Hoshin Kanri in Saskatchewan, Canada
Bonnie Brossart, Jim Rhode and Suann Laurent
IHI National Forum
Session C14
December 11, 2012
1:30 pm – 2:45 pm
These presenters have nothing to disclose
Session Objectives
• Describe the key attributes of a strategic planning process that
embraces continuous improvement principles and puts those who
use the health system first
• Identify how a specific strategic planning process - Hoshin Kanri
- can be used to build a shared narrative, create inspired
cultures and facilitate health system transformation
• Apply these tools and learnings in other health systems
2
Who we are:
Bonnie Brossart
CEO
Health Quality Council
Suann Laurent
President and CEO
Sunrise Health Region
Jim Rhode
Board Chair
Saskatoon Health Region
3
Some Context
Saskatchewan
5
Saskatchewan's health care system:
• 13 Regional Health Authorities
• 1 provincial Cancer Agency
• 5 hospitals in 2 cities with >
225K pop; 61 other hospitals in
smaller centres
• 156 nursing homes
• 13 home care programs offered
via RHAs
• approx. 2000 physicians
(mostly FFS)
• Aboriginal health services
(federally funded) 6
Key events… Quality as a Business Strategy (2008-2010)
7
Key events…
Patient First Review (October 2009)
• “Patient First” must be
embedded as a core value in
health care
• Health care in Saskatchewan
needs to function as a cohesive
system
• Frontline providers must be
empowered to deliver patient-
and family-centred care.
8
Key events… Strategic and Operational Directions (2010-11)
9
Key events: expression of the health care
system’s strategic intent (2011)
10
Key Events: A commitment to establishing
a World Class Management System (2011)
Hoshin Kanri
Daily
Management
Cross
Functional
Management
Adapted from John Black and Associates, LLC 11
Implementing a
World Class Management System
Daily Management
Cross Functional Management
Hoshin Kanri
Time
Adapted from John Black and Associates, LLC 12
Saskatchewan’s Implementation of a
World Class Management System
Daily Management (Continuous Daily
Improvement using LEAN)
Cross Functional Management
Hoshin Kanri
Time
Adapted from John Black and Associates, LLC 13
What is Hoshin Kanri?
It is an approach to planning that involves:
• Identifying a common vision
• Setting short- and long-term goals
• Executing plans to achieve those goals
• Tracking progress toward them
• Changing course as required
Hoshin Kanri = Management by Policy = Strategy
Deployment = Hoshin Planning
In Japanese, hoshin means shiny
metal, compass, or pointing the
direction; kanri means management
or control.
Purpose: Provide focus and
direction; alignment throughout an
organization
Approach: Requires a high degree
of participation through all levels
of the organization. Operates in
both a top-down and bottom-up
fashion. 15
Hoshin Kanri in Action
Goals were developed from the top down to all levels of the
organization. The goals were few in number, but they enabled
the enterprise to mobilize its total resources to achieve the
desired results. The deployed goals plus the control of daily
work moved the enterprise down the desired path. Each
member of the organization understood the path the
organization was taking.
Bruce Gissing, Executive Vice-President Operations
Boeing Commercial Airplane Group, 1991
Source: John Black and Associates, LLC 16
The straight goods…
The discipline of Hoshin
Kanri is intended to help
an organization:
• Focus on a shared goal
• Communicate that goal
to all leaders
• Involve all leaders in
planning to achieve the
goal
• Hold participants
accountable for
achieving their part of
the plan 17
Hoshin Kanri Characteristics
• Focus on a few key breakthrough improvements (or
hoshins)
• Alignment of the entire organization (or health care
system) around these breakthroughs
• Shared input and responsibility for plan and goals
• High participation throughout the organization
• Equal attention to end results and the methods for
achieving them
18
Breakthrough vs daily improvement
Characteristic Daily Management
Improvement Projects
Breakthrough
Improvement Projects
Performance leverage Continuous improvements
that change performance
over time
Significant leverage
changing performance
Magnitude of
Improvement
Smaller Larger
How many Many, incremental Few, most important
How long? Year after year, ongoing 3-9 months; temporary
Improvement focus Improvements made
within daily work team
Requires changes in cross
functional processes and
service delivery models
Source: John Black and Associates, LLC 19
Breakthrough vs daily improvement
Source: John Black and Associates, LLC 20
Hoshin Kanri in Saskatchewan
21
2013-14 Hoshin Kanri
22
Diagnosis and Review
• Analysis of performance data;
comparison of actual to
expected results
• Joint problem solving and
agreement on follow-up actions
• Determine what needs to
continue, be improved, have
correction action
• Are goals being achieved?
23
Reflection
“Reflect” on the Saskatchewan
health care system environment
and the past year’s performance.
Answer the following:
Where are we today?
What barriers must we overcome?
What opportunities await us?
24
Strategy Development
25
Catchball
• is about dialogue
• involves obtaining input on
plans
• ensures an organization (or
system) has the process
capability to accomplish the
goal(s)
• is a natural, healthy process
of give and take when
setting priorities, assigning
resources, and specifying
targets
• is messy and iterative
process, at least to start
26
Finalize and deploy the plan
Reflect on feedback received from the
system and reach consensus on a final
plan for the entire health system.
Determine accountability for the plan
and a system for course correction and
reviewing progress on system targets
and outcomes.
Throughout organizations, ensure clarity
and understanding of the final provincial
plan, to deselect organizational work
and update project plans accordingly 27
Ongoing monitoring
Ongoing assessment and
monitoring of progress
towards desired results.
Unit level: daily huddles
Organizational: weekly wall
walks
Provincial Leadership Team:
quarterly wall walks 28
What is a
Strategy Deployment Matrix?
A visual tool for outlining an organization’s strategic destination over 3-5 years. It
contains: foundational strategies, 3-5 year outcomes, necessary 3-5 year
improvement targets and 12-18 month breakthrough initiatives 29
Foundational Strategies
Triple Aim Plus: Embracing “The Betters” 30
3-5 year Outcomes/Results
“Big Dot” results the health system is trying to achieve. They
describe the health system we want to see in the next 3-5 years. 31
3-5 year Improvement Targets
Improvement targets specify what specific improvements or things need
to be done to achieve the 3-5 year outcomes. 32
12-18 month Hoshins
These are the short term (12-18 month) improvement projects and
are the most important areas for ‘focus and finish.’ 33
Saskatchewan’s Implementation
of Hoshin Kanri
We are here
34
Saskatchewan’s Implementation
of Hoshin Kanri
Vision without action is just a dream 35
Saskatchewan’s Implementation
of Hoshin Kanri
Our commitment to
and ambition of
“thinking and
acting as one” is
unprecedented!
36
Saskatchewan’s Implementation
of Hoshin Kanri
Working differently
means we are
embracing the
complexity of
Saskatchewan’s
health system and
the challenges we
face.
37
Saskatchewan’s Implementation
of Hoshin Kanri
We are building
and nurturing
strong, respectful
relationships with
each other across
our health system
38
Saskatchewan’s Implementation of Hoshin Kanri
We are cultivating
the discipline
required to stick
to and be
successful in
attaining our
ambitions
39
Saskatchewan’s Implementation
of Hoshin Kanri
We are encouraging and
embracing curiosity
among each other and
throughout our
organizations
40
Some last words from our
colleagues back home Insert video here
Over to you…
42