Image of Patient Inez Martincevic, left, and Tess Devji at the new check-out station​​

Patient Inez Martincevic, left, and Tess Devji at the new check-out station implemented through Lean at Lyndhurst Centre. Martincevic suffe​​red a spinal cord injury in a trapeze-like exercise program – and the Lean program has helped get her back on her feet. (Photo: UHN)​

Inez Martincevic was at a jukari class– a trapeze-like exercise program – when her back hyper-extended leaving her unable to move her legs.

"My legs felt like lava and they were dead weight," said Martincevic. "I began screaming, 'I'm paralyzed'."

Martincevic was rushed to the Toronto Western Hospital Emergency Department where she was told she had a spinal cord injury—a bruise on her spinal column.

The neurosurgeon decided surgery wasn't necessary. After nine days in acute care, Martincevic was transferred to Spinal Cord Rehab at Toronto Rehab's Lyndhurst Centre where she was an inpatient for almost three months.

"When I went to rehab, I couldn't stand and had been suffering severe bowel and bladder issues," said Martincevic. "I was provided a great understanding of my injury and the team was proactive in discussing my rehab goals."

Fostering better care

As an outpatient, Martincevic was approached in spring 2012 to participate in the UHN Spinal Cord Lean initiative that helps create new processes for more efficient and effective patient care.

"I participated in Lean because it was an opportunity to speak on behalf of patients and families who have had much more devastating injuries and may have more barriers to the health-care system than me," said Martincevic, who is a clinical dietitian at The Hospital for Sick Children. "I hope my participation can help make the care better for others at UHN."

The first step for the UHN spinal cord programs in their Lean initiative was to bring together acute care staff, rehab staff and community partners to map out the entire patient experience from the emergency department, to inpatient acute care, to rehab to returning to the community. This gave the teams a clear picture of where improvements needed to be made.

"One of the benefits of the process is having the teams from both sites spend more time together," said Janet Newton, Senior Clinical Director, Toronto Western Hospital. "By developing a better understanding of each other's programs and processes, we are optimizing the care we provide patients."

So far, Toronto Western and Toronto Rehab have implemented 237 improvements and held 14 rapid improvement events, which are used by the team to make the changes.

One of the events, for example, standardized the timing and process of how a patient's discharge date from rehab is communicated to him or her. 

Bridging the gap

"Bringing the Toronto Western and Toronto Rehab teams together has been eye opening on both sides," said Tess Devji, Spinal Cord Rehab Lean Lead, Toronto Rehab. "It has allowed us to address language inconsistencies, for example, how we both define 'medically manageable' or 'rehab ready.'"

Lean has also facilitated important transition conversations that are crucial to improving the patient journey.

"Part of the Lean experience is learning how we can work together, especially during important transition points," said Joanne Zee, Senior Clinical Director, Brain and Spinal Cord Rehab Program, Toronto Rehab.

"One of our early successes was the creation of a standard process that allows us, in minutes to identify which patient is appropriate to transition from acute to rehab. Before, this took days," she continued.​

UHN stroke programs and MSK/ortho programs at Toronto Western and Toronto Rehab have also begun using Lean methodology to enhance patient care transitions and the overall patient experience. Both areas launched Lean this spring.


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