The Brant Community Healthcare System

“Big enough to make a difference; small enough to make it happen.”
The progressive hospital and healthcare provider treats its patients holistically rather than reductively – treating a patient as a whole and using a unique combination of factors, inputs, experiences, and needs. The same holistic approach to the operation of a hospital and healthcare system, in which different departments and employees work together in tandem towards the goal of delivering maximum value for its patients, also contributes to the highest level of outcome and provides a strong working example for the Canadian healthcare industry.
The Brant Community Healthcare System (BCHS) in Brantford and Paris Ont., is a fully accredited, award-winning healthcare organization and an affiliated teaching site of the McMaster University Michael G. DeGroote School of Medicine. The Brantford General is a regional acute care health centre and the Willett, Paris is an ambulatory centre providing urgent care. The 265-bed facility, which services a population of approximately 140,000 in Brantford, Brant County, and surrounding communities is hitting well above its weight, garnering national attention for the success of its patient-driven approach to healthcare provision. BCHS was awarded the ‘Gold’ Quality Healthcare Workplace Award by the Ontario Hospital Association and Ontario Ministry of Health and Long-Term Care for the second year in a row.
In November, 2013, the Canadian Institute for Health Information confirmed that BCHS had the lowest hospital standardized mortality ratio, having been in the top four for as many years. In addition to this achievement, BCHS has the lowest percentage of patients readmitted to hospital after 30 days in their region,  and lower than the provincial and Canadian averages. Additionally, the BCHS rate for the average cost of an acute care hospital stay was lowest in their region and lower than the province.
In combination, these three rankings are indicative of an organization providing safe care in an efficient and fiscally responsible manner. It is the balance of these three things that has proven BCHS is an exemplary organization, unique in its ability to provide for its communities.
This balance is a reflection of their True North – the direction of the organization. “We are trying to achieve some ambitious things,” says Sarah McVanel, Value Stream Leader, Engagement & Community Partnerships, BCHS. “For example, one aspect of our True North, Patient First, means we are working toward zero waiting, 100 per cent patient satisfaction, leading practices, and no adverse events. We select projects that will move us closer to achieving our True North and everyone monitors metrics on an ongoing basis to gauge how well we are doing. Whether you are at a board meeting or working on a busy clinical unit, measures are discussed, as are the improvements that can be made to continually improve them,” says McVanel.
BCHS employs LEAN continuous improvement methodology that prioritizes the value for the end user – in this case, the patient above all else, creating a culture of improvement through improving processes, solving problems, eliminating waste and driving value. In practice, this means “value is created at the bedside. Patients, staff, physicians and volunteers are essential to us evolving as an organization. That means moving away from a traditional, hierarchical healthcare mindset to being more patient-centred and staff-driven,” says McVanel.  In April, 2013, BCHS reorganized and aligned its structure into “Value Streams” to transform health care. In order to drive out waste, and transform how care and services are provided, the structure has to be conducive and enabling to facilitate a successful patient experience. The focus is on the patient journey, and the support required to ensure satisfaction and optimal outcomes.
Supporting BCHS in the journey, and mentoring through the realignment to value streams, was sponsor organization Cogent Power out of Burlington, Ont. “It has been a tremendous honour for our Cogent team to work with the leaders and teams at BCHS as they started their LEAN journey,” says Cogent Power CEO, Ron Harper.  “There are significant operational similarities between manufacturing processes and healthcare processes typical in a hospital environment, and the BCHS team have really embraced the LEAN tools to improve their patient flow and effectiveness. I think the most special part of the achievements at BCHS have come through their focus on the people and cultural side of LEAN, providing significant training, mentoring and coaching to their teams to help understand the lean way of thinking. Change in organizations does not come from technology or structure.  Businesses or organizations do not change, people change the way they conduct their business.  The leaders of BCHS have learned this. One of the other significant changes made by BCHS early on was changing their hierarchical/departmental structure to value streams. This bold step helps organizations lead and manage cross functional processes, in line with the flow of processes – and in healthcare, the patients. This focus allows work teams to concentrate all their efforts on the effective flow of patients through their processes to increase their health, instead of a patient moving potentially through multiple departments or teams. This focus on creating flow significantly lowers cycle times, will help the patient feel more engaged, while improving costs and increasing the patients’ experience. BCHS has moved a long way in a short time on their LEAN journey, and they are to be complimented on their achievements.”
The process of realigning took months of planning and is continually monitored to ensure it’s bringing value to the patient. “We landed on three clinical value streams in our organization – acute and transitional care, planned care and episodic care,” says Jim Hornell, President and CEO of BCHS. “Heading up each value stream are leaders and medical co-leads. We want to make sure this is a shared responsibility. Through this structure we have developed and enhanced the role of team leaders right to the front line so the entire patient experience in any stream is a team effort facilitated within the group of providers and support staff. Team Leaders engage the right people and processes all along the journey so the patient experiences  a smoother journey and better care.”
On a daily basis, the “smoother process” can take the form of many examples. In the Planned Care value stream, staff expertise and engagement resulted in a significant reduction of waste through a Supply Chain project. “By standardizing equipment sets, reducing inventory levels, and removing wasted steps, we have increased consistency and improved work flow. This also reduced the amount of time that nurses need to search for equipment and supplies. In one role, time spent locating supplies decreased from 50 per cent down to five per cent, meaning we have valuable care providers available to do what they do best and love – provide care and service to patients.”
So attuned to its organization goals, the Association for Manufacturing Excellence (AME) the “premiere organization for the exchange of knowledge in enterprise excellence”, chose BCHS as one of only two hospitals in a North America to tour this year, eager to review BCHS’s best practices and showcase them at the International Excellence Inside Conference held in Toronto. “Staff did a great job of explaining the many process improvements they made, from before the patient entered our facility to the time we were preparing for discharge. It was incredible to see,” says McVanel.
It is important to keep in mind when discussing BCHS’s pioneering organizational realignment, there has been zero detriment of patient care, which is commendable.  The patient is always at the front-of-mind. As Hornell says, the system is being reorganized around the patient so the patient doesn’t have to work around the system.
So while BCHS is lauded for its recent accomplishments, its other services are still going forward and providing exemplary care. Programs such as the Willett Life Members Bursary Program, whereby students like Courtney Miles and Emily Marek received a $500 bursary towards completing their education in healthcare-related fields, continued through the changes. Or take the new Integrated Stroke Unit, where patients from across the region who suffer a stroke have access to best practice stroke care provided by a team of professionals with expertise specifically in stroke. Or even partnerships with the Public Health Unit to provide additional resources for new mothers for seamless transition from hospital back into the community.
The list goes on. “As we have learned from our LEAN mentors, we know we have much work still to do. As soon as we think we are finished, we are no longer focused on improvement. We have a lot to be proud of, including the fact that we have embraced a belief that a problem is not a bad thing, but an opportunity.” says McVanel. BCHS is an organization that does not rest until its better is best. It serves as an example of how a commitment to best practice produces the best in patient care.
For more information on BCHS, please visit or follow them on social media including Facebook, LinkedIn and Twitter (@bchsys).