McLeod Health, selected by The Centre for Health Quality Improvement in Toronto, Ontario as a partner for improvement in quality and safety for patients, was paired with a health system in Toronto, Trillium Health Centre to share information and clinical and operational effectiveness processes. Trillium visited McLeod in November of 2009 and their representatives were pleased with insights and models for improvement from our work that they could take back to Canada.
Members of our leadership team, (Dr. Fred Krainin, Medical Director of the McLeod Clinical Effectiveness Program and a cardiologist in the Pee Dee Cardiology; Donna Isgett, Senior Vice President of Quality & Safety for McLeod Health; and Fulton Ervin, Senior Vice President & CFO for McLeod Health).were able to return that visit to Trillium Health Centre and make their own observations regarding common challenges and initiatives shared by the two organizations.
The previous blog reflects responses from Dr. Krainin, from a physician perspective. These are thoughts from Donna and Fulton regarding their experience.
RC: What was one of the insights you gained from the visit to the Canadian healthcare system in Toronto, Ontario?
Donna Isgett: Visiting the Canadian system was similar to “getting to look through fresh eyes” at many of the ways we deliver care and how it could be more effective and efficient. Specifically, I was most impressed with the way they have engaged their patients as partners in their care to assure the best outcomes and functionality for the patient while reducing cost of care. An example of this was Trillium’s Congestive Heart Failure Clinic, which worked hand-in-hand with patients to teach them to self manage many changes in their condition and to utilize the less expensive outpatient options when they needed to see a physician or receive intravenous medications. This provided “better care, and engaged patient for much less expense”.
Fulton Ervin: Canada appears to have a very centralized system with significant and careful coordination between the government and among hospitals. They have tight guidelines regarding quality and they carefully monitor wait times.
RC: What good ideas did you see that we can study for improving our processes and patient care at McLeod Health?
Donna Isgett: The engagement and ownership of the employees was remarkable. They felt it their responsibility to save time and money in all that they do so the resources can be utilized to care for the patients. There was strong involvement from the leadership team “in the work”. The unit leaders were very engaged and visible in daily improvement around efficiency and safety. Specifically, they had created “Safety Crosses” to display both publically and to the other staff the outcomes of care around hospital acquired decubitus ulcers (bed sores), infections and falls by nursing unit. Everyone including support staff understood their role in eliminating hospital acquired conditions.
Fulton Ervin: They have done a significant amount of research in other health systems, bringing back the best ideas for their hospital. They have rapidly rolled out ‘lean’ improvement projects in delivering nursing care at the bedside, as well as improving flow in the Emergency Department and through the hospital.
RC: Is there anything about health care reform in America that may be similar to what you learned in Canada?
Donna Isgett: In health care reform, the concepts expressed in an Accountable Care Organization are very similar to the Canadian Healthcare System. It was actually very encouraging to see how this model could actually result in tremendous improvements in patients outcomes that were much less expensive. It gave me hope that we can actually make changes in our current systems that will be both good for our country and our patients. The push to have patients in the most effective, least costly location eliminated current difficulties that are often found in discharge planning and home health care. In addition, the innovative use of outpatient clinics to manage much of what is currently handled on an inpatient basis while increasing patient satisfaction was impressive. Finally, the integration of physicians and hospital leaders working towards common goals for the patients was inspiring.
Fulton Ervin: There are many similarities between our proposed Accountable Care Organizations and the system in Canada.. They have mastered taking a ‘pool of dollars’ and allocating it to deliver care to their constituents in the most cost efficient manner while at the same time delivering quality care.
RC: Is there anything else you want to share about the visit?
Donna Isgett: We have much to learn from our Canadian friends, and I hope our relationship with Trillium is a long one for the journey.
Fulton Ervin: I believe Trillium could be a great partner for McLeod Health as we move forward into health care reform. They have tremendous insight in how to operate with finite resources and how to coordinate services. They are skillful at rapidly deploying ‘lean’ projects to remove waste from the delivery system. They have partnered with the University of Toronto to produce an impressive leadership development program. For example, each of their Directors is partnered with their physician Medical Director and complete the leadership program together. Each team works through seven to eight projects that have been designated by the hospital.
We have much to learn in our quest for quality and safety. We look forward to continuing the learning journey with other leading health systems.
We appreciate the Centre for Healthcare Quailty Improvement for sponsoring this exciting exchange program. For more information about our colleagues at Trillium Health Centre, their website is http://www.trilliumhealthcentre.org.