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Healthcare thinks lean

By Chris Atchison | January 18, 2012
Healthcare thinks lean
Matthew Anderson

The William Osler Health System is one of Canada’s largest hospital networks, serving nearly a million people in the Greater Toronto Area. Its facilities provide a comprehensive range of acute care, ambulatory and ancillary health services. Osler’s emergency departments are among the busiest in the province and its labour and delivery program is one of the largest in the GTA.

With an annual budget of nearly $560-million, Osler currently operates 803 inpatient beds and employs a team of more than 4,300 dedicated health care professionals, including more than 900 physicians and more than 1,000 volunteers. Osler is governed by a volunteer Board of Directors, supported by a senior leadership team and two Community Advisory Councils that provide input and feedback to the Board on matters concerning local health care delivery.

If it’s true that managing a system in a time of great change is the measure of a CEO, then Anderson and his counterparts across the country face a Herculean task in the years to come. 

The key to maintaining the publicly-funded model cherished by Canadians, he says, is for administrators to start taking concrete steps – such as introducing heightened performance standards, streaming patients more effectively and introducing other innovative customer-service initiatives to encourage peak efficiency. Anderson argues the system can be both preserved and improved.

Since joining Osler in April 2010, for example, Anderson has introduced several pilot projects and transformed many of the health network’s core operational systems. It’s part of his transformative vision to change the culture of patient care from the administrative level down to his emergency rooms.

It starts, he says, by introducing the kind of lean operating principles and standards that have been employed by the manufacturing industry for decades. “Our industry has historically been a little slow to acknowledge that the management tools developed in other industries could apply well in a health-care setting,” he explains. 

Fine when you’re building cars, but what about caring for terminally ill cancer patients or premature babies? Anderson’s point is that if managed properly, a medical system can embrace both compassion and efficiency with relatively simple measures that cost virtually nothing to implement. One key cultural change Anderson and his management team have been driving is to focus on primary prevention by identifying key priority areas – seniors, diabetes and cardiovascular health are just three focus areas at Osler. In one example, Osler has developed stronger relationships with nephrologists in the local community to provide improved preventive services such as nutritional counselling to help renal patients stave off end-stage kidney disease. Osler has also moved to address its aging patient demographics by establishing a unit dedicated to caring solely for the frail elderly. 

But perhaps the most dramatic results have come from the way Osler has applied some of those lean operating principles to reorganize the emergency rooms at Brampton Civic and Etobicoke General Hospitals, two of the hospitals in the William Osler Health System. Although Osler has seen 20 per cent annual increases in emergency room traffic, wait times have dropped by 50 per cent. 

Anderson observed that ER queues are much like an assembly line. If one key person is pulled off the line—say, the sole overnight ER physician called away to deal with a trauma case—the line shuts down. Or, in this case, lower-priority patients are forced to wait longer as sicker patients are tended to first. To tackle the problem, the Osler emergency rooms have set up multiple ER queues to handle different cases. Children are directed to the pediatric queue, for example, while cardiac patients are assigned to a heart specialist. “Emergency was a system that had to be redesigned,” he stresses. Anderson hopes the new focus will reduce ER wait time targets from the current four hours, to just one in the coming years. And if possible, stream less sick patients to other specialized health centres or clinics altogether, thus easing the burden on the hospitals. 

On the customer-service side, Anderson realized that he had ample data on patient outcomes and wait times, but relatively little to assess his patients’ care experience. “With the necessary focus on having our care providers offer safe and high quality care, there can be the tendency to lose that compassionate side,” the CEO points out. So, Osler implemented a new program where admitted patients are contacted by a nurse within 48 hours of discharge from an Osler hospital. The relevant unit then gets a weekly report on patient feedback summing up quantitative scores where patients are asked ‘yes’ or ‘no’ questions, as well as a qualitative section where they’re asked to describe what could have been done to improve their experience. The measure costs nothing as the hospital utilizes nurses that are off regular duty for various reasons, while the CEO says the feedback has proven indispensable in improving patient experiences.

Of course, Anderson – the former CIO – is always eager to embrace new technology to help improve patient outcomes and provide a better care environment at his hospitals. Osler is hoping to experiment with wireless-enabled biomedical devices such as heart rate monitors – Anderson foresees a day when patients will transmit information directly to their physician via mobile apps—while many of its physicians and nurses are already using tablets and other mobile devices to access electronic patient records. 

That task becomes easier if Ontario actually manages to digitize all patient health records by 2015. Anderson thinks the goal is attainable, but says the key to making it work will be tying existing, regional electronic systems together, rather than scrapping them for one province-wide solution. Once that transition is complete, he feels that a portal should be integrated into systems giving patients access to their records. “We get caught up in discussions of things like privacy assessments, which absolutely have to be done,” he says, “but those aren’t things that should stop patients from accessing their records.”  

While Anderson may see opportunities to streamline health care on the digital and operational fronts in unprecedented ways, he knows the key to making those ambitious plans work means obtaining critical buy-in from front line healthcare professionals “The main thing for physicians and nurses from a change perspective is the more they can see how that change is going to improve care, the easier it is for them to change.” 

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