In 2012-13, Saskatchewan employed Hoshin Kanri, a form of strategic planning, as a method of integrating regional and provincial planning. This was part of the introduction to the lean management system in health care in the province of Saskatchewan.

‘Hoshin Kanri’ means managing an organization’s direction or focus. It is a strategic planning and management methodology, based on a concept popularized in Japan. Hoshin Kanri involves determining the strategic priorities to focus on and developing project plans and constant monitoring to ensure they are achieved. One of the key differences in this type of strategic planning is the engagement of staff at all levels of the organization in the development of the priorities and monitoring progress.

Hoshin Kanri is a well-tested, proven way of cascading and operationalizing strategic priorities in an organization. System-wide adoption of Hoshin Kanri was the 1st step in embracing a Lean Management System for the Saskatchewan health system. While Hoshin Kanri has been successfully implemented in other health care organizations, Saskatchewan is the first example of a province-wide alignment for health system strategic planning. Hoshin Kanri prioritizes the large number of initiatives that have been identified as requiring action. A series of provincial breakthrough initiatives or “Hoshins” are outlined, with the goal of achieving transformational improvement for those identified Hoshins.  Each regional health authority/organization then developed its own projects that support the province-wide vision of ‘focusing and finishing’ these critical initiatives.

The provincial Hoshin Kanri work engaged regional and provincial healthcare leaders in developing a plan to improve the provincial system. This work cascaded down into each leader’s organization all the way to the employee level to determine how these priorities would best be  accomplished and to provide feedback to the provincial leaders’ table through a process known as “catchball”. In this way, individual organizations had input into how the improvement work will be undertaken, and local strategic needs and priorities are woven into each individual organization’s strategic plan.

The Hoshin Kanri process brought senior leaders, board members, Ministry of Health representatives and health care directors, providers and physicians together to set the strategic direction for the province. The Hoshin Kanri process involves staff from all levels of the organization having input into determining the vital few priorities for the system (the Hoshins), using current data as a guide for decision-making.

The companion to Hoshin Kanri is Visual Management. Visual Management is a process whereby work units at all levels of the organization meets around posted performance metrics on a daily or weekly basis to evaluate performance and make plans to improve where needed. At the senior leadership level, meetings are held weekly around a select group of indicators, which allow reporting real-time data so we can understand if we are moving in the right direction and if our improvement work is having an impact in a timely fashion. This allows us to course correct quickly. Wall walks are a weekly occurrence and senior leaders review a different subset of indicators each week (quality and safety, delivery and engagement, cost, and strategic projects).

The impact of the wall walks has been transformative in the organization’s ability to hold leaders accountable for achieving the goals and targets and be transparent in our priorities and performance.

Contact information:

Saskatoon Health Region: marianne.Maiboll@saskatoonhealthregion.ca

Sunrise Health Region: ; suann.laurent@shr.sk.c

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