Community hospital “Living Labs” key to our future

Recently, a young woman in her mid-30s was referred to me by her family physician. She is a mother of two children under the age of seven who had discovered a lump in her breast. Our team at North York General Hospital (NYGH) ensured that she had a timely ultrasound and mammogram, which provided enough information for a decision to biopsy the lump. The biopsy confirmed a diagnosis of breast cancer. This process took place over the course of a few days and surgery was scheduled for a date within two weeks.

This case is not exceptional; almost 23,000 women in Canada will receive a similar diagnosis this year alone, and I see several new breast cancer patients each week. Providing the best possible care to each of these patients is the ultimate goal. Researchers in Canada and around the world have made very good progress in understanding the biology of cancer and in discovering and developing new therapies to improve long-term survival rates. That work is truly amazing.

Advances in health systems, including our ability to provide patients with the care they need in a timely, safe, and efficient way can be equally effective in improving patient outcomes. This is an increasingly important area of focus, as these advances are essential to the long-term sustainability of our entire health care system.

In Ontario, some measures estimate that 80 per cent of hospital care takes place in community hospitals like NYGH. Although most of the ‘discovery’ research in Canada occurs in academic health science centres, leading community hospitals have the opportunity to evolve more into “living labs,” where researchers can study and improve the processes by which care is delivered.

A critical lens and an innovative spirit should be applied where the bulk of care is delivered, with the goal of improving our systems each day.

Key to our success moving forward involves a relentless dedication to systems improvements. At NYGH, for example, we were one of only three large hospitals in Canada to achieve Stage 6 of the Healthcare Information and Management Systems Society, which measures progress in electronic health records implementation. These records help us move patients through the system, to the care they need in an efficiently and safe manner. We enjoy a seamless collaboration with a large, interdisciplinary community-based family health team, ensuring that patients can transition through the system and receive the care they need in the most appropriate setting. We also employ a cadre of quality-improvement specialists, who monitor patient flow and outcomes, proving that a moderate up-front investment can yield significant long-term results.

Health care institutions that have the privilege of treating a high volume of patients have the opportunity – if not the obligation – to study, refine and share their successes. At NYGH, colleagues in Mental Health launched a microfinance program to encourage new approaches to care, and they have managed to reduce the number and length of hospital visits by bringing primary care and mental health physicians together in one location.

To support further research, we recently launched a hospital-wide “Exploration Fund” to seed opportunities for staff and physicians to develop new approaches to improve patient care. One recipient, a nurse, has begun to study a Montessori Elder Care method to help calm disoriented geriatric patients in the emergency department. Another nurse, together with her orthopaedic colleagues, is studying different approaches to pain management for patients undergoing knee surgery.

Ultimately, the plan is to seed the hospital with research chairs that will act as catalysts, studying policy-relevant practice across the enterprise. Plans are underway for a chair in health care delivery to create and disseminate new knowledge in process improvement, a chair in informatics to delineate the impacts of information system innovations on patient outcomes, and a chair in the delivery of care to diverse populations to advance understanding of how different cultures interact with the health care system, among others.

That is why real world research is so vital in community hospitals, where there exists an opportunity to study and refine the care provided to large numbers of ‘typical’ patients in real time. This will be vital to health care sustainability.

I’m pleased to report that my patient is on her way to recovery and her long-term prognosis is excellent. She has benefitted from a system where family physicians are collaborating with the hospital system, where specialists within the hospital are working as a team, and where technology is effectively functioning to improve safety and efficiency. This system can always be improved, scaled and replicated in other institutions and settings. Each patient deserves this level of care, as does the entire system.