November 14, 2008

Crafting a Cardiac Centre of Excellence

Dr. Alan Menkis was once one of the busiest heart transplant doctors in Canada. He assisted on the first artificial heart implant in the country, was a member of the surgical team that was among the first to introduce a pediatric heart transplant program and another that pioneered robotic heart surgery.

Menkis probably could have taken his celebrated skills and experience anywhere in the world, so he chose the place he believes will soon be the model for cardiac care excellence around the world - the Winnipeg Regional Health Authority's (WRHA) Cardiac Sciences Program.

"Responding to the Koshal Report, the Regional Health Authority committed to creating a cardiac sciences program comprised of cardiology, cardiac surgery, cardiac anaesthesia, cardiac critical care and cardiac rehabilitation, all under one umbrella with a separate budget, a designated cardiac intensive care unit and consolidation of most services at one hospital." says Menkis, Medical Director of the WRHA's Cardiac Sciences Program and its Medical Director of Cardiac Surgery. "That plan sets the stage for the development and delivery of a world class system of cardiac care in the province of Manitoba. The timing was right to come here. I am Canadian and wanted to stay in this country. Winnipeg afforded a great opportunity to build an exceptional cardiac team."

Menkis says the decision to centralize cardiac services contributes to patient care excellence because it promotes teamwork, better communication and good working relationships among the Cardiac Sciences staff. Improved communication is also vital for program's development including planning and quality research.

"Emphasizing teamwork is a real core value for what we're trying to do as a program," says Menkis. "Teamwork is absolutely essential to our success." Menkis's past experience in pilot training helped him see the analogy between the cockpit and the operating room.

"They were actually very similar - the interaction of people and technology to achieve a common goal," says Menkis, noting everyone, from physicians to support staff, have something to contribute to the team. "We work hard to empower team members to focus on the patient as the centre of activity, recognizing that we're all here to make sure the job gets done properly and safely - nothing less."

The program's $50 million program budget plus a multi-million capital investment, reflects the strong commitment from the WRHA, St. Boniface General Hospital and Research Foundation and the Province of Manitoba to realizing a true cardiac centre of excellence.

"The rapid pace of programs and development has been impressive by even the most demanding healthcare standards." says Menkis.

Strategic recruitment of some of the finest cardiac physicians in Canada has been a key element in the Cardiac Sciences Program development to date. Menkis notes the staff currently includes no less than three surgeons who are not only proficient in cardiac care but are also PhDs, offering a level of research expertise unparalleled anywhere else in the country. The Program's cardiac surgeons have trained at the best facilities in the world and have brought these highly specialized skills back to Winnipeg. A large contingent of dedicated, cardiac care nurses, under the guidance of Program Director Francis LaBossière, is also integral to quality care delivery.

Several of the program's cardiac anaesthetists are considered world leaders, proficient in pre- and post-operative care, but also bring expertise in sophisticated echocardiography, a procedure that involves the use of a sonar device that allows the surgical team to see the heart functioning in real time during an operation.

"These people are extremely well trained, have been doing this for many years and their combined expertise is a real asset that few other heart centres can boast," says Menkis.

The WRHA's cardiac anaesthesia team proved itself to be among the most progressive in Canada through the strides made in fast-tracking patients from surgery to post-surgical rehabilitation. Menkis says their expertise allows 65 to 80 per cent of their patients to come out of the operating room, not hooked up to a breathing machine, but sitting up and talking to the clinical team. Staff work together to have post-surgical patients sitting on the side of their beds just a few hours after surgery, walking down the hallway within 24 hours, and discharged from the hospital in about four to five days.

"All of this is rehabilitation and the whole program philosophy is really a wellness model," says Menkis. "Often after surgery, the patient's health is actually better than it was before, so why treat them like they are worse?"

The WRHA's Critical Care Program has a long, solid reputation for quality care and efficiency and the new cardiac critical care model has only strengthened that service. Nursing staff and attending staff physicians look after patients 24/7, 365 days a year, so patients can be assured their care is in the hands of the most experienced people in the system.

Menkis says the results of the consolidation are already encouraging, crystallizing the team's shared vision that the Cardiac Sciences Program in the Winnipeg health region will ultimately be the model that other jurisdictions will want to copy.

"I truly believe ours will be the best cardiac care program in the world," says Menkis. "And we're getting there - in leaps and bounds."

- Aspire, Winter 2008

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