Posted: May 1st, 2025

Case Study

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HEC075
Volume 12
Issue 1
March 2014
Implementation of a Hybrid Operating Room for Cardiac Surgery at
the Sainte-Justine University Hospital: Collaboration and Change
Management Challenges
Case 1, 2, 3 prepared by Ali FADIL, 4 Professor Céline BAREIL 5 and Isabelle DEMERS 6, 7
How do you prepare managers, cardiologists, cardiac surgeons, and their staff to quickly and
efficiently make changes to their practices? How do you get two medical teams – cardiac
catheterization (cardiologists) and surgical (cardiac surgeons) – accustomed to working separately,
to collaborate on a new intervention technique requiring their joint expertise? And how do you
preserve the credibility of a project after seven years of negotiations and changes to construction
scenarios? These are a few of the change management-related questions that will be addressed in
this case involving the implementation of a hybrid operating room for cardiac surgery at the SainteJustine University Hospital (CHU Sainte-Justine) to provide better, safer, and less invasive care to
children.
Sainte-Justine University Hospital (CHU Sainte-Justine)
The CHU Sainte-Justine is the largest mother and child hospital in Canada and one of the four
largest pediatric hospitals in America. Located in Montreal, Quebec, Canada, and affiliated with
1 Winner of the 2014 Best Case Award of the International Journal of Case Studies in Management.
2 Translation from French, by Debbie Blythe, of case #9 40 2014 001, “La mise en œuvre d’une salle hybride d’interventions
cardiaques au CHU Sainte-Justine : un défi de collaboration et de gestion du changement.”
3 This case was made possible by a research contract between the CHU Sainte-Justine (Sainte-Justine Management School) and the
Pôle santé of HEC Montréal (specifically, Professor Céline Bareil), as part of an action research project titled Une gestion
humaine, proactive et intégrée des projets de changement organisationnel – un projet de formation et de recherche-action au
CHU Sainte-Justine (The humane, proactive, and integrated management of organizational change projects – A learning and
action research project at the Sainte-Justine University Hospital) and thanks to the granting of a pedagogical development budget
by the Department of Management at HEC Montréal.
4 When this case was written, Ali Fadil was an M.Sc. management student.
5 Céline Bareil is an Associate Professor in the Department of Management at HEC Montréal.
6
Isabelle Demers is Director of the Bureau de la direction générale at CHU Sainte-Justine and, as Head of the Sainte-Justine
Management School, played a role in reviewing and approving the case.
7 This case was written from the perspective of change management. It therefore does not cover all aspects of the project to build
the hybrid operating room for cardiac surgery. We wish to thank all the participants (see Appendix 2) who kindly agreed to be
quoted as part of this teaching case study. They were chosen and individually interviewed because they were closely associated
with the project. We also wish to warmly thank Ms. Geneviève Parisien for her assistance in writing the case and preparing several
appendices. She served as project coordinator in the implementation of the hybrid operating room. The authors also wish to thank
several collaborators at HEC Montréal: Caroline Parent, research professional at the Pôle santé, and Amélie Mongrain and Sophie
Gagnon, then M.Sc. students in organizational development.
© HEC Montréal 2015
All rights reserved for all countries. Any translation or alteration in any form whatsoever is prohibited.
The International Journal of Case Studies in Management is published on-line (http://www.hec.ca/en/case_centre/ijcsm/), ISSN 1911-2599.
This case is intended to be used as the framework for an educational discussion and does not imply any judgement on the
administrative situation presented. Deposited under number 9 40 2014 001T with the HEC Montréal Case Centre, 3000, chemin de
la Côte-Sainte-Catherine, Montréal (Québec) H3T 2A7 Canada.
This document is authorized for use only by Shean Cain in DHA 801 Summer 2024 taught by ATUL GUPTA, Lynchburg College from Feb 2024 to Aug 2024.
For the exclusive use of S. Cain, 2024.
Implementation of a Hybrid Operating Room for Cardiac Surgery at the Sainte-Justine University Hospital: Collaboration…
Université de Montréal, it aims to improve the health – i.e., the physical, psychological, social and
moral equilibrium – of children, teenagers, and mothers in collaboration with its partners in the
health and social services network and the education and research communities.
In 2010-2011, the CHU Sainte-Justine had 5,309 employees, 523 doctors, 1,452 nurses, 950 health
professionals, 196 researchers, 300 volunteers, and almost 4,000 trainees and students in the health
disciplines. Of the almost 200,000 patients it saw each year, nearly 20,000 were hospitalized. At
that time, the hospital had 484 beds.
Characteristics of a Hybrid Cardiac Operating Room
A hybrid cardiac operating room is a revolutionary facility making it possible to combine cardiac
catheterization (associated with a catheterization lab) with cardiac surgery (associated with a
surgical suite) for a patient who remains in the same operating room (see the seven photographs in
Appendix 1). Rather than moving patients to different floors during the operation, the medical
teams move around the patient. With this change in procedure, the two medical teams work
together to improve the quality of the intervention and the performance of non-invasive procedures
while ensuring the patient’s safety by allowing for the possibility of surgical intervention if
necessary. Moreover, according to Dr. Poirier, cardiac surgeon, “the equipment emits up to 50%
less radiation, reducing the child’s risk of developing cancer over the long term. Combining
procedures also reduces mortality and especially morbidity among certain patients compared to
separate surgery and catheterization. Previously, the risk was heightened by the need for two
interventions and two anesthesias. Sometimes we would begin with surgery and then have to go to
catheterization.” Sonia Ménard, nurse team leader, cardiac surgery, adds, “Often, we would go up
[to the 6th floor] for emergency cases. We had to go up with the equipment to open the chest and
carry out the intervention. We never could have imagined it would be possible to operate with
cameras in the human heart.” In the hybrid room, if complications arise, the resources are already
in place to take immediate action. In short, before the inauguration of the hybrid room at the CHU
Sainte-Justine, the team would have to stop the intervention and move the child or baby to a
different floor so the other team could continue the intervention. They had to leave the operating
suite on the third floor and move up to the sixth floor for the catheterization, or vice versa.
Cardiac catheterization is a procedure carried out by cardiologists to correct cardiac anomalies in
a non-invasive way. Done under general anesthesia or with sedation, the intervention consists in
introducing probes, or catheters, into the arterial and/or venous circulation to explore the vessels
and the right or left chambers of the heart and correct malformations. This technique is carried out
using fluoroscopy, a type of medical imaging that shows a continuous X-ray image on a monitor,
allowing the cardiac catheterization technologist to observe the progress of the probe. The cardiac
catheterization team is composed of pediatric cardiologists, catheterization technologists, nurses,
anesthesiologists, and respiratory therapists.
The cardiac surgery team includes a cardiac surgeon, nurses, and perfusionists. The surgery is
invasive, opening the chest to carry out various forms of cardiac surgery such as coronary or heart
valve surgery, the implanting of a defibrillator, cardioplasty, valvuloplasty, or heart transplants.
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Implementation of a Hybrid Operating Room for Cardiac Surgery at the Sainte-Justine University Hospital: Collaboration…
Having the cardiology and cardiac surgery teams working together in the hybrid operating room
also meets the highest international standards for treating children hospitalized for heart problems.
The Difficult Beginnings of the Hybrid Operating Room Project
It was in 2002 that Dr. Joaquim Miró, pediatric cardiologist, proposed the creation of a hybrid
operating room for cardiac surgery at the CHU Sainte-Justine (see Appendix 2 for details about the
people interviewed for this case). Rather than simply replacing the old catheterization lab, Dr. Miró
believed that the future of medical technology lay in this daring, ambitious, and innovative project.
“As a university hospital, we have a responsibility to innovate and stay at the forefront of our field.
This type of intervention will become increasingly common in the next ten or twenty years,” he
explained. Dr. Côté, a pediatric cardiac anesthesiologist, added, “We attended conferences in the
field of pediatric cardiology, where we learned about these new medical technologies.” Although
both doctors were convinced of the merits of this innovative approach, combining catheterization
with cardiac surgery, they faced an uphill battle. Several major obstacles had to be surmounted
including finding the financing and the space for such an operating room in their already crowded
facility and convincing the medical teams to change their practices and work together.
The next few years (2003-2005) were devoted to the search for funding (see Appendix 3 for more
information about the project stages). Dr. Miró knocked on many doors to obtain the necessary
financing both from Quebec’s department of health and social services and donors to the CHU
Sainte-Justine Foundation. “The power of the physician is the power of conviction. That power is
enormous, since the doctor is often the only professional with the knowledge and expertise to carry
out such an innovative project,” he explained. “The search for funding took a long time,” recalls
Sonia Ménard, nurse team leader, cardiac surgery. “It was simply a question of money, nothing
more,” confirmed Dr. Côté.
During this period, many discussions took place. Various possible construction scenarios were
developed, placing the hybrid operating room on various floors and in different blocks. Dr. Miró
and Dr. Poirier were discouraged by the slow start: “It was frustrating to see the project stalled for
so long.”
In February 2006, a feasibility study of the layout of the room was finally tabled and approved.
The hybrid operating room would be located in the existing hospital building (rather than awaiting
the construction of new buildings as part of the Growing Up Healthy project). 1 This gave the green
light to a series of preliminary projects between fall 2006 and May 2008 in seven operating rooms
and four storage rooms. This work took two years, during which several people associated with the
project left and were replaced. Réjeanne Dubeau, coordinator of the cardiology section, who
1 The Grandir en santé (Growing Up Healthy) modernization project aims to provide the Sainte-Justine University Hospital (CHU
Sainte-Justine) with the facilities required to meet the needs of mothers and children, providing patients and their families, health
care professionals, students, teachers, and researchers with a living, hospitalization, and working environment that is both modern
and adapted to their needs while taking into account the impact on the environment and the community. The modernization project
has two components: the first involving the construction of new buildings (begun in 2012) and the second involving the
modernization of existing ones.
Visit the Web site: http://www.chu-sainte-justine.org/Apropos/page.aspx?id_page=5321&id_menu=5321; consulted in
June 2013.
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Implementation of a Hybrid Operating Room for Cardiac Surgery at the Sainte-Justine University Hospital: Collaboration…
arrived at the hospital in September 2008, recalls, “The project architects were constantly changing,
so the project kept changing, too.” She also remembers the comments made by staff members when
discussing the hybrid operating room: “People thought that some day it would finally happen …
some day!” She added, “When I first arrived at the CHU Sainte-Justine, very few people believed
in the project.” These doubts were no doubt well founded since her four predecessors had all taken
the same steps with no visible results. She summarized the progress of the project this way: “Plans
for the hybrid operating room were on the table for a long time. There were many delays, and that
worried me, especially since the situation became urgent in 2008 when the manufacturer of the
equipment in the cardiac catheterization lab stopped making spare parts. So if the equipment broke
down, the engineers would have to fix it themselves or manage somehow. The team knew that a
major breakdown would bring their work to a standstill.” Dr. Miró continued, “We were always
under pressure of various kinds. Everything we did was harder and more stressful since the old lab
was outdated.”
The Arrival of a New CEO and the Jumpstarting of the Project
In January 2009, the CHU Sainte-Justine welcomed a new CEO. Dr. Fabrice Brunet is a medical
doctor specialized in cardiology, resuscitation, emergency medicine, and hospital management.
Before his arrival, he participated in the development of a clinical research centre in Paris, a
hospital project in Saint Petersburg, Russia, and a resuscitation and intensive care unit in Toronto.
Two months after his appointment, Dr. Brunet took charge of the hybrid operating room project.
He brought together the key players and administrators (doctors and coordinators of the
departments involved) and asked that work be speeded up: “In eighteen months, the hybrid
operating room was done!” Dr. Poirier remembers that meeting very well: “I’ve never seen a
meeting like it! The doors were closed and he [Dr. Brunet] said, ‘We’re not leaving here until we
have a date and an action plan.’” A new construction scenario was agreed upon: 64 weeks instead
of the original 84, discontinuing work begun on the second floor. The new hybrid operating room
would be on the third floor, where the surgical suite (block 9) was already located – but not at the
end (which would have slowed things down), but rather at the entrance, near the elevators,
providing easier access to families and patients. It would incorporate a cardiac catheterization lab,
which had previously been located in the offices of the cardiology clinic on the sixth floor of
block 9. Dr. Poirier added, “It was perfect; very surgical… We just needed a deadline, and it was
met. That’s what got things moving.”
Dr. Brunet explained why, in his opinion, the hybrid operating room project had been stalled for
seven years: “Here [at the CHU Sainte-Justine], we never got past the planning stage. We kept
trying to improve projects and waited until they were perfect before we could begin. Our intentions
were good – it was part of our culture of excellence. But, as a result, we never managed to complete
projects.” He then explained why it was important for him to start completing projects as soon as
he took up his new position: “I had to successfully complete all the projects; that one [the hybrid
operating room] was one of the first. I had to transform intelligent, worthwhile projects into
achievements, so as to help take not only the organization and its patient care forward, but also the
credibility of the organizational transformation at the CHU Sainte-Justine.”
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Implementation of a Hybrid Operating Room for Cardiac Surgery at the Sainte-Justine University Hospital: Collaboration…
Dr. Brunet therefore addressed the major stumbling block that had hindered the project’s
implementation for years, and the hybrid operating room became an organizational priority.
Geneviève Parisien, project coordinator and manager of the Project office, explained the strategic
importance of prioritizing changes: “A project must be positioned at the organizational level by
gaining the support of the directors who are investing resources. Such prioritization makes it clear
to staff why they should devote more time to project A than to project B.”
Throughout the process of implementing the hybrid operating room, Dr. Brunet was adamant that
the project be completed quickly: “It will be here, and it will begin at this time, and it will be
finished at this time. And that’s all there is to it! The hybrid operating room will be completed in
October 2010!” Réjeanne Dubeau got the same feedback from her team about Dr. Brunet’s
assertions. She continued, “The involvement of the CEO was appreciated by the teams, which
spread the word. The support they felt from the CEO eased the transition period. The staff soon got
the message: ‘He’s involved. He wants things to change, and he wants this to be done. He is with
us.’” Philippe Willame, assistant to the coordinator of the surgical suite, agreed: “The CEO arrived
at work very early in the morning; I didn’t see him, but the night nurse told me.” This visible
involvement was deliberate on Dr. Brunet’s part: “At the time, I had to be more present… to support
the projects – whereas today… the leadership is shared and… change management is more the
responsibility of the directors,” he explained.
At about that time, Dr. Brunet finally obtained the missing financing from philanthropic
organizations. He insisted that the project be carried out as planned, without further changes.
Despite repeated requests, he stuck to his guns: “The changes would have entailed additional
equipment and costs, stalling things again. I said, ‘A project is a project. What you are suggesting
is a different project, and we’ll do it later on.’ Improvements take time and money. We didn’t have
the necessary budgets. The more you delay and the more you improve, the less you accomplish.”
After that, things began to move quickly, with construction work on the surgical suite continuing
according to the new one-year plan. In 2009-2010, the construction and relocation work
preliminary to the implementation of the hybrid operating room was completed: four administrative
offices were moved and waiting rooms for parents and patients, a central reception desk, a surgery
admission office, a dictation room for updating medical records, an x-ray room, and a postanesthesia care unit were built and furnished.
The final year: A Tactical committee to manage the change
In March 2010, when construction of the hybrid operating room was begun, a Tactical committee
was formed at the request of Réjeanne Dubeau. Until then, Dubeau had done her best to support
her team since the hybrid operating room project was in her sector, cardiology, but she felt she
needed help coordinating the new work organization, the training, and the move. The mandate of
the Tactical committee was to coordinate the work of the various players (managers, cardiologists,
cardiac surgeons, anesthesiologists, nurses, technologists) along with that of other support sectors
(technical services, biomedical engineering, communications) involved in implementing the new
activities and practices required by the hybrid operating room.
Headed and supported by the project coordinator from the Project office, the Tactical committee
was composed of the coordinators of the two sectors involved (cardiology and cardiac surgery),
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Implementation of a Hybrid Operating Room for Cardiac Surgery at the Sainte-Justine University Hospital: Collaboration…
the engineer in charge of the construction project, the head of the biomedical engineering
department, two representatives of technical services, a representative of the communications
department, the transition director of the Growing Up Healthy project, and two project management
trainees (see Appendix 4). The medical specialists involved and other players were invited to attend
meetings as necessary. Geneviève Parisien was responsible for choosing the members of this closeknit team. “It was quite easy to determine who should be on the Tactical committee,” she explained.
Philippe Willame and Monique Trachy, who were closely involved with the construction work on
the third floor (surgical suite), were relieved by the creation of this new project structure since it
meant they were no longer solely responsible for organizing meetings and communicating with the
cardiac surgery team. “This is great – we need a Tactical committee to bring the two teams
together!” Monique told her assistant when she heard the news. Because of the location of the
work, Trachy had been solely responsible for overseeing the project since August 2005. She would
now share this responsibility with Réjeanne Dubeau, who represented the cardiac catheterization
team and who, until then, had not participated with the cardiac surgery team.
For the previous year, since the launch of construction, the Construction site committee had held
weekly Wednesday morning meetings. “The Tactical Committee’s schedule was adjusted
accordingly so that it met right after the Construction site committee,” Trachy explained. That way,
the construction project manager and the coordinator of the surgical suite could provide accurate
updates of the progress of construction to help the Tactical committee plan and manage the
project’s impact. Having up-to-date information facilitated the making of just-in-time decisions.
As owner of the project and a future user of the hybrid operating room, Dr. Miró nevertheless
regretted that those meetings were held at 1 p.m. on Wednesday afternoons – when he was busy
meeting with patients. Although he had followed the progress of the project from the beginning,
he was able to attend just one in every four meetings. “It was paradoxical and contradictory to the
true goal of this project, which was to build what was essentially a clinical tool.” For her part,
Dr. Côté voluntarily attended some meetings, where she finally got answers to some of her
questions. “They didn’t go out of their way to include people in the project. It was ‘managed’ in
the offices, but the others were given sufficient information so they could live with that,” she
concluded. Dubeau added, “It’s better to have a small group that works well together. The meetings
lasted for an hour, and they were efficient. There was no time to waste; the meeting agendas closely
followed the progress of the project as the committee members tackled the various difficulties
encountered.”
Martin Cyr explained that, with the Growing Up Healthy project, where many organizational
changes were happening at the same time, “a project management culture began to emerge at the
CHU Sainte-Justine. It became an organizational issue. Before, it was more informal. Now, we are
fine-tuning our approach and our tools.” He admitted that, when he was first invited to join the
Tactical committee, he was skeptical. In the beginning, he saw the project as simply a matter of
construction and training in a new technology. While attending the meetings of the Tactical
committee, he observed the magnitude of the changes involved and their impact on staff and
patients. He discovered the organizational challenges of this multidisciplinary project, which
proved to be far more complex than he had first imagined.
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Implementation of a Hybrid Operating Room for Cardiac Surgery at the Sainte-Justine University Hospital: Collaboration…
Personal and organizational impacts and process mapping
The end of construction work in July 2010 marked the beginning of the next step in the project and
change management process. The Tactical committee faced major organizational challenges with
significant impacts on the medical personnel involved. “The budgets were huge, but significant
personal involvement was also required. We wanted to be sure we considered every possibility and
didn’t miss anything when designing this room. It was really a huge project!” explained Dr. Poirier,
who attended some of the meetings. In the course of the project, the teams realized they would
have to review all the procedures connected with patient admission, the changing rooms, the
reception desk, the patient waiting room, and the classroom. 1 The teams would also have to plan
the management of computerized data, the transfer of clerical activities related to pre-admission,
and the relocation of equipment and offices. To ensure the two teams (cardiac catheterization and
surgical) could work well together, both ergonomically and harmoniously, it was also necessary to
consider the organization of work, the architecture, and the physical layout of the room. “We had
to consider both the existing situation and future needs. We knew we wouldn’t be making changes
to the room any time soon,” Dr. Poirier added.
The committee reviewed the work processes according to the progression of care offered to the
patient and the availability of equipment. It might seem straightforward, but it was critical to have
the right professional available at the right time. The process mapping 2 carried out by Geneviève
Parisien enabled the Tactical committee to address the major changes required by this move and to
run them by those in charge of the different sectors.
Process mapping was one of Dubeau’s major learnings. She explains, “I didn’t know all the details,
but it’s the little things that count when you’re changing locations. Thanks to the mapping, nothing
was left to chance: emergency situations, pre-admission, post-admission – everything was gone
over with a fine tooth comb to ensure the changes did not interfere with the progression of patients,
depending on the circumstances… When you’re working alone, you don’t have all the details.
You’ve got to consult the staff. Moreover, I wanted to avoid repeating past mistakes, when the endof-life and recycling costs of outdated equipment were not considered.”
Hélène Sabourin, cardiac catheterization technologist, helped with the workflow mapping. She
found the exercise useful: “We were arriving in a new playing field, and the surgical suite staff
needed to understand how we worked up there. It was helpful,” she explained.
However, mapping is not always sufficient if you don’t have enough hands. This became clear to
Dubeau when it came time to assign complementary tasks: “It was when we were doing the
mapping that we saw the gaps: ‘Oops! But who’ll do that?’” Trachy had the answers: “Here, it’s
the stretcher-bearer who’ll do it.” Dubeau had no official authority over the employees in the
surgical suite, so it was Trachy who managed the additional tasks. “One of my biggest concerns
was the employees’ reaction … I had to watch for that,” she explained. While Dubeau was firm
about the need to adapt to the new organization of work, she made sure the new environment was
fully understood. The question of changing practices worried her. Outside office hours, she did
1 Interblocs, in-house newsletter, CHU Sainte-Justine, Vol. 32, No. 8, November 2010, p. 16 (in French only).
2 A collaborative planning tool, process mapping involves working with all stakeholders to review processes and establish various
scenarios based on analyzing problems and assessing possible solutions.
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Implementation of a Hybrid Operating Room for Cardiac Surgery at the Sainte-Justine University Hospital: Collaboration…
research and consulted a few books about resistance to change, trying to find the best way to deal
with it.
Communication and participation
Réjeanne Dubeau and Monique Trachy, the two coordinators, continued their communication
efforts to make the project real for their teams. They posted charts illustrating the tasks to be
completed each week as well as those already done, putting a large green check mark in each
square. Dubeau explained, “It’s visual and shows the progress made… We’re getting there! It’s
important to show the staff. They need to see that their manager has not abandoned them. I put
myself in their place… When you’re making changes, you’ve got to let people know where you’re
headed.” She involved her employees in the change management process and worked with them to
set clear deadlines for deliverables and the tasks to be carried out. If deadlines were missed, she
did not hesitate to remind them.
In the cardiac sciences in-house newsletter, space was reserved for updates on the hybrid operating
room. With a colleague, Dubeau did not hesitate to take centre stage, adding her own creative
touch. “This summer, we dressed up in nightgowns and had our picture taken in the new room, and
it was published in the newsletter. It was fun – seeing the room made the change real,” she said.
Trachy also believes in the importance of communication: “The more I communicated with my
team, the more credibility I had.” Among other things, through her weekly communications, she
was able to relieve the fears of some residents in the surgical suite, who were concerned about their
training and their role in the hybrid operating room.
During the construction period, the staff reacted quite well, “because everyone understood the whys
and wherefores [of the hybrid operating room],” according to Willame. Before work began, the
managers held an information session for staff members and users of the operating room. The goal
of the project was clearly explained and all their questions were answered. Dr. Brunet explained,
“We had to convince all the stakeholders, not just those who were going to use the room, that it
would be beneficial to all.” The CEO proved to be far-sighted during this transition stage, trying
to anticipate all possible types of resistance. “The teams most directly involved are not necessarily
the ones most resistant to change,” he said. He knew that other groups could experience spillover
effects from the implementation of the hybrid operating room.
The clinical and medical staff members of the two departments were also consulted, and everyone’s
contributions were welcomed. No detail was too small, from the size of the equipment, the location
of the telephone, the colour of the drug cart, and the shape of the handles to the depth of the drawers.
Those decisions were all left to the nurses and technologists. “There was no resistance. We were
involved in everything, and we went with the flow,” said Denise Turnblom, cardiac catheterization
technologist. The employees knew exactly what the new room would look like. “Everyone was
involved in the big and little decisions, which we found somehow reassuring,” said Sonia Ménard,
nurse and cardiac surgery team leader. Dr. Poirier added, “The entire group was an integral part of
the project. That was important! We wanted to involve them in the implementation of the room;
that’s why they were able to accept the change.”
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Implementation of a Hybrid Operating Room for Cardiac Surgery at the Sainte-Justine University Hospital: Collaboration…
Staff training, the move, and the capacity to adapt
After the equipment was installed in the hybrid operating room, the members of the cardiac
catheterization team received training. In October 2010 and during the two weeks preceding the
opening of the room to patients, the staff had to adapt to the new technology while ensuring the
continuity of operations. “We had to motivate the employees and to manage this transition period,”
said Martin Cyr, head of biomedical engineering. During the training sessions, he tried to present
the change in a positive light by reminding the medical staff that they were now using the latest
technology. While he readily adopted the role of educator, he knew that the hard part was not
implementing the new technology but having the teams absorb so many changes at once. “That’s
a whole other kettle of fish, and you can’t ignore it, or you’ll hit a wall,” he noted. According to
him, the challenge was primarily one of change management and the way the CHU Sainte-Justine
introduced completely new ways of doing things.
In addition to learning about the new technology, the medical staff was also introduced to new
work practices. One component of the training focused on the requirements of surgical asepsis.
The staff had to learn all the rules and infection prevention measures required in a semi-sterile area.
Staff members could no longer take their coffee into the control room, and all staff had to wear
surgical caps and gowns. In addition, all medical personnel had to wear smocks when leaving the
surgical suite. “That naturally caused concern because they had to relearn certain practices, but
they now had the opportunity to work in ultramodern facilities at Sainte-Justine’s,” said Parisien.
On site, the managers made sure those changes were respected. Dubeau recalled the case of a
medical staff member who disobeyed the rules by taking his coffee into the new control room
during the training session. “I had to react immediately; otherwise, people would have thought we
expected certain behaviour of them and not of others. It takes time to change habits,” she said.
The implementation of the hybrid operating room also required changes in the duties of some
employees. Previously, technologists Denise Turnblom and Hélène Sabourin had had to record the
interventions on VHS cassettes before digitizing them, but the new digital technology
automatically transfers the recordings to the archives. The information sharing system also makes
it possible to display a patient’s x-rays or ultrasounds on the monitors in the four corners of the
room, allowing them to be viewed by cardiology and surgical residents. Whereas everything was
once decentralized, the hybrid operating room now makes it possible to integrate content and to
share knowledge. “Collaboration with other medical centres will make it possible to improve
medical practices, benefitting the entire community,” Martin Cyr confirmed. Indeed, the
videoconferencing system can now be used for the purposes of teaching, videoconferencing, and
peer-to-peer consultation. A medical specialist with specific expertise can observe from anywhere
in the world and assist colleagues during interventions.
Stéphanie Brisson, an administrative officer in the cardiology clinic, now handles some of the
administrative work formerly done by a nurse. The nurse had had to take time away from providing
clinical services to update patient files, so this change had broader implications than simply the
transfer of tasks. “The nurse had been in charge of the files for several years, and she had her own
little ways of doing things,” Brisson explained. The nurse was not very computer savvy, so she was
in the habit of using a word processing program to write outpatient lists. The centralization of files
now required the use of a spreadsheet program, and this caused her some stress. “The format was
different, and since the table was bigger, the nurse was unable to see everything at a glance as she
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Implementation of a Hybrid Operating Room for Cardiac Surgery at the Sainte-Justine University Hospital: Collaboration…
was used to doing.” The nurse gradually became familiar with the new program used by the
administration, however. She continues to consult it and, when necessary, occasionally adds
comments to the open files. “Now she is super satisfied and really happy with the new system,”
added Brisson, explaining that, during the transition period, it’s important to be patient, tolerant,
and understanding. “I work with computers all day long, so I had to remember it was not her field
of expertise.”
During the training period, Dr. Poirier was confident that the members of her team were prepared
to handle the change: “In cardiac surgery, there are always new things and a certain risk, so the
teams are used to that. If everything is well thought out, and everyone has been able to think about
it and participate, much of the anxiety is reduced. With my surgical team, everyone’s opinion is
important. This allows us to handle many innovations with little anxiety!”
Coordinators Dubeau and Trachy decided to relieve the technologists of certain housekeeping
duties. Previously, they were the ones responsible for cleaning the room between operations.
“There’s no point having the cleaning done by technologists who are not trained for that, but for
other things,” explained Dubeau. Trachy added, “We gave them a little gift by removing certain
tasks. Change should also have positive aspects!”
This decision created headaches for Michel Allard, head of the housekeeping sector, however. As
the manager responsible for cleaning the new hybrid operating room, he needed answers to a
number of technical questions: “What disinfectants should we use? What shouldn’t we touch?” He
took it upon himself to meet with the representative of the external medical equipment supplier,
who was then present in the room. The sales rep explained the maintenance requirements for the
new technology. “The employees were anxious and were wondering, ‘Can we clean this? Can we
touch that?’” he said. He quickly gave them the answers they needed, and they ended up
understanding. “They said, ‘OK. We’ll make the adjustments as a group, together,’” said Allard.
Parisien admitted that some aspects of change management may have been neglected during the
project’s planning stage. “We tried, but we couldn’t think of everything,” she said. The members
of the Tactical committee were aware of the importance of making a team diagnosis to evaluate
the absorptive capacity of the staff members affected by the change. Faced with this situation,
Dubeau and Parisien took things one step at a time, trusted their instincts, and worked intuitively.
The Move
When the catheterization team moved to the surgery suite, Réjeanne Dubeau and Dr. Miró were
reassuring about this change in their physical and social environment, without doubting the medical
team’s ability to adapt. “In the beginning, some people were uneasy about the change. It was
extremely stressful to move down to the third floor,” Dr. Miró admitted.
In fact, different people reacted to the change in different ways. Dubeau was aware of concerns
and made sure that her team’s needs were met as they arose. Her staff had to adapt to a series of
small changes that, as they accumulated, could have quickly erupted into conflicts, especially in
the case of minor annoyances. “A simple detail such as a missing recycling bin, for example. From
the outside, this might seem insignificant, but the staff could use it to express their resistance.
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People would immediately say things like ‘Oh my God! We’re not the ones who asked for this, to
move down there!’” Dubeau said. “Every minor matter could seem like the final straw,” she added.
Moreover, the tight schedule in the last two weeks, when training, the move, and the simulation all
had to be done, meant that the equipment had to be moved with no interruption to regular activities.
In fact, the cardiology staff had just one and a half days, instead of the planned three, to move all
the equipment to the surgical suite.
With the move to the new room, the surgical team had its share of questions. It was no longer just
a construction project, and the medical teams became aware of the real need to change their
practices. “Change is never easy. We’re comfortable with our old familiar ways of doing things,
and when we suddenly have to change them, it’s frightening,” Sonia Ménard explained. The nurses
on her team had many questions. The surgical team had to make room for the cardiac
catheterization team. Everyone had to learn to deal with new colleagues and to merge into a single
team, that of the hybrid operating room. “The employees clearly had a lot of concerns because they
were working with strangers,” explained Parisien. Dr. Côté agreed: “The two teams did not really
know each other on a personal level. Moreover, they were not familiar with the procedures
followed by the other team or their workflow. That caused some anxiety.” Everyone had to learn
to trust one another and to collaborate. “We had to share our physical space. It was a dance for
which we did not yet know all the steps. We would have to learn them,” added Ménard, who
accompanied her nursing team to the surgical suite.
The CEO was never very far. He reminded his managers of the need to communicate with and
support those affected by the changes. “Everyone must see the big picture. Take the time to explain
where we are going and how things will be better than before. Carefully manage the change and
transition process,” he insisted.
Pre-opening simulation
Just before the hybrid operating room was opened to patients in October 2010, a simulation was
carried out. The housekeeping staff was still adjusting to the new technology, and they were
discouraged by all the last-minute changes. According to Michel Allard, “They couldn’t catch their
breath. They told me how they felt, and I could see it for myself. I listened to their concerns and
made adjustments. The more sophisticated disinfection techniques were designed to meet higher
sterilization standards, and the employees did not all have the necessary training. Moreover the
time needed to clean the room had increased significantly, from twenty to seventy minutes.” All of
these changes required adjustments in the work schedules. Monique Trachy explained that asepsis
continues to be a concern in the operating room. “We should have done more tests. Everything
attached to the ceiling must also be cleaned… It was all new to us. We were constantly evaluating!”
she said.
The staff members also met with the ergonomist, who was making adjustments to the equipment
and noting any problems with positioning. “Any bad posture had to be corrected immediately, or
it would have become ingrained,” Réjeanne Dubeau explained. Where do you stand? Are the
monitors at the right height? No fewer than seventy requests for changes to the new operating room
were made within a short period of time. Sonia Ménard noticed that a fixture needed to support the
surgeon’s arm was missing: “With that fixture, you reduce the risk that the surgeon’s arm will
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Implementation of a Hybrid Operating Room for Cardiac Surgery at the Sainte-Justine University Hospital: Collaboration…
shake,” she explained. These minor changes requested by the medical support staff greatly
increased the efficiency of the interventions.
Dr. Poirier recalled the challenges faced by the medical teams due to protocol changes: “It was all
completely new. We had to combine two different protocols with no model to guide us. We were
learning as we went along; it takes time to implement such changes.”
As a result, the first interventions took longer. Whereas the hospital had previously handled two
cases a day, the number of interventions fell to just one per day during the transition period. “When
you’re learning to drive, you don’t race along at 100 km per hour on the first day,” said Dubeau.
Finally, the cardiology department did not entirely leave the sixth floor. The offices and equipment
storage rooms remained there, with staff going down to the third floor only for operations.
In the hybrid operating room, the two teams nevertheless found themselves in a completely
different work environment with new ways of thinking and acting. “We gradually grew accustomed
to the changes. Everyone adapted. It’s like with a close-knit group of friends; when someone new
arrives, you all have to adjust! Here, it was the same thing,” said Denise Turnblom, cardiology
technologist. The technologists from the old cath lab applied their new work practices in the hybrid
operating room. They became familiar with the new environment and the state-of-the-art
technology. “You’ve got to adjust, so you know where your equipment is,” Hélène Sabourin said.
Turnblom added, “And you’ve got to learn the error codes, how to interpret them.”
Meanwhile, on the third floor, the cardiac surgeons were making similar adjustments. “It was up
to us to welcome them. We offered to share our break room and made space for them in the
changing rooms,” Willame said. But the newcomers also had to adjust: “It was also up to them to
fit in with us by following the protocols and requirements of a surgical suite.”
Once accustomed to working independently, the surgical and cardiac catheterization teams quickly
learned to collaborate on this new intervention method, which required their joint expertise.
Inauguration of the Opération Enfant Soleil hybrid cardiac operating room and press
conference
On September 30, 2010, the CHU Sainte-Justine made headlines. The eighteen-month deadline set
by the CEO had been met, and the hybrid operating room named after its major donor was finally
open. What an achievement!
During the event held to celebrate the opening of the hybrid operating room, Dr. Fabrice Brunet
tipped his hat to everyone who had contributed in one way or another to the project. About fifty
people attended. “This was the first time such an event was held. Guests included representatives
of the community, infection control, anesthesia, infrastructure, technologies: everyone was there
to help us celebrate this success together!” he declared happily.
For Dr. Joaquim Miró, it was the culmination of a long-awaited project: “It’s magnificent! The
room works very well. Everything is going according to plan. I have been more than pleased since
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Implementation of a Hybrid Operating Room for Cardiac Surgery at the Sainte-Justine University Hospital: Collaboration…
the opening of the room! In the beginning, it seemed almost too good to be true. Now, I have the
room I dreamed of!”
Monique Trachy thanked the staff in the surgical suite, which had stayed open throughout
construction. “I was pleasantly surprised, and I want to congratulate you all on your tolerance. This
great achievement is thanks to the diligence of each and every one of us,” she declared with
emotion. Sonia Ménard expressed her satisfaction with the many changes that had significantly
improved the quality of the work environment. “We feel secure now; there is much less tension in
the air! In the other room, we felt distant, isolated. Oh my goodness! Here, everything has been
thought of. We’re in the lap of luxury!” she added.
Réjeanne Dubeau enjoyed watching the staff assume full ownership of the new facility as they
presented it to the media. “It was a pleasure working with colleagues, doctors, and staff to carry
out this amazing project. Together with competent, motivated, and committed people, you can go
a long way!” she said. Dubeau’s mandate as coordinator of this sector was gradually coming to an
end. It was a special time for her since she would also be retiring from her position at the hospital
on December 3, 2010.
As a leading ambassador for the CHU Sainte-Justine Foundation, Dr. Poirier spoke enthusiastically
about the donors and teams involved: “Mission accomplished! It’s important to reassure the donors,
to make sure they know this was a huge project and that it turned out very well. This collaboration
succeeded because everyone was involved at every level. They were part of this project. They can
see that, thanks to their participation, good work was done, and the results were positive!” This
major project, valued at $6.5 million, received the financial support of not just the CHU SainteJustine Foundation but also Opération Enfant Soleil (53%). The remaining 33% was provided by
Quebec’s department of health and social services as part of a program to invest in state-of-the-art
technology. 1
In his speech to journalists, Dr. Brunet focused resolutely on the future, stressing the university
hospital’s commitment to world-class research: “This room will also pave the way for hybrid fetal
surgery,” he announced. 2 It is one more way for the CHU Sainte-Justine to fulfil its mission to
promote Growing Up Healthy and, with this medical innovation, to help shape the hospital of the
future. Much more than just a project to replace outdated medical equipment with an equivalent
facility, the hybrid operating room project embodies the hospital’s objective of providing
leadership and earning renown in the health care sector. Dr. Brunet aimed not just to give the CHU
Sainte-Justine the first hybrid operating room for pediatric cardiac surgery in Quebec but also to
position the CHU Sainte-Justine on the world stage, making it one of the best-equipped hospitals
in the world for complex cardiac interventions in both the fetus and the child (see the in-house
newsletter in Appendix 5). 3
1 Press release from the CHU Sainte-Justine, October 4, 2010.
2 Journal de Montréal, September 30, 2010.
3 See Appendix 5: Interblocs, in-house newsletter, CHU Sainte-Justine, vol. 32, no. 7, October 2010, page 4.
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Implementation of a Hybrid Operating Room for Cardiac Surgery at the Sainte-Justine University Hospital: Collaboration…
Taking Stock One Year Later
The first patient to be treated in the hybrid operating room was a six-year-old child with a complex
cardiac malformation. One year later, almost 250 young patients have benefitted from the care
provided in this ultramodern facility.
The potential of this new environment has also been exploited for other medical techniques. The
therapeutic technique of cardiac electrophysiology 1 has been incorporated in interventions carried
out in the hybrid operating room. In addition, by combining this state-of-the-art technology with
research and development, the CHU Sainte-Justine has distinguished itself in the treatment of
extremely complex cardiac malformations. On August 17, 2011, for example, a new prosthetic
device to correct congenital cardiac malformations was used for the first time ever on a human
being by Dr. Miró’s team in the hybrid operating room. “For a university hospital like SainteJustine’s, it is always important to be the first, to advance medical science. This world first was
made possible primarily because we have a modern platform, a renowned team, and an exceptional
room,” Dr. Miró said. The images recorded by the technologists will make it possible for other
hospitals to follow suit in the coming years. In the long term, about thirty patients per year should
benefit from this new approach at the CHU Sainte-Justine. “These are highly specialized prosthetic
devices used in extremely complex situations,” Dr. Miró noted. “I think this change is a wonderful
success story!” added Dr. Poirier.
Satisfied with the results so far, the various users of the hybrid operating room nevertheless
approach their collaboration from the perspective of continuous improvement. “The room works
very well. Everything is going according to plan. I have been more than pleased since the opening
of the room!” Dr. Miró said. Despite his long campaign, he nevertheless admits that the delay led
to an optimal choice although, if he had been able to design the hybrid operating room when the
CEO arrived in 2009 rather than in 2004, he would have chosen a 3-D technology that is now a
pioneering innovation – just going to show that, even in the best of projects, there is always room
for improvement.
While Dr. Miró seemed particularly satisfied with this success, he noted that challenges remain:
“The science is still evolving.” Dr. Côté agreed: “In the scientific literature, they still talk about
patient selection.” Dr. Poirier adds, “For the time being, cases are chosen that will yield good
results. This has happened a few times, and having a hybrid operating room makes a difference.
We always want to do more; we’d like to increase the number of cases that we take, to combine
cardiac surgery and catheterization, but we can’t do just anything.” She is optimistic about the
future: “Scientific progress will allow us to make better use of the room. In the meantime, science
continues to move forward.” It is interesting to note that sometimes innovation and the
improvements made possible by change go beyond individual, cultural, social, and professional
considerations and bump up against the limitations of medical knowledge.
She added, “One year after the opening of the room, the hoped-for medical results have been
achieved. The two teams are working well together. But we must continue to improve. How can
we do better and make better use of the room?” In line with the hospital’s culture of excellence,
1 Electrophysiology: a sub-specialty of cardiology devoted to evaluating and treating abnormal heart rhythms (according to Santé
et services sociaux Québec).
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Implementation of a Hybrid Operating Room for Cardiac Surgery at the Sainte-Justine University Hospital: Collaboration…
several members of the hybrid operating room team would have liked to have met a little earlier to
take stock: “It would have been helpful to meet to discuss our needs. We’ve got to free up the
people who work together, either beforehand or afterward, so they can discuss what is missing. For
us, it was by working with our cardiologists and our surgeons that we each learned what they were
thinking,” explained Sonia Ménard. “By making time for such meetings, we would enable these
people not only to discuss their respective needs but also to vent their feelings,” agreed Dr. Côté,
who believes there were not enough opportunities for such preliminary discussions: “Such
debriefings would have eliminated a lot of the apprehension and dissatisfaction resulting from
bringing the two teams together. That’s essential in a change process when routines are disrupted,”
she said. It is with this idea of continuous improvement that Ménard is approaching the next
challenge: “We’ll have to work hard to maximize everyone’s potential and collaborate well. It’s
like a baby that must be taught everything it needs to know.”
Meeting minutes, management plans, number of outlets, equipment size… Since 2002, all this
information has been collected several times by the various project participants, but it has never
been saved in a single location. Martin Cyr suggested that all of the documents be stored in a
centralized data base to keep track of the project’s development. This practical solution would give
staff and decision makers easy access to the most recent information.
Geneviève Parisien wants to take it a step further. According to her, the CHU Sainte-Justine must
improve its project management organizational maturity to ensure that, next time, it does not take
eight years to deliver a project. The Project office will no doubt promote the development of this
maturity through its support of major projects and the training of administrators in project
management, something that has already begun using a recognized methodology and proven tools.
Finally, Dr. Brunet wound up the evaluation by expressing his satisfaction with this R&D success:
“It only happened because we had the hybrid operating room. It would not have been possible if
we had not transformed it. A little girl was cured in just a few minutes. She did not need surgery
or lengthy follow-ups. Whether in terms of direct, indirect, or collateral impact, we largely
surpassed all our objectives. The hybrid operating room is a resounding success!” Not only were
the objectives met, but they were greatly surpassed. “In terms of direct impact, the quality and
safety of the room surpassed our expectations. The positive indirect impact is demonstrated by the
full satisfaction of the teams. As for the collateral impact, we rose to the challenge in terms of the
internal organizational image,” he said, highlighting the successful accomplishment of this project
involving two separate departments.
Dr. Brunet concluded by mentioning the changes to his role within the CHU Sainte-Justine.
“Today, because of our organizational maturity, there is much less need for me to personally
oversee projects,” he explained. Change management is now the responsibility of the various
managers, who, depending on the scope of the transformation, are supported by teams created for
that purpose.” It should be noted that, during the last year of the project and subsequently, the CHU
Sainte-Justine took practical steps related to the development of methodologies adapted to and
integrated with project and change management 1 along with the training of its managers at the
1 The innovative CAPTE methodology was developed by the CHU Sainte-Justine in partnership with HEC Montréal and the firm
Brio Change, which marketed it under the name Sherpa TO in collaboration with the Commercialization and Knowledge Transfer
Department at HEC Montréal and the technology transfer firm Univalor working with Université de Montréal and the CHU
Sainte-Justine. At the time of this action research project, the hybrid operating room served as a “control group” project before
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Implementation of a Hybrid Operating Room for Cardiac Surgery at the Sainte-Justine University Hospital: Collaboration…
Sainte-Justine management school, which offers specialized training. Moreover, in-house experts
now devote themselves exclusively to projects: a project office was created and change
management became the responsibility of the organizational development department in the
Human resources directorate and the team at the Transition directorate supporting the Growing Up
Healthy project.
Dr. Brunet continued, “At the time, it was necessary to be more present, but today, the leadership
is shared. I must be looking ahead to the next step.”
2015-03-16
training in this change management methodology was offered to managers. Two “control group” projects were analyzed and five
pilot projects (incorporating change management training) were monitored during the application of the CAPTE methodology.
Since that time, the CAPTE methodology has been offered free of charge to all health care organizations in Quebec via the Agence
de santé et des services sociaux de Montréal.
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Implementation of a Hybrid Operating Room for Cardiac Surgery at the Sainte-Justine University Hospital: Collaboration…
Appendix 1
Photos of Construction and the Hybrid Room1
The hybrid room (seen from the entrance)
1 Photos provided by Geneviève Parisien.
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Implementation of a Hybrid Operating Room for Cardiac Surgery at the Sainte-Justine University Hospital: Collaboration…
Underwater mosaic on the wall of the waiting
room for the hybrid room
Mosaic on the ceiling of the hybrid room for
children to look at before the operation
The hybrid room, CHU Sainte-Justine (from a different angle)
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Implementation of a Hybrid Operating Room for Cardiac Surgery at the Sainte-Justine University Hospital: Collaboration…
Appendix 2
People Interviewed at the CHU Sainte-Justine
CEO
Project coordinator
Department head,
Biomedical engineering
Sector head,
Housekeeping
Departments
Doctors
Medical Support staff
Managers
Dr. Fabrice Brunet
Geneviève Parisien
Martin Cyr
Michel Allard
Cardiac surgery
(Surgical team)
Cardiology
(Cardiac catheterization
team)
Dr. Nancy Poirier
Dr. Joaquim Miró
Cardiac surgeon
Pediatric cardiologist
Dr. Geneviève Côté
Pediatric cardiac anesthesiologist
Sonia Ménard
Hélène Sabourin
Nurse and team leader,
Denise Turnblom
cardiac surgery
Technologists
Monique Trachy
Réjeanne Dubeau
Coordinator and nurse
Coordinator and nurse
Philippe Willame
Assistant coordinator and
nurse
Administrative officer
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Brief introduction to people interviewed
Michel Allard: Head of the housekeeping sector, Allard supervises the maintenance and
disinfection of the sterile fields in the surgical suite. He has worked at the CHU Sainte-Justine for
twenty-five years.
Stéphanie Brisson: Administrative officer in the cardiology clinic since 2008, Brisson joined the
CHU Sainte-Justine in 2001.
Dr. Fabrice Brunet: Dr. Brunet, MD, Ph.D., FRCPC, has been the chief executive officer of the
CHU Sainte-Justine since January 5, 2009. After graduating as a medical doctor from the
Université Paris V, he specialized in cardiology, resuscitation, and emergency medicine. He
completed his training at Harvard University, the University of Toronto, and the École Supérieure
de Commerce de Paris (in health administration), where he taught courses in hospital management.
He is a full clinical professor in the pediatric department at Université de Montréal, a professor of
resuscitation in France, and a professor of medicine at University of Toronto. Dr. Brunet
participated in the development of a clinical research centre in Paris, a hospital project in Saint
Petersburg, Russia, and a resuscitation and intensive care unit in Toronto. His primary research
interests include hospital management and the integration of health care systems, communication
technologies and medical information, the continuous improvement of the quality of patient care
and safety, international collaboration, and knowledge transfer. He has published articles in dozens
of scientific journals. (Taken from:
http://www.chu-sainte-justine.org/Apropos/page.aspx?id_page=5072&id_menu=2837&ItemID=4a2)
Dr. Geneviève Côté: Dr. Côté has been a pediatric cardiac anesthesiologist at the CHU SainteJustine since 2003. An active participant in humanitarian missions, Dr. Côté has participated in
several cardiac surgery missions to Central America, Afghanistan, and African countries such as
Morocco and Mali. She is also an assistant clinical professor in the department of anesthesiology
at Université de Montréal.
Martin Cyr: An engineer, Martin Cyr has been head of the biomedical engineering department at
the CHU Sainte-Justine since 2006. After studying computer engineering at École Polytechnique
de Montréal (graduating in 1992), he specialized in biomedical engineering. What sets biomedical
engineers apart from regular engineers is that they are able to analyze problems from the standpoint
of both engineers and medical specialists since they work closely with professionals in various
other fields such as physicians, surgeons, nurses, technologists, and administrators. In the
university hospital sector, biomedical engineers help to choose equipment and are responsible for
its safe use. They also collaborate on multidisciplinary research projects. (Excerpted from:
http://www.polymtl.ca/etudes/bc/information/biomedical.php)
Réjeanne Dubeau: Holder of a master’s degree in nursing, Dubeau was coordinator of the
intensive care and cardiac sciences departments at the CHU Sainte-Justine. Before retiring from
hospital work, she was head nurse – intensive care in the coronary and cardiology-respiratory units
for fourteen years at other hospitals. She also served as a specialized cardiology care advisor for
eight years. Dubeau is a visiting professor at Université de Montréal’s nursing faculty and
continues to participate in training activities. She collaborated with Monique Trachy in the change
management process.
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Implementation of a Hybrid Operating Room for Cardiac Surgery at the Sainte-Justine University Hospital: Collaboration…
Sonia Ménard: Nurse team leader, cardiac surgery, in CHU Sainte-Justine’s surgical suite,
Ménard trains the nurses on her team and looks after material aspects, including orders, repairs,
and changes to be made to the room.
Dr. Joaquim Miró: A pediatric cardiologist at the CHU Sainte-Justine, Dr. Miró is a medical
doctor. He completed his first post-doctoral degree in intensive care in Paris and a second in
interventional catheterization at Harvard University. After graduation, he became involved
internationally with Doctors without Borders in Nicaragua and Doctors of the World in
Afghanistan. From 2003-2010, he was head of the cardiology department at the CHU SainteJustine, and he has been head of the cardiac catheterization lab since 1993. Dr. Miró was named
La Presse/Radio-Canada “Personality of the week” in 2006 and 2011 for his many personal
missions aiming to transfer his knowledge about cardiology to medical teams in Morocco and
Egypt.
Geneviève Parisien: Project coordinator and manager in the Project office, Parisien manages
organizational projects at the CHU Sainte-Justine, where she has worked since 1998. Parisien has
a degree in social work, a graduate degree in management sciences from HEC Montréal, and a
master’s degree in health administration from Université de Montréal; she is also a certified project
management professional (PMP). Parisien was coordinator of the hybrid operating room project,
playing a dual role in both change and project management.
Dr. Nancy Poirier: A cardiac surgeon, Dr. Poirier arrived at the CHU Sainte-Justine in 2000. She
serves as surgical director of transplantation and ventricular assistance and also works at the
Montreal Heart Institute. She specializes in cardiac surgery at Université de Montréal, with a
fellowship in congenital heart surgery at Toronto’s Hospital for Sick Children. As head of
international activities at the CHU Sainte-Justine, Dr. Poirier is involved in organizing overseas
missions. An associate professor of surgery at Université de Montréal, Dr. Poirier was named La
Presse/Radio-Canada’s “Personality of the week” in 2011 for her remarkable contributions to
science and medicine.
Hélène Sabourin and Denise Turnblom: Technologists specialized in medical imaging in the
Cardiology department’s Cardiac catheterization lab, Sabourin and Turnblom work in the hybrid
operating room in the surgical suite.
Monique Trachy: Coordinator of the surgical suite at the CHU Sainte-Justine since 2005, Trachy
holds a bachelor’s degree in nursing from Université de Montréal and has had Canadian
certification in perioperative care since 1995. Before working at the CHU Sainte-Justine, she was
head nurse of the surgical suite at the Montreal Shriners Hospital for Children for thirteen years
and assistant head nurse in the surgical suite of the Hôpital du Sacré-Coeur de Montréal for twelve
years. For several years, she was also president of the Corporation des infirmières et infirmiers des
salles d’opération du Québec. During the hybrid operating room project, she coordinated all
preliminary work and the construction of the cardiac catheterization lab. She collaborated with
Ms. Dubeau on change management.
Philippe Willame: Willame has a bachelor’s degree in nursing. He worked as a clinical nurse
educator in the surgical suite of the Montreal General Hospital for eight years. He joined the team
© HEC Montréal
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This document is authorized for use only by Shean Cain in DHA 801 Summer 2024 taught by ATUL GUPTA, Lynchburg College from Feb 2024 to Aug 2024.
For the exclusive use of S. Cain, 2024.
Implementation of a Hybrid Operating Room for Cardiac Surgery at the Sainte-Justine University Hospital: Collaboration…
at the CHU Sainte-Justine as assistant coordinator of the functional unit of the surgical suite in
August 2008. Willame is responsible for daily activities in the surgical suite as well as the staff,
including nurses, beneficiary attendants, and respiratory therapists. In 2010, he was elected
president of the Corporation des infirmières et infirmiers des salles d’opération du Québec.
© HEC Montréal
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This document is authorized for use only by Shean Cain in DHA 801 Summer 2024 taught by ATUL GUPTA, Lynchburg College from Feb 2024 to Aug 2024.
For the exclusive use of S. Cain, 2024.
Implementation of a Hybrid Operating Room for Cardiac Surgery at the Sainte-Justine University Hospital: Collaboration…
Appendix 3
Principal stages of the hybrid operating room project
2002
2003
2004
2005
2006
2007
2008
2009
2010
2002
First presentations by Dr. Miró
2003-05
Search for financing
February 2006
Feasibility study of the implementation of a new cardiac catheterization lab in the surgical
suite
Fall 2006
to May 2008
Beginning of work:
– Seven operating rooms
– Four storage areas (including the introduction of the Triax technology for the
anesthesia/respiratory therapy storage area).
This work was preliminary to the construction of the hybrid operating room, including
major work on the second floor of block 9 (Microbiology).
March 2009
The chief executive officer asked that work be accelerated because the 84 remaining weeks was
too long a time frame. Complying with this request from the CEO required changes to the
construction scenario. The time frame was shortened to 64 weeks. The room was moved to the
entrance of the surgical suite and work on the second floor of block 9 was cancelled.
2009-2010
1- Beginning of work on the new scenario
2- Move and renovate:
– Four administrative offices
– Post-anesthesia recovery room
– Waiting room for parents
– Waiting room for patients
– Dictaphone room
– Surgery admissions office
– X-ray room
– Central reception area for surgical suite
– Men’s changing rooms – Women’s changing rooms
March 2010
1- Beginning of work on the hybrid operating room (cardiac catheterization)
2- Creation of the Tactical committee
3- End of preliminary work
4- Beginning of construction of hybrid operating room
July 2010
End of construction
Beginning of equipment installation
Sept. 2010
Inauguration of the hybrid operating room and press conference
October 2010
Training of catheterization staff in the new room
Transfer of health care and storage equipment from sixth floor
to third floor of block 9
Case simulations
October 12, 2010 First patient treated in the room
© HEC Montréal
23
This document is authorized for use only by Shean Cain in DHA 801 Summer 2024 taught by ATUL GUPTA, Lynchburg College from Feb 2024 to Aug 2024.
For the exclusive use of S. Cain, 2024.
Implementation of a Hybrid Operating Room for Cardiac Surgery at the Sainte-Justine University Hospital: Collaboration…
Appendix 4
Organization chart of hybrid operating room project
Project sponsor: Dr. Fabrice Brunet, chief executive officer
Project owner: Dr. Joaquim Miró, cardiologist
Tactical committee:









Head of Tactical committee: project coordinator from Project office
Project owner
Managers: coordinators of cardiac surgery (surgical team) and cardiac sciences (cardiac
catheterization team)
Engineer in charge of construction project
Head of biomedical engineering
Two representatives of technical services
One representative of communications department
Director of Transition office (Growing Up Healthy)
Two project management trainees
Construction site committee:




Engineer in charge of construction project
Project coordinator from Project office
Coordinator of cardiac surgery (surgical team)
Others
© HEC Montréal
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This document is authorized for use only by Shean Cain in DHA 801 Summer 2024 taught by ATUL GUPTA, Lynchburg College from Feb 2024 to Aug 2024.
For the exclusive use of S. Cain, 2024.
Implementation of a Hybrid Operating Room for Cardiac Surgery at the Sainte-Justine University Hospital: Collaboration…
Appendix 5
Translation of article from “The floor is yours!” section of Interblocs,
in-house newsletter, CHU Sainte-Justine, Vol. 32, No. 8, Nov. 2010, p. 16
The hybrid operating room: Teamwork at its best!
The hybrid operating room was used for the first time
on October 12, 2010, for a six-year-old child with a
complex cardiac malformation.
We wish to highlight the exceptional work of the
cardiac sciences staff over the past six months, without
which the hybrid operating room could never have
seen the light of day. The contributions of each one
made it possible to review work processes,
computerize data, transfer pre-admission clerical
duties, manage and move equipment, and carry out
many training activities. Ergonomics planning was also
done, and a simulation was carried out to ensure that
interventions would be completed in total safety.
Réjeanne Dubeau, Coordinator of Intensive care and
cardiac sciences
and Jean-Luc Bigras, Head of the cardiology
department
The surgical suite staff demonstrated enormous
patience and adaptability. To make room for the
cardiac catheterization lab within the surgical suite, a
whole series of moves and construction projects was
required. The list is impressive: a post-anesthesia
recovery room, a surgery admission office, changing
rooms, a reception desk, a patient waiting room, a
waiting and meeting room for families, administrative
offices, an X-ray room, a dictaphone room, and an
anesthesia teaching room. Several operating rooms
also had to be refitted, either by combining specialties
or repurposing them. Oof!
We would like to acknowledge the great patience and
understanding shown by the staff and users of the
surgical suite who, for more than a year and a half,
worked under often difficult and disagreeable
conditions – with no slowdown in activity!
Thank you and congratulations!
Monique Trachy, Coordinator, and
Philippe Willame, Assistant coordinator
Functional unit of the surgical suite
© HEC Montréal
From left to right: Buu Lieu-Hong (nurse, intensive care), Hélène
Sabourin (technologist, cardiac catheterization), Louise Gagné
(nurse, cardiac catheterization), Patrice Girard (nurse, intensive
care), Dr. Joaquim Miró (cardiologist and head of cardiac
catheterization), Réjeanne Dubeau (coordinator, cardiac
sciences and intensive care), Lisanne René, nurse, cardiac
catheterization), Stéphanie Brisson (administrative officer), and
Denise Turnblom (technologist, cardiac catheterization).
Absent: Mohamed Madi (ergonomist), Sylvie Michaud (nurse,
cardiac transplant), Daniel Cartwright (assistant, cardiology),
and the two perfusionists, Marco Martinez and Alina Parapuf
The surgical team
25
This document is authorized for use only by Shean Cain in DHA 801 Summer 2024 taught by ATUL GUPTA, Lynchburg College from Feb 2024 to Aug 2024.