Special Edition | September 2012
Moving forward with the Lachine Hospital’s redevelopment
“We’re moving ahead with the Lachine all public projects valued at over $40 million. redeveloppement project,” says Normand More precisely its role is to provide advice and Rinfret, Interim Director General and Chief expertise related to the planning, execution Executive Officer of the McGill University and management of large public infrastructure Health Centre (MUHC). “The projects and to ensure public CAPS recommendations were When the Lachine funds are appropriately spent. recently approved by the Board Hospital became a of Directors, bariatric surgery In the coming months IQ will is well underway, user groups member of the MUHC be recommending the most are about to begin, as is the family in 2008, the cost-effective way of moving construction of the extension forward with construction for the new MRI.” Quebec Health Ministry work at the Lachine Hospital. promised $55 million to The choices are between “The different pieces of the the traditional mode (the puzzle are coming together,” modernize and expand MUHC’s planning and project Rinfret points out, “and the path the facility. Since, the management teams would going forward is more clearly oversee the work), hiring an The Lachine Hospital’s defined.” budget has been re- outside project management Clinical Plan: a evaluated at $63 million. firm to act as contractor, or a reminder Indeed the coming months will public-private partnership such be busy at the Lachine Hospital. Meantime, the Lachine as the Glen site (a consortium • Emergency Department (14 stretchers) • Operating Block (Minimally invasive The magnetic resonance Hospital Foundation is would be hired to design and surgery room) imaging (MRI) project will be well on its way to reaching build the project for a fixed • Gastroenterology (+ 1 endoscopy moving forward this fall (see price). room) • Dialysis (12 chairs) text page 3). While construction its $3 million fundraising • Research – active geriatrics workers are busy building the To accomplish this, IQ requires • Test centre goal for a total investment • Renovated patient rooms MRI extension, many members organizations to follow a series • Ambulatory clinics (49,450 visits) of the Lachine Hospital staff of $66 million. of pre-determined steps. – Cardiology will be representing their “A number of these steps, – Surgery – Emergency (follow-ups) departments and colleagues in including the development of a – Hematology user groups whose mandate is to better define Clinical Plan, the justification of the need for – Internal medicine space, flow and adjacency requirements going the project, and certain preliminary studies – Neurology – Ophthalmology forward (see text on page 2). (structural and other) have already been – Bariatric surgery completed for Lachine,” says Administrative – Palliative care – Plastic surgery The process: Infrastructure Quebec’s role Director Jocelyne Faille. – Pre-op – Psychiatry The Quebec Government has decided that Continued on page 2 > – Respiratory functions – Rheumatology Infrastructure Quebec (IQ) should oversee LACHINE EN BREF 1 Lachine Hospital’s better re-align our clinical activities and there’s a need for more in-depth redevelopment Recherche Continued from page 1 > consultation with users. et enseignement
The next step: revising the PFT “We are in the process of transformingEntrée | personnel patient care at the MUHC’s only Ambulatoire Clinique “The next step,” adds Faille “is key community hospital, and the ophtalmologie – we have to revise ourAmbulatoire Functional renovations at Lachine will go a long Salle d’attente Salle d’examens and Technical Programclinique (FTP externe or PFT way to help us achieve that objective,” urgence in French). Once that isClinique done, externe we can notes Dr. Tim Meagher, Associate bariatrie obtain a revised cost estimate which Director General of Medical Affairs. “At the same time we have to be fiscally will be used to make adjustments to Entrée the project and determine the phasing responsible and operate within our urgence Nouvel budget envelope. We will therefore ambulances of construction. Then we will beescalier able to break ground.” prioritize the renovations according to clinical needs for Lachine, for the entire The PFT, which was drafted in 2009 and MUHC and for the Lachine catchment revised in 2010, needs to be updated area.” Infrastructure for two main reasons: the puitsCAPS verticaux exercise at Lachine is complete, allowing us to télécom Entrée urgence ambulances
Functional and Technical program User groups
Lachine staff will be participating in user Example of preliminary Research groups this fall to re-validate the Functional and space blocking from and teaching Technical Program (PFT in French) prepared in the 2009 PFT
2009 and revised in 2010 and adapt it to our Entrance | sta current reality. “The user groups, which are Ambulatory ophthalmology comprised of representatives of various job clinic categories, will need to take into account not Ambulatory Exam room only Lachine’s community mandate, but the emergency Waiting room Clinical Plan, CAPS recommendations and external clinic the MUHC’s clinical needs as a whole,” says Bariatric Dr. Matt Kalina, Interim Associate Director of external clinic Professional Services (DPS), who is playing a Entrance emergency key role in overseeing the PFT revision process. New ambulances stairs “Based on clinical best practices as well as Quebec and international design norms and recommendations,” explains Adriana Torrisi, Infrastructure Manager of Organizational and Physical vertical wells Programming who is leading the planning exercise at Lachine, “user groups will help telecom Entrance emergency customize the design of their department ambulances to the particular aspects of their practice based on volumes, specialties and the patient also look at the adjacencies needed with phasing and priorities are established. population they serve.” Over the next several other departments as well as patient They will not only reflect on a room’s weeks the first round of user groups will be flow.” size, but on furniture and optimal looking at the space “blocking” in order to layout as well. “We want the spaces to understand all the functions that have to fit in Another example: CAPS recommended be designed right for the patients and the space and how the staff does its work. an additional endoscopy room. That staff that are using them,” concludes Dr. requires at minimum sterilization Kalina. “Realistically several factors come “In designing the hospital, we will pay equipment, patient registry space and a into play when designing a new space particular attention to the needs of bariatric waiting room. “Creating a second room including budget, but most importantly and geriatric patients, as Lachine will also provides an opportunity to move the space must be functional and efficient increasingly serve these patient populations,” and upgrade this entire service with for the process to be a success.” continues Torrisi. For example, one user group considerations for improving patient flow will focus on bariatric surgery. “The surgeries and infection control,” explains Torrisi. Continued on page 3 > are going well, but we must now make sure all the necessary support functions, such A second round of user groups will look as clinic space, are incorporated into the at the spaces in greater detail once the redevelopment plans,” says Torrisi. “We must
LACHINE EN BREF 2 User groups The first set of User Groups Continued from page 2 > Ophthalmology: The clinic space needs to be expanded and modernized. The 2009 PFT included: Emergency Department: Lachine is enlarging its ED to offer the best care. Functionality and infrastructure Operating Block: This user group will study the support functions needed for the improvements ORs, such as a central sterile core, an appropriate intensive care unit and increased Reconfiguration of the main storage. entrance, in order to enter on the Endoscopy: CAPS recommended the addition of an endoscopy room. The user group 1st floor creating universal access will look at where it would be best located and what support functions are needed. and improving the flow of Ambulatory clinics: Improving the efficiency, functionality and adjacencies for these patients and staff clinics are the main goals. Special consideration will be given to the needs of bariatric Bringing areas of the hospital surgery clinics. up to norms: Urology: The user group will establish what the service’s needs are. – Electromechanical system Dialysis: The Clinical Plan foresees the arrival of 12 chairs to service the Lachine-area – Windows community as of 2015. – Brickwork Medical Imaging: This is not part of the Redevelopment Project, but Lachine has – Security system received new equipment, such as a fluoroscopy machine, and space needs to be – Ventilation system in the Camille-Lefebvre Pavilion appropriately designed in consequence. – New elevator and staircase
Construction to start on new home for MRI
Construction crews will soon be arriving at the proceed. However, once we get to phase two, Lachine Hospital. Work on building a home cascades will be necessary. “ for Lachine’s new special magnetic resonance imaging (MRI) machine will begin this fall. Phase two will include the construction of the interior walls and rooms, as well as “The second floor will house the new MRI, renovations to over 3,500 ft2 of the existing which will have a specially adapted access for hospital surrounding the new MRI area. “These bariatric and claustrophobic patients,” says renovations will provide for a new waiting area, Administrative Director Jocelyne Faille. “It is the preparation rooms and new ultrasound rooms, first such MRI of this kind in the public system in including one adapted for obese patients,” says Quebec, and we are honoured to have it. We will Faille. not only be servicing our local community, but much of the province as well. ” “Construction work of this sort will create some noise and dust,” acknowledges Project Manager The hospital will be adding 4,800 ft2 of space Paula Abi Nahklé. “In conjunction with infection divided over three floors (basement through control, we will be ensuring the best mitigation level 2) in addition to a mechanical room on measures possible. For example, some windows the extension’s third floor. The structure of the will be boarded up to prevent dust and reduce addition is expected to be finished by winter. noise. We will also be consulting with the Next spring the envelope should be complete departments adjacent to the work to decide on with some mechanical and electrical work a suitable construction work schedule.” having been done, completing phase one. “The MRI project will be a wonderful asset for “Any construction project in an existing hospital Lachine,” concludes Faille, “as it will not only provides challenges,” explains Dr. Tim Meagher, provide the hospital with MRI capacity but Associate Director General of Medical Affairs. will also allow us to provide a service that is Red: Expansion for MRI “The good news is that this first phase of currently unavailable to a certain number of Green: Renovations to the construction will not require cascades. In other Quebecers. It will be a great addition to the existing roof words we will not need to move departments Quebec healthcare system, and we are proud it to other locations to allow construction to is happening at Lachine.” LACHINE EN BREF 3 Progress at the MUHC’s Lachine Hospital
“There have been many positives since course called Taking Action with Seniors, Lachine became a key member of the “The Camille-Lefebvre which trains them on interacting with MUHC family slightly more than four Pavilion is a jewel in elderly people in a long-term care years ago,” states Interim Director facility. This program is key to making General and Chief Executive Officer the MUHC’s crown” our seniors feel at home at the Camille- Normand Rinfret. “Although it has not Accreditation Canada inspectors, Lefebvre Pavilion,” says Boyer. On always been smooth sailing, we are well after visiting the facility in 2010 average, nursing staff at Lachine now on our way to ensuring our patients, receives two to 2.5 days of training per their families and our employees year. benefit from modern and up-to- date facilities.” There remain challenges ahead. “We must increase our capacity to “Lachine has been and will continue offer surgical beds with the arrival to be a community hospital, and of bariatric surgery and an overall this will be its primary raison increase in OR efficiency. Over the d’être,” continues Rinfret. “But in next few years, bariatric surgery will certain specialties it is taking on a be ramping up to 370 operations regional mandate. It is becoming a year. That is very significant for a a Centre of Excellence in Bariatric community hospital,” says Faille. Surgery, will be the first in the province’s public sector to offer “The integration of more specialties a magnetic resonance imaging at Lachine over the coming years machine (MRI) that will provide the such as dialysis will be a real best care to all, including bariatric advantage to the community, as and claustrophobic patients, and they will benefit from direct access continues to be a source of pride for to more specialized care,” adds the MUHC as a designated regional Associate Director General of Clinical centre in ophthalmology and Services at Lachine. “In addition, Operations Ann Lynch. “Lachine is cataract surgery.” several services from the MUHC’s other a real asset for the MUHC,” continues sites have been integrated into Lachine Lynch. “We must also remember that Since joining the MUHC in April 2008, such as oral maxillofacial surgery, men’s as a community hospital, it’s not only over $5 million has been invested in health, plastic surgery and certain what we do but how we do it that is Lachine. Initiatives range from a CT- general surgeries.” important to our patients and their scanner adapted for obese patients to a families.” new fibre optic network linking Lachine In the past two years alone, the to the other MUHC sites, new laboratory Lachine Hospital has managed to equipment and the new PACS system recruit an exceptional nursing staff. “It to view x-rays digitally instead of on has been one of my most important film. The palliative care unit has been mandates since I arrived in May 2009,” renovated to offer single-patient rooms says Associate Director of Nursing with space for loved ones to stay the at Lachine Jasmine Boyer. “We had night. previously relied very heavily on agency nursing staff. At one time at Perhaps the most important investment the Camille-Lefebvre Pavillion, 60% of to date has been the new state of the the beneficiary attendants (PABs) were art minimally invasive surgery (MIS) from an agency and 80% of the staff suite, allowing Lachine to perform an there were PABs. Since 2009-2010, we array of minimally invasive surgeries, have reduced the number of agency achine has been hiring including bariatric surgery – key in its shifts by impressive amounts (see text L ! new role as a regional health centre for box).” this specialized operation. Since 2009-2010, we’ve hired enough staff to reduce the number “Our goal is to eliminate agency nursing of shifts done by agency workers by: “Hiring employees – both doctors staff by 2014, despite the nursing and nursing staff – has been one of shortage in Quebec,” declares Boyer. Beneficiary attendants (PABS): our main focuses since 2008, and we “We are doing this because it is clear have made impressive strides,” says that patient care is best when it is given from 3116 shifts/year to 217 shifts/ Administrative Director Jocelyne Faille. by permanent personnel who know the year – a reduction of 1336%! “We have recruited a cardiologist, hospital and the way we operate.” Auxilliary nurses: From 552 a microbiologist, general surgeons, shifts/year to 141 shifts/year – a internists, an anaesthesiologist, a The administration at Lachine has also reduction of 29%. generalist and a specialist in family put a huge emphasis on training. “100% medicine,” says Dr. Matt Kalina, Interim of our PABs have taken a 43.5-hour Nurses: From 5029 shifts/year to Associate Director of Professional 3373 shifts/year – a reduction of 49%. LACHINE EN BREF 4 Bariatric Surgery Update
The number of bariatric surgeries performed each week at Lachine will double as of September. Dr. Olivier Court, Interim Director of the MUHC’s Bariatric Surgery Program and his team will operate on four patients per week, with two full days in the new state of the art Minimally Invasive Surgery suite. The goal this year is to perform 100 bariatric surgeries at Lachine.
Clinical Activities Priority Settings exercise (CAPS Lachine) The future of the Lachine Hospital The CAPS process pushed us to review our clinical activities and decide where we want to invest for the future. The resulting priorities will now guide institutional decision-making and will help direct resources in a logical manner.
“Our continued success and long-term viability depends to a large extent on our ability to strategize around the balance of activities that best serve our patient population and the community of Lachine within the family of MUHC hospitals,” explains Dr. Tim Meagher, Associate Director General of Medical Affairs. “In meeting this challenge we also have to take into account the services and programs being offered elsewhere in the Lachine area.”
For the past year, we have been tackling this issue head-on through our Clinical Activities Priority Settings exercise (CAPS Lachine). This exercise involved the participation of the clinical teams at Lachine in collaboration with clinical leadership from the downtown hospitals. “I am pleased to report that in July the MUHC Board approved the recommendations that were the results of this work. In the future, this information will act as the foundation upon which clinical activities are supported and developed at Lachine. The goal is for the Lachine Hospital to become one of the best community hospitals on the Island of Montreal,” adds Dr. Meagher.
The CAPS Process
CAPS Lachine was based on the conceptual framework “Accountability for Reasonableness (A4R)” and was similar to the CAPS exercise conducted at the downtown sites in 2009-2010. The evaluation of clinical activities at Lachine was performed by the Strategic Directions Committee which was composed of clinical staff from Lachine and representatives from the downtown hospitals as well as a patient representative.
“The CAPS process pushed us to review our clinical activities and decide where we want to invest for the future. The resulting priorities will now guide institutional decision-making and will help direct resources in a logical manner,” explains Dr. Meagher.
Interprofessional clinical teams were asked to complete workbooks reviewing their clinical activities in terms of:
• defined criteria • clinical priorities • areas to improve network collaborations • activities for potential divestment
Continued on page 6 >
LACHINE EN BREF 5 CAPS: the results at a glance
Results Thank you ! The Strategic Directions Five departments submitted workbooks: Create more opportunities for Committee members General Medicine, Specialized Medicine, communication between administrators Surgery, Ophthalmology and Emergency and the Lachine Hospital staff • Dr. L-M. Simard Medicine. Strategic Directions To facilitate exchanges and ensure Committee Chair, Lachine The Strategic Directions Committee was quality service, it is essential that all charged with evaluating the workbooks and professionals working at Lachine • Ms. C. Farmer developing recommendations. are able to express themselves and Paramedical, Lachine document activities in French as per the • Ms. J. Boyer There were two levels of recommendations: unique status of the Lachine Hospital Nursing, Lachine institutional/transversal and program specific recommendations. Implement quality and performance • Dr. M. Teschler indicators through the support of the Clinical Laboratory, Lachine The institutional or transversal recom- Quality-Performance-Patient Safety team mendations provide overarching principles • Dr. C.Tawilie or guidelines to help strengthen activities Continue IT integration of the OACIS Plastic Surgery, Lachine that support the development and platform used throughout the MUHC enhancement of clinical services. • Dr. D. Laliberté Family Medicine, Lachine Establish clinical service corridors with Examples of transversal recommendations the MUHC downtown hospitals • Dr. M. Tanzer are: Department of Surgery, Incorporate teaching and research MUHC Clearly communicate the community activities in alignment with the mandate of the Lachine Hospital to community hospital mandate • Dr. J. Pickering MUHC staff Department of Medicine, MUHC Develop and implement a more Please note CAPS results will be made generalist approach to improve staffing available in the fall on the MUHC Intranet • Dr. A. Brown-Johnston Family Medicine, MUHC flexibility site. • Dr. V. Nguyen Consider the impact on human Surgery, Lachine resources, budget, equipment and Next Steps space and perform a feasibility study • Dr. Laflamme before developing new services and An action plan will be developed outlining Ophthalmology, Lachine programs the implementation process and including the alignment of the CAPS recommendations • Ms. M. Simard Support interprofessional collaboration with the Lachine Hospital Clinical Plan. Patient Representative by promoting meetings between the • Ms. T. Mack clinical teams Project Manager
Townhall Meeting
We invite you to our next Lachine Townhall on Friday, October 5th, 2012, from noon to 1 p.m. in the A & B Room, during which we will update you further and
take questions on Lachine’s Redevelopment Project.
LACHINE EN BREF 6