Contact:
Adam Stoehr
VP Education and Research
Excellence Canada
416–251-7600 or 800-263-9648 | adam@excellence.ca

Lean Advisors Inc., Intersol Group Ltd. and Excellence Canada develop alliance to help Canadian governments and corporations become world-class leaders.

OTTAWA – March 23, 2015 – Today Lean Advisors, Intersol Group and Excellence Canada announced a joint partnership to support public and private sector organizations to achieve excellence through a sustainable, integrated approach to running their operations.
Canada survived the economic downturn of 2008 and is now poised to compete with the world. But, in order to compete, Canadian industry and government must become ‘world-class’ organizations. And ‘world-class’ is not about being the biggest or having control of the major markets. It’s about being able to meet the ever-increasing demands placed on them by their clients, stakeholders and competitors. The goal is to be able to provide services and products better, faster and at less cost while improving staff engagement and involvement in the required changes. If they are successful they will become ‘world-class’ and will become global leaders and models for the future to the benefit of all.

The road to success will require a multi-faceted strategy. No one tool or area of focus will be enough. They will need three (3) things:

1) a Well-defined Standard which can be conveyed to all staff,
2) a Solid, Proven Process Transformation Methodology and,
3) a Change Management Approach that is effective across all leadership and staff.

To achieve this goal, Excellence Canada, Intersol Group Ltd. and Lean Advisors Inc. have formed an alliance that will be able to support any public or private sector organization in pursuing these key strategic elements. “Our clients now have the ability to tap into expertise for any of their needs as they progress on their journeys to Excellence, said Adam Stoehr, Vice President of Education and Research, Excellence Canada. Canada has been in need of this type of integration of expertise and credibility for a long time. Now it’s here!”

“Now organizations will be able to set a strategic vision and communicate that direction to support all staff and provide the knowledge and tools required to successfully create the change needed to become best-in-class”, said Larry Coté, President & CEO, Intersol Group and
Lean Advisors Inc.

Intersol Group with its 25 years of experience and professional staff assisting groups, large and small, on how to engage staff, align strategy and drive common, supported direction.

Lean Advisors Inc. with over 30 years of experience coaching, teaching and adapting Lean (process transformation) in all sectors.
Excellence Canada (formerly the National Quality Institute) with over 30 years of experience improving performance through coaching, teaching and recognizing Excellence with the prestigious Canada Awards for Excellence.

The future vision is attainable by those exceptional organizations that want to lead. This partnership is now capable of supporting, coaching, training and officially recognizing all phases of success through an entire journey to becoming ‘World-Class’.

About Lean Advisors, Inc.
Lean Advisors, Inc. is one of the most respected Lean consulting groups in North America. Lean Advisors, Inc., founded over 14 years ago and based in North America, has built a team of senior consultants with hands-on experience in a variety of sectors. In addition to their work with industry, the company has led the way to successful Lean practice in fields such as Healthcare, Education, Government and Manufacturing.
Our senior consultants’ mastery of Lean and Kaizen methods, combined with hands-on industry experience, has prepared them for tough ‘real world’ issues such as resistance, outside perceptions, conflicting agendas, and the need for senior management support. They help individuals become Lean leaders within their organizations as they overcome resistance to change and instill a Lean culture of continuous improvement. To learn more, please visitwww.leanadvisors.com

About Intersol Group Ltd.
Intersol Group Ltd. is a bilingual team of experienced consulting, facilitation and learning professionals whose expertise lies in harnessing and building lasting organizational capacity for its clients. Since 1989, the Intersol team has successfully delivered over 6,000 projects to hundreds of public sector, private sector and non-profit organizations across Canada.
Whether the focus is on shaping vision and strategy, on managing change, on stakeholder consultation, or on high performance teamwork, Intersol helps organizations leverage the knowledge, experience and expertise inherent in their own people.
Using processes, methods and tools that engage people to collaborate effectively and efficiently, we work with clients in the areas Stakeholder Engagement and Public Involvement; Direction Setting and Organizational Effectiveness; and Individual Effectiveness and Workplace Learning. To learn more, please visit www.intersol.ca

About Excellence Canada (formerly the National Quality Institute)
Excellence Canada is an independent, not-for-profit organization that is committed to advancing organizational excellence across Canada. Excellence Canada has helped thousands of organizations become cultures of continuous quality improvement and world-class role models, through its four-level Progressive Excellence Program.

As a national authority on Quality and Healthy Workplace®, Excellence Canada provides excellence frameworks, standards, and independent verification and certification to organizations of all sizes and in all sectors. It is also the custodian and adjudicator of the prestigious Canada Awards for Excellence program, of which the Patron is His Excellency, the Right Honourable David Johnston, C.C., C.M.M., C.O.M., C.D., Governor General of Canada. To learn more, please visit www.excellence.ca

Mike Boucher, VP of Client Services,  discussed the benefits of the management capacity program and how to free up management time by understanding executive priorities, analyzing management activities, and creating Standard Leadership Roles.

We hope you enjoy our recorded webinar and have the opportunity to benefit from the valuable content that was shared.

Click Here to View Recorded Webinar

To learn more about our management capacity program click here.

If you would like to be notified of future webinars, please join our E Newsletter: Talking Lean.

In this webinar, Larry Cote, President, Lean Advisors Inc. shares an objective assessment of Lean 15 years after the concept was coined ‘Lean”.  He highlights his own experiences as well as examines and identifies how different organizations from all industries have succeeded with Lean implementations.

Watch Webinar

By identifying how health care organizations and other industries have both succeeded and failed at improving timely access across their organizations and examine how to improve timely access across your organization or the system in which it operates.

Click to learn more about the 2013 conference.

About Taming of the Queue

Since 2004, the annual Taming of the Queue (TQ) conference has brought together a community of interest from across Canada to discuss access and wait time issues. Representing a wide range of perspectives, conference participants assess progress being made on wait-time measurement and management. Sponsored by several national health stakeholders, these events have enhanced knowledge about the issue, while exchanging best practices and helping to shape the public policy agenda.

In his first year as President of the UTPA, Dr. Robert Nelsen recognized this challenge right away. He had a transformative vision for his University which required improved responsiveness in administrative functions, without any increase in cost. The university had focused on improving the quality of its curriculum and educational resources without giving much thought to the transactional business functions. Until now, they simply had not been a priority. For him to accomplish his vision, Dr. Nelsen simply could not ask for more money from the UT program, he had to find a way to get more out of the resources he already had. Dr. Nelsen was familiar with the concept of LEAN at an enterprise level, and suspected he could achieve his goals through the identification and elimination of waste and improvement in the flow of tasks. He discussed this idea with an industry colleague, George Reynolds, a pioneer in developing lean transactional processes and formerly employed by Northrop Grumman Corporation as their Director of University Programs and Process Improvement. George agreed to provide some training and assistance to UTPA. After some discussion, both parties agreed to look at the procurement process at UTPA, and establish it as a test case to see if the lean methodology would “work” in an academic environment, and also to see whether it was possible to train UTPA staff to use lean methodology, so that they could continue to make improvements after the Northrop Grumman team left.

In October, 2010, George brought along a Master Black Belt to help observe the procurement process and facilitate a three day Value Stream Mapping event, focused primarily on the procurement process. A VSM, or “Value Stream Map” is a visual representation of a process that is intended to deliver value to a customer. It provides a structured approach for “seeing” the sequence of events required to deliver customer value and defines how each step in the process impacts what the customer values. The VSM shows how the processes link together in a ‘value chain’ and the map provides a way of “seeing” opportunities to minimize waste and improve process performance. The real strength of the VSM approach is in gathering people from different disciplines to see and talk about the flow of processes in a common language, and at a common contextual level. Once the problems are seen in the context of the overall process flow, their impact on performance can be measured, and countermeasures/improvements can be made. This effort using the VSM culminates in designing a detailed Future State Plan and vision to move forward.

The UTPA team went right to work, embracing the idea that they had control of their own destiny. The team quickly outlined the process they intended to improve (2), connecting each process step and output to a customer. This outline framed the starting and stopping points for a more detailed look at the procurement process, which the team mapped in great detail (3). With this detailed view of the process, the team was able to identify the “friction points” in the process – the things that got in the way and slowed things down.

The more detailed map also allowed the team to measure the individual process steps from a time standpoint. As part of the VSM process used by George’s team, the relative variation in time associated with the “friction” in the process was also measured. The facilitator used this specific measure of time and variation to create a Monte Carlo simulation of the time spent in the procurement process, and the relative impact of the variation in time as it impacts the overall process lead time. The marriage of visual representation of the process friction (pain points), and modeled impact on overall lead time helped the UTPA team focus on the “most important” things to work on. They spent almost a day of their time together coming up with, and prioritizing improvement ideas to make the procurement process “better”. While there were dozens of ideas for improvement, the team was able to resolve that all the ideas centered on five basic themes:

1. Lack of Visibility for information
2. Lack of Flow – process stops without warning and waits
3. Choosing the Wrong Path / Routing Errors
4. Training / Insufficient Knowledge – the people involved with the process just were not sure what to do.
5. Infrastructure – The tools (hardware and software) were not adequate to support the procurement needs.

The final day of the three- day VSM process was used to synthesize the process improvement ideas into specific actions (“WHO is going to do WHAT by WHEN”). This involved a lot of discussion, trade-offs, negotiation and estimation of costs and impacts, and is always much more intensive than it sounds. With each improvement idea, the team estimated the relative impact the “fix” would have on the overall procurement lead time, and a “future state” Monte Carlo simulation was used to model the overall expected impact on performance. The ability to visually model the impact allowed the team to focus on solutions that involved the most “bang for the buck”. At the end of the third day, the UTPA team was exhausted, but satisfied. They had addressed the specific changes they needed to make to the process, each dealing with manageable actions that are summarized below.

• Visibility – Understanding where the information is, who has it, and the status of the process
• Priority – Understanding which tasks are more important than others
• Trigger – How to signal that work needs to be done, or that additional emphasis/priority is needed to keep the procurement moving forward
• Handoffs – Minimize the “in box / out box” waits from handing tasks back and forth to different functional organizations. Maximize the amount of work that can be accomplished at one time by each group.
• Delegate – Trust others to accomplish their jobs, and hold them accountable for success
• Metrics – Measure the current process to establish how well it services the stakeholder’s needs
• Better Tools – Improve the ability to flow work, provide priority and visibility and extract information out of the Oracle Database
• Organizational Efficiency – Reorganize the group to be more efficient. House complementary functions under the same organization

The impact of improvement impact was re-modeled using the Monte Carlo approach, and the “Future State” process time was compared to the Current State. Improvements to specific process paths were modeled to be ~ 30% (5), except for the Sole Provider Procurement process, which involved improvements that were out of scope for this initial effort.

At each step of the process, the facilitator instructed the team about the theories of lean and continuous improvement that were used. He further taught the practitioners how to created and model their own maps, so they could continue to develop their improvement skills without the need to bring in expensive consultants each time. As highly engaged and intelligent groups often do, they embraced the concepts of the process improvement paradigm, and diligently went off and worked the action items. Within a few months, the team had met the expectations of the modeled performance, but saw the opportunity to do even more. They met with smaller teams, and continued the process of problem identification and problem resolution. Without increasing costs or headcount, they were able to bring the lead time for the procurement process down by almost 50%!

What happened next was even better – the UTPA staff became encouraged by the success they experienced in the procurement process, and started to map other elements of the administrative and transactional processes. While not every process was capable of a 50% reduction in lead time, each process was capable of being made better without adding more cost or resources. In fact, there was no magic to the improvement effort itself, it was the result of key stakeholders paying attention to what was happening, assessing the current state information, identifying the problems and simply deciding to do things a little better. We call this type of change “continuous improvement”, and it enables us to get control of the seemingly chaotic things that make it difficult for us to succeed at work.

Dr. Nelsen states: “It was the little things that made a big difference. Once we really started looking, we started seeing. Once we saw, we asked questions and then really listened to the people working in the process. They had the answers; we just needed a way to get to them – after that, knowing how to act was much easier. The Continuous Improvement folks helped us figure out what to measure, where to look, and how to listen, it was a great help.”

He goes on to note: “We have a long way to go to get where we want to be. But this is a great start, and now we know that we can ‘get there from here’.”

Yes, good things ARE happening at the University of Texas Pan American. Small improvements add together incrementally, and lead to big changes. According to George Reynolds, the former Director of University Relations and Process Improvement at Northrop Grumman : “All we need are good people, the desire to look, the patience to listen and the guts to act.”

First, let’s alleviate the misconception, apprehension or anxiety that Lean doesn’t work.  It does work!

The caveat is that you must discover the ‘right’ or proper adaptation of the thinking and concept to  your unique situation!

Once you have acknowledged the above, you can then begin to search for the proper solution and resources to lead your Lean Transformation.

Chances are you will try to find the expert internally first and then if you feel you don’t have the internal expert, or need additional resources or guidance, you will go outside your organization to either hire someone or find a credible consultant.

The problem with trying to select the expert talent is that you may feel a little hesitant as you may not know what to look for (or not look for) in an individual in order to make this important decision.

This decision becomes even more stressful because you know that you get one chance to make the right decision and that if you select the wrong person(s), you alone are responsible for taking your organization down the wrong path and it is extremely difficult to start again.  We acknowledge that much of this confusion has been caused by consultants and trainers that have misguided their clients and/or students and given them the incorrect or incomplete knowledge which in turn the leadership unknowingly uses to select what and who they need to guide them.

So we thought it might be helpful in this post to at least highlight some of the red flags to be aware of when hiring a person(s) to lead the change in your organization and that you are willing to put your reputation on the line for.

Here is a list of some of those Red Flags to keep in mind when deciding on the expertise you are looking to engage:

1)      The transformation costs tons of dollars.

2)      The person doesn’t know the difference between Process and Value Stream Mapping and where both are critical.

3)      They speak about tools instead of cultural change.

4)      They have a solution prior to properly assessing the situation.

5)      They will do it for you – your staff won’t be that involved, the staff only have to utilize the changes once the consultant is done.

6)      They use the word ‘bottleneck’ or project to focus on one area.

7)      They call it Lean Sigma and it is really mostly Six Sigma (a tool).

8)      They use a matrix type chart to determine the priority of projects i.e. the one axis is normally large and little impact and then the other axis is little or most effort.

9)      They give you a long list of projects to assign to staff or themselves with no sequencing analysis.

10)   Their plan requires them to be on-site for, what seems like, an unreasonable length of time.

These are only some of the Red Flags you should keep in mind.  If you ‘see’ any of these types of ‘flags’, take notice and do some additional analysis and research into the credentials and approach.  Doing this analysis properly could save you years of regret, not to mention thousands of dollars, and in the end- frustration and disappointment not just for you but for your entire staff.

Lean does work when implemented properly!  The challenge for you is to choose the distinctive and effective adaptation of the theory that is right for your environment/situation that will not only transform your processes but also transform your culture into a sustainable continuous improvement organization.

For more information, contact us at corp@leanadvisors.com.

Thank you to all who attended the January 24  Webinar “Management Capacity: Creating Standard Leadership Roles for the Lean Supervisor” – if you missed it, click here to view the recording.

There were a number of great questions asked by attendees during the Webinar. Mike Boucher, VP of Client Services at Lean Advisors shared his insights and knowledge. Below are Mike’s responses to questions posed at the webinar:

Q.  What is the right time to apply the management capacity program?

A. We have found that management capacity can be applied throughout the 3 phases of our Lean Transformation program. In our Foundations phase, we set the strategic direction with the stakeholders and begin selecting value streams. Often, at this stage, we identify areas where managers or teams are overly stressed to try to support other activities.  The goal is to move change forward where it is critically needed but if our management team isn’t capable of providing the support and resources to make that change happen, then we would introduce the management capacity program to free up time in order to enable the necessary change in the identified areas.

In the second phase, (VSM phase), we assess our current state, develop our future state and create an implementation plan. Once we’ve reviewed the implementation plan and understand the resources required to support the kaizen events, we begin to identify that it might be too aggressive given the available resources. At this point, we would stop, reassess and create the opportunity for the managers to be able to support the implementation plan. Again, we would introduce the management capacity program as a stepping stone to leading our process change.

The third element involves the execution of the kaizens and implementation plan. Quite often, a great implementation plan begins to fade away on us as delays begin to creep in and we lose momentum. At this point, senior leadership needs to take a step back and acknowledge the resourcing issue and lack of management support for the value streams. In order to support those mangers, we would introduce the management capacity program to free up their time and place structure into scheduling the change elements that we’ve introduced in the implementation plan.

Q.  Should we introduce the program across the entire organization or should we introduce it one department at a time?

A. This is not always a straight forward answer. I often ask the organization to look at what their success rate has been in the past in terms of resourcing, programs and making change happen. Often, the answer is “we don’t have a very good success rate.” So, my recommendation typically is to focus on the area where they are trying to drive change first. They should focus on the critical areas, the crisis issues and where crisis is happening and then we figure out how we’re going to resource again and put in the necessary time as senior leaders to support the change.

Q.  Would these assessments be conducted with different levels of management separately or together?

A. In terms of the assessments, I would look at it from a value stream perspective. Who is the management team within the value stream? And within that value stream, I would want all managers, regardless of level, to participate in the program. One manager or supervisor may be creating the problems for someone else, so if they are working on it collaboratively and collectively and doing their reviews as a group, they begin to address issues from a team perspective – rather than individually.

Q.  Can you give an example of a value stream for an office manager?

A. In terms of an office or admin environment, I often see manager’s time tied up not really addressing what they are directly responsible for but actually focusing a lot of their attention in other areas. In particular, I’ve seen a lot of managers putting a large amount of time into a hiring process, perhaps an area that they don’t really excel at but end up being dragged down and spending a lot of their time supporting the hiring process and it’s taking them away from their actual day to day responsibilities and the things they are directly responsible for.  That is not to say the hiring process isn’t important but we need to understand what is the goal of these managers in the hiring process and what can they realistically do and what work should be moved to where it belongs. In many cases, this is because it can be done more effectively. In other cases, we are just duplicating effort.

They are fighting fires while responding to pressures from both the organization above and staff below. Meanwhile, they are being told to cut costs, improve quality and improve service.

With so little hours in a day, where do they find the time?

Join us for our free webinar, “Management Capacity:  Creating Standard Leadership Roles for the Lean Supervisor.”

Mike Boucher, our Vice President of Client Services, will share his insights.

We will show you how to free up management time by understanding executive priorities and analyzing management activities, creating Standard Leadership Roles.

Date: Thursday, January 24th, 2013

Time: 1300 – 1345 EST

Space is limited.  Register Here!

About the Presenter: Mike Boucher, VP Client Services

Mike Boucher has had extensive experience with Lean in his role leading companies in their Continuous Improvement and Lean journey. Over 20 years, he held numerous operational positions with a major distribution and logistics corporation.  Mike has worked with various healthcare organizations and Government and College administrations including the Ministry of Health, Fleming College, Mayo Clinic, Toronto Sick Children’s Hospital, Marietta Memorial Hospital, Luther Midelfort Hospital and others. Lean applications within the healthcare setting include; Surgical Value Streams,Core Labs, Cytogenetics, Micro-Biology, Critical Care Units, Emergency Dept, Pre Surgical Center, Outpatient Clinics, Admissions & Discharge etc.  In the Government and College transformations, he worked on all administrative processes including policy, finance, human resources activities, quality etc.

Consistently, Lean applications in these settings focuses on optimizing service to the clients and improving turnaround times/lead times.  Through this endeavor, Mike has worked with teams to improve flow and truly identify the needs of the client. Unnecessary costs and wasteful activities are eliminated in order to better support staff in their efforts to provide service or value to their clients.

Mike’s greatest asset is his ability to simplify complex production and process issues through the application Lean principles and practice.  Mike is a strong promoter of Value Stream Mapping as one of the most important tools that companies can use to align their organization and promote a customer focused perspective. It is this approach that allows companies to best identify their waste and systematically remove it from their processes and value streams.

Challenge: Not all senior leaders have the vision, understanding and/or have “bought in” to making Lean a priority.

This is one of the critical steps and foundation blocks that must be in place to ensure the success of any Lean Transformation and Organizational Culture Change.

Root Cause: In our brainstorming sessions, the following were identified as some of the possible reasons this occurs.

• Lack of Knowledge/Education about what lean truly is and its benefits.
• Not aligned with Strategic Goals
• No clear metrics or goals associated
• Unclear about the Return on Investment
• Lack of ongoing communication
• Cultural issues internally
• Conflicting priorities
• Control
• Trust
• Resources to support and sustain lean
• Fear of this being just another “flavour of the month”

Each root cause listed above impacts leadership support and each one of those challenges requires an investigation to determine what would need to be in place to most effectively address them.

Possible Solutions:

Some of the possible solutions or ideas that could help to begin to address the challenge of achieving Senior Leadership buy in were as follows:

• Help Senior Leadership understand the value and overall system impact to create the vision
• Learn to speak the language of the Sr Leadership team and what is important to them
• Demonstrate the ROI of Lean through metrics meaningful to Leaders and its Strategic Alignment within the Organization
• Create capacity with staff and allocate resources to support the vision
• Create small wins which tie into the larger picture and work towards winning over naysayers
• Establish Goals and Focused Scope of Project
• Within you sphere of influence, create a pro-active and empowered culture

These are some of the potential solutions that were identified from our session and are worthy of investigation and strategy. Lean Advisors employs senior consultants who are veterans in the industries they serve. To learn more about how we can help you make your organization everything that it can be, contact us.

In 2008, the Montfort Hospital emergency room was one of the province’s worst. Its sickest patients waited up to 20 hours to be admitted. Patients complained and nurses quit. Morale was low and turnover was high. The nurses who remained were overworked and burnt out.

Occasionally, staff frustration boiled over; patients either left without being treated, or went public with stories about rude behaviour and substandard care. The hospital became a focus of negative headlines. “It was a crisis,” admits François Lemaire, Montfort’s clinical director of the ER.

These days, Montfort is no longer a laggard among Ontario’s busiest ERs. Its wait time for the sickest patients is 10 hours — half of what it was in 2008 — even though the volume of patients continues to rise. From 35,000 patients in 2008, the ER now treats 52,000 annually. Many of them are sicker and harder to treat than patients in the past. Yet despite these challenges, Montfort’s wait time continues to fall.

A recent survey of Ontario hospitals indicated that nine out of 10 patients would recommend Montfort’s emergency department to their family and friends. And the turnover in ER nurses is so low that there are currently no full-time openings — a dramatic change from 2008 when there were 15 vacant positions.

The turnaround, aided by $3.7 million in provincial funding since 2008, is one example of how Montfort says it has improved patient care by using practices made famous by Toyota. With the hospital-wide introduction of checklists, streamlining, standardization and non-stop brainstorming with front-line staff, Montfort has joined a growing number of acute-care centres in bringing the efficiency of a factory floor to health care.

The approach, known as lean, has long helped the auto and aerospace industries reduce waste and boost value for customers through continuous small improvements. With a cash-strapped government trying to rein in health spending, Ontario hospitals are catching up, spurred by provincial directives to do more with less.

Nowhere is the need for improved efficiency more critical than in emergency rooms, where speedy care is a key component of good care.

Montfort’s transformation began in January 2009, to teach its staff the lean principles. The hospital paid for the lean consultants with some of the $687,000 it received that year for ER improvement.

The money was part of a four-year, $400-million provincial program called Pay For Results. When it was launched in 2008, Montfort was among 23 of Ontario’s poorest-performing ERs to receive the funding, which gets clawed out of their annual budgets if they don’t show improvement.

Hospital staff deconstructed every aspect of how patients moved through the ER, from the time they arrived by ambulance or car until they were discharged. They examined the “flow” of patients — how they were assessed at triage, how they got their lab tests and diagnostic scans, how they were discharged or admitted and how information moved with them at each stage. They attacked the problem in the same way that factory managers studied the parts of an assembly line.

“We were a whole bunch of people with Post-it notes on the floor that showed all the different steps,” recalls Sophie Audet, an ER nurse. “After it was done, everybody looked at each other and started saying, ‘Oh my God. No wonder we’re so tired.’ There were so many steps. When you see it, you actually realize that.”

Audet and her colleagues worked to simplify the journey for patients and reduce unnecessary tasks for staff. To their surprise, the best ideas were not necessarily flashy, or expensive to implement.

Among other things, a daily activity report was introduced that gave every hospital worker — from the chief executive to department heads, physicians, nurses and housekeeping staff — a snapshot of the traffic in and out of Montfort. It listed the number of patients waiting to be admitted and discharged.

For the first time, staff got a bird’s-eye view of where the hospital’s bottlenecks were. They could also see which departments needed extra help to move patients along. “You see the big picture, not just your own little department,” says Audet.

In the ER, a low-tech whiteboard was introduced. It tracked the location and status of every patient and listed what services they were waiting for. For the first time, method and transparency were imposed, allowing the nursing team to manage patients more quickly and effectively. The approach also reduced the chances of patients being lost in the shuffle.

“Before, we used to write down everything by hand,” says Johanne Gougeon, the ER’s lead nurse. “Now, we write on magnets. If we have a patient go somewhere, we just move the magnet around. It’s on the board, it’s written out, it’s all standardized and everybody can see what’s happening.”

In addition, the triage process was simplified for patients with minor complaints. And the workflow of the diagnostic imaging department as well as the work schedules of housekeeping staff were adjusted to conform with the ER’s busiest times of the day.

Other changes related to inconveniences in the physical layout that added up to hours of lost productivity every day.

For example, the storage and labelling of medical supplies were standardized so that nurses did not waste precious time searching for surgical dressings or catheters. A method was introduced to manage wheelchairs, which were never available when staff needed them, leading to longer-than-necessary delays for patients waiting to be moved or discharged.

“We (drew) a line on the floor and we put up a sign: ‘Three wheelchairs here,’ ” says Lise Vaillancourt, director of clinical services. “All of a sudden, when somebody was done with a wheelchair, they knew what to do with it.”

Even a simple procedure like urine analysis often kept patients waiting because the fridge where the samples were stored was far from the nursing station. “We calculated that the nurse had to walk something like 150 steps and another 150 steps back an average of 75 times per day,” says Vaillancourt. “So we just took the fridge and put it under the counter. Now, it’s zero steps.”

Based on these seemingly minor improvements, ER wait times at Montfort fell by 10 per cent within three months.

Meanwhile, other changes happening hospital-wide also helped to ease some of the ER congestion. Physicians and nurses started to emphasize discharge planning almost as soon as patients were admitted. In the past, discharge planning only took place toward the end of a patient’s stay, which often led to extra days spent unnecessarily in the hospital. The resulting bed shortages triggered a backlog of patients waiting in the ER to be admitted.

Another change involved introducing a system of early-warning signs that flagged hospital staff about imminent overcrowding, giving them more lead time to plan for a higher number of patients.

By 2010, two years after Montfort introduced lean, its ER was among three that were recognized as the most improved in the province. That year, the department was awarded a $200,000 bonus under Pay for Results. By then, the ER had left its cramped and aging space for a brand new facility that was double its previous size, part of the hospital’s $300-million expansion of its premises on Montreal Road.

The new space allowed for even more ER efficiencies to be introduced.

These days, when patients walk into the Montfort’s ER, one of the first things they see are signs telling them what the estimated waiting time is. Based on how serious their illnesses or injuries are, they are directed to different waiting areas and treatment zones. They take a number to wait so they know how many patients are ahead of them.

Instead of having nurses or porters accompany the walking wounded to get their diagnostic scans, there are colour-coded lines on the floor that guide patients to where they need to go. In the past, patient care suffered in part because staff spent so much time shuttling patients back and forth.

Hospital officials say patients, especially those with minor complaints, are now so savvy that they’ll call ahead to check Montfort’s wait times against those of The Ottawa Hospital or Queensway Carleton. “Now, people are shopping around,” says Lemaire, the ER director. “This is our reality.”

Excerpt from the Ottawa Citizen
To Read more: http://www.ottawacitizen.com/health/Toyota+style+management+helps+Montfort+wait+times/7427615/story.html