Trillium Health Centre Case Study
Trillium Health Centre Case Study
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.”1 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.
Janet Davidson, a former nurse who replaced Ken White as CEO in 2007, has continued to support Trillium’s culture of continuous quality improvements and grassroots involvement. For example, Trillium is currently participating in the Canadian Positive Deviance (PD) Project pilot involving six Canadian hospitals. Seeking to reduce the number of healthcare-related infections, Trillium has created a PD group to lead the project. It consists of four nurses, an infection-prevention and control employee, and a representative from the national support team. The team has held luncheon kick-offs and unit-based meetings about the project and will begin working with front-line staff in various units of the hospital for ideas on infection prevention and control.
1. Discuss typical reasons why employees resist change and how Trillium dealt with these.
2. Apply Lewin’s model to the Trillium change process
3. Explain how Trillium’s distributed leadership structure and projects could be seen as a team building organizational development (OD) initiative.
4. Discuss why Trillium has chosen to use internal change agents and the implications of this decision.
5. Choose one of the individual-focused techniques for organizational development intervention and discuss how it was implemented at Trillium.
1.The Trillium case shows an organization dealing with both planned and unplanned change.
2. Trillium is changing hospital practices through a series of quality improvement projects that continue since the merger in 1998. This is an example of a transformational change.
3. Because the change agents are internal, they will be seen by other employees as more neutral and less biased than external agents would have been perceived.
4. Trillium employees would have experienced stress during the merger, even if all the changes were desirable and implemented well.
5. Trillium employees’ perception of White’s fairness would have influenced their resistance to the distributed leadership concept.
6. The leadership training given to staff is an example of executive coaching.
7. According to research on personality and change, what would characterize the frontline-employees who were chosen or volunteered for change management roles at Trillium?
a. External locus of control
c. High risk tolerance
d. High uncertainty avoidance
8. There is no indication in the case of tremendous pushback from Trillium employees when the distributed leadership initiative was implemented. What does this indicate?
a. There was no resistance to the change.
b. Trillium managed the resistance that existed effectively.
c. Trillium’s distributed leadership was guaranteed to be a success.
d. Trillium must have had money that allowed them to buy people’s acceptance.
9. Which of the following Trillium employees would have been particularly keen to get information on how the change would affect them?
a. Those high in organizational identification
b. Those who do not have a close relationship with their supervisor or peers
c. Those in professional positions
d. Those who are in unionized roles
10. In each project at Trillium, changes are piloted and only implemented fully if the pilot is successful. This careful follow-up to changes is aligned with which aspect of Lewin’s change model?
11. According to Lewin, what actions by Trillium would be effective in the refreezing stage of the change to distributed leadership?
a. Rewarding successful implementation by project teams
b. Articulating and communicating the change vision
c. Educating employees about the need to change
d. Increasing forces to return to the status quo
12. Trillium’s change efforts are systematic, goal-oriented, grounded in research, and recognize the reciprocal relationship between individuals and organizations. What change approach operates under those same principles?
a. Lewin’s Change Model
b. Force Field Analysis
c. Change under external agents
d. Organizational Development
13. Interested Trillium employees were trained in project management. What OD technique would this fall under?
a. Job redesign
b. Process consultation
c. Diagnosis and needs analysis
d. Leadership training and development