New regional healthcare network gradually finds its footing

Measures under way to improve quality and continuum of care

Like a photo that comes into focus or a sculpture that slowly takes shape, a clearer image of Quebec’s new public healthcare system has gradually been emerging from the reorganization that was set in motion on April 1.

The picture will grow even sharper this fall—and well into 2016—as a newly created senior management team (see accompanying article) and Board of Directors (coming in September) oversee the delivery of a wide spectrum of services at the Jewish General Hospital and at eight regional partner-institutions, collectively known as the Integrated Health and Social Services University Network for West-Central Montreal (West-Central Montreal Health).

In the JGH Emergency Department, Dr. Alice Yu meets with a patient in a cubicle in the Rapid Assessment Zone.

And when the Board of Directors is launched, its public and institutional members will be drawn from across the network to oversee health care in the entire area. (The law that established the new networks eliminated boards in every provincial healthcare facility, including the JGH.)

The final months of 2015 is when changes to health care will become even more apparent, says Dr. Lawrence Rosenberg, President and CEO of West-Central Montreal Health. The emphasis, he explains, will be in starting to examine where certain services could be best provided to address issues of access and timeliness.

As expected, the first phase of the transition during this past spring and summer has had its share of difficulties, Dr. Rosenberg says, “but nothing that’s been insurmountable.” Of key importance is that the initial challenges are being handled by the newly assembled management team of skilled and experienced senior managers from the JGH and institutions across the network.

What’s still unclear, Dr. Rosenberg says, is how much direct involvement the Ministry of Health and Social Services will have in the fine details of operating the province’s new healthcare networks. “I’m quite confident we can retain control over the quality of our services, and that we will maintain control over the process of transition.”

A resident and member of staff at the Donald Berman Maimonides Geriatric Centre, which is among the JGH’s partner institutions in West-Central Montreal Health.

As attention turns to the reform of healthcare services, many crucial questions have arisen, says Francine Dupuis, Associate Executive Director for West-Central Montreal Health: “Where should each service be based? Who should provide it? Where is it likely to be delivered with the greatest efficiency and for the least cost?

“That may mean, for example, transferring a patient to another program that’s more efficient. Sometimes nurses do something that an orderly could do, and this would have to be completely abandoned.”

According to Ms. Dupuis and Dr. Rosenberg, other measures are being considered or are under way to improve the experiences of patients, residents and clients at the JGH and across the network. For instance, an integrated practice unit for strokes is in development, extending beyond the hospital and into the community to include rehabilitation services and primary care.

In addition, an end may soon come to a procedure in which certain hospitalized patients are regularly reassessed to determine whether they can go home or should be transferred to a long-term care facility. Since these patients almost always end up in long-term care anyway, the reassessment adds little value.

“We also have listen to what members of staff say to us,” says Ms. Dupuis, “because most of the time, they’re on the front lines and are very good at observing. Then we have to have the courage to implement these changes. Even if there is some resistance, we still have to do it, but in a respectful way.”

For Carrie Bogante, Director of Finance for West-Central Montreal Health, spring was an especially tough time: Not only was it the dawn of the new healthcare network, it was a period when all nine institutions had to finalize the 2014-2015 financial year, as well as develop the budgets for 2015-2016. Complicating matters even further was the fact that the each of the member establishments was using a different accounting system.

“Now we’ve finally turned the corner,” says Ms. Bogante, “and we’re in the process of seeing how we can put things together and optimize processes at all staffing levels.”

The objective, she says, is to gather all of the finance professionals into a cohesive unit that will supply accurate and up-to-date data managers throughout West-Central Montreal Health. This information is essential in helping supervisors manage their budgets and identify areas where savings can be realized, while ensuring that efficient spending continues in the new network.

“At first glance, it looks like a huge mountain,” says Ms. Bogante, “and if you keep thinking of it that way, you can’t begin to climb it. So you have to break it down into a series of reasonable goals, and that’s when it gets easier.”

To Beverly Kravitz, Director of Human Resources, Communications and Legal Affairs for West-Central Montreal Health, the creation of the network has been “an exciting opportunity to improve the quality of health care” by making sure that the providers of care—doctors, nurses and other professionals throughout our network—get the help, information and support they need from HR.

“Our goal,” Mr. Kravitz explains, “is to keep enhancing our healthy work environment, assisting staff in achieving a comfortable work-life balance, and placing the right staff person in the right place at the right time. We want members of staff to know that we recognize and value their contribution. That way, they can do their best for the healthcare users who rely on them.”

Ms. Kravitz says the availability of this support will be especially important to staff in the coming year, as they make the transition from working in individual establishments to serving a healthcare network that covers a broad region of west-central Montreal.

At the moment, HR is busy planning its reorganization while ensuring that the needs of its business partners are met. Not only is the department looking to improve the delivery of service, but at the same time, Ms. Kravitz says it will be realizing “organizational effectiveness and economies of scale, as we integrate the corporate services of the network’s various institutions. An innovative example of how we will improve efficiency is the development of electronic employee files.

“We will be looking to optimize our processes through a Lean integration, thereby improving efficiencies and adding value for our clients.”

Ms. Kravitz realizes many members of HR staff, like those in other departments, face the challenge of getting used to working with new colleagues from other institutions. However, this pooling of talent also represents “a unique opportunity for all of us to learn from one another and continue to develop best practice and innovative ways in supporting our network in its delivery of healthcare excellence.”

What’s clear to Francine Dupuis is that a transformation on such a large scale is bound to have its significant bumps and obstacles. “Our priority is to make sure that healthcare users receive safe, high-quality treatment and care,” she declares, “but beyond that, any reasonable proposal will be considered. In the long run, it’s the patients, residents and clients of West-Central Montreal Health who will come out ahead.”