Adoption of innovative procurement methods to improve healthcare has just begun in Saskatchewan. New ways to incorporate value into projects are not only maximizing the value of dollars invested but also are improving the experience of patients though increased quality of care and improved outcomes.
One message coming out of the Council of Federation meetings last January was that ongoing cooperation between provinces, territories and other stakeholders is required to ensure we have a fully functioning, equitable healthcare system that will thrive into the future.
While the premiers decided to focus efforts initially in three areas – scope of practice, clinical practice guidelines and human resources management – public servants have an opportunity to take an innovative and collaborative approach to health infrastructure development that can both maximize the value of the dollars invested and improve the quality and outcome of the patient experience.
Innovation through lean
Health infrastructure (hospitals, long-term care facilities, clinics, for example) is generally built for the long-term and must be flexible enough to meet both current and future needs of staff and patients. Value can be enhanced by adopting a culture of lean with respect to the delivery of care processes and to facility design.
Lean is the continuous pursuit of improvement to create value from the perspective of the customer (patient) by empowering employees to generate and implement innovative solutions. Lean embodies a number of tools, one of which is the project management and design approach 3P (production, preparation, process).
In healthcare, this can involve bringing together teams of physicians, staff and patient/family representatives who are tasked with designing a particular unit or floor. This approach not only garners staff/patient buy-in and ownership, but also achieves a less wasteful, more efficient end product.
In Saskatchewan, we are taking a lean approach to the design of the Children’s Hospital and intend to embed this approach in all future projects. Through the use of the 3P methodology, improvements in the flow of patients, staff and supplies have been achieved. In addition, a significant reduction in space requirements (based on an initial schematic design using a traditional design approach) has also been achieved by improving flow and eliminating wasteful practices.
Innovation through IPD
Value can also be enhanced by adopting cooperative procurement methods such as integrated project delivery (IPD). We are currently beginning work on our first IPD venture: the replacement of the Moose Jaw Union Hospital.
IPD requires project owners, consultants, patients, families and care providers to work together as a team through design to commissioning to increase value, maximize efficiency and reduce waste on a project. This differs from traditional procurement models where the various consultants touch the project at different points with limited user input rather than working through the project in a collaborative manner.
Another facet of IPD that differs from the traditional procurement method is the requirement for more planning and resources up front, a great benefit over traditional procurement methods. Waste through change orders and other means are greatly reduced since contracting partners are involved in the planning and design of the project early on; differing expertise can pinpoint problems that may go unnoticed much later as the project proceeds.
Although procuring for IPD and Lean expertise is a fairly new phenomenon in Saskatchewan, there have been multiple examples of success in terms of using these methods to improve patient outcomes and flow through projects at Sutter Health in California, ThedaCare in Wisconsin and others.
At ThedaCare, for example, a collaborative care unit was redesigned utilizing lean. The unit has achieved zero medication reconciliation errors for the past four years. This not only impacts patient outcomes, but also better utilizes organizational resources (human resources and dollars invested) by reducing patient lengths of stay from 3.91 days to 2.51 days on average. Patient satisfaction also greatly improved from 68 percent pre-redesign to 95 percent in 2010 and the results have been sustained.
These achievements have been made possible by using lean methodologies and supporting a collaborative working model. Saskatchewan is hoping to achieve the same.
Although Saskatchewan is in the beginning stages of our lean and integrated project delivery journey in healthcare, the positive outcomes we have seen in other jurisdictions outweigh the risk of the unknown and the consequences of continuing with the status quo.
Dan Florizone is Saskatchewan’s deputy minister of Health.