In two weeks, a police escort will accompany a motorcade of ambulances from Women's College Hospital uptown to spacious Sunnybrook Hospital - in effect, ushering out an era of medical care in the city. Inside the vehicles will be the last babies to have been born at the downtown Toronto institution that for 99 years has been the mother's milk of maternal medicine.
If the babies hear a rumble while leaving the hospital it will probably be the wrecking ball knocking down the hospital's parking garage, clearing the way for the first stage of what will be a five-year, $460-million rebuilding project. The existing building is 75 years old and has plenty of wrinkles in its linoleum. The tight 1930s floor plan and cramped ward rooms of old will be replaced with a new, emphatically open layout.
As Women's College Hospital aggressively reinvents itself, supporters are looking forward to another pioneering epoch in health care, even if they have to convince skeptics that an approach called ambulatory care is the future of medicine.
Ambulatory care simply means treating patients on an outpatient basis. Everything from diagnosis to treatment will still take place at the new WCH, but overnight bags will not be welcome. The theory, gaining traction across the country, is that inpatient care is on the way out. WCH will put an emphasis on preventing and managing chronic diseases, not curing the acute conditions that fill beds in conventional hospitals.
The new approach rules out labour and delivery programs, but that might be appropriate as the hospital moves into its second century of providing female-oriented care. While women's health achieved a lot of prominence in Toronto during the 1990s, says Donna Stewart, chair of women's health at the University Health Network, it's no longer just about contractions and lactation. "There will be unique opportunities for Women's College to explore and expand into new areas of the still-young field of women's health," says Dr. Stewart.
In recent years, WCH has already been carving out a niche in women's care. It has North America's only cardiac prevention and rehabilitation program designed exclusively for women. It also became a leader in treating osteoarthritis, osteoporosis, and female diabetes.
Newborns and mothers aside, patients in other programs should notice little disruption, since the existing hospital won't be torn down until much of the adjacent new facility is ready to operate in mid-2013.
Being the first of its kind is nothing new to Women's College. It has always prided itself on independence - a quality not easily developed in health-care circles, where palliation and politics go hand in hand. With government as the purse holders standing between patients and providers, hospitals sometimes suffer.
Founded when female doctors were barred from studying at the University of Toronto, WHC's independent streak was originally far from voluntary. By the time the province tightened their funding amid a wave of hospital mergers in the 1990s, that independence was a source of pride for the hospital's administrators and its supporters, drawn from the latest generation of prominent Toronto women. With help from notables like journalist Michele Landsberg, Senator Nancy Ruth and lawyer Marilou McPhedran, Women's College resisted attempts by the Ontario government to merge it with other downtown hospitals, arguing that working with a larger hospital would threaten its unique mission of specializing in women's health.
Finally, in 1998, it entered a forced marriage with Sunnybrook Hospital. But the relationship was an uneasy one, as WCH's current president and chief executive officer Marilyn Emery explains. "Women's and men's health-care needs are fundamentally different. Their symptoms, treatments, diagnosis and prevention strategies are simply not the same and a dedicated facility for women's health was needed."
Faced with a conflict-prone management board, the province decided to grant a legal separation in 2006. Importantly, this was the same time that large amounts of money were being dispensed to both Mount Sinai and Sunnybrook hospitals for each facility to upgrade and expand their maternal-health units. Both hospitals started major renovations for labour and delivery care in 2008, with a combined price tag of $447-million. It's since been a topic of much speculation among scrub-clad medical professionals on hospital row that some or all of that money might have instead gone toward an even larger upgrade of Women's College, had it not been in the unstable position of splitting from Sunnybrook.
Nonetheless, work on the new hospital will start next week. And while it will offer no emergency or labour and delivery departments, it will count among its programs the new Centre for Ambulatory Care Education, Canada's first opportunity for teaching medical trainees how to care for outpatients in an actual outpatient hospital.
Despite its smaller size and the absence of acute-care programs, Ms. Emery says what is taking shape is "the type of hospital that keeps people out of hospitals." With a focused emphasis on outpatient care, Women's College Hospital might be building to help push medicine in a new direction, much as it did a century ago when it insisted women could be doctors.
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