Rolling-out Lean in the Saskatchewan Health Care System: Politics Derailing Policy
Bibliographic record
Abstract
Following on the work of Marchildon (2013) this paper examines the political challenges faced by the government of Saskatchewan in rolling out their Lean reforms to the entire provincial health system. The government’s Lean reforms were meant as a vehicle to empower patients and workers in the redesign of service delivery and the creation of a patient-centred system. Lean focuses on continuous improvement, priority setting, employee engagement and the elimination of waste. The reforms appear to have been derailed to a significant degree insofar as key actors inside the system, the media and the public have challenged the goals of the reform, the Lean methodology and process, as well as the cost of the consultants employed to oversee the process. The government’s implementation of the roll-out suffered both from the ability of key actors to withdraw their support and challenge the viability of the reforms in public as well as from a public relations perspective that put the government on the defensive about how people inside the system were being treated with the reforms. As the government moves forward it will have to adjust its implementation processes and strategy in order to overcome the now strong resistance within the health sector.Cet article fait suite à celui de Marchildon (2013) et étudie les obstacles politiques rencontrés par le gouvernement en Saskatchewan quand il a voulu étendre ses réformes « Lean » au système de santé dans son ensemble. Par ces réformes, le gouvernement voulait donner leur mot à dire aux patients et aux producteurs de soins dans la recomposition de la délivrance des soins et la création d'un système centré sur le patient. « Lean » vise l'amélioration permanente, l'établissement de priorités, l'engagement des employés et la chasse au gaspillage. Il semble que les réformes aient achoppées pour une bonne part parce que des acteurs clé à l'intérieur du système, les média et le public ont remis en cause leurs objectifs, la méthodologie et le processus de « Lean », ainsi que les coûts des consultants employés pour conduire le processus. La mise en place de la généralisation par le gouvernement a été malmenée à la fois par la capacité des acteurs clé de retirer leur soutien et de remettre en cause publiquement la faisabilité des réformes, mais aussi par une opération de relations publiques ayant contraint le gouvernement à défendre la façon dont les personnels étaient traités par les réformes. Quand le gouvernement voudra avancer sur ce dossier, il devra ajuster les processus de mise en place et sa stratégie afin de dépasser des réticences maintenant fortes au sein du secteur sanitaire.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".