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To improve care, senior managers get up-close and personal with patients and staff

Regular tours of CIUSSS sites provide insights into facilities’ day-to-day activities

Early one morning not long ago, several senior managers of CIUSSS West-Central Montreal came together as a cohesive group and headed down to the Emergency Department of the JGH to see how a typical day was unfolding.

No crisis was looming, and nothing required their immediate attention—except that, as usual, many more patients were streaming through the department’s doors than could be comfortably handled.

During a tour of the JGH Emergency Department, the need to make optimal use of a family room is discussed by several CIUSSS senior managers—from right: André Poitras, Valerie Schneidman, Francine Dupuis, Serge Cloutier and Lucie Tremblay. [1]

During a tour of the JGH Emergency Department, the need to make optimal use of a family room is discussed by several CIUSSS senior managers—from right: André Poitras, Valerie Schneidman, Francine Dupuis, Serge Cloutier and Lucie Tremblay.

What the managers intended was simply to arrive unannounced, chat informally with members of staff, exchange a few words with patients, and come away with a clearer impression of how personnel were coping with the latest influx of the ill and the injured.

By following an impromptu itinerary and by observing the day-to-day practicalities of providing care, they acquired a stronger sense of what was working and what needed to be improved.

These 60- to 90-minute outings, known as Leadership Rounds, now take place regularly in facilities throughout the CIUSSS. At the JGH, visits have been made to such areas as Geriatrics, Neurology, Hematology, Palliative Care and the Post Partum Unit. In all, more than three dozen tours have been conducted across the CIUSSS since they became a regular fixture in late 2018.

In addition to being informative, these tours yield concrete results. After each visit, a summary is sent to Dr. Lawrence Rosenberg, President and CEO of the CIUSSS, and twice a year, those who participated must report on the improvements that have been implemented.

“We all benefit from taking the time to understand the real needs of our healthcare users and staff,” notes Francine Dupuis, Associate CEO, who was joined by five colleagues on the recent tour of the Emergency Department.

“By going as a group, and by blocking off time on a specific day, we have an excellent opportunity to bounce ideas and opinions off one another. The tours also give us the same frame of reference when certain subjects are raised in later discussions.”

“It’s also worth noting that these aren’t circumstances that obligate us to hurry to the scene to respond to a specific problem,” adds Lucie Tremblay, Director of Nursing. “As a result, we can take our time and look at a wide range of commonplace situations, including some that might otherwise have escaped our notice.”

“When you talk to people in person, you find out about the full range of big and little things that are on their minds.”

Under scrutiny on this particular Tuesday morning is an empty family room, with Ms. Dupuis and Ms. Tremblay accompanied by Dr. Louise Miner, Director of Professional Services; Serge Cloutier, Associate Director of Nursing; Valerie Schneidman, Head Nurse of the Emergency Department; and André Poitras, Clinical-Administrative Coordinator for the Emergency and Medicine Departments.

During the busiest times, when the Emergency Department is filled significantly beyond capacity, this family room helps in handling the overflow of patients. Lately, though, it’s been used more often for clinical activities than for families.

Given the enormous need for Emergency services, the managers in today’s Leadership Rounds agree to look into discontinuing the room’s availability for families. As Dr. Miner notes, this is not an ideal situation, but since the JGH has the busiest Emergency Department in Quebec—and the third-busiest in Canada, with about 90,000 visits per year—there seems to be little choice in the matter.

At other points in the tour, the managers take note of chairs in poor repair in the waiting room of the Triage area, they survey the department’s psychiatric facilities, and they get an overview of patient flow in the Rapid Assessment Zone. At each stop, they pause to speak with patients and members of staff.

“We’re very well acquainted with what the Emergency Department is experiencing,” explains Dr. Miner, “but seeing these situations in person confirms for us what we need to act on.”

Often, both the strengths and the weaknesses become evident. On a previous occasion, during Leadership Rounds at the Richardson Hospital, Dr. Miner saw for herself why there was such a serious need for renovation.

But, on a lighter note during the same visit, she was delighted to learn more about the tight teamwork between the hospital’s physicians and the other multidisciplinary professionals—a practice that not only enhances patient care, but makes the hospital seem especially appealing when new staff are recruited.

Ms. Tremblay recalls that during a discussion with several nurses at the Richardson Hospital, she held up a pen “and I asked, ‘If this were a magic wand, what would you wish for?’

“Many of the nurses told me they wanted new chairs for the nursing station. And I thought, ‘Chairs? Really? Getting new chairs is not rocket science.’ It turned out that there had been a miscommunication and, somehow, the chairs that they needed had never been ordered.

“We’re running a very large organization, so sometimes these kinds of things fall through the cracks. I’m sure the error would have been caught eventually, but when you talk to people in person, you find out about the full range of big and little things that are on their minds. It makes all the difference.”