The McGill University Health Centre: A project for the 21st century

Philip O’Brien’s speech to the Board of Trade of Metropolitan Montreal
Thursday, February 7, 2002

Good morning ladies and gentlemen,

I’m very pleased to be here to talk about one of the most ambitious and indispensable projects to be undertaken in Montreal in several generations: the design and construction of the McGill University Health Centre’s new hospital.

This is a project of vision. Some of our leaders recognized nearly ten years ago that our current hospitals were being stressed physically, financially and operationally and that these stresses would eventually be felt by the community. They also recognized that regrouping some of the city’s best university hospitals within an infrastructure designed for this century would have immediate and long-lasting benefits to the people of Montreal and on many different levels to the rest of the world.

The McGill University Health Centre isn’t quite five years old but it has a history that goes back over 175 years. Its partners—the Montreal General, Royal Victoria, Montreal Neurological and Montreal Children’s hospitals, as well as the Montreal Chest Institute—helped build this city and they are now, through the MUHC, continuing to be forward-looking, to make room for innovations and to anticipate and provide for the future of health care.

Let me explain what I mean by that:

• The MUHC is one of Canada’s finest university hospitals.
• It is a world recognized research hospital.
• It trains nearly 2,500 health-care professionals a year.
• It offers excellent multi-disciplinary pediatric to geriatric care.
• And it is playing a leading role in developing relationships and protocols with the rest of the health-care network to make sure that our community is well-cared for.

In short, there is no better place to receive excellent treatment and have it delivered by top-notch and caring personnel than the McGill University Health Centre. The caveat of course is that all of this is being accomplished in an environment that is antiquated, that doesn’t allow health practitioners to operate with efficiency, that can’t accommodate today’s equipment, that doesn’t make it easy for patients to receive their treatments and that keeps patients and staff shuttling back and forth between five hard-to-get-at sites.

At its core, the MUHC’s new hospital project is about delivering the best care possible to our community. This isn’t a new and revolutionary idea. It is something that the MUHC—through its partners—has been doing on an ongoing basis since May 1, 1819. That was when Montreal’s community leaders recognized that their city was booming and that the 25,000 people living here needed access to better medical care. And that was when the Montreal General Hospital opened its doors in a converted house on Craig Street with 24 beds and an outpatient department.

Two years later the General moved to new premises and expanded the number of beds to 72. In 1829, through its affiliation with the Montreal Medical Institute, it became North America’s first teaching hospital. This relationship with what would eventually become the McGill University faculty of medicine brought with it—and continues to bring with it—many benefits to the city. Clearly, we aren’t new at this game.

By 1870, despite ongoing renovations and expansion, overcrowding at the General was becoming a serious problem and there was a clear need for a new hospital. And it’s this part of the MUHC’s history that I want to draw your attention to this morning. To fill this very clear and obvious need took nearly quarter of a century from the day Dr. Palmer Howard first wrote about it in the Montreal General’s annual report and the day the doors of the Royal Victoria hospital first opened. To get it done, it also took the courage and commitment of two very driven men.

I won’t go into the details of the relationship between the two hospitals but I will say that building a new hospital in 1893 presented many of the same questions and challenges as we are being presented with today. Did we really need two separate teaching hospitals? Where was the best place to build this hospital? How much was it going to cost? And how would we pay for it?

As I go through my speech this morning I will address these and other concerns. But I will start, if I may, with the question of why we should invest in bringing together the resources of the MUHC onto a single site.

In the 1800s providing for the health care needs of the Montreal community was a matter left largely to the community itself; and so two of our most prominent business and community leaders, Donald Smith and George Stephen each provided $1 million for the construction and running of this new Royal Victoria hospital. In today’s dollars that would be the equivalent of two of our business and community leaders each investing nearly $250 million into the MUHC and the Glen project.

Why did Smith and Stephen do this? They did it because it made sense for a city of Montreal’s standing and future aspirations to invest in the well-being of its community; to offer as an added incentive for people to come from all over Europe to live and work here, the peace of mind of knowing that should they get sick, there would be a place for them to recover. That should they get sick, the best doctors and nurses would be here to take care of them.

In other words, Smith and Stephen invested in the Royal Victoria hospital because it was good for Montreal. They built it as a sound economic investment. And, much as their rail buildings, resort buildings and bank buildings were built to showcase the stability of these industries in this new country, the hospital was a project that would demonstrate the stability of health care. Smith and Stephen’s challenge was probably as daunting as the one we face today but they succeeded and their hospital has been one of Montreal’s finest assets for over a century.

The era of the community looking after the needs of health care ended when the government assumed the responsibility. Now it is the government that must invest in this sector and must manage its growth as a pillar of our socio-economic infrastructure. It is up to us, the users, to think of the future, of our needs as we get older and to think of the health care system as a building block of the economy… and to entice the government to act accordingly and to ensure that the infrastructure exists in order:

• to provide modern care with modern equipment
• to provide continuity of care within the community
• to undertake research that will make a difference to our quality of life
• to make sure that the doctors and nurses of the future are being taught in an environment that is rich in learning opportunities
• and to ensure the long-term viability and success of this major Montreal economic pillar.

This environment and this infrastructure do not exist at the MUHC today.

We need a reality check here. The most modern of the MUHC’s facilities is the Montreal General hospital, which was designed in the 1940s and which opened its doors in 1955. As you can imagine, going to the hospital over 50 years ago was quite a different experience than what it is today. Patients checked in for a lengthy stay. Doctors had never heard of CT scans or MRIs. Surgical procedures were anything but minimally invasive. Drug therapies were limited and the term "ambulatory care" had yet to be coined.

The hospital environment has come a long way since then, and while each of the MUHC’s facilities has been upgraded and renovated—and continues to be modified—so that we can provide the best care we can under the circumstances, we are operating a 21st-century business in buildings whose design goes back in some cases to Queen Victoria’s Jubilee.

How far have we come: when the Vic opened its doors, its total floor space was 180,000 square feet, and there were 14 medical staff to treat the 1,500 in-patients and 4,800 out-patients who came there that year. Today, the MUHC’s facilities take up 3.4 million square feet; we have 11,000 people on staff and our patients open the doors of our facilities nearly one million times every year. More than 900,000 of these patients walk in and walk out again the same day.

Let me put this in perspective we’ve gone from a 1 to 3 ratio of in-patients to out-patients to a 1 to 30 ratio. Three thousand people, many of them needing high-tech specialized treatment, come into our hospitals and go home the same day. Every day. 365 days a year.

None of our original buildings or renovated spaces or additions was designed to accommodate this immense volume of traffic.

None of them was designed to manage the patient flow needs of our hospital today.

And none of them was built to support the large and heavy equipment that’s needed for surgery, diagnosis and treatment.

In any other working environment what we are asking our people and facilities to do would be unacceptable. And the question is not whether we can afford to build this new hospital but whether we can afford not to. Imagine if Nortel were still processing its products out of its plant on Shearer Street in Point St. Charles, or if Bombardier were producing aircraft in a snowmobile factory in Valcourt. What would have happened if neither of these organizations had seized the opportunities that were presented and had accommodated the modern requirements of their businesses?

Now let’s just take a look at this project from the needs of the customers for a second. Modern medicine and modern health-care practices are built around the needs of patients, who are best served by a "one-stop" medical design that offers both vertical and horizontal efficiencies. Patients should be able to go to a university hospital and be seen by their physician in the morning, put through the required tests throughout the day, have the results interpreted and assessed and meet again with the doctor before the day is over.

The benefits of vertical efficiency are obvious; besides compressing what could be weeks of medical appointments into one day, there is also a comprehensiveness and focus that allows someone to either go home with a clean bill of health, or be immediately scheduled for medical follow-up.

For other patients horizontal efficiencies are critical. These people have conditions that are best treated through a coordinated multi-disciplinary approach. Having all the specialists on one site then becomes very important.

The MUHC’s new hospital will offer benefits to the professionals as well, not least of which is the exchange of knowledge that results from the interaction of professionals. Experienced staff will draw a lot from this experience and so will our students, who will have a chance to see how a system can function collaboratively with the well-being of the patient at its core.

The MUHC’s model for the future, is about providing care for children, adolescents, adults and seniors, on an out-patient or in-patient basis. It is also about coordinating care with family physicians through hospital, home or on-site visits with CLSC workers or rehabilitation care professionals.

But just as important as the model is the structure that will accommodate how we want to deliver care. The new hospital has to be designed for the user. It has to be designed to shorten stays. It has to offer comfort and reduce anxiety both by making it easy to access care and by making the experience itself a part of the healing process.

Here are a few quick examples: patient rooms have to be 25% bigger; there has to be a lot more natural light; there have to be better view planes; nursing stations have to be closer to patients; there have to be separate ventilation systems; there have to be separate traffic patterns for patients, visitors and hospital supplies; and family members have to be able to participate in the healing if only by being able to comfortably spend the night.

The infrastructure has to be able to accommodate the technology that we have today and that we will have 10, 20 and even 30 years from now. That means building space that is flexible, that is capable of supporting a lot of weight, and that can act as a part of the healing process.

Our population is aging and our hospital has to accommodate this fact in many different ways. We need to invest in this project so that each of us in this room, our families and our neighbours will be well looked after in the very near future.

An aging population needs special care. And that care needs to be delivered in an environment that is appropriate to the needs of the patients. Face it, climbing a mountain to get care is good for your health only if you’re healthy to begin with. We have to make it easy for people to get to the hospital and once they are there then we have to make it easy for them to get around to receive their treatment and to go back home.

As our population ages, we can expect that our hospital will become a lot busier than it is today. None of our sites can handle this extra load. None of our sites can attract the highly specialized workers we will need to meet the needs that we anticipate in the future.

Right now, the health care industry isn’t attractive to people because there is a lack of funding both to pay people and to provide the infrastructure that allows people to perform their best. If this situation is allowed to continue, we will pay for it.

The MUHC’s Glen project will address one part of the equation. It will attract and retain the skilled professionals we require because it will be modern, bright, airy, properly laid out, properly equipped, and it will offer opportunities to learn, to grow professionally and to contribute to the well-being of our community.

It will also do so because a university teaching hospital of the calibre of the MUHC attracts clinician-scientists, top rated nurses, community health specialists, ethicists, managers and support professionals who want to work with and learn the most up-to-date techniques.

The MUHC attracts innovators who fuel discovery, which in turn generates investment in biotechnology, biopharmaceuticals and bio-informatics. The growth in these sectors worldwide is quickly making science the global business of the 21st century, and the MUHC Research Institute is leading the Canadian charge in this industry and has the potential of becoming a world leader.

The Institute brings together more than 500 researchers from around the world and is Canada’s largest concentration of medical and health-care research investigators. The work that is being done there is leading to discoveries and advances across more than a dozen research themes from cancer to kidney disease, human reproduction, genetics and preventative medicine. The results of these discoveries are having a profound impact on people around the world.

On a strictly economic point, the MUHC Research Institute contributes nearly $140 million a year in salaries and operating expenses to the Montreal economy. It has attracted to the city since 1998 nearly $200 million in large-scale grants, over 50% from sources outside Quebec. Over and above this nearly $35 million last year were pumped into the Montreal economy because of the Institute’s role in life science conventions hosted in the city.

Montreal accounts for 50% of the Canadian biopharmaceutical sector and the MUHC Research Institute is a leading player in growing this sector and solidifying the city’s reputation internationally. The MUHC/McGill ranks first in grant support to outstanding research scientists generating nearly three times the Canadian average. The MUHC has the largest number of researchers of all FRSQ-funded institutions in Quebec. The biotechnology companies created by MUHC/McGill researchers have generated 1,500 jobs and $1.7 billion in market capitalization.

Clearly what’s being done right here, right now is a vital part of Montreal’s knowledge economy. It is driving growth, attracting talent and investment, exporting this knowledge internationally while making sure that the people who live and work here are well taken care of.

By extension it is in the best interests of our city to invest in the MUHC Glen project. Just as our leaders foresaw the moral and commercial need to invest in our hospitals in 1893 our leaders today must step up to the plate to seize this opportunity and assure the future of our community.

Claude Béland spoke to you in November about the scope and importance of the CHUM project. Today you’ve heard about the McGill University health Centre. Together we are laying the groundwork for Montreal’s emergence as the global leader in the business of science. We have a new city administration that is looking forward and outward and we are delivering to them two outstanding projects that will have enormous economic and social advantages for the city.

Montreal is already a center of excellence in the aerospace and biopharmaceutical industries. It achieved this stature because it opened its doors to opportunity.

We as citizens have to band together and encourage the Quebec government to recognize that this MUHC project is absolutely essential for the entire Quebec economy, that it is clearly one of the most important growth areas that the province must invest in, and that it will benefit all Quebecers, regardless of where they come from or where they live.