OPTILAB: Can One Find Happiness in a Forced Merger Andre Dascal MD, FRCP, FIDSA Medical Director OPTILAB grappe Montréal CUSM (MUHC Cluster) “ I can think of no field that is more global in its professional practices yet more parochial in its administrative ones than health care.” Henry Mintzberg

OPTILAB is an MSSS Forced Merger In a national health care systems (NHS) change is often non-optional Evolution of health care expenditures is probably unsustainable In NHS clinical care funding will always “trump” teaching and research Population’s needs – should weigh heavily Teaching, innovation & research require adequate patient volume Question Does the present system work for the patient?

What is OPTILAB? Started in 2011 GRAPPE 1: Bas-Saint-Laurent – Gaspésie Établissements: CISSS du Bas-St-Laurent CISSS de la Gaspésie GRAPPE 2: Saguenay-Lac-Saint-Jean – Côte-Nord – Baie-James CIUSSS du Saguenay-Lac-St-Jean CISSS de la Côte-Nord CRSSS de la Baie-James GRAPPE 3: Capitale-Nationale CHU de Québec-Université Lava CIUSSS de la Capitale-Nationale Hôpital Jeffery Hale-St.Brigid's IUCPQ CISSS des Îles GRAPPE 4: Mauricie – Centre-du-Québec CIUSSS de la Mauricie-et-du-Centre-du-Québec GRAPPE 5: Estrie CIUSSS de l'Estrie-Centre hospitalier universitaire de Sherbrooke (CHUS) GRAPPE 8: Outaouais CISSS de l'Outaouais GRAPPE 9: Chaudière-Appalaches CISSS de Chaudière-Appalaches GRAPPE 10: Laval – Lanaudière – Laurentides CISSS de Laval CISSS de Lanaudière CISSS des Laurentides GRAPPE 11: Montérégie CISSS de la Montérégie-Est CISSS de la Montérégie-Ouest CISSS de la Montérégie-Centre What is OPTILAB? 9 of 11 Clusters Started in 2011 > 500 administrative distinct lab units in Quebec OPTILAB is intended to: Assure or improve on present quality and services Assure cost effectiveness 3-5 years (7-10 yrs.) project Network of 11 “Grappes” (Clusters) Each Grappe responsible and accountable as to quality of services, access, and cost effectiveness NOT novel concept in North America

One laboratory on multiple sites $ 99 M 850 Employees 120 MDs GRAPPE 7: Montréal - CUSM Laboratoire serveur CUSM (HGJ impliqué en pathologie et microbiologie) Centre universitaire de santé McGill (CUSM) Site Glen Hôpital général de Montréal Hôpital de Lachine CIUSSS du Centre-Ouest-de-l'Île-de-Montréal Hôpital général juif CIUSSS de l'Ouest-de-l'Île-de-Montréal Centre hospitalier de Saint Mary's Hôpital général du Lakeshore Hôpital de LaSalle CISSS de l'Abitibi-Témiscamingue Hôpital et CLSC de Val-d’Or CLSC de Senneterre Hôpital de Rouyn-Noranda Hôpital d’Amos Centre de soins de courte durée La Sarre (CSCD) Pavillon Sainte-Famille Point de service de Témiscaming-et-de-Kipawa Régie régionale de la santé et des services sociaux du Nunavik Centre de santé Inuulitsivik Centre de santé Tulattavik de l'Ungava Conseil cri de la santé et des services sociaux de la Baie James Hôpital de Chisasibi CMC Mistissini Most complex “Grappe” One laboratory on multiple sites $ 99 M 850 Employees 120 MDs Grappe Leadership accountable to PDG of MUHC (fiduciary) Academic strengths MNI omitted & correction requested Grappe 7: Montreal CUSM http://www.msss.gouv.qc.ca/professionnels/soins-et-services/optilab/montreal-cusm/

Why is it being created? Quality – e.g. breast cancer 2009 Technologists – penury Accreditation issues QUALITY Large amount of manual work Expensive high throughput technologies Expensive Genomic and Proteomic platforms COST EFFICIENCY PERTINENCE Tests of questionable value OptiLab Grappe MUHC – MOP, Novembre 2016

April 1, 2017 (Beginning of Transition) Fall 2016 announcement Cessation March 31, 2017 April 1, 2017 (Beginning of Transition) Single organization on multiple sites Employees Budget Equipment Space at other institutions ceded June 14, 2017 Creation of a single MUHC “Département clinique de médecine de laboratoire” – Laboratory MDs 3-5 years – “Consolidation work”

What are the top challenges for OPTILAB? Manage Quality across all sites – including accreditation Manage professionals’ (MDs, technologists, prescribing customers) fears, competitiveness and reorganization fatigue Combine different perceived cultures Respond to institutions’ needs, cultures, concerns and especially patients/ population Urban and distant sites Community and academic Mechanics: Information system, transport, test menus by site, budget, etc.…. The devil is in the details

Observations on Clinical Laboratory Medicine Institutions’ Clinical Laboratories Pre-OPTILAB Silos and silos within silos Some unhealthy competition within McGill RUIS (less than other areas) Generally, historically ignored by organizations (not as attractive as Cancer or Heart) Often perceived as a “cost center” Examples: Pathology (Site A), Transfusion medicine (Site B) Management - variable Innovation & Research – variable Foundations’ commitment generally weak compared to other programs MSSS OPTILAB Project Fast – short timeframes - (Emergent Strategy) or “Just do it” Nike prinicple MSSS - Top down (Modulation and adjustments often required) Encountered mostly goodwill and collaboration Foundations’ support

Setting: Population Served RUIS Population (million) % of QC Population Ref U de M 3.7 46 http://www.ruis.umontreal.ca/ McGill 1.8 (incl. 1.5 Abitibi) 22 http://www.mcgill.ca/ruis/ Laval 1.7 21 https://www.ulaval.ca/notre-universite/le-projet-sante/la-sante-ici-et-maintenant.html Sherbrooke 1.1 13 http://www.ruisherbrooke.ca/fileadmin/PDF/Bassin_de_desserte__Lecture_seule_.pdf Total 8,164,361 (5/10/2016) 102 ! Volumes McGill U of M U Laval Cardiac Surgery (‘16-’17) 1388 3472 2175 Radiotherapy (‘15-’16) 4138 6312 Hip Sx (Apr 1 – May 27, 2017) 175 295 Tertiary Hepatobiliary Sx + ++ Thoracic surgery http://wpp01.msss.gouv.qc.ca/appl/g74web/

Setting: Innovation Mentioned U of M mentioned - 7 times McGill mentioned - 2 times CHUM mentioned - 3 times Institut de cardiologie - once IRCM - once Could not find CUSM, Juif or Institut neurologique Pictures used CHUM 2 times Could not find any other hospital pictures

What can we learn ? Real competition not between McGill institutions OPTILAB probably easier to consolidate than other Similarities outweigh differences Vision and missions at each site were generally similar Harness competencies of all – no bias Navigating such a complex project Requires leadership/managerial full time commitment Sophisticated approach Bias: Leadership / management & academic skills may not coincide in one individual

What role should McGill's academic leaders play in the current context of healthcare reform in Quebec? Adapt or learn to adapt to Quebec NHS Embrace uncertainty We can be: IN and participate with an impact or OUT and be left out and considered “prima donnas” Optimizing clinical services will strengthen academic endeavors Size of population served - matters Learn from OPTILAB, learn from Kaiser Permanente, health care is changing

Opportunities for Impacts What are the potential impacts and opportunities of the OPTILAB on the Faculty of Medicine’s academic missions of teaching and research? Opportunities for Better care and it follows opportunity for better Innovation & Research Teaching Reference services - Reputation Learn what is required for a “regroupement” OPTIRAD (Radiology) and others likely to follow Impacts Increase partnership in clinical care delivery Educate staff and trainees on how to cope with uncertainty & change

Academic Department of Clinical Laboratory Medicine within the Faculty How should the Faculty of Medicine leadership facilitate and support OPTILAB in order to further the academic missions of teaching and research? Academic Department of Clinical Laboratory Medicine within the Faculty Promote the field - it’s a gold mine for innovation, research, & teaching Become an active partner in health care delivery by Rally point for “communityship” Educating and evaluative research on health care systems evolution

OPTILAB : Important challenge Difficult challenge Feasible challenge Too important to fail As for happiness we will see… Thank you Questions?