Good morning, Madam Chair and members.
I want to thank the members who are here today.
It's a privilege to be here, so I want to thank you for that.
I got a bit worried when I saw the title of this session. It said “Technological Innovation”. What I want to talk about isn't rockets; it's delivery of health care. I guess the technology we're employing tends to be forgotten a bit, and that's the human mind, the human brain, and the human heart. That's the technology we're trying to harness at St. Boniface Hospital.
I will talk about four years of efforts into improving our care and getting results at a cost that we as taxpayers can all afford.
You do have a PowerPoint. I'm not going to show it to you; I would rather speak with you.
We do have four overarching objectives. We call them true north directions. They are, in order: to satisfy patients; to engage the staff; to reduce harm or do no harm; and to manage our resources. Our belief—and the more we do, the more we believe this—is that to satisfy patients we must engage staff. If we do that, we will reduce harm. In fact, by managing the resources—I will talk about the results in a few minutes—it will kind of fall out of that. That has been our experience over the last four years.
Some people think it's presumptuous to say we're on the road to perfect care. I think we will be close in about three or four CEOs—and I have no intention of retiring any time soon. However, if you think of what is acceptable, it is zero preventable harm, and it is only perfect care that will cut it. We want to make sure we don't forget that.
I will try to be very brief on the story of the Grey Nuns who founded St. Boniface Hospital more than 140 years ago. They came to Winnipeg, then called the new colony, from Montreal, because it was an order in Montreal, by canoe. It took 56 days. They landed about 150 metres from where our hospital is today. They were women of courage and determination, but they were also the fifth congregation to be asked by the bishop to come to the new colony. The four preceding them had not found a way to say yes. We believe the Grey Nuns actually showed a spirit of innovation in going where others didn't necessarily dare to go.
I do have the privilege—this is one of the things we found out by asking our people to improve the work, and to work with us on taking their knowledge and competence and applying it to improvement. I know how privileged I am to work with 4,000 extraordinarily competent, committed, caring, and compassionate people.
Why did we do this? Frankly, it was out of frustration. We have been a leading organization in quality improvement for many years in the country, or we are seen as that. When we are honest and look at the hard facts...we weren't really getting anywhere. Our CMO calls it “patchy improvement”, so once in a while we get a world-class improvement. We went without very serious infections from central lines in our ICUs—not one—for about 15 months. That's world-class. In the same ICU, we got nowhere on infections due to ventilators. It was kind of hit and miss. Even when we hit, more often than not, if you looked back a year later, we were back to where we started. We were frustrated with that. We were lucky to have some excellent examples of how Lean transformation can improve quality and reduce costs.
In Winnipeg, there's a shop called StandardAero that has been doing this for 25 years. They went from a very ordinary aero—not even standard—to world leaders in what they do, which is to fix aircraft engines. We also saw a place called ThedaCare in Appleton, Wisconsin, of all places, that is a world leader at Lean transformation. I visited one of their units that had implemented 752 significant improvements in the last year. Their target for this year, on that one unit, is 1,000. To give you a bit of a comparison, our target for this year at this hospital is 1,000 improvements, and we will be very happy if we get there.
How did we do this? The first thing is we went to our board of directors and said we were tired of having 15 priorities. Eight years ago, we had 15 in our strategic plan; four years ago we had nine. We proposed that there would be one priority at St. Boniface Hospital, and that would be quality. We were brave enough to say, We actually think we know how to attempt this, and that is through Lean transformation.” They said, “Thou shalt do this and never stop.”
So it's not a project and it's not a trial; it's something we are fully committed to. If you want to be part of St. Boniface Hospital's executive or leadership team, you have to fully commit to this.
I am a physician. We also had to spend money we did not have. That was a risk. I will talk to you about how that has paid off for us. The return on investment is great. We did have some very fortunate occurrences with business partners. Bob Hamaberg, the CEO of StandardAero, was my executive coach, pro bono, when they started this 25 years ago. He does this for two reasons. One is that he believes in the inherent moral value, but he is also a very successful businessman. He believes that high-quality care at an affordable cost is a marked competitive advantage compared to his competitors south of the border.
What do we do? Every month we do multiple improvement events. We have done over 100 of these events. You take front-line staff and managers and you give them time to think. We agree on what a problem is, and we give them time to thoroughly analyze it to look at what we do, how it could be made better, what we want to accomplish, and how in that week they are going to experiment with change. What are they going to try to make it better? Then they say, over the next three months this is what we're going to do and this is the expected result. We measure that constantly. We obviously also do projects. Some things are just good ideas that as leaders we have to learn to support and say we're just going to do it. We call them “just do its”. Our goal is to develop 4,000 problem-solvers at St. Boniface Hospital—4,000 improvement agents.
Results? Satisfied patients. We have been measuring patient satisfaction. Not many hospitals do this. We do it continuously and report on it every month. Twice in the last year we hit our highest-ever patient satisfaction scores. Nearly 87% of our patients said the care at St. Boniface Hospital was either very good or excellent. We don't count “good” as satisfied. On “engaged staff”, we measure staff engagement. We use a firm called Aon Hewitt, which does an international survey. We haven't hit our goal. Our goal was to be in the top 10% of employers in the country in terms of staff engagement. We have gone more than halfway between where we started, which was that 41% of our staff were fully engaged, which is in the remedial zone, by the way. This year's result was that 58% of our staff are fully engaged. To be in the top 10%, we have to get to 65%. We believe the more we engage our staff in improving what they do, the more they will be engaged.
On the reduction of harm, a measure is put out by the Canadian Institute for Health Information called the hospital standardized mortality ratio. When we started doing that measure, we were exactly average in Canada for teaching hospitals. The average was one; we were at one. We have reduced that. Our target was a 10% reduction year over year. We have reduced that by 30% in three years. We're now at 0.7 on our most recent result. I believe our patients are doing better. We have managed to reduce the time that patients are in hospital by 18%. That's equivalent to a 30-bed hospital unit in our place. We didn't have to build it. We didn't have to staff it. We already had the buildings and the staff. That represents 4% more patients by volume. Those patients were 4% sicker. That doesn't look like a lot—4%—correct? It allowed us to treat 1,150 more patients with the same budget as the preceding year. That is worth $4.6 million.
Finally, on the financial side, our target is to improve our financial performance by 1% year over year every year—1% in the first year, 2% in the second, and 3% in the third. Two years ago, we hit 1%, which was $3 million worth of financial improvement. Last year, we hit $6.2 million. This year, our target is $9.6 million, and I think we might just hit it. In two years, it will be $15 million. It's a $200 billion health industry. If everyone managed that, that's $2 billion per year, and $4 billion next year.
Finally, we are here to propose something we believe in, which is a learning centre for Lean in health care in Canada. We do have partners in the Asper School Of Business at the University of Manitoba and a École des hautes études commerciales de Montréal, and they want to do this with us. Rather than my flying around the country, we believe that by bringing people to see us, to see what can be done, and how it can be attempted—we're not perfect; we can't tell people what to do, but they can at least look—we can collectively make a dent in improving quality and decreasing cost.
Thank you very much, Madam Chair.
