Today's podcast is presented with a heavy heart, after the recent passing of my friend Dr. Michel Téatrault, the CEO of St. Boniface General Hospital and a great Lean leader. He was a friend to many in the Healthcare Value Network and the broader Lean healthcare community.
As I was remembering Michel, it occurred to me that I had recorded a podcast with him, back in 2010, as part of a series that I was doing for the Healthcare Value Network. I never shared that audio as part of my main podcast series, so I'm doing so today.
In the episode, we talk about “Lean from the CEO perspective.” I hope Michel's words and experiences at St. Boniface continue to help and inspire people. A transcript also follows here in the post.
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Mark Graban: Today, our guest is Dr. Michel Tétrault. He is president and CEO of the St. Boniface General Hospital in Winnipeg, Manitoba, Canada.
He's also Associate to the Dean of the Faculty of Medicine of the University of Manitoba and Associate to the CEO of the Winnipeg Regional Health Authority for French Language Services. He's a specialist in emergency medicine but today will be talking about Lean from a hospital CEO's perspective, as Dr. Tétrault has served as president and CEO since February 2005.
I hope you enjoy our conversation and that you'll subscribe to our podcast series through Apple iTunes.
Michel, I want to thank you for taking time out of your day to talk today on the podcast.
Dr. Michel Tétrault: Thank you, Mark. It's actually a privilege to be with you.
Mark: I was wondering if you could start by introducing, for the listeners, yourself and your organization. You're coming to us today from Winnipeg.
Dr. Tétrault: Yup, and my name is Michel Tétrault. I'm an emergency physician who's been working at St. Boniface General Hospital in Winnipeg for the last nine years, just about six of those in the position of president and CEO of this hospital. It's a mid-sized, 550-bed teaching hospital in Winnipeg, Manitoba, Canada.
Mark: You're part of the Healthcare Value Leaders Network and part of that collaboration with hospitals from the US and from Canada. How do you view things? We're not talking just to an American audience here today, but being in Canada, how do you see issues and the relevance of collaboration with the US and other countries?
Dr. Tétrault: That's an interesting question, Mark. Maybe the best way to answer it is to talk about an experience that we had years ago at IHI, I guess their initial Executive Quality Academy. We'd have CEO breakfasts and conversations during the day for a whole week.
It was interesting how on the Monday, the first day of the week, our conversations were all about the differences, and by the end of the week, our conversations were much more about the differences in our environment, which I believe are true, but how extremely similar our challenges and issues were, and what we had to improve upon, and what we had to change.
Different environments, but I think we're all facing the same problems. Within the network, I think it's visible that we're looking at similar types of approaches and solutions.
Mark: How would you summarize some of those key similarities, the challenges that you're facing and that you see other hospitals facing, as well?
Dr. Tétrault: One of the ways to look at it is what I call three of the things that will keep a CEO awake at night. In no particular order, one of them is being able to find an adequate workforce, to get the people we need to serve all the patients that come to our door. There are a lot of people in health care that are either closing in on retirement or could retire tomorrow.
Then, who's going to replace them with the demographics of, on one hand, patient demand increase because of an aging population and that gap in the generations following us who are going to be the workforce? We want to be a place that people in this city, for example, really want to come and work at. I believe that what we're doing makes us attractive.
The second, which will be a surprise to no one, is the sustainability gap of the cost of health care, and this is a worldwide phenomenon. It's neither only American nor Canadian. How do we address that?
The third, which I think most people aren't quite, I'd say, fully appreciating at this point is how our patients, our communities, our funders, whether they be private funders or public funders, are more and more scrutinizing how safe and reliable our health care actually is and how good our outcomes are.
One way or another, we have to find a way to demonstrate that we're providing better value, that we're providing safer, more reliable health care with better outcomes at a reasonable cost.
Mark: I would agree. You're right, those are very common, very pressing challenges. I'm curious to hear a little bit of your experience as a physician, as a hospital CEO, your initial introduction to Lean, how and where that came about. Maybe thinking back, reflecting on some of your thought process to think how would these Lean principles be applicable to those three challenges.
Dr. Tétrault: The story is interesting, to me anyway. The first piece was actually, I remember, I believe it was December of '04, so a long time ago. At IHI, there was this guy called Gary Kaplan from Virginia Mason who introduced this thing called Lean, and how they'd been working at it, and the results they had.
I remember thinking back then, “Boy, wouldn't that be neat?” Gary was presenting a few places in the hospital, and I said, “What if we did a whole-hospital thing on that?” That was the first spark.
Then, as I mentioned, IHI's Executive Quality Academy in June of '05, there were some really interesting characters on the faculty there. Two of them were John Toussaint, who everybody knows, and Rob Colones, the CEO of McLeod Health. They were talking about how they had managed to, in fact, implement some sustainable improvement.
That was the Holy Grail. We're pretty good at what our CMO and executive lean champion Bruce Roe calls “patchy improvement.” We get some great successes and some not-so-great successes, but even the great successes tend to revert slowly back to the norm after a while. We had a challenge with sustainment.
Over time, it grew more and more compelling that we had to use this Lean methodology to hope to be able to not only grow our capacity to improve but to sustain the improvements.
Mark: Hearing that success and the results from these other hospitals was some of what gave you the confidence to go and pursue that locally at St. Boniface?
Dr. Tétrault: Yeah. That's where the work starts, not where it ends. Part of what we went through was working very closely with our Board of Directors so that they fully understood that this wasn't going to be a flavor of the month. It wasn't going to be an instantaneous success.
It wasn't going to be a pilot project.
It wasn't going to something that we were going to try, and if it didn't pan out in a few months, we would go on to the next fad. We did get the absolute commitment, actually we got a mandate, from our board to go ahead and do this and do it for as long as it took.
Then, convincing the executive and leadership of this hospital that there weren't really very many options, that this is the way we're going to change the way we do our work. Getting that not only emotional commitment but that I'd say visceral commitment that this is it.
Mark: It sounds like it was a situation where, as CEO, you were helping initiate this, helping create expectations that this was not just a program or a project. As I'm sure you're aware, people at a lot of hospitals lay there at night dreaming about CEO engagement. That's often brought up as an issue.
If you have somebody who's a director or vice president trying to initiate Lean and trying to get Lean on the radar of their CEO, people would say, “We need that CEO leadership to really help make this happen.” I was wondering if you could share some thoughts on your role as the CEO and driving cultural change and communicating both with your board and with people throughout the organization.
What do you do, as the CEO, week to week or quarter to quarter to help make this happen within St. Boniface?
Dr. Tétrault: [laughs] I think the most honest answer to that is “what I can.”
Dr. Tétrault: It's been a lot of learning. It's an interesting journey, but it's a journey where trial and error, I think, fit a fair amount. This place has a CEO that sees that this benefits patients directly, and there's a culture here at St. B of really trying to do what benefits patients, so that was the easy part.
As a CEO, I think you have to be out there. You have to walk the walk and not just talk the talk. One of the things I do, and I wonder why I didn't think of this earlier, about 50 times a year, I go out and meet with groups of front-line staff. These groups can be as small as 5 or as big as 200.
Basically, to make sure that they hear why we are doing this, what we're trying to accomplish, how we're going to go about it, and how it ties in with who we are as a hospital, our past and our present and our future. Part of the CEO's role is to “interpret the environment” to people, to help people understand how what we're doing fits in with the world we live in.
Mark: With the emphasis on learning, as you said trial and error and learning as you go through this Lean journey, I know you've been able to learn from people like John Toussaint and Rob Colones. You've also had some other mentors, if you will, within your local business community, correct?
Dr. Tétrault: We were very fortunate here in Winnipeg, and we had a world-leading organization called StandardAero whose business is basically repairing aircraft engines. They had gone along on a sort of 20-year improvement journey. We managed to hook up with them, and go over and visit, and see what they were doing and how they were doing it.
Initially, we were thinking, “What does this have to do with health care?” As we understood the principles of their process improvement, their preoccupation with quality, their necessity to deliver reliable services to their customers, because if an airplane engine fails, they can kill 200 people at the same time not just one, and learned quite a bit from them.
I guess so much so that their quality and innovation guru now is a consultant with us, and my own personal executive coach is the CEO who initiated this transformation of StandardAero.
We were very fortunate to, once again, latch on to a local business that we could learn from and, I'd say, expand our horizons by seeing what is possible once you start systematically addressing quality improvement.
Mark: That's great. Maybe as a final wrap-up and final thought here on the thought of benefit to the patients, can you summarize some of the most noteworthy improvements that you've made or the impact that you think Lean is having within St. Boniface for the patients?
Dr. Tétrault: We could certainly do a lot better, but maybe three rapid examples. In our emergency value stream, the time to do an EKG, a cardiogram, has gone down by more than 50 percent. Our mortality from MIs for patients with chest pain has gone down by about 40 percent, so we're hoping there's a link there.
We implemented, within a week, the World Health Organization's safety checklist in the OR and our surgery value stream. We're at the point now where we're convinced that that's about 200 patients a year who will not have significant incidents in the OR. We're starting to log those, and the results are encouraging.
In our medicine value stream, we've implemented shift-to-shift bedside reports. Actually, that is spontaneously — this is a nice story, to my mind — rolling out throughout the hospital. There are patients who, in fact, have been saved by this, because nurses, instead of being off the ward in the morning, are actually there with patients.
I had a patient this morning, a patient visit, who, in fact, told me she couldn't understand that we hadn't been doing this forever because it was so great that she would know who knew what about her and knew that the person knew. These are the small things, but I think they add up over time.
Mark: Yeah, I'm sure they do, and I think that's a general Lean idea of lots of little things, lots of improvements through staff engagement and initiatives, like you mentioned with the World Health Organization checklist methodology, lots of little things add up to big success generally with Lean.
Dr. Tétrault: The difference, a few years ago, someone would have put out a memo that we are now doing this checklist, and no one would have ever known if we were actually doing it or not or if it was well-done. Whereas now, our most recent audit shows that 100 percent of our ORs were doing it when we last checked.
Mark: I think that's certainly a noteworthy shift in the culture, to move to that approach.
Dr. Tétrault: I've got to tell you, Mark, our latest patient satisfaction survey in our medicine and surgery programs, both of our in-patient value streams, have hit absolutely unprecedented levels, so I think the patients are noticing something about what we're doing.
Mark: That's great. I want to thank you for taking time to share some of your perspective and insights here. Our guest, again, has been Dr. Michel Tétrault from St. Boniface General Hospital in Winnipeg. Want to thank you for joining us. Do you have a final thought, maybe, to leave the listeners with?
Dr. Tétrault: Thank you, Mark. It's a very interesting, very hard piece of work, but I can tell you, if you asked anyone on our leadership if they'd stop and want to go back to the old ways, I think everyone would say, “Absolutely not.” We're starting to see some positives here, and I think people are building confidence that we'll see more.
Mark: I hope so. Michel, thanks again for taking time to talk today.
Dr. Tétrault: My pleasure.
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