The need to enter the operating room

If you were to paint a picture of Humber River Hospital (HRH) back in 2014, it wasn’t pretty.

Patients constantly rotated in and out of the 549 beds spread across 3 hospital sites, as 600+ physicians struggled to manually write down patient data. As patients met with various physicians, they would have to recount their medical history repetitively, leaving a lot of room for human error.

It became clear that working on paper simply wasn’t working. Something had to change.

That’s where Dr. Laura Copeland comes in.

When Laura started, she had no team, no budget and no buy-in, giving her plenty of reasons to justify why a digital transformation initiative wouldn’t work.

Despite that, the hospital’s mission became the driving reason why a digital transformation had to work.

HRH’s driving mission is to reinvent patient care.

To do so in the Innovation Economy, doctors will require a very different skillset. Not only do they need to understand how to treat patients, but they’ll also need to leverage technology better. This will provide doctors with the necessary data to improve efficiency and quality in care.

At the onset, one thing became clear.

Reinventing patient care isn’t a one-time event – it’s an ongoing process.

Breaking down the surgery process

When medical professionals have spent years with paper as the status quo, the challenge becomes figuring out how to get them on board with using electronic systems. After all, implementing AI/robotic technology is often portrayed as a scary initiative that will displace jobs through automation. Driven by fear, employees are hesitant to accept change.

Using a psychology-based, change facilitation methodology that “leads people through the process of change,” Dr. Copeland broke down the digital transformation process by involving everyone around the surgery table. Knowing that she couldn’t do it alone, Laura recounts how HRH came together under that mission.

“Our team grew to include 3 Medical Informatics Specialists who were international medical graduates with degrees in eHealth. They were able to understand the physicians, their workflow and the technology they needed to adopt. They are the true heroes here! Their compassion and understanding for the doctors was the driving force behind the success.”

1. Co-create the change strategy

Instead of telling the organization what was going to happen (top-down management approach), the project started by asking doctors what key functions they were looking for (co-creation approach). By involving various people from the very beginning, employees became active participants in shaping change. Additionally, all physician committees were asked what they wanted in terms of communication method and frequency along the way.

For instance, an MD informatics group was formed to design the MEDITECH solution, Physician IT teams endorsed the solution, a cross-department medical advisory team approved the solution, and the board steered the organizational direction.

2. Training the hesitant ones into champions

“The culture at HRH certainly shifted to become a place where you could voice your weaknesses and fears without feeling afraid of what others would think.” Dr. Copeland commented. For instance, it was okay to acknowledge that you were typing-impaired. Staff had doctors self-report their levels of technology capability and coached them whenever they needed help.

Early on, the most unexpected champions were doctors who learned how to type on the job. By showing their peers that it wasn’t that hard, and even maybe fun, the HRH team was able to get buy-in from everyone. After all, if the digitally illiterate could learn it and become advocates, why couldn’t anyone else?

3. Rolling implementation in real-time

To avoid the pressure of a single go-live day, HRH did not go electronic immediately. Instead, people’s workflow was slowly changed 6 months prior to go-live, with a rolling implementation process throughout different sites. Whereas traditional training focuses on scheduled training workshops outside of your day-to-day activities, HRH encouraged trainers to roam the halls and train medical staff in real time in their workspace, practicing exactly how they play.

This spread-out approach relaxed tension because there wasn’t a single go-live D-Day – there were many. People had time to adopt to the new system so it wasn’t intimidating.

Out with the old, In with the robots

It’s hard to describe robots as harmful to the workplace when you can see firsthand how helpful they are.

To improve surgery outcomes, HRH implemented da Vinci Robotic Surgery, which use high end technology with little fingers to do minimally invasive surgeries. To decrease anxiety for children, Pepper the robot helps kids navigate the hospital and explains what to expect during their surgery. Pepper will even take selfies and dance if you want.

Humber River is also a shining example of IoT technology in action.

With Integrated Bedside Terminals (IBTs), patients can choose their meals from doctor-approved diets, teleconference their families, and even change the tint of glass in the window. Through IBTs, physicians can access electronic health records that consolidate all patient records and can submit physician orders in the EHR.  The drug request is electronically verified by a pharmacist. Upon approval, a pill picker machine selects the packaged pill, then delivers it through the hospital via a pneumatic system straight to the nurse/patient or via automatic guided vehicles (AGVs.)

Finally, to quickly communicate important medical information, there are electronic room sign monitors. In the past, nurses would put pieces of tape on laminated signs and attach them to the patients’ doors, but now various icons (that indicate allergies, fall-risk, infectious disease, etc.) automatically show up as patient information is updated in the system. Honestly, the new way seems much more sanitary.

Discharged one day, AI the next

As the Director of Medical Innovation & Transformation at HRH, Laura led 600+ physicians from a predominantly paper-based world into North America’s first Fully Digital Hospital. In the past 3 years, HRH has consolidated its 3 sites into a single hospital spanning 1.8M square feet, with the capability of serving 850,000 people in the Greater Toronto Area (GTA).

Remarkably, there are 0 inpatient progress notes on paper – 100% of inpatient physicians are entering orders through computerized provider order entry (CPOE). These numbers were reached upon go-live and sustained for 3 years and counting. Due to the digital transformation, HRH has been able to decrease both the average length of stay and re-admission rates.

What was accomplished was nothing short of extraordinary.

Despite a successful change, HRH isn’t done quite yet. Through the first of its kind AI-driven Clinical Command Center, which is currently in Phase I of 3, HRH will be able to better optimize the flow of patients through the hospital.

HRH team, thank you for being a great example of digital transformation in action. You’re leading the way by showing us that leading change with AI and robotics is not a single feat, but rather a daily journey of deliberate learning.

Jay Kiew