Located in the heart of Kitchener, Ontario, St. Mary’s General Hospital is the second-largest acute care hospital in the St. Joseph’s Health System. Since 1924, the organization has been a cornerstone in the community, providing patient-centered care. Today its team of 2,000 physicians, professionals and volunteers serve a population of more than 700,000 people.
A Need for Lean Transformation
The leadership team at St Mary’s attempted its first foray into lean healthcare in 2008. This initial effort aimed to reduce emergency department wait times. Within a few months, the organization experienced the taste of success, however, staff did not have the training, tools and processes in place to ensure sustainable improvements.
But Don Shilton, then serving as a vice president at St. Mary’s, had a long-term vision he refused to abandon. In 2009, he began working with KPMG consulting and soon obtained an invitation to Appleton, Wisconsin. There he met Dr. John Toussaint and toured ThedaCare, which had earned a reputation as a model of lean healthcare success.
“The high performance of ThedaCare was obvious everywhere we looked, and the focus on improvement was astounding,” said Shilton. “I knew if I ever became president at St. Mary’s that we could implement lean successfully.”
A year later, in 2010, Shilton was promoted to president. He and his board members created a new vision for St. Mary’s and made a commitment to lean healthcare transformation.
Lean Transformation and Results
With new leadership in place, St. Mary’s chose to focus its lean effort on improving its hospital standardized mortality ratio.
“We first established a performance team, trained key people on new thinking and skills and worked to understand the tools whose application would result in daily improvement,” said Lydia Chudleigh – who served as vice president of quality, performance and diagnostics at St. Mary’s. “We began in just two departments, but within six months nearly every department was huddling each day, discussing staff suggestions and improvement measures.”
Shilton said a key learning was to focus at the corporate level on just a handful of improvement measures rather than attempting everything at once. “Our senior team quickly understood that 13 improvement goals were too many. We reduced our focus to seven goals, then to five and finally four, which seems to be an ideal number for us.”
In 2013, Shilton, Chudleigh and the team began working in earnest with Catalysis. With the help of Kim Barnas, president at Catalysis and a lean transformation coach, combined with input from members of the Catalysis Healthcare Value Network, St. Mary’s was able to further its lean journey.
“Catalysis helped us train our teams in lean thinking based on the successes of other healthcare delivery organizations. Specifically, they helped us develop a Lean Management System that worked for St. Mary’s,” said Shilton. “We worked with four or five groups at a time, ultimately training everyone at the entire organization. This has made all the difference in the world.”
Since refining its lean transformation efforts, St. Mary’s has achieved many results including meeting its goal to lower hospital standardized mortality ratio. In fact, the hospital scored the lowest mortality ratio of any hospital in Canada not once, but twice in the past five years. In 2015 the organization set a goal to implement one improvement per employee per year (1,300 in total) and exceeded this goal. The goal was doubled in 2016 and the hospital is on track to implement more than 2,600 improvements across the hospital.
“One recent goal was to reduce patient falls at our facilities by 25 percent,” said Chudleigh. “We reduced patient falls by 32% the first year and another 25% in year two, for a two-year reduction of greater than 50%. Our focus today is on reducing infection rates by 25% and so far, we’ve lowered infection rates by 50%. Because of lean thinking, these improvements can be sustained across organization.”
According to Shilton, the success at St. Mary’s was due in part by the board of trustees, who embraced their role in keeping hospital-wide initiatives focused on lean.
“Most of our board has been to ThedaCare to observe and learn how a lean hospital functions,” said Shilton. “Board members came to the conclusion that we needed to recruit new board members who possessed lean expertise to help with our journey and educate board members about their roles. Today, our board meetings start with a 15 minute board huddle focused on the corporate goals and board-level improvement ideas.”
The Catalysis Difference
Typically, a healthcare organization’s transformation journey involves a turning point where momentum starts building and the organization’s leadership team finds itself on the same page.
“Seeing, firsthand, the success that Dr. Toussaint had in transforming a healthcare organization, and having Kim as a transformation coach made the difference for us,” said Shilton. “We would not have known where to go next without their expertise, particularly when we hit our transformation plateau. Without the right connections, and assistance from those going through their own healthcare transformations, we would have been lost.”
“Lean principles help keep our focus sharp. We’re able to apply lean thinking to everything,” said Chudleigh. “Most importantly it provides us with regular opportunities to coach and mentor others across the organization. Leaders and staff think differently than we did 10 years ago. This culture shift was vital to our success.”
Shilton recognizes that his organization wouldn’t be making significant change without Catalysis. “They have inspired us to do better – to become a model organization that, today, serves others as they begin their lean transformation journey.”