Saturday, March 15, 2014

I want to make clear that I am not taking sides in the internal political debates of another country, but I think it is instructive for all to watch a current scuffle in Saskatchewan.

Several years ago, the provincial government began an effort to adopt the Lean process improvement philosophy in the health care facilities across the province.  This was to require a large investment of time, money, and other resources.  Those of us in the health care world who have participated in Lean roll-outs--and have seen the value that it offers in increasing efficiency and quality--were impressed by the vision and commitment of the government.  We knew, as did they, that this kind of cultural transformation would take years, and we admired a government that had a long-term view of the return on the taxpayers' investment.

Over the months, consultants have been brought in to conduct training and offer support, and staff members in the various institutions have become more and more familiar with the philosophy and with the techniques and approaches used to create true front-line driven process improvement.

But the size of the investment has now raised concerns.  This article in the StarPhoenix summarizes the dueling points of view:

Under fire from the Opposition, Premier Brad Wall defended the provincial government's spending on the "lean" health quality management system.
"The overall amount is a significant investment and when we made the decision in cabinet, we're a government that looks at these things from the perspective of thrift and value and it was a long discussion."

The premier said the province is recouping its investment.

"We sought the very best and made the difficult decision to do this because of the dividends. What we're able to show is that between the savings just on the design of the children's hospital, on the design of the new Moose Jaw hospital, on the blood management system, we've recovered the entire costs of the four-year program, never mind all of the efficiencies that we have found," Wall said.

Opposition Leader Cam Broten took aim at the government over the issue during question period Thursday in Regina.

"There are good components to 'lean' . . . but this government has taken the 'lean' process and allowed it to become fat, allowed it to become a cash cow for consultants," Broten told reporters.

He said $40 million doesn't represent the total cost of "lean" in the province, since regional health authorities and other ministries also have "lean" contracts.

"I think it's gone overboard," Broten said. "I've looked at some of the Twitter feeds of health administrators who are paid to champion these kinds of things. It sounds like they're in a cult, the way that they pursue this type of language, over the top. We have to allow common sense to have its place."

This is an important debate with ramifications beyond this province.  I know from my visits and conversations elsewhere that people in health care throughout Canada are watching the Saskatchewan experience closely.  I think its fair to say that its success would be a signal throughout the country that it is possible to increase quality and safety and service levels and improve operating efficiency.

So how to resolve the political debate? I'm not taking sides, but it seems to me that this is too important an issue to have a "he-said-she-said" type of debate. Two ideas come to mind to help resolve the issue.  First, the government should be utterly transparent with regard to process improvement successes and failures during the roll-out.  Where successes have occurred, document what was achieved and how the stories of those advances are shared throughout the province and therefore contribute to the spread of good ideas.  Where failures have occurred, explain what has been learned from those experiments.

Second, bring in a (volunteer) group of outside experts to review the steps taken by the government and offer an objective appraisal of the roll-out.  Provide that report to the public and allow the government to explain how it will take those expert opinions into account going forward.


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