The Centre for Health Quality Improvement in Toronto, Ontario, selected McLeod Health as a partner for improvement in quality and safety for patients. McLeod Health was paired with a health system in Toronto, Trillium Health Centre. The leadership team from Trillium visited McLeod in November of 2009. McLeod leaders recently returned a visit to Trillium to learn more about health care in Canada. Both visits resulted in understanding many common challenges and initiatives shared by the two organizations.
The McLeod team included Dr. Fred Krainin, Medical Director of the McLeod Clinical Effectiveness Program and a cardiologist in Pee Dee Cardiology; Donna Isgett, Senior Vice President of Quality & Safety for McLeod Health; and Fulton Ervin, Senior Vice President & CFO for McLeod Health. After talking with them about their visit to Trillium Health Centre, I thought it would be interesting for you to hear some of their thoughts. This blog reflects Dr. Krainin’s responses from a physician perspective.
RC: What was one of the insights you gained from the visit to the Canadian healthcare system in Toronto, Ontario?
Dr. Fred Krainin: Despite all one hears about the Canadian health care system … long wait times for elective procedures, limited funding, etc…., the quality of care in the Trillium Hospital System in Toronto is equal to, or in some ways ahead of the typical health care system in the U.S. For example, they are way ahead of most areas of the U.S. in ‘home to balloon time,’ … where the clock starts when EMS arrives at the patient’s front door, not when the patient arrived in the Emergency Department. With a heart attack, time saves heart muscle and improved recovery. They also have an outpatient Heart Failure clinic that would be the envy of most U.S. systems. In Ontario, they provide high quality health care to 100% of their citizens and are adept at managing chronic diseases to help keep patients out of the hospital. They are paid for performance and outcomes measures, incentives to reduce hospitalizations and readmissions.
RC: What good ideas did you see that we can study for improving our processes and patient care at McLeod Health?
Dr. Fred Krainin: They have extremely enthusiastic and energetic employees. The most memorable encounter we had was a random meeting with a housekeeping staff member who proudly demonstrated their new and improved system for cleaning and storing medical equipment, and having them readily accessible for use by nursing personnel. They have made a science of efficiency in reducing unnecessary steps and improving efficiency among nursing and technical staff. They can’t afford private rooms for every patient, but their semi-private rooms are designed to be as close to private as possible. Their resources are limited, but they have learned to maximize the resources they have.
RC: Is there anything about health care reform in America that may be similar to what you learned in Canada?
Dr. Fred Krainin: There is a phobia among Americans about health care “rationing.” In Ontario, the Canadian system allots a certain number of health care dollars to each hospital per year, based on the expected incidence of disease and procedures for a given population. It is up to the hospital to utilize those dollars wisely and efficiently. Those health systems that are well managed and efficient thrive in this system. Those that are not well run will be in trouble. The government does not decide who gets heart by-pass surgery or who receives a hip replacement. Health care providers make those decisions based upon the need of the patient. If someone needs a procedure urgently, we did not find that they would have to wait.
Additionally, hospitals in a given region of the Province specialize in different areas. For example, one hospital performs all the open heart procedures. One hospital does all the orthopedic joint replacements. One hospital provides all the inpatient dialysis. This system operates by regionalizing care, and unnecessary duplication of care is avoided. The rationale is that treating high volumes of patients with a specific condition generally breeds excellence in care. Having multiple low volume centers in a defined geographic area, as we have here in the U.S., is inefficient, and may not promote excellence in quality. I also found it interesting that they have found that it is more efficient for them to transfer certain neuro-surgical procedures to Buffalo, NY, which is about an hour away, than to attempt to build a program within their own center. All this seems to make empiric sense.
RC: Is there anything else you want to share about the visit?
Dr. Fred Krainin: I came away very impressed with the improvement work at Trillium. I am sure every organization or health system has challenges, and not all of their programs would work here, but I think we could learn a lot from their model.
We have much to learn in our quest for quality and safety. We appreciate the Centre for Healthcare Quality Improvement for sponsoring this exciting exchange program. If you would like to learn more about our colleagues at Trillium Health Centre, please find their website at http://www.trilliumhealthcentre.org. We also express our thanks to Janet Davidson, President & CEO of Trillium, and her team for continuing the cross-border learning journey as we prepare for health reform and look for models of improving care for patients and families.