Must Listen: CBC Radio Piece on #Lean in Ontario, ThedaCare, and Saskatchewan


Screen Shot 2014-11-09 at 11.53.55 AMI was thankful to find this CBC Radio news story / podcast from the program “White Coat Black Art,” hosted by Dr. Brian Goldman:

The Toyota Way for Healthcare

It's just under 30 minutes long and I think it's a “must listen.” You can also get this through iTunes and your iOS device.

Here are the notes that I took and my comments.

St. Mary's General Hospital

They first visited St. Mary's General Hospital in Ontario and talked to their CEO, Don Shilton (they are a member of the Healthcare Value Network and Don was a CEO panelist at one of the annual Lean Healthcare Transformation Summits that I participate in.

At St. Mary's, Lean has meant:

  • Less waiting better quality
  • Lower mortality, less cost
  • No patients waiting for bed in ED

Shilton says they couldn't have done it (gotten improvements on that scale) without Lean.

Dr. Goldman summarizes three key Lean principles:

  • Identity the customer (the patient, not the doctor)
  • Identify problems
  • Fix only the things that make it better for patient

Next, they talked to an internal Lean facilitator, at St. Mary's, who came from the Toyota Cambridge plant with ten years of experience.

He said it's tough to take things that embedded in the Toyota culture to the new place and install it like a thing. He said, “At Toyota change is expected.”

There, any team member simply brings idea to team leader. Their standardized work can change in hours or days; at most a week.

There are hundreds or thousands of improvements a day in that Toyota factory, he said.

They talk to a heart patient, who they describe as a “Lean Sensei Black Belt” from heavy industry. Dr. Goldman says a “LSBB” is the “highest level” of achievement. What? Nobody stops learning or getting better. OK, end of my digression.

The patient said he could tell it was a Lean hospital because “you didn't have to beg for information.” Things were so consistent across shifts. Things seemed error proofed. It was a great relaxation to learn it wasn't a normal hospital. You feel part of the team.

The whole hospital (catering) isn't Lean yet, he said and “you might want to edit that out.” The attitude was “Here is a tray, eat it. There was no feedback loop”. The CEO Shilton said he wants to hear that feedback and there was no need to edit anything. The entire hospital can't get Lean overnight. They chose to focus on cardiac care areas before catering and dietary services.

Dr. Goldman says the CEO seems comfortable taking about unsolved problems. That's a big culture change from  “don't go looking for problems.”

Visiting ThedaCare and John Toussaint

Dr. Goldmann next went to Appleton, Wisconsin. Dr. John Toussaint, former CEO of ThedaCare and now CEO of the ThedaCare Center for Healthcare Value said, “You're never done learning this” (as I suggested above). You're never done, but it takes “three to four years to get into the culture, sometimes up to seven.”

John said ThedaCare has been “learning from other industries. I don't know why weren't doing that [before].”

Dr. Goldmann asked what are the “wrong lessons” people take from a visit to ThedaCare?

John said it's when the CEO delegates Lean. This is about everyone's engagement from CEO to front line. Otherwise don't try this, he says.

Lean Healthcare in Saskatchewan

The discussion with Dr. Toussaint turned to Lean in Saskatchewan, with John saying they will hopefully prove this can be done at such a large scale.

A representative from the nurses' union said nurses were being told to take out trash and change linens because of Lean. That's puzzling, since that seems to be a waste of their talent. I've seen Lean drive hospitals to REDUCE the amount of time nurses are doing non-nursing tasks, which allows them to focus MORE on the patients. That's what I see as a “Lean approach” – having support staff let nurses be nurses, pharmacists be pharmacists, etc. The nursing union admits that “Lean has things to offer” but they are concerned about patient safety. Well, Lean has a lot to offer to improve quality and patient safety.

I still don't understand the apparent disconnects up there.

Steven Lewis, a professor of health policy was interviewed and was described as a ” fan of Lean, given the right circumstances.”

Lewis said, “Morale was already bad. Superimpose a big experiment implemented a certain way and that will be disruptive in the short term.”

He said their are many ways to try to get Lean and he described the consultants for Saskatchewan, John Black & Associates, as “militaristic”  with a “my way or highway approach.” That doesn't sound very Lean to me, telling people what to do. We should be engaging people in the improvement process.

I thought it was a very balanced and interesting program. I hope, again, that everybody in Saskatchewan can focus on the goals that matter (safety, quality, waiting time, morale, etc.). Lean should help accomplish those goals and Lean should make people happy, not upset.

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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. If you’re still in Japan and have a chance to talk with hospital leaders, is there a “my way or the highway” approach from the sensei or consulting group as discussed in this blog about Lean in Saskatchewan?
    Also, what is the focus of Lean in the hospitals? Flow? Safety? or other?

    • I just arrived and the Lean tour is next week Monday through Friday. The hospital visits are Wednesday through Friday. I will try to bring these questions up.

      Last time, I saw a lot of focus on 5S in the two hospitals we saw. One also had a much broader quality program that had evolved from TQM to also include Lean terminology… more focused on quality and patient outcomes, it seemed.

  2. Hi Mark

    It is nice to see that things can happen even in publicly run healthcare. There are two issues that I think get overlooked when beginning most Lean Journeys first is before you can begin to sustain any type of improvement you first need to reach a state of stability. In healthcare stability is often much harder to achieve than it is in most factories. One of the best reason for adopting Lean to me is that it over all the other business improvement ideas comes packed with tools you can use to first gain a level of stability in an organization (5S, Standard Work Instructions, Quick Changeover, Just In Time, Error proofing, Total Productive Maintenance and work cell layouts are all first and foremost means by which you create stability). Once you have obtain a state of stability you can than actually begin to identify opportunities for improvement (what some people might call problems), work to develop and test possible solutions, and ultimately implement new instructions and procedures that improve any or all of the stability tools of Lean you are using (5S, TPM etc.). Waste reduction is the natural by product of creating an improved new stable process. One of the big reasons organizations fail in Lean is that they put a cart that needs to be pulled in front of the horse instead of behind it, they look to get rid of a waste before first stabilizing the process which depended on the waste being there.

    I also feel there are more MEAN fake Lean attempts focused on using all the right buzzwords than real Lean attempts focused on actually doing the right things what ever you want to call them. After all Toyota never talks about doing Lean, they just focus on following and improving their Toyota Production System. If any organization would first focus on creating a stable work environment, and shift their view from fighting problems to looking for improvement opportunities they can and will succeed in implementing a production system of their own just as good as Toyota’s, Ohno and Toyoda were just human like the rest of us they just choose to look at the issues they faced as a challenge to be overcome instead of as a threat.

    • Creating a stable work environment would be a huge step forward for healthcare. People focus on “muda” (waste) instead of also looking at unevenness and unreasonableness.

      We can’t ask nurses to do 80 minutes worth of work in an hour. It’s just impossible, yet hospitals try. So people have to cut corners and that’s where problems occur… system problems to say the least.

      I’ve been reading the book by Patty Gabow, former CEO at Denver Health. Even though she talks about the need to change the culture, what comes through the most is doing lots of Rapid Improvement Events and adding up cost savings. Yes, there are examples of quality and flow improvement and they said their three goals were always cost, quality, and human development, but it comes across as heavily weighted toward cost.


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