Traffic cone

If you were asked to describe the shape of an orange traffic cone, what would you respond? For many of us, our first instinct would be to say, “It’s a triangle”. But, what about if you looked at it from above? The triangular shape would disappear and be replaced by a circle. As the old saying goes, “It’s all in how you look at things.”

Last week, I was fortunate to attend a stimulating three-day course at Harvard University where, among other things, the topic of situational awareness was discussed at length. It reminded me a great deal of the Transformational Change project we started at the JGH in 2009, and how the thinking behind it has continued and expanded across our network.

The crux of it being, with over 9,000 employees comprised of physicians, nurses, allied health care professional, engineers, housekeepers, administrative professionals (and that’s just to name a few) we each see the health care sector from a slightly different vantage point, with each opinion just as important as the next. Part of the design of Transformational Change, was for me to personally meet with staff, whether at events, department visits or simply an impromptu chat in the hallway.

The conversations I have with staff, whether long or short, leave a lasting impression on me and in many cases help shape decisions that are made at the senior level. Each person I’ve spoken with sees the proverbial traffic cone as a different shape, and I think that is what has helped, and continues to help, shape us into one of the best networks in the province.

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The Purple Cow

Working in health care, we are forever under the microscope. This results in a climate where we are constantly trying to improve ways of doing things, so that our patients, residents and clients receive superior care.

As I thought about this it made me think of the marketing concept known as the purple cow effect. Author Seth Godin coined the term when he explained that to be successful, one ought to be remarkable, not in the conventional sense of being noteworthy or interesting, but quite literally, by doing something that people remark on. In his view, in a pasture of cows, you want to be the purple one among the hundreds of Holsteins. But how is this possible when everyone in health care—from social workers to nurses, from housekeepers to dietitians—is already accomplishing some pretty amazing things?

Here’s how: Last week, many of us read in the Montreal Gazette about Stephanie Treherne, a nurse in our Neonatal Intensive Care Unit at the JGH. Over the past several months, Stephanie has been hand-crafting superhero capes for infants in the Neonatal Intensive Care Unit (NICU), each with the first initial of the baby’s name stitched onto it. I can only imagine the joy that this has brought to the parents and family members of these infants. Her story hasn’t just captured the hearts of Montrealers, but has spread globally, with media inquiries from as far away as London, England.

Stephanie’s story is inspiring, and it represents the sorts of professionals who dedicate themselves to our network. Right now, the spotlight is on this particular person, but I know there are many stories about the purple cows among us that are still waiting to be told.

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When staff “get it”

Often, when we think of the most fragile members of society, we tend to think of newborns or infants who, would not thrive—or possibly even survive— without our care. But what about the elderly? I’ve spoken in a past post about our aging population, but how many of us truly understand the additional care and attention that are needed by many of our seniors?

Last weekend, 66 residents from the Henri Bradet Residential Centre moved to the Jewish General Hospital for 12 to 18 months while the Centre is being renovated. The care that staff took was nothing short of inspirational. From the planning right up to the day of the move, over 15 departments banded together to make sure these fragile individuals received not only the appropriate attention and support, but the respect and compassion they deserve. The planning was so carefully thought out that the new accommodations in the JGH were ready well ahead of schedule, and the move itself finished right on time. This bodes well for the full renovation project at Henri Bradet, which promises to be completed as scheduled—an anomaly for construction projects in Quebec, as we know!

Since I have an elderly mother, and because my wife has worked as a nurse with seniors over the years, I’ve seen and heard, first hand, about the special needs of this often vulnerable group. The thoughtfulness and kindness that staff and volunteers displayed before, during and after the move confirms in my mind that staff in our network not only understand, but “get it” when it comes to the needs of the elderly. And for that, I thank you.

Lawrence

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Why I’m so happy about accomplishing “nothing”

Usually, when someone asks you to scale something from zero to 10, the higher the number, the greater the level of satisfaction.

However, last week our CIUSSS achieved something so truly outstanding that we got a zero—and I’m thrilled!

On May 15, we launched a week-long pilot project entitled “Zero Emergency Department (ED) patients over 24 hours”, the culmination of almost a year of planning. The mission that we embarked on was to ensure that no patient stayed in the JGH Emergency Department for more than 24 hours. Patients were either admitted to the hospital, or seen and discharged.

The behind-the-scenes efforts—from planning (which included bi-monthly meetings) to measures that were implemented early last week—were nothing short of monumental. Our group, comprised of members from SAPA, Rehabilitation, Mental Health, Nursing, Professional Services, the medical chiefs and multidisciplinary staff, worked together to prepare a plan that not only enabled us to meet our target for ED patients, but created a positive ripple effect throughout our healthcare network.

I’m not saying that this was accomplished without significant obstacles, or that some around the table didn’t, at some point, question my grasp of “reality”. But after two weeks, even the naysayers had to admit it: the project was a success. Not perfect yet, but a magical improvement indeed!

Now the goal is to determine how to make this happen on a regular basis, as opposed to limiting it to just a couple of weeks. We have a phenomenal team of professionals tackling this challenge, and I’m confident that before we know it, zero will be our new normal.

Lawrence

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Jobs to be done

We live in an age of surveys, with marketers constantly asking us our age, gender and personal preferences. All the while, they hope this information will unlock the key to edging out their competitors, once and for all.

If we apply this trend to health care, we can agree that some of this information could prove useful, but is it going to help us provide the best possible experience for our patients, clients and residents? The simple answer is – no.

A favourite author of mine, Clayton M. Christensen, wrote in 2016 that instead of focusing on demographic or psychographic information, we should focus instead on what he called “the job to be done.” Simply put, it means focusing to a greater degree on what users are trying to accomplish—that is, the progress they are trying to make—in a given circumstance, versus what age bracket they fall into. For instance, regardless of age, gender or profession, anyone who visits one of our facilities for a blood test is looking for the same thing: quick, efficient and thoughtful care that will allow them to complete this task easily and with no problems.

This line of thinking reminds me of the “Empathy” video we produced when I first became President and CEO of CIUSSS West-Central Montreal. We can look at all the statistics we want, but at the end of the day, when we pause for a moment and put ourselves in the shoes of our users, we can see quite clearly what they are going through. If we understand what our users need, and if we look beyond their diagnoses, we can not only provide them with better care, but with a generally improved experience on their road to recovery.

Once we’ve done that, we won’t just have accomplished “the job to be done,” but a job well done.

Lawrence

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The Helpers

Like all of you, I have listened with sadness to the stories of Quebecers who have been affected by the flooding these past weeks. The loss, as we know, is widespread—from personal belongings to homes and even life.

Many members of our network’s staff come from the areas that have been hardest hit. This week, I learned of employees who have lost everything. But as I read about these tragedies, other emails started to trickle in—emails of hope. Each told of staffers who had decided to give of their time to fill sandbags, or to donate food or clothing. In other cases, staff were asking how they could help, whether by donating items or time.

When our CIUSSS came into existence two years ago, there was no way of knowing at that time how long it would take for us to start to feel like a true, cohesive network. As a result of this natural disaster, as well as the willingness across all of our sites to help one another, I have clearly seen that we are becoming a family, with staff banding together to set up donation bins across our sites, and to join the growing relief effort.

There’s an adage that encourages us when tragic events like this arise: “Look for the helpers. You will always find people who are helping.” Our staff at the CIUSSS Centre-West Montreal, are just that—helpers, and I could not be more proud.

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Grappling with the ever-increasing needs of the elderly

One day last week, while reading the morning’s top news stories, I was fascinated to discover that we’d arrived at a turning point that’s been anticipated for years. There, in black and white, were some key figures from Statistics Canada’s 2016 census: The number of seniors in our country (5.9 million) has officially exceeded the number of people 14 years old and younger (5.8 million).

Statistics Canada also projected—as gerontologists and demographers have been telling us for two or three decades—that this lop-sided situation will become even more glaring as more of the baby boom generation hits retirement age.

As a physician and healthcare administrator, I’m gratified that advances in medical science and technology are helping Canadians to live longer, better lives. But there’s no denying the fact that tending to their healthcare needs is disproportionately complicated, since each person often has multiple medical problems or conditions.

The saving grace is that our healthcare system is now better equipped to grapple with the growth of the elderly segment of our society. Ever since the creation of CIUSSS West-Central Montreal in April 2015, we have been improving the continuum of care among our facilities. That means an elderly person can move more smoothly from a hospital to a rehabilitation centre, to home care or to a long-term care facility, in sync with his or her evolving needs.

On a related note, we’ve been working toward an even tighter integration of staff across our facilities. Regardless of where they work in our CIUSSS, members of staff who have expertise in a particular field, such as stroke, collaborate to ensure the timely treatment and care of those in all of our facilities.

Interestingly, last week’s turning point brought to mind a paper from the Journal of Gerontology that I pulled from my files. Published in 2006, it examined home care programs and other services for seniors in two Montreal CLSCs, concluding that there is “potential for integrated systems to reduce acute hospital and [long-term institutional] utilization, without increasing costs or caregiver burden, while increasing satisfaction among caregivers.”

Today the dream of creating this sort of integrated system has been realized, and we’ve already begun to appreciate many of its benefits. While we’re aware of the need for further improvements and refinements, I’m encouraged by our enhanced ability to make the elderly the focus of so many of our efforts. The ever-increasing demands of our graying population will be tough to cope with, but the foundation for doing so has been laid.

Lawrence

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Better health care through collaboration

Last Monday, along with our partners at Polytechnique Montréal, Université de Montréal, Sainte Justine Hospital and the CHUM, we unveiled the TransMedTech Institute. This collaborative project will see us develop superior designs and methods to treat three areas that pose major health risks for Canadians: cancer, cardiovascular illnesses and musculoskeletal disorders. The Jewish General Hospital, a key facility in CIUSSS West-Central Montreal, is proud to play a crucial role in the area that focuses on cancer.

This marks not only the first time that all of these organizations have come together on a project, but the first project of its kind in Canada. From engineers to physicians, from researchers to patients, we’re not looking at issues in a vacuum; instead, we’re working together as Quebecers who know the important roles that innovation and technology play in health care. Silos have been dismantled, and instead of protecting research as if it were a trade secret, we’re sitting together to share what we’ve learned so far, and what we need to focus on next to improve the quality of care, and the way it’s delivered.

By having this varied group of individuals working cooperatively, our hope is to develop new technologies that will provide faster, more efficient care to our patients. Of the budget of almost $100 million, over half is provided by the institutions involved. This reaffirms that throughout health care and beyond, the need for new technologies is not only recognized, but prioritized.

I’ve said it before and I’ll say it again: It’s amazing what becomes possible when we work together.

Lawrence

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The art of the huddle

Ask someone what they associate with the word “huddle”, and nine times out of ten, they’ll say “football”. However, in the last few years, that has begun to change.

On my recent trip to Yale New Haven Health, when I received an invitation to the morning huddle, I wasn’t being asked to suit up for a friendly game. Rather, I was welcomed to participate in the daily patient safety report.

I wasn’t sure what to expect when I arrived the next morning at 8:00 a.m. As I sat there, senior leaders, nursing directors, middle managers and department chairs came in, with others joining by phone or video conference. For the next 20 minutes, the safety and quality issues of the previous 24 hours were reviewed. Updates were provided, decisions made and celebrations held. Yes, you read that right—celebrations. Whether the group acknowledged having caught a potential problem before it materialized or having solved an actual problem, each was mentioned and the teams were praised. Before I knew it, the meeting was over and people were filing out of the room, back to their work areas to tell their teams what had just been discussed.

You might ask, Is this type of huddle sustainable? The answer is, Yes. For over two years, Yale New Haven Health has used this model to provide clinicians at all levels with an opportunity to address problems quickly, face to face, and in an efficient and effective manner.

Having witnessed it first-hand, I can confirm that it’s a model that will be of benefit to our network and, more importantly, to our users. In partnership with our leadership team, I look forward to introducing huddles in the near future.

Hut, hut, hike!

 

Lawrence

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Dr. Mark Wainberg: an exceptional man

For those of us who observe Passover, celebrating with family and friends is a focal point of the holiday. Together, as we sit around the Seder table, we read the Haggadah and relive the chronicle of the Israelites’ exodus from Egypt.

Our wine glasses are filled, emptied and filled once again- four times. However, at the centre of the table, one wine-filled cup remains untouched—reserved for the prophet Elijah. According to a centuries-old tradition, the contents of this special cup are never consumed. Instead, it sits ceremoniously and symbolically, representing staying power, perseverance, in anticipation of the Messianic times to come.

Sadly, this year’s holiday has been interrupted by the sudden and tragic passing of Dr. Mark Wainberg, a gifted scientist and a wonderful man who also exemplified traits of commitment and a desire to make the future better for those in distress. Through his own perseverance and staying power, he greatly changed the lives of so many through his contribution to HIV/AIDS research.

Mark was a colleague and friend to many of us at the Jewish General Hospital (JGH) and the Lady Davis Institute—in some instances, as far back as the mid-1970s. A humble, but determined man, his smiling face and desire to do and bring good to the world are typical of the values of the many individuals who built and continue to push the JGH toward new heights.

I can only hope that this tragic loss will serve as a reminder of the impact that any of us can have on the world of health care and especially on those who look to us in in their most difficult hour. As Dr. Wainberg ably demonstrated, our patients must be at the centre of all of our efforts, and it is to them that we must dedicate ourselves in providing the best possible healthcare experience.

For me, as for many of us, the untimely passing of Mark Wainberg will forever colour this holiday season. May his memory be a blessing for us all.

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