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Mississauga rising: Why health care here is better than in Toronto

Michelle DiEmanuele, president and CEO of Credit Valley Hospital and Trillium Health Centre, in one of the clinical training rooms at the health centre.

Fred Lum/The Globe and Mail

Live slow, die old … in Mississauga!

Doesn't quite have that bumper-sticker ring, but it could very well be the new branding strategy for the sixth-largest city in Canada.

While hospital row on University Avenue is justifiably famous, there's an outpost of high-quality health care in Mississauga: Credit Valley Hospital and Trillium Health Centre.

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This week, as part of Mississauga Rising – a month-long series that explores what Hogtown could learn from its westerly neighbour – The Globe and Mail considers why the largest 905 burg might be a smarter place to get chemotherapy, hip surgery or treatment following a stroke, despite the prevailing wisdom that Toronto offers the best health care in the country.

Through a landmark hospital-comparison tool developed this year by the Canadian Institute for Health Information, Credit Valley (which merged in December with Trillium Health Centre) ranks at the top of the pack among all 14 large community hospitals in the GTA (to clarify: the five teaching hospitals in Toronto, which see much higher patient loads, were rated in a different category).

Based on data from 2010 and 2011, the tool shows that a patient's odds of dying in hospital within 30 days following a stroke are much lower at Credit Valley, compared to the provincial and national average. The hospital also beat most of its counterparts when it came to low readmission rates in the 90 days after hip and knee replacement.

And the hospital's becoming a magnet for top talent. In September, it poached Dante Morra, revered internal-medicine specialist and the co-founder of the Centre for Innovation in Complex Care at the University Health Network. He's Credit Valley-Trillium's new chief of staff.

At the helm of the newly merged hospital is Michelle DiEmanuele, who left Toronto – and a range of top gigs – in 2008 to become Credit Valley's CEO. We caught up with her in her office.

You're a Toronto girl. Why are you here now?

For 20-plus years I had worked in Toronto and was very satisfied, very happy, great opportunities. Then the opportunity to run the Credit Valley Hospital came up, and, I have to say, there was a pause where I thought, "Would I really go out and work in Mississauga?"

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I was coming out to potentially run a hospital and you ask yourself, "Are we really going to have, in the community, the kind of opportunity to drive health-care change so we can improve services for patients outside the core of Toronto? Or do you have to be on University Avenue to be able to make change?" When I started looking at what was going on between the Trillium Health Centre and Credit Valley and our [Community Care Access Centre], what I saw was a group of very dedicated leaders trying to really create a new kind of health-care for the decades to come. And not doing the same thing the same way, getting the same solutions.

After last December's merger between Credit Valley Hospital and Trillium Health Centre, you were dealing with bigger patient loads, but also reported a $5.3-million surplus. Explain how that was possible.

We spent a great deal of time looking at every single service in the hospital against our strategy and ensuring that we were the best place that could be provided, and if we weren't the best place, then we needed to partner with others.

One example of that is some services we agreed to have transition to Erin Oak, which is a children's treatment centre. An excellent facility but they did some things better than we did. That allowed us to focus in on the kinds of things we did well.

When people are sick and they need a hospital, they come in through the emergency room. So really spending time on our wait times – which we can still do better on – but we've made improvement.

What is it that you think you do better?

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We take our strategy and we communicate what that means for the front-line health-care worker – that person touching the patient every single day. Every day across all our sites, every single part of our hospital huddles for 10 or 15 minutes on quality. They talk about what's going well, they talk about what they need to do better, they talk about what resources or changes in behaviour or policy or practice they need to engage in to be better.

When you think about the emergency department, our front doors, one of the important measures they huddle on every day has to do with the communication tool and they self-assess how they're doing in that area.

The last part is celebrating and rewarding that behaviour. We have shout-outs in the organization. I write five to 10 thank-you cards to staff every single week and every manager who works with me does that as well.

One of the biggest budget drains are patient readmissions. It's a strength of yours that patients aren't coming back. Can you tell me on a more micro level what is being done differently here?

We want to make sure that transition out of the hospital is very effective. If we're not sure, we're not discharging. [Other hospitals] may be more effective at some things on the front end, but if it means at the back end you don't get the right conclusion and it comes back in through the door, you have to ask yourself, are you moving too quickly here?

I think everybody knows that getting something right the first time is always a better process. We have spent a good deal of time with partnerships. Our social workers, our relationship with our CCAC, the follow-up calls, the follow-up clinics. We don't see care ending as you leave the hospital.

There are people in the GTA who go to downtown Toronto because they think that's where the best treatment is. How do you make the case that they can receive equivalent quality treatment here?

Until I was the CEO of this hospital, I didn't know we were running the best chemotherapy program in the province. We are running some of the best services in pediatric care, pediatric cancer care, cardiac care, neurosciences care. We're pretty humble out here. We don't probably share enough about our success beyond the city parameters. And so one of the things we certainly have done is try to link more with our community through our foundations to really be very proud and celebrate what we do well. As we start to take our newly merged hospital to where it can go next, I think people are going to be saying Hurontario is the new University Avenue.

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About the Author

Dakshana Bascaramurty is a national news reporter who writes about race and ethnicity. She won a 2013 National Newspaper Award in beat reporting for her coverage of changing demographics in the 905 region. Previously, she was a feature writer for Globe Life. More


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