Leadership, research and renewal at St. Michael’s Hospital

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Before I talk about our renewal project at St. Michael’s Hospital, I want to take advantage of this column’s publication in May to thank nurses across the health care system, but particularly at my own hospital, for the care and compassion they show for our patients and families. While Nursing Week gives us an annual reminder to reach out to these superb professionals, we all know that they demonstrate their importance to the system every hour of every day.

The excitement is growing at St. Michael’s as we work with the Ministry of Health and Long-term Care and Infrastructure Ontario on procurement for a massive project that will renew our main hospital campus at 30 Bond St. in downtown Toronto. St. Michael’s has just announced the three consortia that will participate in our tendering process and is well along in preparing the hundreds of drawings and thousands of pages of specifications that will help the consortia make their bids.

Just as our Li Ka Shing Knowledge Institute, opened in 2011, positioned research and education for the future, this new project, that we are calling St. Michael’s 3.0, will transform patient care.

Like a handful of other projects in Canada, St. Michael’s 3.0 will be a Pebble Project. The Pebble initiative, from the Center for Health Design in the U.S., is a collaborative that we joined to share evidence-based design. Each Pebble Project has access to a library of existing evidence and commits to conducting research on the impact of its own design work.

St. Michael’s 3.0 includes a 17-storey tower, a major expansion of our Emergency Department, the creation of new ambulatory clinics and a number of other renovations to our existing building to re-purpose space.

St. Michael’s is a leader in three broad areas of patient care: inner city health offering high-level, respectful care to the most vulnerable populations in downtown Toronto; critical care, including trauma and acute cardiovascular and neurosurgical emergencies; and a variety of specialized services such as therapeutic endoscopy, adult cystic fibrosis, multiple sclerosis, complex cardiac and cardiovascular care and many, many others.

But our ability to move forward as a leader is becoming compromised by our aging facilities. We still have patients in a wing that was built 80 years ago. Our Emergency Department, on any given day, is like something out of M.A.S.H. Our Medical-Surgical ICU has inadequate room for families, equipment or even the inter-professional teams required to provide intensive care. And many of our operating rooms are just too small to allow the technology required for image-guided and minimally invasive surgery.

When it comes to involving families in the care of patients, adult acute care hospitals have lagged behind children’s hospitals. But change is coming and St. Michael’s wants to be part of it. When a patient is in hospital, families assist with care and take over when the patient is discharged. Clearly, it makes more sense to accommodate family involvement effectively; so our new inpatient and intensive care rooms will have a family area that makes an overnight stay more comfortable and allows families to participate in the care if they wish to.

Today’s evidence provides dozens of small and large examples of how to improve patient safety through design. For example, in our tower design, all inpatient rooms will be private, which helps prevent infections, and each will have a bathroom placed so that a patient can get out of bed and hang onto a railing all the way, which helps prevent falls.

Technology enables a host of new possibilities – chips that will help us locate patients, equipment and staff, individual controls for light and heat within each room, improved wireless infrastructure for the potential devices of tomorrow and many other features that will improve safety and the patient experience.

Five new operating rooms will be equipped to handle medical imaging equipment and be large enough to accommodate tomorrow’s high tech equipment so we can continue to lead as surgery rapidly evolves.

And finally, we are completely redesigning the entrances to the hospital – concentrating on accessible entries through the new lobby at the corner of Queen and Victoria streets and also adding grade-level access to the historic Bond Street entrance. The south end of the hospital will be largely for patients and families with the Emergency Department taking most of the first floor with its entrances at the north side of the hospital. This will give us a more “on stage, off stage” layout than now.

Planning a renewal project is an amazing amount of hard and detailed work. And yet, we know that if we do it well, we will be building the infrastructure that will allow St. Michael’s to lead health care change into the years to come … St. Michael’s 3.0.