Canadian Government Executive - Volume 23 - Issue 02

8 / Canadian Government Executive // February 2017 Strategy Finding True North A s Canada’s government agencies strive to improve delivery and efficiency under evolving cir- cumstances, many are seeking to initiate customer-focused cultures that encourage innovation and collaboration. Such change, however, can’t be brought about by decree – here leaders must en- gage the hearts and minds of employees at every level and rally them around a com- mon purpose. Although significant, this challenge is be- ing pursued successfully in a growing num- ber of organizations that are adopting the Lean management system, many of which are doing so with limited resources. Because Lean depends on wide employee participa- tion in continuous improvement activities, purpose-driven culture is a requirement. Successful Lean organizations, therefore, are excellent role models for any organiza- tion contemplating major cultural change. One of the keys to Lean culture is a concept called True North, which establishes the shared purpose for all employees, regardless of rank. True North typically consists of three or four long-term aspirational goals that sup- port the organization’s mission, and can be tied to specific measurements. “True North is where we all start. With- out it, we’re a rudderless ship,” says Dr. John Toussaint, CEO of Catalysis, a not- for-profit specializing in Lean healthcare. An excellent example of True North can be found in Kitchener-Waterloo, Ontario at St. Mary’s Hospital. In 2010, Don Shilton signed on as the hospital’s new CEO with a mission to launch a comprehensive Lean transformation. Shilton knew that culture would be criti- cal, so the first step was to adopt a vision statement that would galvanize employ- ees. The statement reads as follows: “St. Mary’s will be the safest and most effective hospital in Canada characterized by inno- vation, compassion, and respect.” “That was a key element, because that was something that the staff could buy into,” says Shilton. “Many people go into healthcare because they want to help others. And so it’s that inner motivation that the vision helps capture.” The next question was how to measure progress towards that vision. Shilton and his team decided on Hospital Standardized Mortality Ratio (HSMR) from the Canadian Institute for Health Information (CIHI), an independent third-party organization. With their mission and their method of measurement in place, the team then established the four elements that consti- tute their True North: • Quality and Safety: “Zero harm.” • Patient and Family Centred Care: “Zero wait.” • Our People: “100% engagement.” • Financial Stewardship: “Zero waste.” Next, management launched a series of improvement targets using the True North as a roadmap. “We felt that if we were strong in each of those True North buckets, that would help us move to- wards the vision, and would help us be successful with that vision,” says Shilton. Reducing patient falls, which was ini- tially the hospital’s largest cause of patient harm incidents, was one of the early suc- cess stories. For the first year, management set a target of a 25% reduction. “We actu- ally reduced it by 32%, and by 25% in each of the following two years,” says Shilton. These results came not from interventions crafted in a boardroom, but from literally Moving towards a purpose-driven culture Jacob Stoller hundreds of incremental improvements that were designed, tested, and stabilized by employees on the hospital floor. For example, staff reviewed the data on patient falls and learned that these often occurred when patients got up to go to the bathroom at night. Then, using Lean tools, employees initiated a series of improve- ments – night lights were installed, room layouts were standardized to prevent clut- ter and obstacles, maps were installed for cleaners so they’d put objects back in their proper places. All these improvements were then audited by staff during random visits to ensure they were being maintained. After the 50% reduction, falls ceased to be the largest source of patient harm. “Now hospital acquired infections is our biggest problem area,” says Shilton, “so this year, we’re focusing on that. At this point, 9 months into our year, we’ve got a 47% reduction so far.” Today, St. Mary’s is the safest hospital in Canada, but the journey continues. In keeping with the “100% engagement” True North metric, a goal of one improvement per employee was set last year. “We have 1,300 employees and collectively they im- plemented 1,356 improvements,” says Shil- ton. “This year we doubled that goal and they’re ahead of target.” A strong purpose-driven culture has been key here, Shilton notes. “We’ve really been able to capture the hearts and minds of staff, and they’ve risen to the challenge,” he says.