This presents a unique challenge to the staff and management of the 388-bed facility, which serves patients with rehabilitation, long-term and palliative-care needs.

President and CEO Norm Kasian says Riverview began evaluating ways to improve the clinical environment and the quality-of-life experience for patients, their families and staff members 16 years ago upon gaining autonomy from being a city-operated facility since 1911.

The solution was an organizational model called Patient-Focused Care. Instead of independent departments working in isolation, all care providers work in interdisciplinary patient care teams. Since being adopted, the model has touched every aspect of operations, from the design of buildings to how Riverview's 850-member staff is empowered to interact with patients.

"We're constantly trying to improve upon the model and deliver greater patient satisfaction," says Kasian. "This is not a start-to-finish process like building a car. It's something that will continue to evolve as we move forward."

Q: What led to the introduction of Patient-Focused Care at your facility?

A: Separating from the City of Winnipeg in 1993 set the stage for us to redevelop our complex inside and out. When we started the new design, it was also time for us to look at bringing in a new health-care model that included both the clinical and the people side of things. Patient-Focused Care breaks the traditional silo model because rather than having the health-care worker or the board at the centre of our focus, we put the patient at the centre. Then we designed the campus, staffed it and began operating it around the patient's needs. Riverview was the first hospital in Western Canada to adopt this philosophy and most hospitals have since moved toward this model. But it was considered to be revolutionary at the time.

Q: How did your organization have to be restructured to fit this new philosophy?

A: First of all, we were finding that both our patients and their families were becoming better educated, and therefore their expectations were changing. Thanks to the Internet, they were no longer willing to accept only what the health professional said was best for them. So we started working on a patient-care plan that was to become the core of the clinical side.

The other part of it was our people. Under the traditional structure, virtually all staff worked in silos and their allegiance tended to be to the department rather than to the patient. So we looked at ways to break this down. We developed the concept of a patient-focused team, which meant disbanding most of those silos, blending job descriptions, getting rid of department managers and bringing in a patient-care manager. We clustered like-patients within the complex and then built treatment teams around them based on the patients' needs. Of course, it all sounds so logical and simple now, but at the time, it was not a popular move to make.

Q: What new challenges did these changes create?

A: As well as Patient-Focused Care has been received here at Riverview, we still need to figure some things out. When you get blended positions, you also create gaps in the system and some things inadvertently fall by the wayside, so we are working to fix those ups and downs. Also, because of normal turnover and our changing resource base, we can't always spend as much time on education and re-education as we like. We had hoped that the new model would be self-perpetuating, but to be honest, without reminding people of it, some tend to fall back on the traditional way of doing things because that is how they were first taught.

Q: How has Patient-Focused Care affected the quality of life you offer to patients?

A: In many cases, the patients who come to Riverview will not get better, no matter what we do for them. So we do our best to provide an environment that enriches the quality of life as much as possible -- whether you're here for a week or for the remainder of your life. If you look around, I think we walk the walk. For instance, in our courtyard, we have tried to duplicate what people would enjoy seeing at home, whether it is the trees and landscaping, the children's playground, the fish pond or our many bird feeders. Through our foundation, we also put in almost a mile of sidewalks to encourage patients and staff to get out and enjoy the luxury of our beautiful campus.

Q: What type of quality of work life do you promote to your staff?

A: With the exception of management, virtually all our staff is unionized and their contracts are negotiated provincially. Because of this, we have taken a creative approach to the way we recruit and retain staff. We've worked hard to promote ourselves as an employer of choice based on the empowerment, the recognition and the support we give our people. More specifically, we designed an attractive campus with plenty of affordable parking, security and amenities such as a 24/7 staff-only health club. Through our foundation and generous donors, we have also created educational bursaries for staff and for their families if their children wish to go to college or university. That's been a roaring success. We are also proud of our numerous staff programs such as RBay, much like the eBay online auction. Hospitals always have surplus in their system, so instead of wasting it, we make it available to our people. They can log in to RBay and bid on items ranging from TVs and computers to clothes hampers and furniture.

Q: What role does technology play in your organizational culture?

A: I'm a great believer in technology and once again, this is an area where we walk the walk. We were the first health-care facility in Canada to bring in Vernacare, a safer, cleaner and more efficient human-waste disposal system that has allowed us to do away with reusable bedpans. We were the second facility in Manitoba to go to the PYXIS computerized drug dispensing system, which is like a giant vending machine that cuts down the risk of accidentally giving a patient the wrong medication if it does not match what they have been prescribed. We were also one of the first facilities in the province to move to Evergreen computer services. We could not keep up with the constant demand for new computer technology, so we started leasing our computers and every three years, we upgrade to new systems. It's another reason our staff like working here -- because they're working with the latest technology. It is part of my commitment to them to provide the best equipment that we can possibly afford.

Q: What is the most valuable leadership advice you have ever received?

A: When you're in a leadership position, the first rule is don't panic. Every day, there is a crisis of some kind, so if you can get your wits about you, (you can) take your time to work it out. In my younger days, I made some mistakes by jumping before truly looking, so I know how worthwhile it is to slow the process down, listen to every opinion and gather all the information you need before deciding on the solution. The other piece of advice I value and that I remind my staff of all the time is to never go in with only one option. If you've only got one plan, you're in trouble.

--With reporting by Barbara Chabai

John McFerran, PhD, CMC, F. CHRP, is founder and president of People First HR Services Ltd. For more information, visit www.peoplefirsthr.com.