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The C4 Team: Creating order in a crisis


Why they won
The CIUSSS COIM Command Centre (C4) Team was formed in December of 2020, during the second wave of the pandemic. The CIUSSS COIM was nominated by the Ministry of Health to be the designated pandemic center for Montreal’s COVID-19 patients. This greatly influenced bed flow and required significant coordination through the C4, which stands for Care Collaboration. Communication and Creation. More than two years later, the results of the C4 Team are hard to ignore.

The Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Ouest-de-l’Île-de-Montréal (CIUSSS COIM) is a healthcare network comprised of 35 institutions in West-Central Montreal, including the Jewish General Hospital (JGH), rehabilitation centers, long-term care sites, research facilities, and more. Currently, over 11,000 staff members and 750 doctors work at CIUSSS COIM.

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Tackling this formidable healthcare challenge with so many players from different institutions required high-efficiency, complex collaboration among the various institutions and departments within the network. The C4 team was formed with the goal of making this collaboration workable on an ongoing basis and giving patients the right care, in the right place, and at the right time. This interprofessional team is led by C4 medical director Dr. Shannon Fraser (who also serves as JGH Chief of general surgery) and is comprised of nursing representatives (André Poitras and Serge Cloutier), a group of allied health professionals (led by Mary Lattas), a patient flow manager (Carol Viegas), quality and performance directorate (Joanne Coté and Erin Cook), a command center coordinator (Suzette Chung), and the assistant executive director of the CIUSSS (Dan Gabay).

The innovative command centre is located inside the Jewish General Hospital. Within the Command centre, (and accessible remotely), the team has access to patient data and works with network physicians and the interdisciplinary team to efficiently transfer patients through the various stages of testing and care, from admission to discharge or home care. Communication is facilitated between the team through several “daily huddles,” hosted by C4, to connect with network staff in different departments, such as the emergency department, hospital wards, and alternate care sites. Microsoft Teams’ chat feature is used to stay up-to-date throughout each day.

The improvement in patient care for this initiative was measurable. In fact, the Quebec Ministry of Health recognized the C4 with a Minister of Health Fond de Soutien d’Innovation Santé et Services Sociaux grant to study the C4 model. One example of the C4 team’s work and success is the reduction of the JGH’s NSA (alternative level of care) patients. NSA patients are typically finished treatment and waiting to be discharged or moved to another facility. The C4 team made it their mission to reduce the wait time and the overall number of NSA patients in their system. They accomplished that goal, halving the number of NSA patients from approximately 67 (11.5% of our total acute care beds) in 2020 to approximately 45 (7.8% of our total acute care beds) in August 2021. These results are promising, suggesting that the C4 Team is charting a new course toward the future of Canadian healthcare, a future that must involve well-functioning interprofessional teams.

“One of the biggest challenges of creating C4, is also one of our proudest achievements,” said C4 medical director Dr. Shannon Fraser. “We have been able to develop and use powerful information tools to create a positive culture of shared accountability for our patients, and to each other, breaking down traditional service silos.  We truly try to provide Care Everywhere, for the right patient, at the right time, in the right place.”

Read: Awesome docs: The Medical Post Awards celebrate Canada’s physicians

What one judge said…
“All the interprofessional teams who were finalists are doing great projects but the C4 Command Centre project came out on top: It is affecting a very large group of people and showed very strong quantitative outcomes.”

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