“It’s our donors who bring us to the highest level,” says Dr. Marc Afilalo, Director of the ED at the Jewish General Hospital

Read the news and you’ll see that our healthcare system is facing many complex challenges and demands. In spite of this, the Emergency Department at the Jewish General Hospital (JGH) remains a symbol of excellence in patient care.

How has the JGH’s ED been able to achieve and maintain its high level of performance in the face of sometimes overwhelming challenges? There are three big reasons, according to Dr. Marc Afilalo, the Director of the ED since 1986.

“The high standard of care in the JGH’s Emergency Department is the result of both experienced leadership and community support in the form of donations to the JGH Foundation.”

First, he said, “The culture of our ED has been one of the main causes of our success for years. It is a culture of strong collaboration among all the different professionals and staff. Each has a role, but we work together. We refer to ourselves as a family and work together and help each other.”

The second reason for the ED’s success is research and innovation. “We measure everything,” said Dr. Afilalo. “From that, we find new and better ways to deliver care and incorporate them into our practice plan. We always look for ways to improve, and we do.”

The third key to high performance makes the first two possible – community support through donations to the JGH Foundation. “None of our accomplishments would be possible without the extremely generous support of donors to the Foundation,” said Dr. Afilalo.

“The hospital budget covers patient care, but just care,” he continued. “There is no budget for extra equipment, for research, for teaching or innovation. We only have those things if we get funds from other sources – from donors. Without the JGH Foundation, we wouldn’t be able to have designed and built one of the leading Emergency Departments in Quebec.”

Making use of technology with the Command Centre

Innovation is also seen in the hospital’s donor-funded Command Centre, which was developed during the COVID-19 pandemic to coordinate care among departments of the hospital and other facilities in the JGH’s healthcare network, the CIUSSS West-Central Montreal. Using real-time data and predictive software, the Command Centre provides a panoramic view of patient flow throughout the CIUSSS.

For example, when the ED had a sudden surge of mental health patients that overwhelmed its resources, the Command Centre found ways to move patients and allocate resources to ensure all were managed.

“The Command Centre is fantastic and provides enormous service to the whole hospital,” said Dr. Afilalo. “It’s the only one in Quebec that has reached that level of success. It’s major.”

Facing the current healthcare challenges

In many ways, the JGH’s ED is a victim of its own success. Because of its long-standing positive reputation, it attracts more patients from outside its immediate area than any hospital in Quebec. While most hospital EDs have 80-90 per cent of their patients coming from the hospital’s immediate proximity, Dr. Afilalo noted, only 42 per cent of JGH’s ED patients come from nearby and more than half, 58 per cent, come from outside the hospital’s official catchment area.

Furthermore, the population it serves is among the oldest in Quebec, resulting in its patients requiring longer and more complex care. “We see a lot of advanced cases of cancer, diabetes, heart disease, respiratory problems and more,” said Dr. Afilalo.

Is it too busy and does it struggle to keep up like every other hospital? Certainly, acknowledged Dr. Afilalo. This winter, the ED is facing new operational challenges due to three main causes that to a large degree are outside the hospital’s control.

“Using real-time data and predictive software, the Command Centre provides a panoramic view of patient flow throughout the CIUSSS.”

The first is that more patients arrive at the ED with advanced illnesses, often due to lack of care during the pandemic. The second is the healthcare staff shortage (though this issue is less acute at the JGH, which has a higher retention rate due to its policy against compulsory overtime for nursing staff). The third is a shortage of beds, which stems from staffing issues and hospital beds being occupied by patients waiting to go to other facilities, such as long-term care.

“It’s a perfect storm. Everything evolved in the wrong direction at the same time and it has created a crisis being faced across the health system,” Dr. Afilalo said.

Despite these serious challenges, the comparatively high standard of care in the JGH’s Emergency Department is the result of both experienced leadership and community support in the form of donations to the JGH Foundation.

Dr. Afilalo summed it up succinctly: “It’s our donors who bring us to the highest level.”

To make a donation to the Jewish General Hospital Foundation, please go to www.jghfoundation.org