Lean at the Peterborough (Ontario) Regional Medical Centre


Ontario's Peterborough Regional Medical Centre is about 18 months into their Lean transformation. They are being featured in a series of four articles in their local newspaper, the first two of which are already out.

Article one: LEAN machine at PRHC

Article two: New RX remedy

Some highlights of the first story, as it starts with a framing of their financial challenges:

For the past 18 months Peterborough Regional Health Centre has been applying a new management system to patient care in an attempt to streamline and improve service while paring $27 million out of its annual operating budget.

Unlike traditional “cost cutting,” Lean gives hospitals a methodology to improve quality and service… which leads to financial improvements in cost and revenue.

Some of their results:

  • Reducing turnaround time for CT scans from 4:44 to 2:51, a savings of almost two hours
  • Savings of $870,000 in the first year from supply expense reductions and capacity improvements

The CEO says:

“You can't use lean methods to downsize your staff,” he said. “You have to figure out how to continue with these processes with the staff you have. That's what lean has done for us.”

That's right, but the hospital (driven by the province?) laid off 182 people in March. It sounds like those layoffs weren't the result of Lean productivity improvements (being driven by budget cuts?), but it's hard to separate Lean from layoffs, even when they are just correlated as opposed to being cause and effect. I wonder how those layoffs are interfering with the embracing of Lean by front-line staff? It's too bad that they couldn't find enough benefits from Lean quickly enough to avoid the layoffs. Given that the layoffs happened… I guess Lean is the best strategy for improving the workplace to get by with fewer people… but it's not the best circumstances for Lean.

The first article also has a good summary of the Lean management system and philosophy:

The lean system of management also relies on a series of basic principles which, while they seem obvious, are often paid little heed:

* The employees actually involved with the process are the best source of information about how the system works or doesn't.

* They must be able to speak up without fear of repercussion.

* Making the customer, (the patient) the priority, not the service providers.

* Total involvement, from the CEO to the team on the floor, in the constant pursuit of improvement.

Article number two in the series features improvements in the pharmacy. The article starts with the sad story of an elderly patient who was given the wrong dose of a medication in the emergency department and then fell and broke her hip, as an inpatient, when the rails weren't properly put up on the side of her bed. Process errors leading to harm.

Before the Lean improvements, the medication ordering process was broken. It sounds like people and systems were overburdened… so quality suffers as an unexpected result.

Inevitably, the orders backed up. Facing lag times of between 24 and 48 hours, doctors and nurses were increasingly forced to turn to the override system, which is intended to be used only in emergencies.

“It was a broken system,” says nurse Laura Cranley.

The override of the system led to the medication error mentioned above.

It wasn't an isolated case:

As well as acknowledging the override safety issue, the document reported that, “Patients are experiencing between 80 and 120 medication incidents [wrong dose, med, and/or time] a quarter.”

The hospital has used Lean to reduce turnaround times and improve service:

Pharmacy personnel visited and observed the area of the hospital where drug orders originated, and staff on the wards traveled to the pharmacy. The “ah-ha” moment was the realization that the system could be fixed by putting the pharmacy techs in the nursing units, embedding them with the rest of the on-the-ground health-care providers at the point where patients were being treated.

Instantly, the units had real-time access to the drug dispensing side. They were talking to people, not firing off faxes. Orders could be filled by techs who floated among their assigned units, typically two or three. Orders could be adjusted more efficiently, with the techs having access to the doctors on the floor.

And, best of all, no more faxes.

I'm looking forward to reading the next two stories in their series… I hope you'll give the first two a read.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Re: 182 layoffs at Peterborough Hospital – Driven by Province?You\’re correct: The Provincial Government passed legislation that prevents provincially-funded hospitals (which is to say, *all* of them) from running deficits. Peterborough was the worst of the lot in 2011, leaking $14M, which prompted the board there to announce the layoffs last July. This is a simple consequence of having a socialized health care system and a unionized workforce.The no-deficit order arose out of cost-control measures due to the province being underwater with a huge debt – projected to hit $314B in the next two years thanks to profligate spending. Every Ministry is now running really close to the red, and so the heat is shared.(Incidentally, Ontario used to be the economic powerhouse of the country, and now, with unemployment that has been above the national average for the past 64 mos, has to accept federal transfer payments from other provinces to stay afloat.)Could Lean make them more cost-effective with what they have? Definitely. But when Lean runs into deficits and the province holds the purse strings, Lean loses. Every. Time.

    • So I guess we should (as I suspected) cut local leadership and the hospital CEO some slack… the layoffs were forced on them and Lean is at least a good strategy for trying to recover from them… if they can get staff engaged. I hope it just slows Lean down a bit rather than leading to a total loss and total failure.

  2. 4.5 hours to get a CT in the ED??

    Go ahead and get a bunch of point improvements, but Lean is unlikely to fix incompetent management working in a broken system.

  3. I think that’s the point, Anonymous: There’s a recognition that the systems employed right now by Ontario hospitals needs to be improved – which is precisely what a transition to Lean practices enables. From the outside it may seem like ad-hoc “point improvements”, but within there is a mindset, from the CEO to the janitor, to look for ways to continually improve how services are delivered all over.

    But there’s a double-edge to Lean: It reveals, rather obviously, where inefficiencies are. And when it comes to diagnostic imaging and tests, we already know that the bottleneck is access to a limited number of machines. It gets alleviated when we get more equipment and people to run it – and that’s not likely given the state of the province’s finances right now.

    And, rather unfortunately, the Premier played politics on having private sector partners provide additional services here some time ago. That attitude may change for the aforementioned budget issues.

  4. I am not sure this start is good enough. I would be much more encouraged to have a list of the same problems and then a report of how the executive team is going about to improve their personal competency (through lean learning and practice) to address the system problems above and below.

    The article does not say that they are not working on this so my optimistic side is encouraged and agreeing that at least they are starting to do things differently.

    My personal reality is that it is quite easy to make even a substantial single point lean improvement, but a bunch of point improvements don’t make for a lean organization.

  5. I appreciate Chris Chapman’s comment clarifying the layoffs that happened to coincide with the implementation of lean. Lean is difficult enough to implement in an organization’s culture. The changes that lean inspires can cause enough fear in staff without stories about lean caused layoffs circulating as well.

    Any implementation of lean in healthcare that produces improvement is a victory, I believe. There will never be “big” victories for lean in healthcare without “small” victories first!

  6. Thanks Chris for the focus and balanced responses. The layoffs were necessary to get our fiscal house in order. The result of which has been a complete fiscal recovery within 2 years (we’re now in the black even with no funding increases) and our quality, access and safety metrics have improved.

    Getting out of red ink was difficult on our people (just a note that only two people left our employment unwillingly – the remainder took early retirements, accepted buy-outs or were reassigned to other vacant positions) but relatively straightforward- right size our resources to the service levels we were actually providing and improve efficiency. The second goal (maintaining quality, safety etc…) was where LEAN really paid off. By the way, we also added new programs during this time for cardiac care (angioplasty), vascular surgery (as a regional provider to many hospitals), and cancer radiation bunker (under constructions).

    LEAN – with the ongoing dedication of our staff, physicians and volunteers – works! And while I can understand what Anonymous is saying, I also wonder about the sustainability of LEAN when the big picture is the first step. Such efforts are very worthwhile but generally entail extended timeframes – making ongoing engagement and commitment of physicians and staff even more challenging.

    Our current efforts are two pronged (1) continue with targeted LEAN improvements – extending the scope and penetration and (2) developing the larger formal and sustainable organization-wide LEAN program. AT PRHC LEAN is becoming a culture. It is also a journey.


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