Changing landscapes
in healthcare
Presentation and discussion
CAAHP conference Ottawa
May 29th 2014
Ewa Sidorowicz MDCM, FRCP(c), MSc
ADG medical Affairs and DPS
McGill University Health Center Montreal
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 project
A 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 practice
An 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 prévoit un nouveau partage des champs
d’exercice professionnels dans le domaine de la santé et les
activités désormais réservées aux médecins, aux pharmaciens,
aux infirmières et infirmiers, aux technologues en radiologie,
aux diététistes, aux orthophonistes et audiologistes, aux
physiothérapeutes, aux ergothérapeutes, aux infirmières et
infirmiers auxiliaires, aux technologistes médicaux et aux
inhalothérapeutes.
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The objectives
• Abolish certain barriers
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• Better permeability between
professions
• Loosening of the legal and
regulatory framework
• More flexibility
• Increase multi and inter
disciplinarity
• Improve inter and intra
professional collaboration
• Recognition and
optimization of
competencies
• 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 training
CEGEP
UNIVERSITY
• Radiology techs
• Laboratory techs
• Social Service techs (data
collection)
• Physiotherapy techs
•
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)
• Nutrition techs
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A bit more about imaging:
MSSS focus on access
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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 MUHC
The 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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