What happens when you make a 180 degree shift in your business model, moving from acute care to an ambulatory care model?

by Insigniam Read more from the Healthcare: Special issue

What happens when you make a 180 degree shift in your business model, moving from one of acute care to ambulatory care? Women’s College Hospital in Toronto, Ontario, Canada – with 130 years of service, specializing in healthcare for women – did just that, challenging traditional thinking at all levels of its organization about healthcare delivery. This radical shift was precipitated by a pre-arranged merger with two other healthcare institutions in 1998. Eight years later, administrators successfully negotiated with the government of Ontario to once again be a stand-alone organization.

“Part of the price that we paid for independence was a stipulation from the government of Ontario that we could operate only as an ambulatory facility,” says Marilyn Emery, president and chief executive officer of Women’s College Hospital. “We could have chosen to go down the mainstream route, but we chose instead to take a visionary approach, one more suited to where we felt healthcare is headed. While we continue to focus on advancing healthcare for women, we are aggressively addressing the transitions between acute-care and post-acute care.”

Why has Women’s College Hospital thrived in its pursuit of outpatient excellence? How has it succeeded when others are struggling? What does the future look like for the organization?

Emery credits a comprehensive 2 1⁄2 year strategic planning process guided by the hospital’s mission as the foundation upon which all programming has been built. The process was driven by the need to answer two questions — who is Women’s College Hospital and what did it provide to the community? The honest conversations that took place among key stakeholders, including board members, physicians, staff, and the community, provided a bridge between women’s healthcare and ambulatory care. A key driver was the provincial government’s interest in shifting people from inpatient care, the most expensive type of care, (tweet this!): to outpatient care through innovation that could ultimately result in people never being hospitalized in the first place. The strategic roadmap that emerged defined a clear vision and focused on identifying gaps and developing innovative services, not duplicating existing services.

To achieve its mission, the organization identified three specific areas of focus: health for women, health system solutions, and complex chronic conditions. These are supported by six innovation streams: driving systematic solutions in healthcare for women, preventing acute care admission and readmission, enabling superior coordinated care, transforming inpatient care models to outpatient care, enabling system integration and care transitions, and building a virtual hospital. Three corporate directives guide the hospital’s decision-making and action planning: drive the innovation agenda, strengthen the capacity to lead from its mandate, and grow its academic impact.

Emery says the senior team talks about the corporate directives daily. “It really is the culture of the organization. The directives enable close integration between research, clinical care and everything else that goes on in the organization,” she says.

Women’s College Hospital has been deliberate about designing outpatient programs to serve marginalized and underserved patients — a gap identified in its strategic plan. An example is the Toronto Birthing Center, a midwife run program located in a free-standing facility in a high-needs neighborhood. The center is designed to improve access for a variety of frequently underserved groups, including Aboriginal women, immigrant women, inner city women, women who identify as LGBTQ, refugees, teens, and the noninsured.

The hospital operates in an undefined space in healthcare, so it is difficult for people to grasp what it does. It is used as an incubator for the rest of Canada’s health system. The work it is doing has grabbed the attention of health leaders across Canada and around the world.

‘We are often contacted by other organizations interested in learning who we are, what we do, and how we do it,” says Emery. “We just hosted a group from Vietnam and our physicians and scientists are frequent speakers on the international scene. We’ve adapted concepts such as the virtual ward from the United Kingdom. A U.K. delegation visited our organization, studied the improvements we had made, and took our ideas back with them.”

Partnering with other healthcare providers and government agencies has been vital to Women’s College Hospital’s success. “We need the ability to refer patients to inpatient facilities,” says Emery. “When you’re looking to solve problems that are difficult for everyone, you need multiple perspectives and resources. We constantly ask other providers what we can do to help them meet the challenges and resolve the problems they are facing.”

Heather McPherson, Women’s College Hospital’s executive vice president of patient care and ambulatory innovation, says data related to patients’ expectation of ambulatory care has helped align physicians and staff with the hospital’s mission and strategic plan. Patients expect to wait around 20 minutes for service in an outpatient care setting. Benchmarking the organization’s actual performance against these expectations, as well as against the performance of peer organizations and incorporating patient feedback on their experience, has provided evidence to help the hospital improve.

“We can’t fall back on inpatient beds, so that’s created a tremendous opportunity for innovation,” explains Emery. “We have one of the biggest breast reconstruction surgical programs in Ontario. The average length of stay for this procedure is five to six days. Our interdisciplinary teams spent one year developing a care pathway that created higher quality care, increased patient satisfaction, and reduced the amount of time at the hospital to 18 hours.”

By adopting systematic innovations across their business model, Women’s College Hospital is a living embodiment of what’s on the horizon for the healthcare industry.

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