Leading the Way to Healthcare Improvement in Quebec: Three CFHI-Funded Healthcare Transformation and Coordination Approaches Realize Results

Ottawa, March 14, 2013 — Three Quebec-led teams are accelerating the transformation of healthcare and seeing positive change, as a result of having applied innovative project and change-management processes to the healthcare challenges in their regions.

The findings are revealed in three reports funded by the Canadian Foundation for Healthcare Improvement (CFHI) released today. They include:

Strategic Community (SC): An Approach for Developing Interorganizational Collaboration

Improving the accessibility of healthcare services within the Estrie region of Quebec, with a population of more than 315,000 and characterized by scarce human and financial resources, was the catalyst for pursuing the “Strategic Community” (SC) approach. “The SC came from a need to end gridlock and to be innovative very fast,” says Mario Roy, one of the lead authors. The first SC trial took place in the field of telecommunications in Japan where the primary goal was to promote innovation and bring together key players from various partner organizations. It is the first time the concept has been applied to the healthcare sector.

Dr. Roy and his team used SC to transform the organization of work among three institutions in Estrie, to maintain and improve the quality of services for cancer and mental health patients with complex care needs. SC made it possible to implement, relatively quickly, initiatives for improving the organization of work, the accessibility of services for clients and the degree of trust between the partners involved. 

“It was unusual for a Centre de santé et de services sociaux (CSSSS) nurse to go to the university hospital to interact with a patient care team, so there was a bit of a learning curve before her participation was fully accepted,” says Roy. “When vulnerable patients have to move back and forth several times between organizations, people on the frontlines of care have to know each other. Because the health situation of these patients is always changing, and changing so rapidly, we really need collaboration at the operational level rather than rely on standardized processes,” adds Dr. Roy. “The care team must be interorganizational.” 

Dr. Mario Roy and his team demonstrate through SC, it is possible to challenge the status quo and to break down barriers in institutions in order to implement simultaneous change. The SC process began by understanding what each group (psychologists, social workers, physicians and other frontline care workers) was doing. “A willingness to collaborate is key, but the thing to remember with collaboration is that it involves people, not roles. People change positions, and that will impact the collaboration,” says Dr. Roy.

At the conclusion of the study, several organizations decided to continue, including the Centre hospitalier universitaire de Sherbrooke (CHUS), the fourth largest hospital in Quebec. “We are continuing this approach for our clients,” says Patricia Gauthier, General Director, CHUS. “SC showed us where we must improve the continuum of care and services between institutions in our network.” 

Innovative Strategy in Organizational Transformation: Creating and Implementing a Transition Support Office within a University Health Centre

In 2008, the McGill University Health Centre (MUHC) set up the Transition Support Office (TSO) to guide the implementation of its large scale redevelopment project which is still underway. Once complete in 2015, the care and services now provided at six hospital sites will be absorbed into three. More than 10,000 staff and thousands of clients will be impacted by the redevelopment. The TSO’s goal is to ensure consistency around the harmonization of clinical practices, team consolidation and process optimization.

“Since being introduced, TSO experts have made it possible to improve practices and patient care, making them safer and of better quality,” says lead researcher Melanie Lavoie-Tremblay. “Our participants stress that they would be unable to execute change without the TSO’s support.” One example involves harmonizing the use of central catheters to reduce levels of bacteremias (BACC). Since April 2011, the MUHC has harmonized central line practices across its critical care sectors and avoided 45 cases of BACCs while client reinsertions have dropped to 11% from 24%. TSO has supported more than 35 clinical teams in projects to improve health and healthcare.

The creation of the TSO has facilitated and supported a culture of optimization for the MUHC. “By promoting the positive outcomes through a clearly defined process and specific objectives, change is not only supported, but enhanced,” says Lavoie-Tremblay. 

Knowledge in Action: Healthcare Management and Governance Innovation Lab

The will to encourage innovation at the local level, to transform regional governance and to build greater synergy among all players was the impetus for creating the Healthcare and Social Services Management and Governance Innovation Lab (LEGG) in the Montérégie region of Quebec. 

The LEGG brought together decision-makers and researchers to actively support teams from different organizations and program areas who wished to experiment with ideas that have a potential to transform service delivery. Three key ingredients were conducive to its success: improvement-focused leadership, project management and active knowledge mobilization.

The researchers note that all innovation projects supported by the LEGG have led to sustained changes in local practices and many have received recognition from external bodies and peers. According to lead author Denis Roy, “The LEGG approach is now embedded into regional governance in the Montérégie region. It should be considered as a promising practice and has implications for the modernization of health system governance in Quebec and elsewhere.” 

“The Montérégie region has worked very hard to transform governance over the past 10 years, and today, it is leading in this area. One of the most significant outcomes of the project has been to secure ongoing regional funding that’s co-managed with the local institutions. Regional and local actors both recognize the benefits of investing in innovation,” adds Dr. Roy,

The Canadian Foundation for Healthcare Improvement (cfhi-fcass.ca) is a not-for-profit organization dedicated to healthcare improvement and transformation for Canadians. CFHI collaborates with governments, policy-makers, and health system leaders to convert evidence and innovative practices into actionable policies, programs, tools and leadership development. CFHI is funded through an agreement with the Government of Canada.

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