Update on the Primary Health Care Center

The Sunrise Health and Wellness Center opened in Yorkton in November 2014.
The Saskatchewan ministry of health announced it on November 27, 2014. The local news reported on it as well.

Photo Diary of Patient Central Innovation site 3P design process

We have completed 5 days of a LEAN 3P (Product, Preparation, Process)  to plan and design our new Primary Health Care innovation site.  

There were about 60 participants with some coming and going, but mostly 30 - 40 participants present at any given time.  Participants came from all perspectives of Health Care: 

Some of the participants 

• Community members / Patients / Clients (The most important ones)
• Health Care Providers : Physicians, Nurse Practitioner, Pharmacy, Dietician, Diabetes Ed, Exercise therapist, Registered Nursing, Optometrist, Mental health, Podiatry
• Health Care support and admin staff
• Patient Safety and Improvement folks
• Also representation from:
• Health Quality Council
• Ministry
• Architect firm - Aodbt



Dallas is our architect from Aodbt in Saskatoon

• First Nations
• Sunrise Health Region senior management
• Public Health

Mike Weishaar (Main Facilitator) from JBA

 All of this was facilitated by LEAN consultants from John Black and associates (JBA).

Steve Manthey (Architect background) from JBA

There was a lot of work that came before the 5 day 3P process:  

• Introduction to LEAN philosophy and terminology
• Crafting our innovation site Mission, Vision and Principles
• Identifying our "service lines" 
• Primary Care
• Urgent Care
• Chronic Disease Care(Prevention and management)

Vision, Mission and Service lines on the wall

• Identifying what data we need to collect for each service line
• Hours of operation
• Conditions and symptoms patients present with 80% of the time
• Numbers of providers
• Time spent with provider
• Time spent in different places / procedures / processes etc
• Time spent waiting  
• 3 Weeks of data collection: (Yes - for those last few measures we had patients and others with stopwatches timing every step of the way)

Then the 3P started on Monday 16 July 2012:

Day 1 of 3P:

•  Review of LEAN philosophy for benefit of new participants not present previously
• Overview of project scope

• Freeing the mind game (out of the box ideas)

• Signing a "contract" on being respectful to other's ideas and to feel comfortable coming up with creative ideas even if they sound crazy.

• Creating fishbone diagrams for the 3 service lines
• Every step involved in different processes
• Identify for every process the 4 M's:
• Method
• Manpower
• Machine
• Materials

Fishbone diagram for 1 of the servicer lines

Day 2 of 3P:

• Report out on the fishbone diagrams:

Lindsay explaining the urgent care fishbone diagram

Dr Johan (Vorster) reviewing primary care fishbone diagram

• Reviewing the data that was collected over the 3 weeks prior to 3P:

Some of the data that was collected displayed on the wall

Some data was collected by the health region for planning the new hospital.
We picked the relevant data to our project

Brenda reviewing some of the data

• Creating Prado graphs (Graphs containing data of what happens 80% of the time):

Mary and Terilynn creating a Prado graph

• Creating routings (line with different steps in a process) for the top 80% of presentations
• Grouping similar routings together and recognizing 3 "cells" with similar steps

• Reviewing the "Must Have" Components and "Nice to Have" Components for our site
• Report out at the end of the day 

Dr Phillip (Fourie) summarizes for the report out at the end of Day 2

Day 3 of 3P:

• We started the day with "blue sky" designs (no restrictions, no walls) - we only had to think about flow in the 3 cells.  Everybody had to individually come up with 3 designs.

Wilmer telling us all about his 3 designs

• We had a report out and everybody got a chance - about 30 people and each talking 1-2 minutes about their design concepts.
• Then the architect gave us the confines of the floor plan and we had to design within those confines.  All 3 tables with the service lines had to come up with 4 designs with 2 people per plan.

Dr Johan (Roodt) busy designing

• Once each table had their 4 designs, then the table had to vote with "dot voting" after each plan was explained to the others 3.  

Dr Johan (Roodt) showing the highlights of his table's winning plan to one of the other tables

• The plans that were not chosen were put up on the wall.

Some of the designs that were not chosen

• We were then left to start building 3D models of the winning design at each table.  So we ended  up with three 3D models at the end of the day.

• The day ended with a report out to senior management.

Dr Phillip (Fourie) showing his design to senior management (Sherrell and Lorilei)

Day 4 of 3P:

• We continued on building on our 3D models
• On day 4 we gave the facilitators some extra stress.  We had left some space for future development that could potentially be used by other interested physicians.  We decided to add a fourth table with 1 member from each table that would catch up and design space for the other physicians. 

Adding rooms to the plan

The plans came alive when the 3D designs started to take shape.

• We had to add in some different coloured string lines which demonstrated flow of patients, providers, machines and utilities.

Patient and provider flow demonstrated with different coloured string

• We then had 4 3D designs and with dot voting we chose 1 winner.   

The vote was close between first and second place - this was the second place design

The winning design

The provider conference or "offstage" area in the winning design

• The facilitators then split us into 2 groups and 1 group made a larger 3D model of the winning design and the other group started building life size rooms of some of the more frequently used rooms - like the exam rooms.

Putting together a room

An exam room to test flow and positioning of furniture.

Day 5 of 3P: (Final day)

• We were ahead of schedule on the morning of day 5
• We had a lot of fun.  I wrote a play with 5 common scenarios to demonstrate team based care delivery.  Every single participant in the 3P had a role to play and the cool thing was that the real patients played the patients and the real providers played the providers.  (the others were either patients or family members or helped with data collection on the times it took for patients to move through the system.
• At 3pm we had a report out which was in the form of a play.  It was a huge success, but that is a story for another day .....

Yorkton Primary Health Care Innovation Site

There has been some exciting developments here in Yorkton.  There has been some giant leaps towards setting the stage where new concepts in primary health care redesign can be put to the test.

In May 2012 the Minister of Health of Saskatchewan announced the redesigned primary health care plan.  A more detailed report is available on the Saskatchewan Ministry of Health  website under Primary Health Care.  To briefly summarize: Patient Centered, Community Designed and Team delivered.  There is a lot more engagement at ground level with a bottom-up approach for design and supported by a ministry that enables the process.  This is a paradigm shift from the previous approach.

The minister announced that there will be continued support for existing primary health care sites and he also announced 8 innovation sites across Saskatchewan where new concepts will be put to the test so that successes can be spread throughout the province.  This is a strategic decision to fund new innovation sites without diluting available funds (by spreading it to multiple sites and end up with a situation that nobody has the resources to innovate.)

This is where we got the opportunity to prove what we have been saying all along - we can deliver innovation.  Our Yorkton project was chosen as 1 of the 8 innovation sites in the province.

Our initial concepts will include the following :

• Starting with a team made up from different silos in health care to deliver chronic disease management and then move to collocation in a primary health care site.  (Building the team before the building)
• Using a different EMR vendor (Optimed) than what Primary Health Care in Saskatchewan has been using until now (Medaccess)
• Our design for clinical space to be scalable if possible so that the design can be scaled up or down according to community size and needs.  Different functional components could be added or taken away from the design.  This would save others who want to move to team based care delivery the trouble of designing physical space from scratch.
• Having a different governance model.  This would mean not grouping people together in a team from different silos and keeping them accountable to their own silos, but rather manage them under a single umbrella with one vision, mission and principles
• A Physician led approach as opposed the Regional Health Authority led

So as an innovation site we got approved for funding to go through a LEAN design process called 3P (Production, Preparation, Process).  Here is a video of a clinic in Regina that went through the 3P process.

We had 2 days in June 2012 to get basic training in LEAN concepts and terminology.  Get consensus on our Vision, Mission and Principles.  We identified our service lines and crafted an action plan for data collection that will help guide us with our design process.  We have our 3P process scheduled for 16-20 July 2012.

CDM TEAM

So needless to say - we cannot wait to start our 3P process to design our new clinic / innovation site in the week of 16-20 July 2012...

We are ready to innovate ...