HUMANCARE campaign aims to improve patient experience

TORONTO – If you’re one of the nearly seven in 10 Canadians who believe our country’s health system is in need of an overhaul, it’s time to put on your imagination cap. After commissioning a survey that showed the majority of people feel there is room for improvement, Toronto’s St. Michael’s Foundation has launched a $1-billion-dollar, decade-long campaign to reinvent the patient experience, and the end result is expected to look very different from what we’re used to.

“Our vision is really, over 10 years, to design everything we do around the patient,” said St. Michael’s Foundation president Lili Litwin, in announcing HUMANCARE, a mission to “humanize” every aspect of healthcare.

What the Leger Canada survey showed is that even though 81 percent of Canadians surveyed are confident with the technical care they receive, 68 percent are unhappy with their overall healthcare experience, reporting they don’t feel “safe, comfortable, listened to, accepted or connected” as patients.

The results are worse for those experiencing marginalization, including those living with a disability, those belonging to the LGBTQ2+ community and those who identify as Black, Indigenous or People of Colour, who add that they also don’t feel respected.

“We already have a research facility called the MAP Centre with the largest number of scientists studying health equity and caring for those who are disadvantaged,” said Litwin, “so we were already in a position to look at the care experience, and this idea was really born through the leadership at the hospital.”

The goal of HUMANCARE is to help patients feel comfortable when they’re at their most vulnerable, connected to their care team and involved in decision-making, and confident that they are receiving the best care possible, no matter who they are or where they come from.

The new patient experience will include: easier access to care and shorter wait times; equitable care; seamless care that allows patients to flow through the system without needing to repeat information or travel to multiple locations; built spaces that are about wellness, not illness; health teams who treat patients as individuals, not categories; and, personalized care that reflects individual needs.

“We’re going to start with a centre for measurement, which has never been done before, and we’re going to measure the patient experience from the patient point of view,” added Litwin.

The movement includes the creation of a first-of-its-kind Care Experience Institute which aims to rethink healthcare design and delivery by challenging old ways and developing new, innovative approaches.

The institute’s 11 specialty centres – including Centres for Food as Medicine, Substance Use and Mental Health and Healthy Aging – will focus on developing new research, education and programs throughout all facets of the healthcare experience, supported by digital technology and analytics.

Instead of pigeonholing technological advances into an existing system, with a focus on bricks, mortar and machines, the idea is to always put the patient first and ask: How does this impact them and their loved ones?

“Right now, patients have to conform to hospital buildings, monitors and processes. Maybe we should shift our thinking and try to conform what we do and how we’re structured to what the patient wants,” explained Dr. Muhammad Mamdani, vice-president of Data Science and Advanced Analytics at Unity Health Toronto, whose team will be leveraging data and artificial intelligence to help form the reinvented patient experience.

For example, one of the biggest frustrations identified by patients is long ER wait times. Dr. Mamdani’s team is working to disrupt the entire experience, by applying advances like individualized wait times, virtual triage and wearable sensors.

Instead of waiting for eight hours in an uncomfortable waiting room not knowing when they might be seen, patients would be told their expected wait time based on their specific condition.

If the wait is lengthy, they’d be given the option to go home and return later, or to book a clinic appointment the following day. They might also be provided with wearable technology so that their heart rate, temperature or other vitals could be remotely monitored by an ER nurse while they wait at home.

Another option is to incorporate a virtual triage process, where patients are assessed by phone or video in the comfort of their own home, perhaps avoiding a trip to the hospital altogether.

The innovative approach will enable hospitals to “completely flip around” wait room designs, to create smaller, more comfortable, visually appealing spaces that both look good and feel good, said Dr. Mamdani.

“I don’t think it’s a matter of decades away. I think it’s a matter of a few years away,” he said, noting that the transformation requires tough problem solving but is not impossible. “It’s about rethinking that process of brick and mortar and having people wait on these uncomfortable chairs. How do we revise that? That’s what HUMANCARE is about.”

Another goal of HUMANCARE is to provide equitable care that takes into account each person’s life circumstances. One group of patients often disregarded or dismissed in the current health system are IV drug users who are at a high risk of mortality and yet typically don’t identify themselves for fear of being stigmatized.

Dr. Mamdani’s team is working on an AI algorithm that uses natural language processing to rapidly pore through clinical notes, lab values and other data to flag vulnerable patients, so that a highly skilled addictions team member can discreetly intervene.

“You can imagine a specialized team who really understands how important it is to be compassionate, courteous, to approach things in a much more sensitive manner,” said Dr. Mamdani. “If we can get the team to coordinate with the patients, it would be a much better experience for them.”

The four main pillars of change involved in HUMANCARE are Care, Research, Education and Digital Transformation (CRED), and advances in each area include: removing the need for travelling from appointment to appointment by providing one-stop care; extending the reach of world-class surgeons by using remote robotics to perform complex surgeries at community hospitals; replacing one-size-fits-all ventilators with smart units that can be customized for each patient to give them the best chance of recovery; using patients as teachers to help medical students better relate to the patient experience; and, offering food that is sustainable, and respects a patient’s culture, health conditions and dietary preferences.

Some achievements – like St. Michael’s innovative early warning system that is reducing mortality rates by 20 percent by automatically assessing 100 different variables in a patient’s chart every hour – are already implemented; others will be developed as the HUMANCARE movement evolves.

“I think the big difference is the leadership of our hospital. They are behind this 110 percent,” said Litwin. “We’re not just saying it. We’re measuring it, studying it, simulating it, practicing it and then we’re going to perfect it, measure it again and teach it … in 10 years, the care will be patient centred.”