Six years after the start of an innovative program
MUSCO manager Aurélie Vigné shares her observations with us
When Aurélie Vigné took charge of the deployment of the MUSCO program in 2018, her first impressions were of a “giant jigsaw puzzle” that had to be assembled with the help of the multiple stakeholders to be mobilized. Each of the facilities held a part of the answer that could be provided to support patients and their families. Initially recruited as a project manager, her position naturally and rapidly evolved into that of manager in order to be able to respond adequately to the requirements of the mandate.
As a reminder, the launch of the MUSCO Initiative took a form never before seen in the Quebec healthcare environment: that of a collaboration between four major institutions in the pediatric landscape, who agreed to join forces to facilitate the management of patients requiring complex care. It was “unprecedented” and seen as particularly ambitious. Six years later, the efforts of CHU Sainte-Justine, Centre de réadaptation Marie Enfant, Montreal Children’s Hospital and Shriners Hospitals for Children – Canada, have demonstrated that integrated collaboration can bring many of the benefits that more and more professionals are expressing in the field.
As soon as she arrived, Aurélie helped the partner establishments define their objectives and what MUSCO could become. To achieve this, it was necessary to overcome misunderstandings of the respective services by bringing together all stakeholders to clarify the common vision of a program that should above all benefit the patient, an approach she had already taken during her previous mandate as coordinator of the Users’ Committee at CHU Sainte-Justine.
I shared this vision of a project that had to work for the benefit of the patient. This was made possible by the creation of the Advisory Pole within the governance structure, to give a voice to these families and support a global change in favor of patient partnership.
As the meetings progressed and the projects evolved, Aurélie could see that the medical teams and parents shared the same objective. And today she is particularly proud to see that we no longer question whether we should involve patients or families in the projects we develop, which should ultimately serve them. Teams have evolved in their practices and ways of doing things, but families too have been able to gain increasing confidence in the crucial role they play.
Aurélie has noticed that the transformative benefits of inter-center collaboration are increasingly perceived and felt in the field. And yet the gamble was not a foregone conclusion… she remembers hearing when she took up her new post: “Good luck, you won’t be able to do all that in five years!”. And with good reason: any process of organizational innovation or cultural change takes time. But even if there are still many things to be done, it’s clear that small seeds have been planted.
Finally, against all odds, MUSCO took on the form of a fully-fledged program. Several projects were reoriented to reflect the needs of families and professionals alike, and everyone was invited to make their voices heard and get involved in the design and implementation of the projects. The result: a committee meeting attendance rate in excess of 70%, nearly 180 employees mobilized and more than twenty projects implemented or underway to support the care of patients living with neuromusculoskeletal disorders and receiving complex care across these four facilities and the healthcare network… Data that demonstrate everyone’s commitment to achieving a common goal.
According to Aurélie, the key to success?
Communication. In my opinion, listening and mutual understanding are the essential foundations for building bridges, forging bonds of trust, opening up to co-construction and considerably increasing the scope of collaboration. It also makes it easier to accept change, and to be vulnerable to things that don’t work or don’t work any more: this has also been one of the great learnings of the program, the fact that everyone has the right to make mistakes, that it’s possible to go in one direction and then change course along the way to adjust as needed.
The way the program has developed has enabled this flexibility and given us this space. Aurélie considers herself “lucky to have a team at her side who agreed to follow her on this adventure, without knowing what they were going to be able to achieve: navigating in a blur, constantly moving and being mobile from one site to another, building and deconstructing – it takes great agility, patience and listening skills”.
For this “intrapreneur” by nature, this cross-functional positioning she shares with other team members, who are also resources shared between the centers, is a major asset: it enables her to be close to the teams, to have front-line information and at the same time maintain a neutrality that enables her to intervene without bias. It’s a positioning that has enabled her to step outside the box even more, and forced her to take alternative paths to find appropriate solutions.
And what about the future?
Aurélie is confident that several of the projects that have proved their worth will find lasting roots within the facilities, such as the inter-establishment Trajectory Navigators project and the Patient Trajectory project. “I’m curious to see how the little seeds that have been sown will continue to grow and evolve, here and elsewhere, so that the proverb ‘alone we go faster, but together we go further’ continues to take on its full meaning,” she explains.
It’s also important that the trust that families and professionals have placed in the Initiative finds continuity. Passing on what has been learned is definitely one of the objectives she is pursuing for the final year of the Initiative: to bring out the essence of MUSCO, how things developed, how they could or should have taken shape, so that other collaborations can benefit from these lessons learned.
Indeed, we can only hope that all the efforts made and trust gained will continue to bear fruit, well beyond the end of the program.