Centre hospitalier universitaire de Québec (QC)

  • Martin Lamarre, Directeur adjoint, Services professionnels, Centre hospitalier universitaire de Québec, Québec, Quebec (Assistant Director, Professional services)

L'implication médicale dans l'amélioration de la performance chirurgicale au CHU de Québec 

Involvement of Medical Staff in the Improvement of CHUQ’s (Centre hospitalier universitaire de Québec) Surgical Performance

The Quebec City University Hospital Centre is the third largest centre in Canada and is comprised of the five following medical institutions: CHUL, Hôtel-Dieu de Québec, Enfant-Jésus, Saint-François d’Assise and Saint-Sacrement hospitals. Surgery takes place on all five (5) sites. A University Hospital Centre has the following missions: clinical services, teaching, research and evaluation. Its management principles are rigorous governance, co-management, professional collaboration, consistency and communication.

Medical staff within the organization must comply with the stated missions and management principles. Partnership with the organization must be based on five (5) priority areas: behaviour, performance, organizational structure, finances and strategy. Trust is the cornerstone of this partnership.

Physicians collaborate better in a bottom-up approach enabling short-term wins. They recognize the value of clinical champions and function better in an environment with a healthy dose of competition.

Performance is not well embedded in Quebec’s healthcare network culture. High performance companies such as Intermountain HealthCare focus on solid clinical pathways based on the best clinical evidence, backed by a strong information system. The Hospital for Special Surgery (HSS), an orthopaedic surgery facility, has improved its performance by bringing its physicians together in centres of clinical expertise. Performance indicators

The conventional doctor-nurse co-management tandem is insufficient at CHUQ, which counts on multidisciplinary care services that manage their own staff. It should, therefore, be possible to initiate some innovative experiments.

Tactical, operational and strategic issues were covered in this project.

With respect to strategy, the role and composition of the Strategic Committee on Surgical Treatments were examined: this Committee is made up of the main stakeholders of CHUQ’s surgical program and is in charge of guidance and goal achievement. The role of the Department Head has been reviewed to include a focus on partnership, performance and accountability. The Orthopaedics Department has been overhauled according to areas of expertise.

From a tactical standpoint, the role of Chief Medical Officer was revised to create better alignment with the rollout of the areas of expertise, the implementation of optimized clinical pathways and the use of indicators.

In operational terms, based on the recommendations of Bone and Joint Canada, the clinical pathway for a fractured hip was implemented and has given rise to a sharp improvement in the average length of hospitalization. The ERAS Model known to diminish complications by fifty percent (50%) and hospital stays by thirty percent (30%) has been implemented in colorectal surgery.