A forced merger between two different organizations is not a typical predictor of major quality awards and top employer awards. Yet that is exactly the case for Trillium Health Centre. Trillium came about in 1998 as a result of the Government of Ontario merging Queensway General Hospital and Mississauga Hospital.

One of the largest community hospitals in Canada (and it retains the two locations), Trillium now serves over one million people in the Mississauga and West Toronto region and has achieved amazing successes:
• From 2001-2004 Trillium ranked as one of Canada’s Top 100 Employers.
• In 2004, Trillium was the first multi-site hospital in the world to receive ISO 14001 registration.
• In 2009, Trillium was inducted into the National Quality Institute’s Canadian Hall of Excellence.
• Trillium has earned awards in areas as diverse as innovations in patient safety, environmental leadership, and innovations in patient information technology

What lies behind Trillium’s achievement as one of the most rapid and successful hospital mergers in Ontario? Why didn’t animosity and resentment create an obstacle? Many credit CEO Ken White’s vision of the power of distributed leadership. “[Our] principles are based on the belief that people don’t just come for their day jobs, they come with leadership skills from other work they do outside the organization and a passion to make a difference.” Knowing that hospitals are typically hierarchical structures with clear authority relationships, the success of White’s “1001 Leaders” concept shows how much cultural change was part of the merger’s success.

Making Distributed Leadership a Reality

Trillium supported leadership initiatives through a comprehensive planning process. Staff development was undertaken to develop leadership skills through courses and opportunities for learning on-the-job. Trillium identified organizational and patient-centred projects, dedicated funds to the projects and offered formal secondments to front-line staff to put those projects into action. External experts mentored staff in improvement methods, and project management consultants introduced a systematic approach to planning, implementing and evaluating projects.
The non-nursing task force is an example. Nurse Karen Kallie and porter Lakis Faragitakis co-led the project team focused on how to address nurses’ frustrations with tasks that took them away from bedside care. The most frequent complaints were around searching for missing medications and equipment, searching for supplies, performing housekeeping activities, and preparing patients for transport. The task force’s aim was to design a service model that would enable nurses to work more effectively and enlarge the support staffs’ contributions to patient care. Using the model as a basis, environmental scans and performance metrics were completed and improvement ideas collected. Ideas that were achievable within the budget were fully implemented only after pilot testing first. One of these was for volunteer service teams to be assigned to dedicated units where they took on greeting and directing family members and distributed water to patients. Another led to pharmacy services installing a uniform bin system on all in-patient units to expedite medication drop-off and pick-up. Work was redistributed among nursing, portering and hospitality associates. The schedule for hospitality associates was altered to match peak in-patient admission times. The success of the service model underlying these changes led to its spread to other parts of the hospital and to further quality improvement initiatives. The project’s success also led to changes for the co-leaders. Kallie went on to coordinate a second care project and Faragitakis moved into a formal management leadership role.

The non-nursing task force was one of many projects led by front-line staff and undertaken to challenge traditional working practices and aim to achieve best practices. Another example is the fractured-hip best practice project. In less than a year, the project led to significant improvements in timely access to surgery, in pain management and in patient satisfaction. To achieve this, changes were implemented not just within specific units but across the system, requiring collaboration and trust. This was possible for a number of reasons. As with all other projects, the changes were evidence based, informed by process mapping, literature reviews, benchmarking and consultation with experts in the field. There was clear commitment from leadership that included resource dedication and the delegation of project leadership to frontline staff. The project was led by an interdisciplinary team comprised of a manager, physicians (including orthopaedic surgeons, anaesthesiologists and an internist), nurses, clinical educators, an occupational therapist, physiotherapist, dietician, pharmacist and other support members from information technology, health records and finance. All relevant stakeholders in the project were informed of the project’s activities at regular intervals, promoting engagement from the larger hospital community.