How UHN’s Spinal Cord Lean Initiative Helped Inez Martincevic Heal

UHN Spinal Cord Lean InitiativeInez Martincevic found herself in the Emergency Department of Toronto Western Hospital in October of 2011 after her back hyper-extended during a trapeze exercise class called Jukari. Unable to move her legs and in extreme pain, her worst fears crossed her mind—paralysis.

The neurosurgeon that treated Martincevic diagnosed her with a contusion, a bruise, on her spinal column and deemed surgery unnecessary. Her spinal cord injury was treated for nine days in acute care before she was transferred to Toronto Rehab’s Lyndhurst Centre for almost 3 months of inpatient spinal cord rehabilitation.

“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.”

An Invitation to Make a Difference

During Martincevic’s outpatient therapy, she was invited to participate in the UHN Spinal Cord Lean initiative. The goal of this initiative is to ultimately deliver better, more effective and efficient care to patients that have experienced a critical spinal cord injury.

Martincevic, eager to help improve care at UHN, was excited to join the initiative. “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.

UHN Spinal Cord Lean Initiative

As a first step to the UHN Spinal Cord Lean initiative, teams were brought together from acute care, rehab and the community partners to map out the entire patient experience.  This helped point out areas that could be improved. Janet Newton, Senior Clinical Director, Toronto Western Hospital, explains the importance of this collaboration, “By developing a better understanding of each other’s programs and processes, we are optimizing the care we provide patients.”

Working to Get Better Together

“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.’” Communication, standardization, minimizing inconsistencies, and improving processes were all areas addressed together by the teams.

Outcomes and Results

To date, Toronto Western and Toronto Rehab have implemented 192 improvements and continued to make changes through 11 rapid improvement events.  “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!”

UHN has seen both quantitative and qualitative improvements since Lean was implemented:

  • 13% reduction in total length of stay for acute and rehab patients
  • 4-day average reduction in ALC (Alternate Level of Care) days
  • Higher patient satisfaction

For more information on the UHN Spinal Cord Lean Initiative, visit

Jasmit Sehmi


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