts such as: the Lean house (an exploration of how the Lean concepts work together); patient procedure quantity analysis (a method to understand the demand for services and patient flow in clinic); and, 5S (a way to mistake proof and visually organize the work space).
Module Deep Dive (MDD) and Module Marathon (MM). The MDD is an opportunity to deepen your understanding of the concepts covered in LLT by asking questions and sharing examples. The MM is the conclusion of the classroom training. You must present on The House and Standard Operations, as well as one of the 8 other modules (chosen at random). Participation in a Rapid Process Improvement Workshop (RPIW). An RPIW is a focused improvement event. You will work with a team to make changes to a specific area during a week of intense Kaizen activity. Participation in the North American Tour (NAT). The NAT is a study tour of organizations that are further along in their Lean journey. You will spend time at Autoliv, Virginia Mason Medical Centre, and Seattle Children s Hospital. As part of the tour, you will be assigned to a mistake proofing project as a context expert. Your role will be to consult with the team as needed as they work to eliminate defects in an area. What exactly is the time commitment? This new option requires approximately 22 days over the course of 12-18 months for certification, compared to close to 80 days for the full program. To maintain this certification, physicians will be required to participate in one 5-day Rapid Process Improvement Workshop (RPIW) per year. Will I do my Lean training in a separate physicians-only cohort, or alongside other managers and providers? Physicians will do their training within the existing cohorts. There is not a separate cohort just for physicians. How will I be evaluated? The evaluation criteria for each component are outlined below: Kaizen Basics VSM LLT MDD MM NAT MPP RPIW Evaluation criteria To complete this component you must Attend the session Attend all days of training Attend all days of training Score 80% (or higher) on the LLT book quizzes Attend the session Score 80% (or higher) on the Module book quizzes Score 3 (or higher) on each of the 3 modules Attend all days of the tour Team must pass mistake proofing project that is part of the NAT Score 70% (or higher) on the evaluation. Evaluation includes: participation, professionalism, working with others, ability to learn new skills and openness to change. 3
What if I ve already started in the original program? How does this change affect me? Can I switch to the physician track? If you started in the original track, you can have the option of staying in that program or changing to the new physician track. Physicians in formal leadership positions are strongly encouraged to undertake the full Lean Leader Certification. The Full Certification track is mandatory for further training and development as a Kaizen Fellow. Will I still receive certification for the new, modified program? Yes, your participation will be recognized within Saskatchewan. Your certification will be for the Physician Track. Can I still participate in the regular certification program if I prefer? Yes, by all means. That option is open to any interested physicians. In particular, we are encouraging any physicians with formal leadership roles to pursue the original certification. Is this certification recognized outside Saskatchewan? No, this program has been created to meet our province s specific needs. That said, individuals with Lean training including physicians are increasingly sought after across North America. Is this certification eligible for Continuing Medical Education (CME) credits? Not at this time. Does the new modified physician track still qualify for reimbursement? Yes, all fee-for-service physicians who participate are eligible for repayment. See the attached policy for full details. Is Lean training available to any physician who s interested? Yes, both the original program and physician track are available to all Saskatchewan doctors. Who is delivering the training? A Seattle-based consultancy group called John Black and Associates. 4
Who is John Black and Associates? John Black and Associates is a Seattle-based consultancy group that has helped a number of other North American health care systems (including Virginia Mason and Park Nicollet) implement Lean management. With the support of JBA, these other systems have become more patient- and family-centred, with fewer defects and less waiting. John Black and his senior team have over 200 years combined experience implementing Lean in health care. Who determines whether I am accepted into Lean training? What selection criteria will be used to determine whether I am accepted into the new track? As is the case with the full certification program, decisions about who is accepted into training rests with a health region s Senior Leadership Team (SLT). In reviewing a list of interested physicians (self-identified or submitted by others), SLT will consider the following selection criteria: Quality improvement champion past participation in Kaizen activity. Leadership ability influence with peers, positive team relationships. Retention investment physician will add value to the system with Lean knowledge. SLT forwards its recommendations to the provincial Lean Guiding Coalition and John Black and Associates for final approval. 5 Who should I contact if I m interested in getting more information about Lean training? Please contact the Kaizen Promotion Office nearest you. They will help arrange and coordinate your training. Here is a list of KPO directors across the province: Region KPO Director Email Phone Number SHR Candice Bryden candice.bryden@saskatoonhealthregion.ca 306-655-0160 RQHR Alan Chapple alan.chapple@rqhealth.ca 306-766-6401 FHHR Myles Cairns myles.cairns@fhhr.ca 306-691-7664 PAPHR Pat Stuart pstuart@paphr.sk.ca 306-655-5364 PNHR Jody Davidson jody.davidson@pnrha.ca 306-820-6060 ext 6183 MoH Trish Livingstone trish.livingstone@health.gov.sk.ca 306-787-3146 SCA Kevin Lacey kevin.lacey@saskcancer.ca 306-791-2140 Cypress Erin Soos erin.soos@cypressrha.ca 306-778-5129 Sunrise Sherrell Fox sherrell.fox@shr.sk.ca 306-786-0421 Sun Chris McKee chris.mckee@schr.sk.ca 306-842-8207 Country KTHR Vivian Campbell vcamp@kthr.sk.ca 306-752-7562 HHR Mike Morrill mike.morrill@hrha.sk.ca 306-882-4111 x232 KYHR Rowena Materne rowena.materne@kyrha.sk.ca 306-235-5834 MCRRHA Teresa Watt teresa.watt@mcrrha.sk.ca 306-425-4824 AHA Jennifer Conley jconley@athabascahealth.ca 306-439-2200
How do I apply for Lean training? Please contact the Kaizen Promotion Office nearest you (see list above). They will help arrange and coordinate your training. What does it mean to be a Lean Leader? To be a Lean Leader is to demonstrate the fundamental philosophy, principles, concepts, and tools of the Toyota Production System, every day, to everyone, in the processes of health care delivery. Lean Leaders achieve this by applying deep personal knowledge and expertise about removing waste and waits in our process(es) and ensuring we have mistake-proofed our processes to avoid injury, harm, or death to patients. By learning and applying the Lean modules, Lean Leaders guide their teams to improve patient care. Lean Leaders are unwavering in their support of colleagues who are making changes. They remove all barriers to change. Lean Leaders never say we can't and instead always say how can we? They use Lean tools to understand current care processes, then incorporate this data to determine the scope of improvement that is required. Lean Leaders help others see the future being created by positive change and the delivery of quality and safe care to patients. What other information is available about Lean? You may find the following video links of interest: Virginia Mason Medical Centre PBS News Hour did a feature story on the Virginia Mason Lean journey: http://www.pbs.org/newshour/bb/health/july-dec12/health_10-24.html Rapid Process Improvement Workshop: This video documents a Rapid Process Improvement Workshop as it unfolds over five days at the City Hospital in Saskatoon. The RPIW team makes improvements to one of the preoperative processes in orthopedic surgery. http://www.youtube.com/watch?v=qifveuniztg&feature=youtu.be Dr. Thomas Schmidt: A Clinician s Perspective on Lean In November 2012 Dr. Schmidt, an Executive Consultant with John Black and Associates (JBA), presented to the SMA s Representative Assembly. http://www.youtube.com/watch?v=t2lveews6g&list=plsmd5sbzhsch5tpq_znplwakltyuelneu&index=2 John Black and Associates, LLC is facilitating deployment of the Saskatchewan Health Care Management System. 6 Continuously improving the care experience of patients, families and providers.