In 1998, Ottawa underwent a merger of the Civic, General and Riverside hospitals. Normally, mergers and acquisitions of any kind in an organization can disrupt normal services provided, while the enterprise copes with change and levels itself out. But what happens when the organization facing a merger is responsible for people’s lives?

Chaos, or a level of it in some form, is commonplace to any hospital, whether it be Canadian or otherwise. But when lives are at stake, the most important thing is that caregivers in a healthcare situation are able to properly administer the care they were trained to provide. The Ottawa Hospital is a perfect example of how a difficult merger can be conducted successfully, and ultimately result in the changed face of an organization. Jack Kitts, M.D., MBA, FRCPC, and President and CEO of the Ottawa Hospital was kind enough to share with CBJ how the hospital has become a leader  in patient care – even after a chaotic merger.

A tumultuous time
The merger, which took place over the course of four years, involved the integration of 15,000 workers, a variety of different working cultures, and a multi-site, multi-language scenario – not an easy process to manage. Luckily, Dr. Kitts had extensive experience in the hospital and was ready to take on the mammoth task of reforming the vision and values of the hospital.

Dr. Kitts joined the hospital in July 1998, starting a post in the department of anaesthesia. When the opportunity for him to become head of the department came along, he was more than happy to take on the challenge. Dr. Kitts recalls the phases of the merger: “The first of the three phases of the merger was in 1998-2002 – those were the early chaotic days of the merger, the very stormy formation of what we now have as The Ottawa Hospital”. By 2002, the hospital began to come out of the depths of the forced merger. After a Canada-wide search, Dr. Kitts was asked to assume the role of CEO of the hospital. Though coming out of a hard time, Dr. Kitts says that “in retrospect, it was one of the easiest times to basically create a new vision and motivate the staff around it”. And of course, the key to the success of the hospital today is a direct result of the motivation of staff, and their rally around Dr. Kitts’ exceptional vision.

The vision…
“Initially when I was acting CEO there were 1000 things that needed to be done. However, I knew I need to focus and I decided to focus on the most important three aspects of creating the new version of the hospital” Dr. Kitts explains. He adds candidly that “over the course of my career, people have kidded me about the fact that I can’t do more than three things at once – but that’s become our guide – we don’t even do more than three things at a time”. What were Dr. Kitts’ first three initiatives? “I had it in my mind to make this place safe. The merger had increased concerns for patient care. We also wanted to make it clean and friendly, like your home, a place you’re proud to bring people to. The third thing we wanted to do was get the hospital’s finances and operations in order, and establish guiding directions.”

Of course, a vision can’t be executed without the support of all key players in an organization. For the hospital, that meant Dr. Kitts had to make sure that all hospital personnel understood the vision – that it was clear and the purpose was communicated. Reinventing the hospital meant identifying a core focus.
“We had to decide – were we going to be a large full-service community hospital, or a large multi-site academic science centre. If we became the first, we would disenfranchise all the academics, if we became an academic hospital we would disenfranchise all of the community” Dr. Kitts reflects. “It wasn’t an easy decision, but in the end, the right decision was to become a large academic health science center committed to patient care, and be a place where future health professionals would be trained and educated, and where leading edge health research would transform the health system. We wanted to become a nationally recognized academic health science centre where we would at least be recognized on a level playing field with our peers. More than anything – we wanted to be known as a value based organization.”

We’ve come a long way…
Many things have happened along the journey of The Ottawa Hospital, but there have been several milestone moments on the way, according to Dr. Kitts. “One of my most gratifying moments as a CEO was at our last accreditation where the surveyors from Accreditation Canada announced that after having interviews with our focus groups of community partners and patients they found both groups to unanimously believe strongly that our behaviours and relationships absolutely reflect our values” he recalls. 

Of course, it’s not all smooth sailing from here on in, though the hospital is years away from the initial insanity of the merger. There are many challenges that lie ahead for Dr. Kitts and his team. True to form, he groups them into three key areas: health human resources, capital investment, and the continued accountability and leadership of hospital physicians. “Everybody in the country knows there are doctor and nurse shortages. But I think that we can manage if we are innovative and change the service delivery model that will improve the quality of patient care. If we actually create inter-professional teams, where everyone practices to the full scope to their regulations and practice, we can deal with the shortage and provide at least as good, if not better patient care. I am less concerned about this shortage because I know we have strong medical nursing and other leadership and we will find a way to provide better care” Dr. Kitts reasons, with regards to personnel shortages.

“Clearly, everyone is aware that the health sector lags behind other sectors in terms of capital investment. But we need to encourage more information management. My concern is how we keep our eye on the ball, and use the full power of the knowledge we have in the hospital. This concerns patient care but also involves being able to invest in new capital, new buildings, state-of-the-art equipment and information technology.”

The future of The Ottawa Hospital’s culture
Dr. Kitts says that the hospital has set itself a lofty goal of becoming a top ten per cent performer in quality and safety care in North America. He says however, that “although it seems lofty, we need to remember that the Canadian health system is a top health system and I believe that the big academic centres can compete quite well with our American counterparts”.

As for the future? Dr. Kitts, with his tremendous hospital staff, plans to: “take us to a culture that is committed to quality and safety and being a top ten performer”. The plan is to “create a culture of service excellence, a culture that is driven by performance measurement – and engage our physicians in leadership and accountability. This hospital is one where each patient receives world class care, exceptional service and compassion and that’s what’s going to be our new vision as we move forward”.

If it’s possible to tell over the phone how passionate and proud someone is, Dr. Kitts’ commitment could be proved by his concluding thought: “I can’t tell you how proud I am of the frontline staff. I’m humbled when I walk around this hospital at the incredible professionalism with the patients that our staff provides. I would like to acknowledge and commend them for where the hospital is today.”

For more information on The Ottawa Hospital visit www.ottawahospital.on.ca.

The Ottawa Hospital 2008/09:
*    46,426 In-Patients (approximately 1200 beds)
*    126,850 Emergency Visits
*    48,903 Surgical Procedures
*    6,808 Births
*    938,209 Ambulatory Clinic Visits