Since November of last year, our research team has interviewed about 50 health system CEOs and industry leaders across Canada, Europe, Australia, and the Middle East to find the common ways they are capturing "systemness"—the ability for disparate business units to achieve collective benefits faster and more easily by working together (or consolidating) than each party can do on its own. In our next executive workshop on April 21 for members in Asia-Pacific, we'll share a short-list of tactics systems are taking advantage of to overcome long-standing barriers to collaboration and stakeholder engagement in their pursuit of systemness.
During our research, we tracked down one story from Canada that illustrates the gains made when organizations with competing service lines embrace collaboration; in essence, creating systemness between competitors to improve care for shared patient populations.
Pediatric bed closures during Covid-19 created the need for a regional, collaborative patient flow approach
SickKids is a pediatric teaching hospital and tertiary and quaternary referral center in Ontario's Greater Toronto Area, with about 291 beds occupied daily in 2019-20. In December 2020 and January 2021, pediatric inpatient wards at three hospitals in the region fully shut down and three others operated at half-capacity to increase capacity for adult Covid-19 patients. Thus, all pediatric patients from the affected hospitals had to be transferred or referred for inpatient care to SickKids.
As this was a stop-gap solution, SickKids convened a regional service line partnership with 15 nearby community hospitals to create a set of shared principles they could collectively use for community transfers during this, and any future, crisis period. At the onset of the partnership, about 20 operational leaders and directors of pediatric wards met weekly to design pathways and protocols for patients being transferred out of the closed sites. The partnership has grown considerably in size and scope since its inception. Currently, 30-50 pediatric medical chiefs, operational directors and managers across the region meet regularly to co-develop and co-design new care models for their shared patient population.
A daily bed reporting system underpins the partners' collective goals. Every morning, participating hospitals share whether their pediatric units are open or closed for transfer, the number of staffed pediatric beds available that day, and a contact number for transfers at each care site. The data is aggregated on Excel and displayed through a daily bed reporting graph that is shared with the partners. This enables data-driven decisions about where to allocate patients.
Better outcomes for patients and increased systemness between competitors
There have been two major patient flow 'outputs' from the forum thus far:
- Co-developed principles for community transfers: The hospitals created a document that outlines clinical, operational, and quality guidelines for transferring patients across the region. This document serves as the memorandum of understanding (MOU) for the partnership.
- A new regional pathway for patients with eating disorders: During the pandemic, SickKids saw a substantial increase in the number of patients presenting to its ED with eating disorders. Providers in the regional forum co-developed new pathways and patient flow guidelines for those patients, shared educational resources on new pathways and triage guidelines, and upskilled staff by virtually consulting with SickKids' psychiatric team. As a result, SickKids transferred over 35 patients with eating disorders to community hospitals, thereby increasing capacity for high-acuity, complex patients at its own hospital. The regional daily bed reporting system now includes figures on admission rates for patients with eating disorders.
In terms of service distribution, this partnership strikes the balance between interdependence and specialization. Because patients are redistributed based on acuity, this partnership enables all providers involved to deliver top-of-license care. SickKids transfers its low-acuity patients to community hospitals to create capacity for the neediest patients, and community hospitals can maintain their pediatric service lines in part due to the increased volumes. It is a win-win.
Notably, the partnership has improved trust and increased stakeholder engagement and collaboration between historically independent organizations—so much so that SickKids is now determining how to include community hospitals in its long-term strategic plans.
Julia Orkin, SickKids' medical officer for integrated community partnerships, told us in an interview that this level of collaboration is unprecedented, "This never would have been possible in the past … Covid-19 showed everyone that they all needed to work collaboratively to enhance care for our patients. We've never needed to rely on each other like this before."