February 10, 2016
Dear colleagues,
Communication has been slow in coming regarding the current situation at the MUHC, and I regret that some of
you have had to once again, learn about major developments through the media and hearsay. There is no way to
sugar coat this phase of our transformation, it is a profound and in some ways redefining moment for our hospital.
The move to the Glen was a hugely challenging undertaking, but it turns out that the new positioning of the
MUHC within a transforming health care network is as difficult, if not more so.
What is going on?
In a nutshell, the MUHC argued for a transition budget in 2015-2016, allowing our clinical teams time to balance
volumes of activities across our 4 sites, and adjust to the realities at the Glen. It was a prudent request in the
context of a massive transformation in the governance of all of its partners with the implementation of Bill 10 on
April 1st 2015. The difference between what the MUHC felt it needed for this transition year and what the
MSSS was prepared to fund was $ 50 million.
In November 2015 we were informed, in no uncertain terms, that only $18 million of this $50 million would be
recognized by the MSSS. The MSSS also immediately and retroactively insisted on a $32 million annualized
correction in spending at the MUHC. Several clinical and non-clinical areas are targeted by this $32 million
reduction plan but the one that you are probably hearing the most about is the accelerated alignment to our clinical
plan which translates into a $13 million compression on the inpatient units.
Why $ 13 million on the inpatient units?
The MSSS has decided to fund the new MUHC inpatient activities (Lachine excluded) according to a certain
number of patient-days (263 115 to be precise). These patient-days are allocated across all of our missions. The
cost per patient-day varies if you are in a med-surg bed, an ICU bed or a neonatology bed. This number of
patient-days translates to 832 beds at 85% occupancy; this is how the MSSS calculates the final implementation
of the 2007 clinical plan. The $13 million is the delta between what had been budgeted for 853 beds at 91% and
the allowed 832 at 85%. Budgeting at 85% occupancy has been a difficult concept to accept, and has been
vigorously debated with the MSSS. The MSSS has maintained its position and has informed us that all healthcare
institutions will soon be funded using a similar principle or a variation on the theme (activity based funding).
So how will this play out?
Your clinical mission leaders have been engaged in challenging discussions with the MUHC administration
looking at various scenarios to minimize impacts on patients. It has been a difficult exercise; communicating to
all of you in real time such a complex and rapidly evolving conversation, has been daunting and admittedly
inadequate. It has forced conversations about what it means to be a University teaching hospital in the
transformed Quebec landscape of CISSSs and CIUSSSs, and a centralized ministerial governance structure. It is
an emotional and soul-searching ask.
The bottom line is that in order to achieve our target we will need to operate at 799 beds across the MCH, RVH,
MGH and Neuro, with additional seasonal closures of several weeks across all sites during the summer,
Christmas-New Year’s holidays and spring break. Details of these should be discussed with you in your
departmental meetings. The plans put forth are being actively monitored by the MUHC Board and the MSSS.
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 How will we be able to mitigate the impacts of these bed closures?
Open emergency rooms, wait lists to manage, scheduled surgical activities to accommodate so that we can fulfill
our role as providers of complex care, are the issues that will challenge all of us as we move forward with a
smaller number of beds. In many areas we will need to collaborate with our network partners as never before
(and they will need to work with us like never before). Patient safety, quality of care as well as access to
investigation and treatment must not be affected; maintaining these core objectives will require close monitoring.
In some areas we already know that we need to do better, and this will be a further challenge.
Here are some of the measures being taken to mitigate the impacts:
1. A further decrease of our ambulances quotas (the RVH is already only receiving patients who need
to come to the RVH because they are followed there or have a problem that needs the expertise of
that site);
2. Concerted and refocused initiatives to improve internal processes around bed management
(admission, discharge, etc), patient trajectories at the MUHC;
3. An action plan with our network partners with the support of the MSSS to accelerate the trajectory
of our end of active care patients (I am fully aware that this is a hardy perennial that has yet to find
a sustainable solution, but this is a critical must in particular for the medicine and mental health
missions);
4. The actualization of geographic repatriation of patients to their local hospital (this was mandated in
May 2015, but not enforced given the massive reorganization caused by the implementation of Bill
10);
5. Optimization of the use of the beds added to the CIUSSS Centre-Sud (Verdun) and CIUSSS de l’Ouest
(Lakeshore) with the purpose of supporting the MUHC in its transformation.
So where do we go from here?
Realizing that these pressures are pushing us to accelerate the implementation of a clinical plan which may seem
dated, is frustrating and disconcerting for many of you. Our university teaching hospital is rich with talented
individuals, caring professionals and incredible interdisciplinary teams providing clinical care to our community.
The fact is, the MUHC will remain an essential and vital element of the Quebec Healthcare Network.
major teaching and research mandates built over years of dedicated work and commitment by all.

We have

I have no doubt that we will survive this difficult period, and emerge stronger and more focused. This is the
renewed CHU that the MSSS will support in the future, and we must excel at what only a University Teaching
Hospital can do. I don’t think that there is any other choice.
Regards,

Ewa. Sidorowicz, MDCM,FRCP(C), MSc
Associate Director General, Medical Affairs and
Director of Professional Services, MUHC
ES/jme