By Aaron Stuckel
Not even the fabled Lean Initiative can save the Regina Qu’Appelle Health Region from running in the red by this time next year.
With the release of the 2013-14 provincial budget, the health region has been tasked with finding roughly $15 million in “efficiencies” by next year. That would probably be doable if it weren’t already sitting on a $23.5 million deficit. And with wait times increasing and the city’s population rising, it’s going to be a tight year for the region.
The province is burning the RQHR candle at both ends here. While the effort to reduce costs is going to be trouble enough, the province has also set some pretty hefty goals when it comes to reducing wait times for surgeries. And with growing populations and heavy patient flows, it’s hard not to think of the region as a bit like a Stretch Armstrong doll.
So what is the lowly RQHR to do?
“Uh… is the answer Lean?”
Good question. Complicated answer: Yes, but no.
Let’s face it; hospitals in Regina need some work. Wait times in the RQHR are still the highest in the province, and I’ve heard more than a few health workers curse both hospitals as inefficient.
This is where Lean comes in. The program looks at the health system as a whole to find ways to make it faster and less wasteful. This could be simple things like stocking fewer towels, or putting something in an easier-to-reach place. But it can also mean big things like changing the way a hospital is built (like the children’s hospital in Saskatoon), or altering job descriptions.
I have to say I was skeptical of the Lean program at first. After all, the program’s model is based on a Toyota program that helps to make cars cheaper. The thought of real human people being treated like parts of a Corolla was off-putting enough. But I was also suspicious of a contract the province signed with JBA Associates in Aug. 2012 to implement Lean across the province: $9.5 million for one year with an option to renew for the next three years. It seemed like a lot of money to spend on something that still hadn’t really proved its effectiveness, especially when these contracts seem to grow rather than shrink. And the slim prospect of a change in government ending the program down the road would make it all for naught.
But Lean has seen its fair share of successes. It’s saved $30 million in the construction of the Children’s Hospital of Saskatchewan, improved processes for applying for health cards, and helped to reduce surgical wait times across the province. It’s even helped the lowly RQHR reduce the number of cancelled MRI’s per week, allowing them to perform 600 more a year.
The problem for the RQHR is that even though Lean has made it more efficient, with rapid population growth and a majority demographic moving into old age, it hasn’t been effective enough to save the kind of money the provincial government is asking for in this year’s budget. Just because they’re doing more MRI’s per year doesn’t mean they aren’t spending the same amount of money on MRIs. In fact, it’s likely costing more.
Some of the biggest changes out of the Lean program come from what are called Rapid Process Improvement Workshops (RPIW’s), which involve a small team of individuals studying a single department for nearly a month. They look at processes from a number of different angles, following around nurses, doctors, patients, or anyone else involved in that system, to come up with a list of improvements that need to be made. From there, representatives from all wards involved gather for five days and come up with a more efficient way of doing things that focuses on making the patient’s experience better and reducing waste.
A number of recent changes have resulted from RPIWs, including changes to emergency room intake which now involves less paperwork and cuts down on the amount of time patients spend moving around. They’ve changed the way information flows for stroke patients, making forms easier to fill out and more consistent in the way doctors use them. And they’ve improved the way they put together case carts for knee-surgeries so that all doctosr have exactly what they need every time they do a surgery.
But when you look on the RQHR’s Lean website at all of the improvements made, the results rarely come in the way of actual cost savings. Sure, doctors and patients take fewer steps and spend less time waiting for redundant things, and that’s good. We need that to happen to clean up our hospitals so we all get the quality of care we pay taxes for. But the only thing the RQHR has been proven to have saved money on as a result of Lean is at the Pasqua Hospital’s Central Pharmacy where they’ve reduced the amount of inventory on hand, resulting in a small cash savings that hardly puts a dent in the deficit the RQHR is under now.
Even with the help of Lean, the RQHR is still not hitting its targets when it comes to wait times for surgeries. According to the latest numbers (Jan. 2013), the RQHR has the highest number of people waiting longer than a year for surgeries, and is the only health region in the province that has people waiting longer than 18 months. This is a serious issue considering the goal set by the provincial government was for them to have all wait times at less than six months by now. By this time next year, they are expected to have all surgeries being completed within a three-month time frame—from point of order to completion. Right now, 37 per cent of people waiting for surgeries have waited for longer than three months.
So with that goal in mind, and a $23.5 million deficit from last year, the RQHR will carry a little bit of the Saskatchewan government’s balanced budget on its back. It likely won’t hit its wait time goals by 2014, and will likely still be in the red by this time next year. There are a few tough hills to climb, but we haven’t seen the full results of a Lean healthcare system yet. The small changes made in the last year will eventually flower into some cost-savings. They just aren’t coming fast enough for a health region that is struggling to meet its goals.
But they’ll find ways to make it up. Expect to see a few program cuts here and there. And expect to see more procedures out-sourced to private clinics like they’ve done with some dental and knee surgeries. Also, expect to see a lot of the money from this year’s budget going towards hiring more physicians and surgeons. And, of course, expect to hear a lot more about Lean. Luckily enough for the RQHR, the province has given it the tools to dig itself out of the mess that the province is putting it in.