Listowel Memorial Hospital in Listowel, Ontario, Canada, recently added a new emergency room, as well as new ambulatory, surgical and diagnostic imaging departments.

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Through the formation of the Listowel Wingham Hospitals Alliance (LWHA), two healthcare providers have not only saved money and eliminated redundancies, but also now operate effectively with a single, common structure, CEO Margret Comack says. “We take the best-practice standards and use [them] across both sites,” she says.   

The alliance is the partnership of two acute care hospitals in the province of Ontario, Canada: Listowel Memorial Hospital in the town of Listowel; and Wingham and District Hospital in Wingham. “The primary goal of the two hospitals is to create sustainable and accessible services for both their communities by looking at ways to integrate and provide appropriate care as close to home as possible,” Comack says.   

LWHA was formed, she explains, after a movement began in the late 1990s to close Ontario’s smaller hospitals. At the time, closure of small hospitals was thought to be an effective cost saving initiative. “The [local] community got concerned about loss of their small hospitals, [and began looking] for ways to find some savings or efficiency,” she says. 

A decade ago, local hospital administrators began to look for ways to improve efficiency by working more closely together. This process resulted in a partnership that joined eight local hospitals, but “was too challenging,” she says. The operational savings of shared support services and common management structures were very effective, but the challenge of centralized governance/management to the local communities and their volunteer boards created a real fear of loss of control over their local hospital services.    

In the end, the Listowel and Wingham Hospitals formed a more effective two-site alliance in 2003. LWHA has only grown stronger out of the chaos of the eight-site partnership, Comack says. Although the two hospitals are individual corporations with their own boards and board members, “The boards meet [together] as one,” she says. “All the by laws, policies, procedures, clinical practices [and] standards are common across both sites.”   

In addition, the alliance allows both hospitals to share resources and clinical knowledge. “There have been very effective benefits to working together,” Comack asserts. Resources – both staff and good ideas – are shared between specialty areas and in a recent process redesign, the best practices from each site was adopted by the other site as a new hospital information system was built for both sites.

Staying Interesting
A nurse and veteran of healthcare management for nearly 40 years, Comack has worked at both hospitals for the past decade. She originally joined them as an administrator and says she has enjoyed her time in the healthcare field, particularly in this rural location.    

“It’s always interesting,” Comack says, noting that she has enjoyed working with board members to develop a stronger governance model for LWHA. “[I’ve] kept myself active in creating new projects and new ideas in the work that I do.”    

One current project is the redevelopment of the Listowel and Wingham sites, which have long served their local communities. Listowel was founded as a corporation in 1919, and the Wingham hospital was formed in 1906, Comack says.    

LWHA planned to make renovations at each hospital that will meet the needs of its growing area over the next two decades. Already, Comack reports, a $20 million project at Listowel has been completed. This was the first phase of redevelopment designed to rebuild the hospital on the existing site and saw the addition of a new emergency room, as well as new ambulatory, surgical and diagnostic imaging departments.   

Through this renovation, “We corrected problems with departmental adjacency, patient privacy, access to the building and patient flow as well as modernized [it] to more current standards,” she says. Wingham’s renovations are awaiting approval.   

Although Listowel’s renovations saw an initial expansion of the hospital, both hospitals will eventually be taken from a three-level structure to two stories. But through this reduction, “We’re actually creating better efficiencies and more effective use of space within current standards,” Comack asserts.   

“For example, we have multiple entranceways for patients to access the building,” she says, noting that this not only can jeopardize patient privacy, but also make maintaining security more difficult. With the renovation, Wingham will be reduced to one main entrance, which will be easier to manage.   

“We’ll have one major access [door] for people to come in [through],” she says. “That can be [easily] locked down for staff security at night.”  

LWHA is also at work on implementing a new hospital information system (HIS), Comack says. Both facilities will have electronic healthcare records in the near future and the new system will provide a link to the physician office systems, which are already automated through the support of the hospitals’ IT team. The new HIS will support the existing state-of-the-art Diagnostic Imaging Departments, which have been digital for more than five years. “[That] makes a tremendous difference in information management, communication and quality of care,” she says.

Looking Forward
Comack says she is proud of the team that LWHA has assembled, which includes Director of Planning and Support Services Bob Sangster. “Without his expertise and on the job supervision every day of the construction process, [the redevelopment project would not be] as successful as it has been,” she says, also praising the hospitals’ clinical leaders and chiefs of medical staff. “They’ve been very involved and highly supportive of all the work we do together.”   

Another key member is Chief Information Officer Brent Boschart. “[He is] very much the backbone of innovation in what we have accomplished,” Comack says.    

Boschart has demonstrated a very scientific approach to technology for decades, having designed a lab information system on his own nearly two decades ago. He also has the capability for understanding the clinical importance of information systems and the technical ability to build and interface LWHA’s systems along the way.    

At the moment, LWHA is coping with the challenge of managing declining revenues within its budgeting process, Comack says. To cope, “We are looking at ways to integrate further some of the services we have,” she says.   

She adds that the alliance is investigating a new governance model that would support further integration of services and staff for both hospital sites, Comack says. “[We could] secure sustainability of our services over a longer period of time by having a more consolidated approach to integrated services,” she says.    

This will assist LWHA in dealing with the challenges of recruitment and retention of health professionals in a rural area and to secure access to healthcare for its local communities, she explains.   

Additionally, LWHA may also soon add another facility adjacent to Listowel, on property that the hospital has purchased. “We’ve had a vision that we should have a campus model of healthcare for this community,” she says, noting that the Primary Care Centre would house the offices for physicians and the interdisciplinary group of Family Health Team staff.   

At the moment, “We have the architectural drawings and contract documents for this health center completed,” Comack reports, adding that LWHA is now working on the financial plan for the new facility.