The MUHC’s Clinical Plan
Ask colleagues to describe Dr. Tim Meagher, Chief of Clinical Development at the McGill University Health Centre (MUHC), and you will quickly learn about his even temper, keen wit and strong communication skills. Because of his low-key demeanor, what you might not hear about quite so frequently is Meagher’s nose-to-the-grindstone resolve. Yet it is this quality, as much as any other, that has allowed him and his colleagues to successfully complete in only seven months a task of daunting complexity and scope: creating and refining the clinical plan that will guide the MUHC’s redevelopment.
As Meagher explains, this modest-looking document holds the key to defining the MUHC of the future, distilling precisely what will take place within the walls of the specialized, internationally competitive 21st-century academic health centre that is being created on the Mountain and Glen campuses. “The clinical plan is a document that describes the patient care services, teaching activities and research platforms we want to provide at both of our campuses. It’s an elaboration of our mission and an expression of where we want to see ourselves in the next 10 to 15 years. Although putting it together has been exhausting, it’s been one of the most exciting steps we’ve taken with the project so far.”
According to Meagher, the idea of formulating a clinical plan for the MUHC’s development is hardly a new one. While the recent spate of intense work is in response to a request made by the Quebec government in June of this year, the plan’s underlying ideas have been circulating since 2003, when the government announced that the redevelopment could begin in earnest. “Our administrators, planners and clinical chiefs have spent years debating what should be included in our new facilities. Now, with a solid budget and a construction timeline in place, and a clear sense from the government of the overall vision for health care in the province, we’ve been able to refine this creative thought into a realistic clinical blueprint.”
At the heart of the blueprint is a rethinking of what the MUHC is all about. As part of the government’s far-reaching plan to restructure how health care is delivered in Quebec, the MUHC and McGill University were designated co-leaders of a network that encompasses all of the health care institutions within a territory that extends from the U.S. border to Nunavik and from the mid-point of the Island of Montreal to the Ottawa Valley. This dynamic network, called the McGill RUIS (réseau universitaire intégré de santé), is designed to ensure that all Quebecers have access to the right care in the right place at the right time (for more information on the McGill RUIS, see the April 2005 issue of Health Perspectives).
For the MUHC, the RUIS means focusing its energies on the kind of specialized care, teaching and advanced research that only a university health centre can provide, while helping to make sure that other institutions in the network have the resources to offer more day-to-day services. “The government’s philosophy with the RUIS is that every Quebecer should have excellent basic care close to home. If they need something a bit more involved, there will be a regional centre capable of providing it. And for those patients needing the most complex and critical kinds of interventions, the four university health centres will be more capable than ever because of their singular focus on tertiary and quaternary care.”
The clinical plan has one chapter dedicated to each of the MUHC’s seven missions (Medicine, Surgery, Pediatrics, Cancer Care, Women’s Health, Mental Health and Neurosciences), as well as sections addressing technology, support services, teaching and research. The clinical plan allows each of the seven missions to describe in detail which highly specialized services they currently excel in, what directions they predict their specialties will take, and how they can put themselves in the strongest position to meet new challenges. “Even before the RUIS system came into effect, many of us at the MUHC had been thinking that the best way to serve our community would be to turn ourselves into a world-class research-based health centre, focused exclusively on the most advanced and specialized treatments and protocols. This is what we asked our Mission Directors to aspire to, while also bearing in mind our overall budget, the urgent needs of our current patients and their interactions with other departments and with partners across the RUIS. As you can imagine, there’s a lot of blood and sweat on these pages!” Meagher laughs.
Despite the intense and serious effort that went into the production of the clinical plan, which runs to 150 pages, reading it is an inspiring experience. There emerges from the detailed statistics, dense tables and long lists of services that fill the pages a tangible sense of enthusiasm for the potential of academic medicine to relieve suffering. Also present is an overriding faith that the MUHC can take the lead in realizing that potential. Although it is impossible to neatly summarize all of the diverse strategies and predictions the plan contains, certain themes reveal themselves across missions and specialties, providing a tantalizing glimpse of how the MUHC will operate down the line.
From operating theatres to patient rooms, the clinical plan describes the kinds of spaces needed to provide the care of the future.
Nearly all of the missions describe an increasing need for interdisciplinary, disease-based programs. Instead of being sent from one specialist to another – imagine a long line linking physician, surgeon, nutritionist, social worker, nurse specialist, physiotherapist and other health care professionals – patients will be assessed from the beginning by a team of caregivers that will collaborate on their care program and follow them throughout their treatment and recovery. A breast cancer patient, for example, will be seen from the moment of diagnosis by a group of specialists with a particular expertise in the disease: radiologists, oncologists, surgeons, psychologists and even genetic therapists. By working together, the team can ensure that the patient moves smoothly from one stage of treatment to the next without delays; that her particular concerns (for example, fear of recurrence or anxiety about her daughters having the disease) are addressed and factored into the treatment plan; and that the cumulative expertise of the team is brought to bear at every juncture.
Another priority for many missions is to make more space available for day hospitals, which are outpatient spaces that contain beds and other equipment to accommodate therapies that are too invasive or complex for conventional ambulatory clinics. These dedicated spaces will provide a level of care, comfort and supervision that is appropriate to such treatments as chemotherapy and radiotherapy, but without requiring patients to be admitted to an in-patient ward.
As any good futurist will tell you, technology is a central consideration when planning for the decades to come. While all of the MUHC’s missions intend to have the most advanced equipment and the flexibility to accommodate as yet unimagined technologies, they are also intending to create efficient technological platforms that can be shared across departments and institutions. These include clinical information systems that will allow patient records, test results and other information to be easily transmitted between departments and hospitals; telehealth systems that will give MUHC specialists the ability to communicate and even operate remotely across the RUIS; imaging equipment that will be accessible to many specialties; and surgical technologies that will be used for diverse procedures.
Although the MUHC plays host to thousands of medical, nursing and allied health students every year, its current cramped facilities make the logistics of teaching a challenge. The clinical plan reveals a renewed commitment to the MUHC’s teaching mandate through its blueprints for facilities that will host conferences and consultations, will include simulators for complex surgical procedures, and will have the capacity to broadcast video from operating suites into remote classrooms.
Finally, to become the truly specialized, high-level centre that Meagher describes, the missions will focus more than ever before on research. From expanding the capacity for clinical trials to building more laboratories and enhancing resources like tumour banks and patient databases, the clinical plan paints a picture of an MUHC where every patient can be both the source and the beneficiary of new discoveries.
Now that all of these ideas have been put down on paper, what will happen next with the clinical plan? As Meagher explains, both the clinical plan and its more nuts-and-bolts sibling, the Functional and Technical Program (FTP), are currently under consideration by the government. “I’d say we have agreement on about 80 percent of the plan and we’re making good progress on the remaining 20 percent,” he says. It is expected that government approval for both the clinical plan and the FTP will be granted in early 2007.
What does Meagher see for himself? “Well, there’s still a lot of hard work to be done. The negotiations with the government need to be completed, and then we begin the even bigger challenge of collaborating with our missions to make sure that everyone is working together to make these conceptions a reality. Oh yes, and then we must design and actually build the thing.” With a wry laugh he adds, “I’m not quite ready for a vacation yet!”
