Changing landscapes in healthcare

Changing landscapes in healthcare

Presentation and discussionCAAHP conference Ottawa

May 29th 2014

Ewa Sidorowicz MDCM, FRCP(c), MScADG medical Affairs and DPS

McGill University Health Center Montreal

CAAHP Conference Ottawa2

Disclaimer!I am a physician with some knowledge of the complexity of the

work of all of the allied professionals, but certainly not an expert.I am happy to be here with you to share some of what is going on in Quebec, but mainly I am eager to understand the views of the

ROC!

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Outline

• Update from the MUHC and healthcare transformation in the greater Montreal area;

• Transformation in healthcare practice

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About the MUHC

• A new hospital born in 1997 from the merger of the Royal Victoria, Montreal General, Montreal Chest Institute, Montreal Children’s and Montreal Neurological Hospitals. Each component rich in history and tradition;

• In 2008 the final component is added, the Lachine hospital, a community partner.

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MUHC redevelopment

projectA terrific idea which was hijacked onto a shocking and

shameful path, but which will come to fruition thanks to the hard work of a resilient and proud organization,

thousands of devoted healthcare workers, appreciative patients and volunteers

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MUHC Redevelopment project

• 2.25 billion dollar investment in to the new Glen site hospital, the Montreal General Hospital and Lachine Hospital;

• Funded by the Quebec Government, a CFI grant of 250 million dollars and 300 million raised through the Best Care for Life Campaign;

• Massive transformation supported by a transition office which is accompanying some 50 different projects.

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MUHC Redevelopment project

• A once in a lifetime opportunity to harmonize and standardize practice;

• A once in a lifetime opportunity to review work flow and service organization;

• A once in a lifetime opportunity to innovate healthcare delivery. Examples: interventional platform at the Glen site,

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The Glen site, 2010

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View of the Glen site, July 2013

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Glen site, September 2013

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Glen site stacking diagram

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Women’s Health: inpatient room

Research Labs


A complex series of moves

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Montreal Metropolitan Landscape, so called 450-514

• Besides the MUHC, the Centre Hospitalier Universitaire de Montréal is also building a new hospital, and Ste-Justine University Hospital is also expanding as is the Jewish General Hospital;

• There is a Ministry mandated shift in the offer of services towards the regions and away from downtown Montreal;

• MUHC and CHUM to focus on tertiary and quaternary care with less emphasis on primary and secondary care.

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Transformation in healthcare practiceAn overview of the allied professionals in Quebec.

Staff shortage are unfortunately present throughout most groups

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Bill 90 (physical health)Adopted June 14th, 2002

Ce projet de loi prevoit un nouveau partage des champs d’exercice professionnels dans le domaine de la sante et les activites desormais reservees aux medecins, aux pharmaciens, aux infirmieres et infirmiers, aux technologues en radiologie, aux dietetistes, aux orthophonistes et audiologistes, aux physiotherapeutes, aux ergotherapeutes, aux infirmieres et infirmiers auxiliaires, aux technologistes medicaux et aux inhalotherapeutes.

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The objectives• Abolish certain barriers

• Loosening of the legal and regulatory framework

• Increase multi and inter disciplinarity

• Recognition and optimization of competencies

• Better permeability between professions

• More flexibility

• Improve inter and intra professional collaboration

• Improve organization of services and work flow

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Bill 90

• Took away the necessity for delegation;• Gave the right of title and the right of practice;• Requirement to belong to a professional Order;• In general seen as a positive step, though

certainly did nothing to curtail, and in some cases worsened turf wars;

• Some excellent work: radiology techs and nurses in the cath lab document.

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Bill 21 (psychosocial health)2009

• Reviewed scope of practice of Social Workers, psychologists, occupational therapists and others

• For psychologists there was a major change in terms of scope of practice with the ability to make a diagnosis amongst others.

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Some of the various professionals in Quebec and

their trainingCEGEP

• Radiology techs

• Laboratory techs

• Social Service techs (data collection)

• Physiotherapy techs

• Nutrition techs

UNIVERSITY• Physiotherapy (Master’s)

• Occupational Therapy (Master’s)

• Speech pathology (Master’s)

• Psychology

• Clinical Nutrition

• Social Service (Bachelor + Master’s)

• Perfusionists (new post bachelor’s program)

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A bit more about imaging: MSSS focus on access

• In Quebec, colleges offer a 3-year DEC program in Radiological technologies, Radiation therapy, Electrophysiology & Nuclear medicine. The radiological technologies program includes disciplines such as Ultrasound, Mammography, CT, Angiography & MRI.

• Advanced certification can be obtained for all disciplines through institutions in Quebec, as well as in other provinces and through providers (public and private) like Berwin, BCIT and The Michener Institute.

• In Quebec, an ultrasound technologist can obtain an attestation of autonomous practice and perform ultrasound examinations without the presence of a specialist., if the criteria are met.

• Criteria: 5 years experience ( min 26 weeks/yr.) or number of exams (1000 exams in vascular; 1000 exams in cardiac; 2500 exams in abdominal or surface, 2500 exams in obstetrics; 1000 exams in Mammography; 1000 exams en MSK, 50 exams nuchal scan measurements; with a written confirmation from the employer.

• Ultrasonographers need to maintain their skills with a minimal amount of courses and / or examinations per year.

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About the MUHCThe work setting

• The allied professionals report to three different ADGs:• ADG clinical operations, adult sites• ADG pediatric site• ADG medical affairs and DPS (imaging and

laboratory services)

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What do we need to aim for…

• Emphasis needs to be focused on enhancing interdisciplinary work with the allied professionals, nursing and physicians:• Admission (example psychiatry TCAB

initiative)• Discharge planning (daily huddles)• Organization of care around interventional and

cardiac imaging

• How we get there requires integrated training at the earliest possible moment.

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Questions?

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Documents

Changing landscapes in healthcare