| Editor’s
Note: This interview with Dr. Arthur Porter, the Director General of
the McGill University Health Centre was initially published in MUHC Health
Perspectives: a publication of the MUHC Foundation. The development of
the Glen Campus and the redevelopment of the Montreal General Hospital
facility are of vital importance and interest to our community and city;
and I am pleased that by special arrangement with the MUHC Foundation,
we are able to present this interview to our readers. I believe that you
will find it interesting and informative. Dr. Porter had a successful experience
in a similar health centre redevelopment in Detroit, and he brings to Montreal
his knowledge and high level of energy and drive – important personal traits
for such a major project. |
"When
I was 9 years old
I
knew that I wanted a media career.
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Dr. Arthur Porter was named Director General
and CEO of the McGill University Health Centre (MUHC) March 2004. Since
then he has brought focus to the MUHC's redevelopment project and provided
it with a roadmap to a successful conclusion.
Q. On behalf of the MUHC Foundation, welcome
to Montreal. Your arrival coincides with a period of dramatic change to
the health-care network and to this institution. What are your thoughts
regarding the challenges and opportunities the MUHC is facing?
A. There is probably no better or more
exciting time to come to the MUHC than this. It is very rare to find a
situation like the one we have in Quebec at the moment, where all of the
natural paradigms of health care are being challenged, from networks to
academic enterprises to how hospital facilities are put together. This
gives us the unique opportunity to create what can truly be a new health-care
system based on the principles and practices of world-class patient care.
An important part of this system will be
what we are referring to as the redeveloped MUHC, which includes a refurbished
Montreal General and a new facility on the Glen site.
I want to emphasize as strongly as I can
that, even with a two-site plan, there is only one MUHC. This will be a
single facility on two sites. There won’t be one university part and one
non-university part or anything else that suggests two classes of service
or citizenry. Ultimately we will be able to say that we have a strong site
at the Montreal General and a strong site at the Glen Yards, and we have
an MUHC that expands across them all.
Now, some people have expressed anxieties
about how we will be able to deliver care on two sites. First, to the greatest
extent possible, entire services or program lines should not be split.
So for example on one site you would have an oncology program with radiation
therapy, chemotherapy and surgical oncology services all in one place.
And on another site you'd have trauma and all of the ancillary surgical
services that support it. The thing that you shouldn't do, and the situation
that to some extent exists at the moment, is to have bits and pieces of
these programs split up in different places.
Second, it is absolutely imperative to
have the input of physicians as you make these determinations. I think
one of our great assets at the MUHC is that we have tremendously knowledgeable
physicians who have a great interest in what goes where. I intend to listen
to those physicians and to use their expertise to delegate services in
the manner that will allow us to serve patients as well as we can.
Q. Are physicians and other professionals
and staff being brought into the planning process already?
A. Absolutely. For example, I've spent
the better part of my time here meeting with physicians to make sure that
they are involved-- integrally involved-- with the planning process. Whether
it's the elected physician bodies, the physician leadership such as department
chairs or simply individual doctors that have a large patient practice,
a long history with the organization and a commitment and desire to be
involved, I'm making sure that physicians' opinions and those of other
professionals and staff are being heard and acted upon as we move forward.
Q. Can you summarize the status of the
project and the redevelopment plans?
A. I think this can be summarized in terms
of six areas where we are making truly substantial steps forward.
First, and maybe most important, I want
to get started with the project as quickly as possible. Because I'm a terribly
impatient person, I'd like to see a shovel in the ground by the end of
the year. I don't know that this will be possible, but I will do everything
in my power to get started by year's end. (Editor’s Note: The Glen Yards
site clean-up has been completed.)
Second, we now have made an absolute commitment
to being on two sites. There is no question any more. I think in the last
little while there have been some lingering hope or desire from some people
that we would be on a single site, but that's off the table as far as I'm
concerned.
Third, and related to the first point,
is that not everything needs to be done at once on the site. I'm perfectly
happy with a phased-in approach, with a master plan that calls for certain
services or pavilions in place before others. This is a massive undertaking,
like building a health city. A phased-in approach is sensible, and might
allow us to be more responsive in our plans to changes in health-care over
the coming years.
Fourth, as I mentioned before, physicians
are heavily involved with the project, which is different from how things
have been done in the past and which they’ve been lobbying for actively.
Fifth, I think we have some other partners
who might look at sharing the site with us. There may not only be the MUHC
at the Glen, but also other institutions that will use the site in a sort
of condominium arrangement. For example, we will be working very hard over
the next few months to persuade the Shriners to stay. (Editor’s Note: The
Shriners have voted to stay in Montreal.)
Finally, we have created a strategic plan
that tells everyone, from the physician to the staff member working in
the laundry, what our goal is and how we will set out achieving it. One
of the things that has bothered me, I'll be very honest, has been the level
of uncertainty within the MUHC. This has included everything from whether
their job was secure to questions about the future of the Children's Hospital
to where an individual's office was going to be located. The strategic
plan will provide answers to these questions, will give us clarity, and
will give everyone a chance to get on board this train.
Q. How would you address concerns
that the new MUHC will have fewer patient beds than it does today?
A. It is interesting how people focus on
the numbers. From my perspective, far more important than the number of
beds is how they are managed medically; and how well they accommodate the
services for which they are required. The incredible increase in ambulatory
care in recent years has reduced the number of beds required by all health-care
institutions, as have strategies to manage the length of time patients
must stay in hospital by maximizing the efficiency of tests and other medical
resources.
In terms of the MUHC's redevelopment, I
want to emphasize that the Technical Review Committee didn't actually reduce
the total number of beds; they just suggested we move them around a bit.
At the end of the day we need to have the appropriate number of beds at
each site for the services we configure. And so, based on our calculations
and the government's, the way I plan on doing things is not starting with
an arbitrary number of beds and working backwards. We'll start with what
we have to do to provide the best care to our patients, how that optimally
can be organized, and then determine how any beds we need to achieve it.
Q. There has been a lot of debate about
the government's suggestion that the MUHC examine Public Private Partnerships
(PPPs). How do you see the role of PPPs in the MUHC's redevelopment plans?
A. As with many things, PPPs can be either
good or bad depending on how they're implemented. They can take many different
forms, from engaging a private company to take on the capital risk and
the risk in terms of construction times, to forming some kind of joint
venture with a clinical facility. This might mean engaging a private company
to run the laundry or the parking facilities. What people must understand,
however, is that we are not in any way looking at privatizing the delivery
of care at the MUHC. Patient care will always be delivered by us and controlled
by us.
What is crucial in the end is that we look
very carefully at why we are engaging in these partnerships, how they will
be organized, and whether or not they will enhance our ability to care
for patients. The government has floated this idea of PPPs and asked us
to consider it, but no decisions have been made and whatever we do will
be cautious, considered, and in the best interests of our patients.
Q. The Mulroney-Johnson Commission made
suggestions for the Centre hospitalier de l'Université de Montréal
(CHUM) that are quite different from what they recommended for the MUHC.
How do you see the relationship between the two institutions and their
redevelopment projects?
A. From my perception, health care has
no linguistic or geographic barriers. Our goal, and the goal of the CHUM,
is to provide the right health care to the citizenry of Montreal. In order
to do that, we need to work together to ensure that our projects are successful
in the long term, whether or not they start or finish at the same time.
I don't know that the timing of their project and ours should necessarily
be linked, as I think each institution needs to proceed in whatever way
works best for the community. We will continue to support the CHUM fully
and to work together on the complementarity initiatives that we need to
implement.
Q. Finally, when do you think we're going
to see the new MUHC up and running?
A. The MUHC is up and running. However,
its redevelopment is a major project that will take a long time to fully
complete. Once you have a project that is visibly underway, you will find
that everything runs more smoothly and that more and more people will get
excited about what the MUHC can become. And what that will end up being,
I cannot say because I cannot predict to any great extent what will be
the new innovations of health care in the next ten years. What I do know
is that they will be different from what they are today and we must plan
flexibility into our project.
In my specialty there has been a decoding
of the human genome. Every year there is an exponential increase in the
number of genes for cancer that are found. There were four two years ago;
there were 160 last year; there will be about 1,000 this year. Once you
have a rate of explosion like that; what about genetic therapy? We don't
have it in the plan, but it's going to be there because it's going to be
part of medicine. Our plan is flexible enough to meet our needs today and
to accommodate the future of health care.
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