Network formation in hospitals: how do they do it in Canada?

The way in which healthcare is organised differs greatly from country to country. Because it is always good to learn how others do things, the MINOZ Research Centre organises a study trip for its members every three years. This year, professor Paul Gemmel, professor Brecht Cardoen and researcher Lies Schoonaert travelled to Canada with 17 participants from eight Belgian hospitals. On the programme was a visit to some innovative hospitals, lectures on hospital management at HEC Montreal University, networking, and even a private tour of the Canadian parliament.

Minoz study trip Canada 2017

Hospitals as part of a network

The main aim of this study trip was to provide an intensive introduction to the way in which hospital networks are organised within the context of the Canadian healthcare system. “As part of a government reform some ten years ago, hospitals and other healthcare organisations in Canada had to regroup themselves in order to make access to care easier”, says professor Brecht Cardoen. “The Belgian healthcare system is moving towards a similar reform. However, it is still unclear to what extent the government will control these networks. The idea of the trip was to provide inspiration and gain insight into how this network construction was rolled out in Canada - both vertically and horizontally - and more specifically in the regions of Quebec and Ontario. Thanks to our academic connection, we could also literally take a look behind the scenes of hospital departments.”

The remit of the Canadian Federal Government is limited to matters such as cybersecurity. It is really the provinces themselves that determine the details of the networks; and these systems vary quite considerably, as researcher Lies Schoonaert observed. “The province of Quebec, where we visited Montréal, opts for integrated care networks that, in addition to hospitals, also encompass home care, first-line care, social services and elderly care. These networks are closely monitored by the local government, with the advantage that prevention also forms part of the policy. Conversely, in Ontario, there are ‘Local Health Integration Networks’, which have far greater autonomy by comparison to Quebec. The contrast between these two systems - each with their own advantages and disadvantages - was very interesting for our Belgian hospital professionals.”

Rudy Maertens - AZ AlmaThis statement is echoed by Rudy Maertens, Managing Director of AZ Alma in Eeklo, who as a member of MINOZ took part in the study trip. “It was very interesting to see how within a single country, there can be such major differences in terms of how the government controls healthcare. In Quebec it is very centrally governed, whilst in Ontario it given a relatively free rein.”

Apart from this specific study trip, MINOZ Research Centre as a whole offers a wide range of advantages according to Rudy. AZ Alma has already been a member for almost 10 years: “We get access to high-quality research for an affordable price and on a specific subject that you, as the management of a healthcare organisation, most need at the time. The fact that an entire year is always set aside to work on a specific subject, which is considered and debated with other professionals, is invaluable. Moreover, this also sometimes results in tools and insights that are pretty much ready to implement internally straight away. This way of working makes it easier to make your organisation perform continuously better and more efficiently. And that’s what we’re here for in the end, isn’t it? To achieve a high standard of care for the lowest possible cost.”

Patient-centric

The first important lesson that was learned on the study trip was that Canadian hospitals resolutely opt for a patient-centric approach. “Patients are thoroughly informed about the treatment (for cancer or otherwise) that they are about to undergo. Or about how they can help themselves to recover after an operation”, says Lies. “To enhance their comfort, patients of the oncological day centre in the Laval hospital* always stay in the same room. It is their carers who go to them. And in the Cedar Cancer Centre at McGill University Health Centre*, patients referred to another doctor can still speak to that doctor on the same day.”

There was also a great deal of attention paid to the communication between patients and carers on the one hand, and between the various different carers on the other. “The CHU Sainte-Justine* - one of the four largest paediatric hospitals in North America - uses special boards to make communication between carers and parents run more smoothly. These signs include doctor’s appointments, for example, or as a parent you can write questions on them when there are no carers around. Hôpital Montfort* chooses to represent the patient’s mobility visually, for example whether patients are bedridden or need a wheelchair, or how many carers are needed if the patient needs to be moved. Or they simply hang the board with the thank-you cards for staff in the hallway, instead of at the nurses’ post. All of these efforts, however small, can make a huge difference. Not only for patient satisfaction, but for carers’ job satisfaction too.”

Minzo study trip Canada 2017 - communication

Maximum profit, minimum waste

A second aspect that Canadian hospitals prioritise is lean management. “The study trip was particularly interesting, both for the aspect of lean implementation all the way to the work floor, and for the approach of combining strategy and operations structurally in the day-to-day operations of the hospital”, says Rudy Maertens. “The idea of a ‘control room’ was one that I found extremely valuable, and I’d like to try this out at AZ Alma.”

Minoz study trip Canada 2017 - salle de pilotage

This is a sort of central command centre where you hang up the strategy, overview and progress of improvement projects visually on the wall. Lies: “This enables all staff to get a good overview the bigger picture, and of the link with strategy. This kind of visual depiction of improvements helps to change small things step-by-step within a broader, continuous process of improvement.”

Behind the scenes

Finally, the participants not only looked behind the scenes at a number of different hospitals, but also at politics. MP Mona Fortier took them on a private tour of the Canadian Parliament.

Minoz study trip Canada 2017 - parliament

* CHU Sainte-Justine is the largest mother and child hospital in Canada, and one of the four largest paediatric hospitals in North America. In 2007, CHU Sainte-Justine was accredited by the WHO as a ‘Health Promoting Hospital’.

* McGill University Health Centre (MUHC) is one of the leading medical care centres in the world offering multidisciplinary, patient-centric care. In 2015, a brand-new, centralised modern care complex was put into operation on the Glen site, which includes the Cedar Cancer Center. This new oncological day centre centralises all the chemotherapy for the various different hospital sites.

* Centre intégré de santé et de services sociaux de Laval was set up in summer 2004 as part of a government reform that regrouped hospitals and other care organisations with the aim of making access to care easier. This healthcare centre works with local partners on prevention programmes to encourage the population to have a healthier diet and do more exercise.

* Hôpital Montfort works with a very special management system (evidence-based management). Their emergency services have also undergone a significant overhaul, resulting in improvements to waiting times, triage, and patient satisfaction; as well as a reduction in the length of stay, staff absenteeism and overtime. In January, the hospital received the award for emergency service of the year, and has also won several awards for being a good employer.

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