McGill’s new Initiative for Transforming Healthcare (ITH) targets the thorniest challenges facing Canadian healthcare systems – access to family doctors, overcrowded ERs, and long waits for elective surgeries – but not in the way you might expect.
“The ambition of the ITH is to bring the organizational and managerial dimensions of healthcare to the centre of the conversation,” says founding director Samer Faraj, a professor in the Desautels Faculty of Management who holds a Canada Research Chair in Technology, Innovation and Organizing. Healthcare is a key focus of his research.
“We have superb clinicians in our system, but the organizational structure they operate in is not optimal for providing the best care flow,” explains Faraj. “There are a lot of silos and processes that are paper-based, making coordination slow or unnecessarily complex.”
“It’s not simply a matter of throwing money at the problem,” he adds. “It’s also a question of working with better structures and systems, and deploying technology where it can help improve processes and coordination.”
Anchored at the Desautels Faculty of Management, the ITH also brings medical and public policy expertise to the table with its founding partners: the Faculty of Medicine and Health Sciences and the Max Bell School of Public Policy in the Faculty of Arts. A $5.75 million donation from Power Corporation of Canada, Canada Life and IGM Financial spurred the launch of the cross-sector initiative, which will seek further philanthropic support. The ITH will work with healthcare leaders, policymakers and practitioners to find organizational and technological solutions that stakeholders can support.
We spoke to Faraj about the initiative and the work already underway.
Each provincial healthcare system in Canada is a large, complex operation. How can the ITH help solve pressing challenges?
The Canadian healthcare system is quite similar. The details may differ from province to province, but all of them have difficulty providing a GP to everybody who needs one, overcrowded emergency departments, and delays for surgeries. We believe that the lessons learned from studies in one or two provinces would apply to all and allow for innovations.
Go to a typical hospital, for example, and you will find out that non-emergency surgeries are scheduled Monday through Friday, from 8 a.m. to 3 p.m. We know from other countries that surgeries can be scheduled on the weekend, in the evening, sometimes at night. The question is why can’t we increase the number of hours where ORs are being utilized?
People often point to the complexity of the system and the number of interdependencies that need to be managed. There have been many efforts to use economic incentives to improve performance and capacity either among general practitioners or to speed up the number of surgeries. Such efforts rarely lead to an increase in volume.
These are not things that money by itself will solve. It’s a question of how can we intelligently reorganize assigning spots for surgeries, or how to better prioritize different patients. It is a question of how to incentivize all the actors involved in surgery to engage in a helpful transformation. Again, we are not suggesting a specific solution. It’s more that we know there are specific ways of doing things that have been frozen in time and based on old agreements. If we could revisit these, we may be able to come up with a new approach, possibly one that uses technology to improve coordination.
What kinds of technology solutions might be considered?
Technology is an essential part of the solution, especially when you consider that much of the healthcare system still runs on faxes and paper.
For example, AI is now promising solutions such as AI scribes that take notes in the patient-doctor meeting. Many doctors have had positive experiences with them and a lot more are trying them. But maybe in this case, we need careful deployment and engagement. Take the problem of AI hallucination. You do not want an AI scribe software that would hallucinate about your condition, treatment plan, or any aspect of your patient-doctor meeting.
There are possible areas of concern, which is why I am not a champion of ‘technology will solve everything immediately.’ In the long run it will be very helpful, but it has to be done right.
Tell us about the first step in the ITH’s work, delving into the root causes of the bottlenecks in the system.
In the short term, we are fanning out first to Montreal hospitals. We’re talking to the CHUM [Centre hospitalier de l’Université de Montréal], the Jewish General Hospital, and the McGill University Health Centre and its various sites.
We recently met with the leadership of the Montreal Children’s Hospital and discussed a number of innovative projects that they have initiated. We can help by analyzing their experience, offering both quantitative and qualitative research expertise. There was a lot of common ground, and they see us as a resource to help with their efforts.
Another example is in the emergency department of the Montreal General Hospital. I have a doctoral student studying the coordination in the ED and how they are managing to run a Level 1 trauma centre – one of the busiest in Canada – in a resource-constrained environment.
So, there’s a lot of work that’s already started.
This is a pan-Canadian initiative. We already have a project with the Children’s Hospital of Eastern Ontario. We will be seeking more partnerships as we grow. We hope to involve more researchers from other provinces who adopt our approach and know their local context best.
What’s the goal of the team’s field work at this stage?
To understand the organizational challenges that hinder system improvement, we want to develop a baseline of how coordination is happening, and how priorities are decided.
Much of the work will be carried out by McGill undergraduate and graduate students in addition to professors and researchers.
Once we have acquired in-depth knowledge, we will be able to convene directors of these institutions that specialize in running EDs, for example, and co-create with them either best practices, new ways of doing things or pass on local innovations from one place to another. We are helping the sector to come together and co-create solutions, but they will be the primary movers.
How do you get buy-in from the healthcare system and hospitals?
That is the best part: we are welcomed with open arms. They see the need for this sort of innovation. It could be something as simple as ‘we’ve got our data, we need people with expertise in analytics so we can make sense of what we’re doing right, what we’re doing less well.’
This is where a McGill student or a team of students can be of great help because we have excellent training programs that focus on those skill sets. We have PhD students that can spend a longer time helping solve problems and analyze a transformation that’s taken place – let’s say when you introduce new technology. And we have professors who are going to guide these students and participate themselves.
Why we’re welcomed almost everywhere we go is because of the necessity. Everyone in healthcare wants to improve their patient experience, outcomes, and processes. That’s an essential ethos for those working in healthcare.