Mackenzie Health creates first-in-Canada living lab for process improvement

RICHMOND HILL, ONT. – Mackenzie Health, a 500-bed community hospital, has transformed a 34-bed ward into an ‘Innovation Unit’, a living laboratory that will test evidence-based practices and technologies to produce the most effective ways of treating patients.

The busy hospital, located in Richmond Hill just north of Toronto, has partnered with Hill-Rom Canada, which helped design the unit and supplied much of the initial technology. As well, Mackenzie Health will be working with the International Centre for Health Innovation, at Western University’s Ivey Business School to assess the impact of the technology on quality,safety and patient care.

The team at Mackenzie Health believes it has created a first-of-its-kind facility in Canada, a real-life laboratory that will test technologies and methodologies to improve the quality of care – with an emphasis on patient safety and outcomes.

“The innovation unit will allow us to accelerate the adoption of innovation,” said Tiziana Rivera, chief nursing executive at the hospital. “It will also put us at the forefront of evidence-based medicine.”

She said the results, which will be analyzed by a team from the Centre for Health Innovation, will be shared so that new methods are adopted by the rest of the hospital and at the new Mackenzie Health Vaughan hospital the organization is building. The Vaughan site, located several kilometers away, is to open in 2019. Ultimately, said Rivera, the Innovation Unit findings will have an impact on patient care across the country. “We want to produce system level change,” she said.

The Innovation Unit went live in April with an investment of $500,000, and the initial technologies being evaluated include:

• Smart beds that can alert staff to patients who are trying to get out and are in danger of falls – a major hazard for many frail or elderly patients. The beds can also weigh patients, eliminating the need to get out of bed and onto a scale, another potential occasion for falling.
• Smart communication panels on the walls of every room, which enable nurses and other caregivers to communicate with each other.
• Badges that interact with the smart panels and workstations, showing the location on the unit of each staff member and allowing them to respond to patient calls more effectively.
• Hand hygiene solution – the hand-wash and soap pumps in the rooms all have sensors, and track whether staff are washing upon entering and leaving a room. Nurses can be alerted, too, when they’ve forgotten to wash their hands, and performance is all tracked.

At a June reception marking the official launch of the Innovation Unit, hospital CEO Altaf Stationwala said the leadership team wanted to blaze new trails in research and development, but felt there wasn’t any point in duplicating the efforts of the academic centres located on University Avenue in downtown Toronto.

“Their strengths are in pure research,” said Stationwala. “We’re strong in lean methodologies, workflow and technology. With our new hospital coming on-stream in Vaughan, we focused on applied innovation – real technologies that will have an impact on patient care today.”

Dr. Aviv Gladman, chief medical information officer, noted that in addition to the current technologies being tested, “new IT projects are forthcoming that will transform how we deliver care.” He said all projects will free up staff and physicians, enabling them to spend more time at the bedside.

Dr. Gladman, an engineer as well as a physician, said the unit will be exploring real-time decision support tools in the future. “As an engineer, I just think this is very cool.”

On a more serious note, he emphasized that every dollar spent on technology is a dollar withheld from other areas – such as staffing. Ultimately, investments in electronic wizardry have to prove their worth in better patient care or staff efficiency. “Using the Innovation Unit,” Dr. Gladman said, “we’ll learn a lot about how to move forward.”

On a tour of the Innovation Unit, professional practice lead Sabina Sabo demonstrated how the system can track the location of each caregiver by using the wireless badges and wall panels. Patients can quickly call nurses by using a handy control with one button for pain medication and another for washroom help.

“How fast are we responding? It will all be measured,” said Sabo.

Using the Hill-Rom system, patient calls can follow a nurse, no matter which room he or she happens to be in. That’s because the room sensors can identify the badge worn by the nurse and route the call through the nearest wall module. “We can reply through the module, too,” said Sabo, to reassure the patient that help is on the way.

If a nurse is about to leave a room without properly adjusting the bed rails of a patient with a falls precaution, an alarm will sound – reminding the nurse to fix the bed. And when a fragile patient is climbing out of a bed, alerts will be transmitted to nurses. “The nurse can come into the room before anything happens,” said board chair Dina Palozzi. “It’s a first

in Canada.”

While other hospitals have bed exit alarms, the system used at the Innovation Unit will transmit the alert to the nurse, wherever he or she may be on the floor, via the wireless badges and modules on the walls of rooms and in the halls.

“The alert follows the nurse,” said Sabo.

When a patient is in distress or needs help, an alert will go to a secondary nurse if the primary caregiver doesn’t respond in 60 seconds. If that nurse doesn’t respond, the signal flips back again to the first care-giver. “It’s a loop that ensures someone will respond,” said Sabo.

Sabo noted that in the second phase of the project, slated to start in 2015, each nurse will carry a personal device. That means he or she can be alerted not just on the Innovation Unit, but anywhere in the hospital. In a bid to improve the patient experience, the system collects performance data showing the speed with which nurses respond to alerts, such as patient calls and bed exits, and whether they’re consistently washing their hands.

Managers know, however, that the statistics collected by the system must be interpreted in the right context. For example, a nurse helping a patient into a room, and supporting him with both hands, won’t be able to use a hand-wash pump.

Dr. Anne Snowdon, chair of the International Centre for Health Innovation, commented that change is not easy. “Technology is sometimes terrifying,” she said. “But thanks to the frontline staff here that have embraced it, we expect to see benefits for patients and their families.”

Dr. Snowdon added that, “Our job is to create the evidence to show the rest of the world how it’s done, what’s possible and what’s achievable.

“We’ll probably start with Ontario, though,” she quipped.