Coping with change in the delivery of health care

Réjean Plante is Executive Director of the Lindsay Rehabilitation Hospital.

The vision guiding the creation of the McGill University Health Centre’s Glen project is one that Réjean Plante is fully in agreement with because it addresses the needs of one of the country’s foremost university hospitals while accruing benefits to his hospital.

Mostly, Plante is convinced that the MUHC is following the most appropriate process and timetable for getting this mammoth project off the ground while keeping the needs of the patients at the focus of all decisions.

"Over the past seven years, medical care in our city has undergone dramatic changes. The merging of the MUHC hospitals was an appropriate response to the way health-care delivery was reoriented and I think it is extremely wise of the MUHC to have spent as long as they have consulting with their internal staff on the planning of the project. By the time all the personnel are together at the Glen, they will be well over any stumbling blocks arising from having coordinated services and blended personnel."

The LRH has been involved in some of that coordination directly. About five years ago a task force on admission criteria was set up bringing together representatives from the two institutions. Its outcome was the creation of an evaluation form for orthopedic patients who were transferring from the MUHC’s Montreal General Hospital site to the LRH. All the parties involved in the process—nurses, patients, physio- and occupational therapists—began using common admission and assessment criteria. The result is that everyone has a common understanding of exactly what capabilities a patient has at the time of transfer and what they have to achieve once at the LRH. Patients no longer have to experience delays, setbacks or interruptions in their treatment when they are moved from one team to another.

On the Glen, the collaboration will continue and will improve patients’ situation even further. "Our patients will appreciate being able to have all their tests done in one place," explains Plante. "As well, those who travel there on their own will certainly enjoy the better parking arrangements and accessible public transportation. It goes without saying that those who are on crutches or in wheelchairs will benefit from a modern facility that will more appropriately accommodate their needs." The Glen site will incorporate moving sidewalks, handicap-accessible areas and dedicated patient elevators into its design.

The relationship between the LRH and the MUHC began years ago. In the mid 1990s Montreal experienced the closure of seven hospitals and accepted that medical services for less-acute conditions would be handled through a network of 29 community CLSCs as well as rehabilitation and convalescent centres. As Executive Director of the Reddy Memorial Hospital from 1982–1997, Plante experienced firsthand the closing of that hospital. "In principle, I understand the government’s push over the last twenty years to strengthen the ambulatory and outpatient establishments in order to reduce the financial burden of the costly acute care hospitals. But it has been a painful and swift process that has not always been easy to comprehend, so the MUHC is right in reorienting itself—and us—in a measured way."

Over the past 20 months more than 1,000 MUHC-related people have come together in various groups to discuss the functionality of the new hospital. The result is a program that looks at the physical environment of the new hospital while keeping in mind what needs to be put into place throughout the health-care network in order to accommodate a more modern, thorough and responsible way of delivering care.

A few years ago, the Lindsay (as with all other Montreal rehabilitation hospitals on the island) was visited with a 20 percent slash in its budget. "As a health care administrator in Quebec," Plante states, "it was frustrating to experience across-the-board cutbacks when we were already operating in a fiscally responsible way. Before that experience, when city health-care partners met as a group, we tended to look at our own situations; after that we began sharing our information and finding solutions together."

Last year the Lindsay had 1200 adult admissions. Instead of 203 beds, it has reduced the number to 155 and the length of a typical stay to around 31 days. Careful planning had to be undertaken in order to ensure that this didn’t negatively affect a patient. The goal was to put all the resources into play to get the patient moving from hospitalization to rehabilitation to reintegration, more efficiently.

“We put our patient at the centre of all decision-making by asking, ‘What is best for her/him?’" Plante affirms. "Our answers often come from our front line staff. It is these workers, for instance, who suggested we have patients do their exercises in rooms on their own floor, instead of in one location downstairs. Now the patients don’t have to travel so far and the professionals on the wards are closer to the action, enabling them to see what activities are prescribed by the physio- and occupational therapists."

Knowing that the MUHC has undertaken a similar planning phase (albeit more elaborate, more comprehensive and well-ahead of design and construction) has left Plante comfortable with the eventual outcome, which can only have benefits for the community.

"I recently did a tandem [attached to an instructor] skydiving jump out of a plane at 13,000 feet," he said. "There was planning before but the first minute of the jump was a free fall-down to 4,500 feet... it made the adrenaline rush. Then the parachute opened and I sailed gently the rest of the way home. The MUHC is preparing thoroughly for the same soft landing... so we can all enjoy the ride."

Published by the MUHC Foundation in The Gazette