New report 'final straw' for Lean, Sask. NDP says

A study in the International Journal for Quality in Health Care says Lean did not improve patient outcomes. The study also found the methodology cost Saskatchewan $1,511 for each dollar saved.

The study found Lean cost Saskatchewan $1,511 for each dollar saved

NDP Leader Cam Broten says a new report is the last straw for Lean. (CBC)

A new report published in a medical journal said for every dollar saved by Lean, Saskatchewan spent $1,511.

The study by the School of Public Health at the University of Saskatchewan was published in the International Journal for Quality Health Care. It found that Lean in hospitals did not improve patient outcomes and it brought down morale among nurses.

"The study should be the absolute final straw for the disastrous and costly John Black Lean program," NDP Leader Cam Broten said.

Modelled after Toyota's production system, Lean is focused on rooting out waste. The Saskatchewan Ministry of Health committed to a multi-million dollar investment bringing the Lean methodology across the province's healthcare system starting in 2008. It was government-wide by 2010.

The process has been filled with controversy and a few months before expected, the Lean contract with American consultant John Black and Associates ended in March 2015.

The new study followed the implementation and roll out. It showed that Lean doesn't help patient satisfaction, health outcomes, and hurts worker satisfaction.

"For the government, for the Sask Party and Mr. Wall, to be shovelling out the millions still on this project is offensive to every person who needs proper health care in this province, and every person who works within our health care system" Broten said.

No proof of savings or improved patient outcomes, report says

The report said there was no data to show cost savings, and the province of Saskatchewan appeared to be the only jurisdiction with actual financial cost information. The study found that if the numbers reported were accurate, it means that $1,511 was spent on Lean for every one dollar saved by the province.

The report also evaluated both health and process outcomes.

"When measuring direct outcomes for 90,000 patients on their experience with doctors and nurses no effect of Lean was observed. Only three outcomes showed statistically significant positive outcomes," the report said.

Those positive effects were a slight increase in staff washing or disinfecting their hands, an increase in staff checking ID bands, and a slight increase in patients being given safety brochures.

The report also looked at 1,500 randomly surveyed nurses.

"Outcomes reported a statistically significant negative effect of Lean on nurse engagement, usefulness, patient care, time for patient care, workplace issues, availability of supplies, workload stress, and patient safety," the report stated.

The report concluded that there is no evidence to prove quality improvements to healthcare.

"For now, the question remains whether continuing to heavily invest in Lean is bringing us closer to or taking us further away from a much needed, viable, long-term solution to an increasingly problematic and unsustainable healthcare delivery system," the report stated.

In December, the provincial auditor Judy Ferguson said she did not have the information to say whether the Lean program worked.

Province responds to report

Health Minister Dustin Duncan says the report is not an accurate reflection of Lean. (CBC)
Health Minister Dustin Duncan said the report is "not an accurate reflection" of the impact of Lean. 

"We require our health regions, including the chief financial officers, to sign off on any savings that are derived from Lean," Duncan said. 

"Right now, our number is well over $130 million we've seen saved in the system because of Lean."

As for how the report came up with its findings, Duncan said he figured the authors were working off old information. He added that more rigorous analysis is needed to really evaluate the impact Lean had on the health care system.

Duncan said the Health Quality Council has commissioned an academic at the U of S to create the baseline methodology, and that report should be coming out in "short order".


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