In October, Dr. Gaétan Tardif retired from his position as Physiatrist-in-Chief and Medical Program Director at Toronto Rehab/UHN. He also stepped down as Vice-Chair of the Network's Coordinating Council, a position he held for more than six years.
Rehab Report spoke with Gaétan this fall.
What do you see as the most significant developments in rehab over the last few decades?
We have started seeing populations that we never saw before. For example, when I graduated in 1986, if you were 85 years old and broke your hip you were sent to a nursing home to die. Now we get most people with a hip fracture home in a month.
Also, as technology keeps people alive longer, they develop comorbidities. To me, that’s the biggest thing: technology has not reduced the need for rehabilitation. In fact, it has increased the need for a newer kind of rehabilitation that is less of a handover and more integrated in the patient care pathway all the way from the intensive care unit into the home. All the providers need to be very intimately connected with one another to succeed. It will be a continuing challenge to achieve this goal.
What are the implications of our changing patient profile?
There’s no such thing as a simple patient anymore, or there are very few and we’re not going to see them in rehab hospitals. If you’re 70 years old, reasonably healthy and you get a total joint replacement, you need a physio to get you moving. I would not describe this as a rehabilitation program. It’s not that different than providing post-op antibiotics! We’re doing a fairly simple intervention and a single person can provide it.
I think the rehab of the future is really more the complex patient that’s hanging by a thread at home. How do we make sure this patient gets the services they require not only to be at home, but to reasonably thrive at home?
You say we are a long way from fully integrating rehab into the patient care pathway. How do we get there?
I heard the medical director for the United Nations speak, and what she said resonated with me. She said the biggest failure of leadership is to try to solve complex problems with technological fixes, because technological fixes only work for simple problems.
We merged Toronto Rehab with UHN. Eight years later we hardly have more rehab in acute. We also implemented RM&R. These technological fixes were not sufficient — you need to work at culture very purposefully. You need to work at the level of health care provider training and show them models of interprofessional care that work and that are patient centred. A culture change has to occur through leadership that is modelling patient-centred care. It’s all about the commitment of the leaders.
What were your key learnings in your work at an organizational and system level?
I think one of the big lessons of my career and that I would tell any young leaders is: Don’t get too comfortable. Don’t assume that the things that you’re doing are the best things that can be done. Continue to look ahead at what else can be done, new models and that whole integration of care. It’s not because you talk about it that it happens. You need to structure it; you need to organize it; you need to create a voice.
What role can the GTA Rehab Network play in this kind of system change?
I think the Network has probably been one of the most important factors in the growth of rehabilitation in Toronto, in the GTA and provincially. I think for rehab to have organized and joined with acute care organizations is important. Cultures don’t change overnight. But I think it was important to bring people together to initiate those conversations.
I really think rehab done the right way can provide a phenomenal improvement to system performance. We’re just not gathering the data. I keep saying we need more health services research. Also we must speak with a single voice to decision-makers about some of the things we know need to be done. That voice has to break through very noisy environments of acute care and the emergency room and hallway medicine. Our role is to be system performance enhancers and catalysts.
How do we do that?
I think we share information. I think we continue to be assertive about the things that we can do and why we must do them. If that means telling stories of people that thrive because they access rehab, let’s tell those stories. But if we have people that are number focused, let’s show them the efficiencies of rehabilitation on a system basis. And if we continue to do that, at some point somebody’s going to say: “Why aren’t we doing this? Why aren’t we starting to think about how people will thrive at home the day they arrive in hospital?” Because that should be our ultimate goal.
If you could change one thing in how rehab care is currently delivered what would it be?
It starts earlier. I was going to have integration of rehab in acute care as my five-year plan when I arrived in 1998. I cannot claim success 20 years later. I totally underestimated the amount of culture change that is required to make it happen.
What are you most proud of in your many years in rehab care?
I’m proud of the culture that we’ve instilled in our rehabilitation environments at UHN. We are the high performer on staff engagement. And if you can do that, I think really good things will happen from a patient-centred perspective, from a results perspective and even from a system perspective because people are enthusiastic. They want to do more and they really want to participate in that system redesign. An engaged workforce, with people doing what they like to do best and feeling supported in doing it — that’s the secret sauce.