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This guide builds on work already done in a variety of organisations, both in the UK and overseas, to show both how and where Lean has been applied to successfully improve patient safety and where the absence of the form of systematic thinking that Lean b

Dr. Mark Lemstra outlines the high price tag for Lean in Saskatchewan health care. "If you're not dead, you're going to end up in one of your health-care systems here in bed, with a tube up your ass and one down your throat. You're going to be saying to yourself: 'My God, I wish I could have asked John Black to come in and help improve my care.'" The words belong to consultant John Black of Seattle, who received $39 million over four years to reform Saskatchewan's health-care system using lean management practices. However, a private, for-profit American hospital that was close to financial ruin was hardly in the same situation as a publicly financed, not-for-profit Saskatchewan health-care system with a seemingly endless supply of taxpayers' money. even the Canadian Medical Association now concludes that at least 50 per cent of all health outcomes are due to social factors. Others suggest the number is as high as 75 per cent. Lean management obviously will not have any impact on social factors that cause disease.

It is here, in a tightly packed maze of buildings in Seattle's First Hill area, that 880 Saskatchewan health care leaders flock to learn. With Virginia Mason as their model, the treks are part of a sweeping overhaul of how the provincial health system is managed. ....... Based on lean management principles, the goal is to constantly improve what they do with seemingly small steps that sound like no-brainers, but weren't happening before. ......... When Saskatchewan's health ministry decided lean management was the way to improve an ailing provincial health system, it did not dip a toe in the pool. It capsized a cruise liner into the ocean. One University of Saskatchewan researcher tasked with evaluating the initiative calls it "the biggest experiment worldwide in terms of implementing a quality improvement philosophy or approach like lean." The ministry is now two years into an up to four-year contract with Seattle-based consultants John Black and Associates. Black is their sensei, and if the ministry renews all four years of the contract, the province will spend nearly $39 million.

Saskatchewan's health care system is "broken," according to many sector leaders interviewed for a report into the first phase of Lean implementation. But those same leaders seem optimistic the sometimes controversial management method is the "best hope yet for true system transformation." The report calls the structure of Lean "rigid, prescriptive and stifling at times," noting it can "disempower leaders who feel the need to adapt tools and programs to their local contexts." It also noted "a lack of ability to set local priorities, and lack of flexibility to adapt tools to local contexts." (for full story click on the link)

This paper analyzes the political dynamics between a newly elected, right-leaning provincial government and a left-leaning public sector union that resulted in the privatization of 4000 health support housekeeping jobs in southwestern British Columbia in