Human resources were key ingredients in building new smart hospital

VAUGHAN, ONT. – Mackenzie Health opened its second site, the Cortellucci Vaughan Hospital, north of Toronto, as a full-service hospital in June. The hospital, with capacity for up to 350 beds, has the ability to expand up to 550 beds, and it’s already one of the most technologically advanced medical centres in Canada.

Uniquely, it features a smart network that “anticipates” the needs of patients and clinicians. Other advanced technologies include real-time locating systems (RTLS) for equipment and people, and devices such as infusion pumps that are electronically connected to the patient record system.

However, while the network and hospital were powered up in an instant with the flip of a switch, the opening of this “smart” hospital actually required about a decade of thinking, testing and training.

“It all started in early 2010 and 2011, when we were challenged by fiscal issues,” said Mackenzie Health’s president and CEO Altaf Stationwala, who participated in a webinar about the launch of the hospital that was sponsored by GetWellNetwork, the company that supplied the bedside patient engagement system offering access to the Internet, patient records and images, education and entertainment.

“We started thinking about a redesign, and we relied on the ideas of our frontline staff.”

In the process, Stationwala explained, the hospital implemented a new electronic health record system – the Epic Health system – and became Canada’s first end-to-end Epic hospital, one with a full range of service. It also emerged as the country’s first full-service hospital with a HIMSS EMRAM Level 7 ranking, the highest on the EMRAM scale.

Throughout the webinar presentations, Stationwala and his colleagues, executive VP Richard Tam and CIO Dr. Aviv Gladman, emphasized that the support and active participation of staff and clinicians were crucial to the success of the creation of the modernization efforts – both at the existing hospital in Richmond Hill, Ont., and at the newly opened facility in nearby Vaughan.

“HR is the most precious commodity that we have,” said Stationwala.

But the staff had to become aware of the benefits of the re-engineering work; they would be required to do things in new and different ways, so they’d have to adjust their work habits and ways of thinking.

“It was all about our staff and change management, and how they understood the benefits of what we were doing,” he said.

Dr. Aviv Gladman, the hospital’s CIO and an ICU physician, observed that 10 years ago, when this process began, nobody knew what a “smart” hospital even was. “Even today, many can’t answer the question, and we’re still being asked, ‘what is the point?’”

He explained that the investment in smart technologies is all part of the quadruple aim of improving the patient experience, the provider experience, improving clinical outcomes and reducing overall costs.

Underlying this effort are several major building blocks, including a very robust network, effective electronic records, a unified communication system, and a real-time locating system.

“The RTLS is really an activity-based service,” he said. “It anticipates what someone is trying to do and anticipates problems before they happen.”

The system senses, for example, when clinicians enter and exit patient rooms. Their hand washing activities are monitored by the sensors at hand hygiene stations, and reports are created at each shift, serving to prompt them to wash their hands before and after touching patients.

We know, of course, that handwashing is the most basic foundation of good healthcare; the system assists with hand hygiene compliance.

On another front, the system will be able to detect when patients need pain medication, faster than before, so that it can be delivered more quickly to suffering patients.

These are all components of the “smart” hospital.

As well, virtual care has emerged as a major ingredient in the healthcare mix at Mackenzie Health, just as it is in other centres. The COVID-19 crisis had much to do with it.

Before the new site opened as a full-service hospital in June, it was operated as a COVID-19 hospital – starting in February 2021 – to help relieve the pressure on other hospitals. Over 500 patients were transferred from other hospitals during a four-month period.

During that time, Mackenzie Health operated a “virtual” COVID-19 clinic, enabling remote assessments of patients who might have contracted the novel coronavirus.

“This resulted in 850 prevented admissions and the savings of $8 million,” said Dr. Gladman.

The work with COVID-19 patients, and infection control, spurred a great deal of virtual care, with the hospital caring for patients in their own homes through the use of remote technologies.

“Virtual care had already started before COVID hit, but it accelerated because of the pandemic,” said Dr. Gladman. “We were well-positioned technologically, and our goal was a hospital without walls.”

Dr. Gladman said remote monitoring will continue after the pandemic ends. The new systems will be critical for this purpose: “We’re using workflow automation and rules to manage the patients, without relying on people,” he said. “Otherwise, it’s too much data to manage.”

Automated systems can monitor patients, sending alerts to doctors, nurses and other clinicians when human attention and intervention is needed.

He noted that some patients and visits don’t fit the virtual model, and in-person care is really needed. As well, video is not always required for virtual care. “Some patients want just a phone visit,” he said.

Richard Tam emphasized the need for testing and training when building a smart hospital. He noted that when the modernization effort began at Mackenzie Health, an “innovation unit” was created, consisting of an actual unit in Mackenzie Richmond Hill Hospital.

There, the new systems could be tested and modified. One smart solution, he recalled, consisted of software that would automatically handoff the care of patients between nurses as they ended and started shifts.

“They didn’t have to remember to give a phone to the next nurse on the shift,” Tam said. “The system would automatically re-route the calls to the new nurse’s phone.”

Another benefit of this system was unexpected. Without the overhead alerting system, there was less noise. “The patients and visitors noticed that it was calmer on the floor, and very quiet – unlike most other hospitals. That was an ‘aha’ moment.”

When talking about lessons learned in designing and building a smart hospital, Tam had some words of advice. First, he observed, a good deal of education must be done with patients and providers to get everyone on board. “We’re always anxious to get started with hardware and software, but it’s important to start here, with education and training.”

As another recommendation, Tam said that hospitals should be ready to pivot when necessary. “Like with cooking, you should have all of your ingredients at hand, so you can be agile about whatever comes up.” Things don’t always work out as envisioned, and components of various projects may have to be altered or tweaked – or even completely revamped – to work properly.

He said a real focus of both Mackenzie Health hospitals will be on eliminating “never events”, those events that should never take place to patients in a hospital – such as falls or surgical infections.

“That will be version 2.0 of the smart hospital,” he said. In jumping to this level, he said more intensive partnerships with vendor teams will be needed.

When it comes to vendor relations, and the healthcare system in general, Stationwala had his own advice. Not only has he been deeply involved in the planning and creation of smart systems at Mackenzie Health, but he has observed the activities of other hospitals and has advised many of them.

Just as hospitals rigorously assess vendors, he said that solution providers should be careful about diving into projects without assessing the readiness of the hospitals.

“Vendors should be vetting healthcare organizations to ensure they are ready and set up for success from a human resources and change management perspective. Without this foundation, we’ve seen implementation can be very challenging and more likely to fail,” Stationwala said.

For its part, Mackenzie Health conducted years of regular training and information sessions for staff, clinicians and patients. And it implemented the new electronic records system years before it embarked on the construction of a new hospital.

“We deployed the new EMR five years before building the new hospital,” said Stationwala. “We knew that we couldn’t do both projects at the same time.”