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A week before last
Christmas, Angela Graham went into University Hospital
in London, Ont., to have her left
hip replaced. The hospital, a state-of-the-art facility when it was built in
1972, had seen its enviable reputation threatened over the past few years as
government funding declined. Graham had witnessed the cutbacks firsthand
when she had her right hip replaced by the same orthopedic surgery unit two
years earlier. “They’d just lost a large number of staff” she remembers.
“People were nervous — standing in corners, talking among themselves,
worrying. The care was excellent, but you could tell they were uncertain
about the future.”
Graham was
surprised and impressed on her second visit. “I was prepared for less than
super service. But all the key staff I appreciated so much the first time
were still there. And I was really impressed by the friendliness, the
courtesy of each service provider — everybody: the X-ray technicians, the
people in the blood lab, the porters, the volunteers and the admission
staff. They said they just wanted to maintain the quality and the philosophy
of care they could provide that people were used to — that was what was most
important to them.”
University Hospital
had undergone some radical surgery of its own before Graham’s second visit.
Rather than simply cut services as budgets dropped, the hospital’s board of
directors decided to merge
University Hospital
with the city’s oldest hospital,
Victoria (built in 1875), to form the new 976-bed London Health Sciences
Centre. But the merger was just the first step in the center’s revolutionary
approach to curing the sick; it is a complete rethinking of what hospitals
are supposed to do and how they’re supposed to do it. And one of the bedrock
principles of the merger was that the new hospital had to be run more like a
private business, anathema in Canada’s health-care system.
The reborn London
Health Sciences Centre is winning praise. In mid-March, the initiative
garnered top marks from two hospital-rating agencies. It was recently named
one of the best teaching hospitals in Canada by the Canadian Council on
Health Services Accreditation, a non-government, non-profit national
organization. The second edition of the independent guide, The Best
Hospitals in America, ranked London Health Sciences Centre — alongside
Stanford University Hospital, Johns Hopkins Medical Institution and the Mayo
Clinic-among the top 87 such facilities (out of more than 10,000) in North
America. And the hospital is toeing the bottom line. London Health Sciences
Centre had to eliminate $32 million from its budget this year, but it won’t
run a deficit.
The task of leading
the change fell to the center’s president and CEO, Tony Dagnone. “We saw
this financial crunch coming 30 months ago, and thank goodness we did,”
Dagnone says. “There are five teaching centers in this province. Not all of
them were going to be able to survive.” A graduate of the master’s program
in hospital administration at the University
of Toronto, Dagnone had worked for 25 years at Royal University
Hospital in Saskatoon and was aware of the sterling reputation of London’s
old University Hospital.
“In Saskatoon, when we had
patients we didn’t feel we could handle because we didn’t have the skills,
we sent them to London. That’s what drives us here: to make damn sure we
don’t lose our reputation as a standout hospital.” Dagnone and his team not
only succeeded in merging and revitalizing the two London hospitals, but
they also provided a lesson for both public and private institutions in how
to manage drastic change while focusing squarely on the task of serving the
customer-in this case, patients such as Graham.
The merger wasn’t
the first attempt to renovate
London’s aging hospital
infrastructure. Three previous attempts to improve the region’s healthcare
options had failed. “The city had not been bold enough to make changes that
would have made the efficiencies we needed possible,” says Dr. Tim Frewen,
vice-president of the center’s medical, dental and academic staff. The
hospital’s board of directors hired management consultant Ernst & Young,
which concluded that a single, large hospital made sense. Small
organizations are often praised as agile, speedy and rapidly responsive.
But, in health care, bigger is often better. In its first year, London
Health Sciences Centre will take care of more than 500,000 people. It
maintains a full schedule of major surgery, including complex, difficult
procedures such as organ transplants, brain surgery and multiple bypasses.
Its research department pioneers cutting-edge medical equipment. Its patient
roster lists 28 countries of origin-patients from all over the world come to
London for procedures and expertise unique to the facility. And as a
teaching hospital, the centre is training the next generation of doctors,
nurses and medical technology specialists. Doing all this will cost $392
million per year and involve 7,497 employees.
“You need a
critical mass of both doctors and patients,” says Dr. John Girvin, director
of neurosurgery and the senior medical adviser for London Health Sciences
Centre. “Take teaching, for example. Residents can see many more people in
this merged facility. That’s obviously better than having them see fewer
patients. They’ll get more experience.”
Once the final
decision was reached by the boards of trustees at both Victoria and
University hospitals -- on July 11, 1995the speed of the merger astounded
everyone. By Aug. 24 the new senior management and administrative structure
was in place. “The longer it took, the more resistance would have formed,”
Paul Faguy, the center’s vice-president of human resources and corporate
services, says. “It took courage from the boards to back it, but they agreed
unanimously.” Employees in every sector of the institutions were already
nervous. Management allayed fears by framing the changes in terms everybody
could understand. “Change means anxiety,” Frewen says. “We’ve tried to keep
everyone focused on our main goal, which is taking care of patients.”
Doctors and nurses were consulted, along with every other person on the
hospitals’ staffs. “Hospitals are notorious for taking too long to make
decisions. They solicit opinions from everybody beforehand,’’ says Glenda
Hayward, a registered nurse in the cardiothoracic unit who also helps run
the center’s human resources transition team. “This is working differently.
We’ve made the decision; now we’re concentrating on making it happen.”
Putting the two
operations together revealed a lot of needless duplication. “If a piece of
equipment in your operating room costs $200,000 and you’re only using it a
few times a year, it sits there idle and eventually has to be replaced when
it’s outmoded,” Girvin says. “It makes more sense to have one of those
machines and use it twice as often. There are people who think that all
hospitals have to be all things to all people, but that’s a fading
philosophy. Not every hospital can have every facility.” Both sites still
have emergency rooms but the neuroscience unit will be moved to the
University Hospital
campus, for example. Victoria has
always had more pediatricians, so the children’s services will be
concentrated there.
Dagnone used the
momentum of the merger to rethink the way the entire University Hospital
was being run. “You usually hear, ‘If it ain’t broke, don’t fix it,’ “
Dagnone says. “Our attitude was, ‘If it ain’t broke, maybe it ought to be
broken for the sake of future patients.’ “ He and other managers consulted
staff, looking for improvements in every sector of patient care, from
admission through release. “A lot of synergies came out of that,” Dagnone
says. “The physiotherapist was saying, ‘If I could have Patient X for 15
minutes on Day 2 instead of waiting until Day 3, I’ll get him mobile a day
earlier.’” The social worker was saying, ‘I could start planning for
discharge on Day 1, and have some ready answers earlier.’ If we can treat
you so that you’re back to work being a productive citizen earlier, we will
have done our jobs.”
Reorganizing the
hospital also meant getting more bang for the institution’s research buck.
“Research isn’t an expense, it’s an investment,” Dagnone says. One project
in the works is the development of a 3-D ultrasound-imaging system that will
provide a more detailed view of a patient’s internal organs without using
radiation. Three Canadian venture capital companies are putting a total of
$4.5 million toward developing and marketing the technology, which will help
pay for the research and defray the cost. “In the past, we would have done
that research only to have to buy the product from a US company two years
after developing it. Not this time,” says Dagnone.
At the heart of
the new hospital is the Customer Support Centre. The whole support staff was
reorganized as a department unto itself, answering to patients, clinical
staff and hospital visitors. Coordinators in the center’s nexus at the
University Hospital
campus field calls, then dispatch the right people to solve problems. That
includes everything from delivering extra linen supplies and ferrying late
meals to patients to booking conference rooms for meetings. Anyone needing
any kind of assistance dials one phone number. “It used to be that each
support department had its own phone number, its own staff and its own
hierarchy,” says Hayward. “If you
needed a light bulb changed, you’d have to make a series of phone calls just
to find out whose responsibility that was. Physical plant? Housekeeping?
Electricians? It got more complicated on weekends, when the whole structure
changed. With one number to call, you spend less time figuring out who’s
responsible for something and more time taking care of patients.”
“I’ll put that
centre up against the service staff of any hotel in North America,” Dagnone
says. “They can solve any problem in a matter of minutes and with no fuss at
all:” To accomplish this, the hospital launched a partnership with
ServiceMaster of Canada Ltd. of Mississauga, Ont., to set up its new
customer service centre. The support service initiative at the hospital is
the first such project for the company; its core business had been
management services to hospitals and school boards. “Getting people [at the
hospital] to understand the new skills they needed and to comprehend the
vision of how this is all supposed to work was one of the biggest
challenges,” says Brian John, ServiceMaster’s business leader of integrated
support services. “One of the department managers asked me, ‘Are we
McDonald’s, or what?’ Well, yes, we are. We have a product that has to be
delivered correctly and on time”
The same philosophy
is being applied in every one of the hospital’s support services. John
drilled in the concept of adding value to everything the department does.
“We’re trying to eliminate ‘That’s not my job’ as a response to any request
from a customer,” says John. That extends to the hospital cafeteria, where
servers should ask, “Would you like fries with that?”, which would increase
revenue as well as the level of customer service. “People take pride in
their work,” says John. “We’ve found most of the frontline staff want more
responsibility.”
“The old system by
which hospitals used to run needs to be restructured,” Frewen says. “That’s
especially true of acute-care facilities such as this one. These are painful
and challenging lessons, but we must create these efficiencies for the
general health of Canadian society.” For Dagnone, the architect of the
London Health Sciences Centre merger, the lesson of the private-business
approach to running the hospital isn’t that governments and public
institutions are incapable of becoming more efficient, but rather that they
can accomplish a great deal when they put their minds to it. “It’s a
precious commodity,” Dagnone says of Canada’s health-care system. “We can’t
let politicians come to the conclusion that health care shouldn’t be
supported. What have you got without health care? Everything else doesn’t
really count.” |
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