Accelerating Health System Transformation in Saskatchewan: Lessons Learned from the Saskatchewan Surgical Initiative

In 2010, the Saskatchewan government set out to “transform the surgical patient experience” through an ambitious multi-year, system-wide strategy. While the Saskatchewan Surgical Initiative (SkSI) placed strong emphasis on wait time reduction for elective surgery, the breadth of the initiative also gave priority to quality, safety, patient experience, and sustainability.

Through the systematic exploration of a single policy case study—the SkSI—this research identifies the critical factors that facilitate and inhibit major health system change. The main results demonstrate that achieving large-system change, within the context of the SkSI specifically, requires a complex and interdependent set of strategies, processes and organizational arrangements.

Key lessons to be drawn from the Saskatchewan Surgical Initiative Experience

  • Realizing a unified vision—system-wide reduction of elective surgical wait times—required clear goals and strategically staged “big, bold” targets.
  • More comprehensive performance information, pertaining to the quality of patient care and outcomes, is necessary to effectively implement and evaluate system-level initiatives, such as the SkSI, and support a more performance-based health system.
  • Through the rigorous application of Lean methodology—including Hoshin Kanri (strategic planning and deployment) as well as daily visual management—an environment has been created to: improve the alignment of front-line provider activity with the strategic direction at the organization and system levels; support the daily use of measurement to drive improvement efforts; foster a culture of continuous quality improvement; enable forums which allow for team engagement, knowledge sharing, mutual learning and enhanced accountability among stakeholders.
  • Leaders from across the system—from the executive levels to the front-line providers—need to be engaged in processes of collaboration, teamwork and collective decision-making to achieve large system change. Considerable investment is required to develop leadership capacity, both administrative and clinical, at all levels of the system.
  • The autonomy of physicians, for the most part, enables them to voluntarily opt in—or out—of participating in government-led initiatives, such as the SkSI. The government and decision-makers rely heavily on the “cooperation of the willing” to move such initiatives forward. Hence, meaningfully engaging physicians presents a considerable challenge. The evidence shows that presently there is insufficient involvement of physicians in collaborative processes and decision-making at both the regional and system levels.
  • Within the predominantly hierarchical structure, the network strategically established for the SkSI involved a broad and diverse group of stakeholders—including patient and family advisors—in ongoing system level leadership and governance. The groups’ collective ideas and energy fuelled the development and implementation of a comprehensive policy framework to address the wait time issue and improve the surgical patient experience.