1. Changing landscapes in healthcare Presentation and discussion CAAHP conference Ottawa May 29 th 2014 Ewa Sidorowicz MDCM, FRCP(c), MSc ADG medical Affairs and DPS McGill University Health Center Montreal

2. 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! 14-05-29 CAAHP Conference Ottawa 2

3. Outline Update from the MUHC and healthcare transformation in the greater Montreal area; Transformation in healthcare practice 14-05-29 CAAHP Conference Ottawa 3

4. 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. 14-05-29 CAAHP Conference Ottawa 4

5. 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 14-05-29 CAAHP Conference Ottawa 5

6. 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. 14-05-29 CAAHP Conference Ottawa 6

7. 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, 14-05-29 CAAHP Conference Ottawa 7

8. The Glen site, 2010 14-05-29 CAAHP Conference Ottawa 8

9. View of the Glen site, July 2013 14-05-29 CAAHP Conference Ottawa 9

10. Glen site, September 2013 14-05-29 CAAHP Conference Ottawa 10

11. 14-05-29 CAAHP Conference Ottawa 11

13. Glen site stacking diagram 14-05-29 CAAHP Conference Ottawa 13

14. Women’s Health: inpatient room

15. Research Labs

16. A complex series of moves 14-05-29 CAAHP Conference Ottawa 16

17. 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. 14-05-29 CAAHP Conference Ottawa 17

18. Transformation in healthcare practice An overview of the allied professionals in Quebec. Staff shortage are unfortunately present throughout most groups 14-05-29 CAAHP Conference Ottawa 18

19. Bill 90 (physical health) Adopted June 14 th, 2002 Ce projet de loi prevoit un nouveau partage des champs d’exercice professionnels dans le domaine de la santé et les activites desormais reservees aux medecins, aux pharmaciens, aux infirmie ̀ res et infirmiers, aux technologues en radiologie, aux dietetistes, aux orthophonistes et audiologistes, aux physiotherapeutes, aux ergotherapeutes, aux infirmie ̀ res et infirmiers auxiliaires, aux technologistes medicaux et aux inhalotherapeutes. 14-05-29 CAAHP Conference Ottawa 19

20. 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 14-05-29 CAAHP Conference Ottawa 20

21. 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. 14-05-29 CAAHP Conference Ottawa 21

22. 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. 14-05-29 CAAHP Conference Ottawa 22

23. Some of the various professionals in Quebec and their training CEGEP 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) 14-05-29 CAAHP Conference Ottawa 23

24. 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. 14-05-29 CAAHP Conference Ottawa 24

25. 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) 14-05-29 CAAHP Conference Ottawa 25

26. 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. 14-05-29 CAAHP Conference Ottawa 26

27. Questions? 14-05-29 CAAHP Conference Ottawa 27