Dealing with Uncertainty and Ambiguity in a Complex Project: The Case of Intravenous (IV) Pumps in a Healthcare Center
Authors: M. Aubry; M. Boulay-Bolduc; Marie-Claire Richer; M. Lavoie-Tremblay
Year: 2018

A University Hospital for the 21st Century In 2008, the Quebec government approved a CAD$2.3 billion budget to build a modern academic healthcare facility that would provide state-of-the-art, highly specialized healthcare services to the Montreal population and to a broader community of 1.7 million Quebecers scattered from Nunavik to the U.S. border. The new facility would house a great part but not all of the McGill University Health Center (MUHC) activities. The opening of the Glen site in 2015 was the conclusion of a multifaceted project involving hundreds of workers, over a period of close to eight years. The physical architecture conveyed only a glimpse of the complexity and magnitude of this redevelopment project, much of which resided ‘within its walls,’ where clinical teams from different hospitals needed to prepare to work together day one after the move. The programs and activities of the two larger general hospitals, the Royal Victoria and the Montreal General, had to be reconfigured and redeployed, which required many teams to merge and many clinical practices to be harmonized. In addition, throughout the organization, many major clinical and administrative processes had to be streamlined and optimized to meet the expectations set for the new MUHC. The physical move to the new Glen site of the MUHC took place between April and June of 2015 and represented the largest hospital move in Canadian history. A total of 273 patients were transferred, a very complex task. The Royal Victoria Hospital, the Montreal Children’s Hospital, and the Montreal Chest Institute sites closed down, while the reconfigured Montreal General Hospital, the NEURO, and the Lachine Hospital remained on their existing site. A Turning Point: The Creation of the Transition Support Office In preparation for this redevelopment project, MUHC executives visited hospitals in Europe and in the United States that had undergone similar redevelopment projects. What they learned was alarming: close to 50% of managers had resigned from their position in the months following the move. Testimonials pointed to a lack of dedicated resources to support clinicians and managers in preparing this major transformation. Typically the time needed to prepare for the transformation was scheduled very late in the process, as part of the move planning activities. This situation led to operational disruptions and disconnects, raising the level of stress and distress among clinical teams. In other words, bricks, mortar, and IS/IT considerations represented just the tip of an immense iceberg. First and foremost, the success of a redevelopment project would lie in preparing the people to transition seamlessly to a radically new work environment, while maintaining a high quality of care and uncompromised patient safety. It was with this in mind that the MUHC created the Transition Support Office (TSO) in 2008. This project management office was intended to support teams in harmonizing practices and processes across sites as well as to facilitate the merger and the move. The TSO had to act on the following three areas to facilitate the merger: