Specialist Physicians Realize the Future Lives in Surrey
Mayor Dianne Watts talks to media outside the Jim Pattison Outpatient Care and Surgery Centre in Surrey on June 8, 2011.
If you talk to people who work in, or alongside, the healthcare industry, you will no doubt pick up a common theme related to physician resources — they are scarce and recruiting them is a veritable challenge. The situation is so serious that attracting specialist physicians is often identified as one of the major threats to success when opening a new hospital or adding additional beds to an existing facility.
It is precisely this contextual backdrop that makes what is happening in Surrey so intriguing.
Physicians are realizing that Surrey has the necessary ingredients to be one of the best places to practice the craft of medicine. Indeed, the historic trend that has seen Vancouver be the bigger draw when compared to communities such as Surrey is reversing as I write.
But, why Surrey? Quite simply, it is the patients. Canadians have made Surrey one of the fastest growing communities in Canada. The population growth has accelerated a healthcare infrastructure investment of over $750 million just in the last few years. Leading the way has been visionary Mayor Dianne Watts and her team, who are helping physicians, like many other Canadians, realize that, per the city slogan, “the future lives here.”
The specific appeal for physicians, in my opinion, is the combination of a unique patient population mix and the following characteristics:
1. A focus on culture
The major driving force bringing physicians to Surrey is the concerted effort to promote a new culture of healthcare innovation and excellence. A significant shift is now underway which is seeing Surrey positioning itself firmly among the traditional major players such as Vancouver General, St. Paul’s and Royal Columbian Hospitals.
This shift from its traditional role as a community hospital will see Surrey become a leading academic centre of excellence with enhanced research, academic and educational opportunities. This shift is attracting not only practicing physicians but also more and more physician learners who, once their training is completed, will plan to set up practice in Surrey.
2. The practice opportunities at the Pattison centre
Many physicians have been afforded the unique opportunity to practice in the Jim Pattison Outpatient Care and Surgery Centre, the first stand-alone dedicated outpatient facility of its kind in Western Canada. What is making physicians so enthusiastic about the Jim Pattison centre? Well like the name implies, only outpatients are seen.
Here physicians can focus directly on the patients at hand without the constant interruptions for emergency and urgent cases that comes when clinics are located within hospitals. This allows a cardiologist, radiologist, or orthopedic surgeon to be highly efficient in the delivery of their care. The design of the Jim Pattison centre was heavily influenced by LEAN methodology, which reduces the inefficiencies in patient flow and maximizes the effectiveness of care delivery. In short more order, less chaos.
3. The Surrey redevelopment and expansion project
A major redevelopment and expansion effort is underway in Surrey including the building of an eight-storey Critical Care Tower on the Surrey Hospital campus. This state of the art facility will add 120 beds to the Surrey campus including much-needed emergency department capacity as well as both adult and neonatal critical care beds. This development is bringing some of the latest technology, equipment and care models to Surrey and the physicians are anxiously awaiting the opening of this new facility.
With the population mix that it has, and the traits outlined above, it is no wonder that Surrey has managed to attract some of the best physicians to the city.
And this certainly bodes well for the future, as in my experience, once doctors begin to practice in Surrey, they often remain committed to the region for their career. With an opportunity to raise their kids in a thriving and vibrant community and to practice great medicine, why would they move?
So while many people from within and around the healthcare industry will make commentary about the challenges associated with securing quality physicians, it is refreshing to have a story like Surrey’s to brighten the picture ever so slightly.
Dr. Allan Holmes grew up in Surrey and has spent the last 20 years working within the Fraser Health Authority in a variety of capacities. Recently he served as the hospital medical co-ordinator of the Jim Pattison Outpatient Care and Surgery Center and his current role is the physician resource planning consultant for the Surrey Memorial Hospital Redevelopment and Expansion Project. Dr. Holmes is also the founder of Global Medical Services, a continuing medical education provider and regional distributor of automated external defibrillators.
Question: What is Physician Engagement?
Answer: A better means to draw from one of healthcare’s most highly trained and expensive resources.
Engaging a fluid pool of independent contracts is tricky task for even small organizations, so it is easy to understand why large health authorities who are appropriately dedicated to service delivery have a hard time including the perspective of physicians in its planning. Engaging any staff member, contracted or salaried takes time, energy and financial resources. This creates a natural tension in the decision making process on where to allocate healthcare resources: do we spend it on actual service delivery or on internal improvements?
The answer is simple, you spend it on both. However, the spending has to be done critically and effectively.
Physicians are critical members of health care delivery systems. They are well-educated, highly compensated, and adopt key decision-making roles on clinical teams. Unfortunately, they often also constitute a fluid pool of independent contractors that are rarely easily engaged in key planning projects. Without engagement of these key stakeholders, many health improvement projects face significant risk of unnecessary challenges and possible delays.
Unnecessary challenges and possible delays impact service delivery, which inevitably results in wasted healthcare resources. Front line healthcare professionals, including physicians need to provide that on the ground insight and feedback on the service delivery.
In our view, physician engagement is best led by physicians. In response, we have assembled a team of clinicians from a cross-section of specialties. They not only relate to the physician journey, but they also understand the physician mindset and appreciate how the doctor role fits within the overall care delivery system. Our physician leaders look to identify values and beliefs common to physicians and to the broader stakeholder group. From this foundation, specific mechanisms for, and the timing of, the engagement are identified. This approach ensures that physician teams are meaningfully engaged in a sustainable manner.
We’ve taken a classic stakeholder engagement mechanism and tailored it to get a better feedback loop for improved healthcare service delivery. Imagine a healthcare service built by a team, that includes the perspective of all key resource, who wouldn’t want that?
ICED Project Celebration
Last Wednesday, Fraser Health celebrated the successful launch of the Implantable Cardiac Electrical Devices (ICED) Project, a regional model to standardize the service and delivery of cardiac devices.
The ICED celebration brought together various stakeholders, such as sponsors, surgical and cardiac representatives and Fraser Health CEO Dr. Nigel Murray.
As a major contributor to the ICED project, Global president, Dr. Allan Holmes was on hand as Master of Ceremony. In his role as the Hospital Medical Coordinator, Dr. Holmes worked with the ICED project as a senior physician leader and liaison for the site. He also provided expertise into the management of adverse events and coordinated a specialized ACLS training program for the implanter group.
ICED celebration cake
The vision
To have the BEST Implantable Cardiac Electrical Devices program in Canada
What did we do?
Implemented a regional model for Implantable Cardiac Electrical Devices
Why did we do it?
- To enhance the quality of care provided to patients
- To maximize operational efficiencies in order to meet or exceed recognized wait time standards
- To standardize pre and post-procedure care in accordance with evidence informed practices
- To improve timely and equitable access to service
- To optimize existing capacity and provide for future growth
- To enable ongoing surveillance and monitoring of the ICED program
How did we do it?
- Consolidated from four sites (ERH, SMH, BH, RCH) to two regional sites (RCH & JPOCSC).
- Centralized referral/booking and patient triaging processes
- Standardized clinical practice support tools & inventory management processes
Learn more about the ICED Project
Implantable Cardiac Devices Standardized Throughout Fraser Health
Effective September 2012, a regional model to standardize the service and delivery of Implantable Cardiac Electrical Devices (ICED) has been implemented throughout the Fraser Health Authority (FHA).
The purpose of the ICED project is to improve inpatient and outpatient access to device implants and replacement.
The types of devices included are:
- Permanent pacemakers (PPM)
- Implantable cardioverter defibrillators (ICD)
- Cardiac resynchronization therapy (CRT) devices
In his role as Hospital Medical Coordinator for the Jim Pattison Outpatient Care and Surgery Centre (JPOCSC), Dr. Holmes (president of Global Medical Services) was involved with the ICED project by assisting and providing input into the project to the extent it impacted on physicians and/or service planning at the JPOCSC.
The team at Global Medical Services also contributed to revisions to the transport and admission protocols for the JPOCSC and other FHA facilities for patients receiving cardiac implants.
Presently, two hospitals have been designated as regional ICED sites:
- Royal Columbian Hospital (RCH) – PPM, ICD and CRT devices
- Jim Pattison Outpatient Care and Surgery Centre (JPOCSC) – PPM only
The development of the ICED project has led to a variety of new clinical practice tools with the standing goal of improving device implants and replacement:
- Regional referral form
- Pre and post-procedure pre-printed physician orders
- Inter-hospital transfer instructions and checklists, outpatient checklist and pamphlets
- Patient and Family Information booklets
Current pacemaker practices were refined to align with the new regional model, such as the exclusion of an anaesthesiologist during PPM implantation for certain patients who meet defined criteria.
In lieu of an anaesthesiologist there will be trained personnel present during the procedure dedicated to monitoring the patient. In the future, this practice change will allow for PPMs to be implanted in procedure rooms other than operating rooms; allowing for more versatile use.
Dr. Holmes and Global Medical Services applaud Fraser Heath for their excellent work developing the ICED project.
A Look at the New Critical Care Tower at Surrey Memorial Hospital
At Global Medical Services, we are very excited to see all the progress on the $512 million expansion and redevelopment project at Surrey Memorial Hospital.
The Critical Care Tower
The centerpiece of the expansion is an eight-storey Critical Care Tower, fully equipped with the following:
- New emergency department (five times larger than the current one)
- Dedicated neonatal centre (including 48 neonatal intensive care unit (NICU) beds)
- Teaching and research space
- Rooftop helipad
- More parking
- More beds
- 25 Intensive Care beds
- 25 beds for seriously ill patients in the High Acuity Unit
- Two medical floors of 25 beds each
- An expanded laboratory
Virtual Tour
Renovations to the existing hospital will complement the new tower. They include:
- Expanding the Family Birthing Unit and increasing number of single-family rooms in it
- An enlarged and renovated north entrance to the hospital
- Renovations to the kitchen so that it will have the capacity to handle the demands of the new tower
- Renovations to provide additional space to Sterile Processing & Supply
- Renovations to the Linens and Logistics areas to provide better work flow and increased capacity, and
- Other infrastructure upgrades that will benefit the entire campus
August 2012 Construction Images
With the help of our team at Global, the Surrey Memorial Hospital expansion will address capacity and efficiency, well into the future. At Global, we engage with this project by providing assistance in the area of clinical and non-clinical physician services.
We are excited to be taking this journey with Fraser Health and look forward to all the benefits the Critical Care Tower will provide once open.
Opening Dates:
Emergency Department: Fall 2013
Rest of Tower: Spring 2014
2012 National Health Leadership Conference
The NHCL
Earlier in June, Global’s president, Dr. Allan Holmes had the opportunity to present the physician engagement strategy that was successfully implemented at the Jim Pattison Outpatient Care and Surgery Centre (JPOCSC) at the 2012 National Health Leadership Conference (NHLC).
The NHLC brings together senior health administrators from across the country. This year the conference was held in Halifax and provided a chance for Dr. Holmes to re-visit the city he did his rotating internship 25 years ago.
The NHLC delivered a range of workshops, speeches and panel presentations throughout 30 themed sessions. Dr. Holmes’ delivered his physician engagement strategy during: Session 13: Engagement – Networks, partnerships and collaborative
From the NHLC: “This session will feature presentations on family physician networks in Nova Scotia, successful strategies in physician engagement at the Jim Pattison Outpatient Care and Surgery Centre and lessons learned from the BC Rural Collaborative governance framework.”
For a better understanding of the physician engagement strategy implemented at the JPOCSC, we have provided Dr. Holmes’ slideshow presentation.
Slideshow
For more information about the National Health Leadership Conference please visit their website: NHLC
Or view the conference program:
Breaking the Ice – Orienting Physicians to the Pattison Outpatient Centre
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New to Our JPOCSC Blog Series?
Read the preceding posts:
The Final Chapter
In the final posting in this series outlining our accomplishments at the Jim Pattison Outpatient Care and Surgery Centre in Surrey, we will highlight our work in organizing Education, Training and Orientation (ETO) for physicians to this new facility.
Prior to opening on June 1st 2011, there was a need for over 175 physicians to be educated on the various clinical services and features of the building, trained on existing and new Fraser Health processes and programs and, finally, oriented to the building. This need resulted in the development of an orientation program designed by physicians for physicians.
Physician Orientation
Through collaborative efforts with a Physician Orientation team at Fraser Health, Global assisted in developing the program, communicating with physicians, and conducting both group and individual orientation sessions prior to the opening of the facility.
The tour of the facility was led by Global employees acting as patients with different “appointments” to attend throughout the Centre. Not only did this provide physicians with a thorough induction to the different clinics within the Centre, it also served as a reminder of the “one-stop” function of the facility. Interspersed with the physical orientation of the building were training sessions on the new computer systems and health and safety policies applicable to the Centre, all conducted by Fraser Health staff.
The most rewarding part of this whole project? The fact that all of the 175 physicians attended an orientation session and that over 80% of them rated the clarity of the presentations, usefulness of the site tour and the hands-on computer training as “Good” or “Excellent”.
Evidently, orientation and training doesn’t always have to be boring, even when the sessions are lengthy! By being mindful of physicians’ time and interests, we were able to create a stimulating orientation program which was able to effectively inform and engage physicians.
JPOCSC 1-Year Anniversary Speech
On June 1st, Global’s president, Dr. Allan Holmes had the pleasure of delivering a speech to honour the 1-year anniversary of the Jim Pattison Outpatient Care and Surgery Centre (JPOCSC).
The event, hosted by the Surrey Memorial Hospital Foundation brought together individuals from throughout the Fraser Health network to celebrate the important milestone.
A transcription of Dr. Holmes’ speech
Snapshot
“It’s my honour to give you a snapshot of the life here during the past year.
We opened June 1st 2011 and up until the end of March 2012 we have seen 225,000 patients.
There are hundreds of people who have provided care to thousands of patients since we opened a year ago.
We have tried to create a vision that equals best practice clinical integration, great workplace.
Programs
I would like to share a few examples of the kind of programs, and the type of patients who are seen here.
Breast health
For instance, you’ll find on Level 2 our breast health clinic; where they have set an aggressive target of diagnosing breast cancer within three weeks, instead of the three months.
The women who come here can get their testing done in one day, instead of coming back during multiple appointments.
The program has seen more than 2,700 patients in the past year.
Pain Management
On the third floor, our pain management clinic sees close to 800 patients a month.
Patients like an ex-boxer from Langley who came to the clinic after breaking his wrist and struggling with pain that wasn’t going away.
Because of the care he’s receiving, he’s now able to do things again that others take from granted; like opening doors and holding a cup of coffee.
Urology
Our urology program includes a continence clinic on the 4th floor.
The caregivers there have helped hundreds of people improve their quality of life.
Patients like a retired Richmond RCMP corporal who was left incontinent after prostate surgery.
Some exercise and education helped him regain a sense of freedom he felt he had lost.
On a recent cruise, he was able to dance with his wife again without worrying about leakage.
Cardiac Services
Speaking of education, our Cardiac Services provide valuable information so patients who have suffered heart failure, or are at risk of a heart attack can help improve their own health, through self-management.
Primary Care Clinic
Another program here is our Primary Care Clinic, which helps patients who are discharged from Surrey Memorial but don’t have a family doctor to get follow-up care.
More than 3,300 patients have been connected with a primary care provider through this program.
Donors
Neurology services are an area that benefited greatly from the generosity of donors last year.
With the direct help of donors to the 100 Days to Give Campaign, Fraser Health recruited a new neurologist who has been working here ever since.
I could continue, but there are about fifty clinics and programs here.
I hope I have helped you get a feel for the role this facility plays in the lives of thousands of people.
Thank you for being a part of it.”
Fraser Health is the largest Health Authority in BC.
From Dr. Holmes’ speech you can get a true sense of the importance of the JPOCSC and of Fraser Health’s commitment to the residents of the Lower Mainland. In 1-year alone it has become a huge success and this is just the beginning.
At Global we are thrilled to have had the opportunity to work on the development of the JPOCSC.
Uniting the Team – Setting a Standard for Collaborative Work at the JPOCSC
New to the Jim Pattison Outpatient Care and Surgery Centre blog series? Check out the introductory post and part-1 of this series.
In the second posting in this series outlining our accomplishments at the Jim Pattison Outpatient Care and Surgery Centre (JPOCSC) in Surrey, we will highlight our work in establishing a framework for Fraser Health administration and physicians to work together in a way that embraces the Fraser Health vision of “Better health, best in health care”.
Many businesses and organizations, including our own, ask their employees and contractors to sign a document which outlines the standards and responsibilities of the stakeholders to ensure that all professional expectations are clearly understood by all concerned.
At the Pattison Outpatient Centre, there was an opportunity to port this concept to the healthcare world by creating a Statement of Expectations (SOE) between Fraser Health (FH) administration and physicians to ensure patient-centered care was at the forefront in this facility.
Working with the Physician Engagement Team within Fraser Health, Global helped to develop an SOE outlining the vision of the facility, expectations between physicians and FH administration, and guidelines for the practice of evidence-based patient care.
When the project was first initiated, 175 physicians scheduled to work at the new facility required privileging (and credentialing if new). The privileging process was amended to include two SOEs – an overarching SOE and a program-specific version unique to the JPOCSC. By August 2011, following several months of collaborative communication and dedication, all 175 physicians representing 25 medical programs at the JPOCSC had signed and agreed to the SOE, thereby demonstrating their commitment to the overall vision of patient-centered care at the JPOCSC.
From Global’s perspective, the successful development and implementation of a Statement of Expectations at the Pattison Outpatient Centre was a significant achievement and an exciting contribution to the vision and culture of the facility.
Prince George Fire Rescue – EMR Trial
On June 11th, 2012 our president at Global Medical Services, Dr. Allan Holmes spoke to the Prince George City Council to give an update on the Emergency Medical Response (EMR) trial currently underway with Prince George Fire Rescue (PGFR).
As the Medical Director for PGFR, Dr. Holmes was tasked with delivering a presentation summarizing the project to date.
View the presentation:
Summary from Prince George Fire Chief John Lane:
“The EMR Program has proven safe, cost effective, and has improved the emergency medical care provided to Prince George’s citizens. The results have been presented at a meeting of the Provincial Medical Leadership Council (PMLC) on May 10, 2012. The PMLC was urged to recommend to the Emergency and Health Services Commission (EHSC) that the Prince George EMR Program is made permanent, and that similar initiatives by other Fire Services in BC be approved. The PMLC was also urged to recommend the EHSC follow provincial regulation and EMA Licensing Branch policy compelling individuals to provide care at their license level at all times.”
Read the full staff report to Prince George City Council:
At Global we are thrilled to have the opportunity to have worked with John Lane and Prince George Fire Rescue in the development of the EMR trial. We truly hope this is just the beginning for pre-hospital care.
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