Santé et Services sociaux Québec.
Previous page Adjust text size

Brief analytical summaries or syntheses #38

Canada - Lean in British Columbia’s Health Sector.

Annual Report 2010–11


Published in September 2011 by the British Columbia Ministry of Health, this annual report presents seven case studies of Lean process redesign work carried out by B.C. health authorities in 2010-11. In the health sector, Lean is a patient-focused approach that systematically eliminates waste in health care organizational processes in order to improve quality, productivity, and efficiency.


Lean is an approach to systematically eliminate waste in organizational processes in order to improve quality and productivity, and reduce costs. At the heart of Lean in health care is the mapping of a patient’s journey through the system in order to identify steps that are of value to the patient, and those that add no value (i.e., are waste).

Lean may be used to redesign a discrete process, as a strategy for improving the patient care journey across service lines, or it may form the management philosophy and culture of an organization. Applying Lean through process improvement events equips staff with the tools and knowledge they need to embed continuous process improvement in their everyday work.

The Lean Network2 was established in early 2011 with representation from each of the health authorities and the Business Transformation Branch of the Ministry of Health. The Network assists the Ministry in supporting the coordinating provincial Lean activities, facilitating information sharing across health authorities, and championing the use of Lean within members’ regions.

The Provincial Health Services Authority (PHSA) aims to adopt Lean as a mindset of continuous improvement, in a management system that empowers staff at all levels to remove waste and maximize what is valued by the patient.

Lean has historically been applied most extensively in the private sector, and predominantly in the manufacturing industry. Over time, it has been applied in other sectors and industries, and there is a growing body of evidence that it may be successfully applied to the health care sector. Much of the evidence demonstrating that Lean can improve the quality of patient care and reduce costs has been accumulated in the privately-funded health system in the United States.

Analysis and results

For this report, the PHSA chose two Lean projects, one at the unit level and a second, program wide. The unit-level Lean project took place in the BC Children’s Hospital Pediatric Intensive Care Unit. Caregivers reviewing patient blood work during patient care rounds had observed that there was no standard for the amount of lab work that was ordered for non-cardiac post-operative patients. In addition, the technique for obtaining blood samples was thought to be causing incorrect test results, and duplicate blood tests were being run on the same patient. Through the Lean process improvement workshop, standard blood work has been established for these patients, the method for sampling blood from arterial lines has been improved, and duplicate blood testing has been reduced by 90%. Cost reductions are estimated at $32,400 per year, based on 3,600 patient days per year and the elimination of 2,160 unnecessary tests.

The other PHSA Lean case study took place in the Provincial Specialized Eating Disorders Program for Children and Adolescents. The program received funding in 2008 of approximately $1.5 million from the Ministry of Health to increase tertiary care, including expanding intensive in-patient treatment, and developing a full day-treatment program. PHSA’s imPROVE method was used to achieve the program expansion while aligning the Eating Disorder program’s approach with best and promising practices for treating eating disorders in children and adolescents. Process improvement workshops were carried out on 11 program processes with the goal of improving access to care, implementing best and promising practices, and standardizing care processes. The Lean events led to a reduction in wait time from referral to assessment from 66 to 8.5 days, a reduction in wait time from assessment to first treatment from 48 to 8.5 days, the development of two care pathways for eating disorder patients, and the standardization of several care processes.


The Lean Network will be discussing the case studies described in this report, and other compelling health authority Lean initiatives undertaken in fiscal 2010/11, to determine which may be suitable for broader adoption. Once identified, these initiatives will be monitored to ensure gains are sustained over time, and to support Network recommendations to Leadership Council about initiatives that potentially could be implemented across health authorities to reduce waste and increase value for patients.

Implications and recommendations

The case studies presented in this report also highlight several factors that need to be in place for Lean to be most successful in the health authorities. These include: executive support; staff dedicated to Lean; involvement of staff and other stakeholders in Lean events; viewing the change process through the lens of the patients and families served; linking Lean projects to the organization’s strategic goals; collecting good data upon which to base decisions; communicating with staff before, during, and after a Lean event; assigning responsibility for measuring and auditing progress; and continuing to refine improvements to put into practice the philosophy of continuous improvement. 


Canada - Lean in British Columbia’s Health Sector. Annual Report 2010–11