Head-to-head
In this column, the OOAQ president shares opinions inspired by the current events within Quebec’s professional system. This is an invitation to pursue an individual and collective reflection.
English version
Marie-Pierre Caouette, M.O.A.,
présidente et directrice général, Speech-Language Pathologist
Clinicians: Are you well versed in management
talk?
September is the perfect time to start planning the organization of services. In
several cases, supply and demand seems to be a difficult equation to solve.
Statistics linked to practitioners’ dissatisfaction and uneasiness sadly illustrate
this.
Over the next few years, we will be called upon to ensure the provisioning of
services based on both prevention and the treatment of chronic problems
associated with the aging of the population, considering the broad spectrum of
interventions across the boardquite a task. Forecasts regarding demographic
changes and labour shortages do no argue in favour of optimism. Should you feel
faint at the thought of tackling such a colossal task, you are not alone!
What to do?
It has now been acknowledged that Québec is trailing behind the rest of Canada
and other countries around the world with respect to performance and the relevance
of care. It has been noted that this slow start is mainly due to Québec’s
organizational structure. In comparison with Uganda’s Lucille-Teasdale hospital,
where 1,200 patients walk in every day and are seen on the same day, without
having to wait 17 hours before being tended to, it becomes urgent to assess and
modify our current individual and collective practices.
Our Health and Social Services Minister’s proposed solution, which can be used in
the field of education and in the private sector as well, consists in promoting the
use of the LEAN Healthcare method in all work environments. This philosophy is
already producing interesting results in Québec as regards authorizing pharmacists
to prescribe emergency oral contraceptives in particular, as in the case of the
health and social services centre (CSSS) in Trois-Rivières in an effort to improve the
quality of emergency services offered, or in response to the efforts made by
Montréal’s Jewish General Hospital. This vision of work must now be widespread
and the resulting benefits maximized for all.
Network managers are increasingly aware of this philosophy whose success lies in
the engagement of all interdisciplinary team members. It would therefore be
beneficial for all clinicians to familiarize themselves with this framework, which
should serve as a guide to their supervisors’ decision-making process. To avoid the
deception associated with the rejection of a project that would stray from this path,
speech-language pathologists and audiologists must be well versed in management
talk.
This fall, I invite you to:
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Take the time to discover the LEAN method
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Initiate a voluntary process to assess the performance, relevance and quality (including continuity and accessibility) of our services
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Reflect on our responsibility in meeting the needs of the entire population while realistically taking into account the current and future context, including the resources available and our collective capacity to pay.
The LEAN Healthcare model
What is it?
An organizational philosophy basically aimed at solving problems, where decision-making is guided by an ongoing review of operating practices with a view to improving processes, using optimum human and material resources, and eliminating waste. It is estimated that 60% of total operating expenses stem from wasted time, resources and materials.
The LEAN philosophy
An organizational culture shared by all team members (interdisciplinarity), focussing on continued improvement and based on relevance and performance, in an effort to improve the quality of care. In other words: “The right service, at the right time, at the right place, for the right person, by the right practitioner”. This method applies to all sectors, be it health, education, public or other.
The results
Recognized around the world as the most efficient management tool, the LEAN method has been used for many years now in European hospitals as well as in the industrial sector. In Québec, it is best known in English-speaking circles.
This growing operating method increases productivity and reduces irritants, improves the organization’s work climate and quality of life, and improves satisfaction and motivation among personnel members. It is known for attracting and retaining staff.
All of these positive changes translate into improved care, reduced waiting time and greater client satisfaction.
Avoiding a shock of value
Overall, clinicians wish to contribute knowledge and skills for the betterment of the population. As for managers, they are required to make decisions based on sound management practices and quality and performance concepts. The meeting of a clinician well rooted in comforting traditional practices and a clumsy manager can only result in a strong shock of values, followed by resistance to change. Yet, each has the profound desire to offer quality servicesa task that will prove successful if both parties show open-mindedness, respect and mutual understanding through dialogue.
The clinician must be willing to take part in an assessment of the relevance of his or her practices based on the population’s needs (age, geographic location and a host of problems), beyond his or her personal areas of interest. In this day and age, the multi-level approach and “outside my area of expertise” way of thinking no longer hold true.
As for the manager, he or she must be aware that such a change in organizational culture brings its share of pitfalls and that consultation and adequate communication of information are crucial to team members buying into this concept and the success of this endeavour. The manager must respect the long-term vision principle, as a common error would be to make drastic changes in an effort “to do more with less” in the short term. Cost reduction through layoffs is certainly not the objective of the reflection, reorganization and ongoing assessment stages of the LEAN process.
Societal choices
Managers’ often complex and difficult directions and decisions are based on the
following principles, which must be shared by clinicians: effectiveness and
efficiency of care or services, assessment of risks as regards security, costs,
ethics, legal aspects, the code of conduct, relevance (measurement of actual
impacts), quality, etc.
Given the current context, would it not be relevant to consider the following questions?
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When does “professionalism” become “bureaucracy”? For example, what are the actual requirements of my order as regards record-keeping and the protection of the public? There are so many myths.
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Does corporatism sometimes hide behind competence?
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Does the “universality of care” entail “comprehensiveness” of services for all? For example, is individual therapy (which is so gratifying) really necessary for all and is this the best way to meet the needs of the population when waiting lists are tallied in years? What are the long-term impacts of health deterioration in individuals who could not be seen in time? Despite the significant increase in OOAQ membership, is it realistic to think that one day individual services in speech-language pathology and audiology will be free and accessible to all?
Clinicians cannot hold managers solely responsible for answering these difficult questions. They must be actively involved in finding solutions as well. As such, professional orders can no longer focus on corporatism at the risk of slowing down the process. In fact, it is with this change in attitudes and practices in mind that Bill 21 (in mental health) and its sharing of competencies concept was introduced.
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Improving
quality through relevance and performance
The concept of relevance forces the practitioner to reflect on the impact of the services offered, realize the importance of setting up a method to assess the results and effectiveness of his or her interventions, and understand the perverse effects of irrelevance. Do the clinical choices we make always allow us to prevent, “cure”, relieve, and support and maintain autonomy?
Quality of care translates into results, of course, but also refers to the concept of “responsiveness”, i.e. the system’s ability to properly respond at the right time, and the possibility, for the beneficiary, to quickly access the required services. Does the preferred approach allow us to have a real impact on the needs of the entire population, with all types of problems and all geographical regions combined? |
The relevance of
interdisciplinarity
The interdisciplinary approach focuses on a shared objective: responding
adequately to the client’s needs. In an ideal setting, this approach is intended to
simplify procedures as well as the individual’s path towards the right services at the
right time. At its core is better planning of care for continued services. Within the
interdisciplinary team, the goal is not to level down; after all, professionals are not
interchangeable. However, they work with ease and collegiality when it comes to
transferring their knowledge and sharing work and responsibilities equally for the
purpose of adequately responding to overall needs. Going beyond the “private
preserve” concept, interdisciplinary work focuses on the optimal use of every
professional’s skills, in every situation. If certain activities, with a high risk of
prejudice and requiring specific certification, are reserved with good reason, we
must avoid working as though our entire area of practice were as well. This holds
true for the various roles in which we should ensure leadership in the area of
prevention: researcher, trainer, consultant, etc. For example, in an optimal service
model, how can we justify carrying out ourselves all the activities of a program we
have designed?
The LEAN method in speech-language pathology and audiolody
The LEAN method is not strictly intended for doctors and nurses. Let’s be frank, every one considers accessibility to services in speech-language pathology and audiology to be dependent on bottleneck problems. There is no question our clients and colleagues appreciate our excellent services… when available. However, this is not sufficient. Despite the beneficial effects of the fight against labour shortages and of the significant increase in the number of speech-language pathologists and audiologists, the current situation does not allow us to pass the quality test given the dissatisfaction caused by waiting lists and sometimes lack of services in some geographical regions and for specific clienteles. We must act!
Some of us have proven to be very creative and have already initiated promising projects in outer regions, namely:
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In-school speech-language pathologists acting as trainers and consultants as regards support to teaching staff
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Audiologists in private practice who provide backup support to outer regions on an ad hoc basis
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Speech-language pathologists in local community service centres (CLSCs) who work with parents and educators with a diploma of collegial studies in language stimulation
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Audiologists working in collaboration with nurses on newborn hearing screening
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OOAQ members increasingly using videoconferencing when serving beneficiaries in remote areas, etc..
Regardless of our profession or work environment, possibilities abound and we must be proactive. At this time, what would be your answers to the following questions: Is there a waiting time for my services at my office/establishment, in my city, in my region? Has my practice been adapted to this reality? Have I built a network that uses the skills of colleagues working in other professions? Have partnerships been created with community organizations? Do I spend at least one day a week performing innovative (less traditional) clinical activities allowing for optimal outreach to a wider population? Do I sometimes go beyond my role of clinician to become a trainer, researcher or mentor?
Performance: A state of
mind
Of course, Québec will not be LEAN overnight. Generally speaking, the progressive
adaptation of practices calls for conviction, patience and perseverance… and can
be realistically achieved over a period of 5 to 10 years. Clearly, LEAN is not a
cure-all. No method is perfect and some projects will fail, especially at the
beginning. For the time being, let us familiarize ourselves with the basic principles.
Should the directive become national, true changes and real impacts will come out
of hands-on experience. Can we afford not to collectively improve the labour force’s
well-being and the performance of healthcare in Québec?
What do you say?
Are you ready to propose a project based on human values and to do so using
management talk?
Notes Biographiques
Fiers de nos racines et ouverts sur le monde
Jeter le bébé ave l'eau du bain...
