Hugh Scott PHOTO: OWEN EGAN

Turning four into one:
Hugh Scott's challenge as director of the MUHC

DANIEL McCABE | Hugh Scott has it all mapped out. Sometime in 2004, a new high-tech medical centre -- one of the most sophisticated in the world -- will officially open its doors to the public. The new home of the McGill University Health Centre, this structure will house the physicians, residents, nurses, staff and patients who currently reside in the four McGill teaching hospitals that make up the MUHC. There will be balloons. There will be music. There will be smiles aplenty. "And the next day," says Scott, the MUHC's new executive director, "I'll retire." Scott, a cardiologist, makes no secret of the fact that he isn't interested in multiple mandates for his current job. "I see myself very much as someone who's here to help the MUHC through this transition period. I subscribe to the notion that you need different types of leadership for different periods. I might not be the right person for this job anymore at the end of my mandate. I do think I can make a contribution right now." Scott arrives at the MUHC with an impressive résumé. He earned his M.D. at Queen's University and did his residency at the Royal Victoria Hospital. He traveled to a Swedish medical institute and to Michigan State University for postgraduate studies. At the latter, he displayed an early interest in administration when he chose to study the organizational structures of medical faculties. He joined McGill's Faculty of Medicine in 1969 as an associate professor. Before leaving in 1978 to become the chair of Université de Sherbrooke's Department of Medicine, Scott reorganized McGill's residency programs in Medicine and served as the founding director for the Centre for Medical Education. He returned to McGill in 1983 and became the associate dean for post-graduate medical education, as well as a senior physician at the Royal Victoria. In 1986, he took on the top job at Bishop's University, serving as the school's principal for 10 years. "Hugh left this place in tip-top shape," says Bishop's alumni and public relations director Bruce Stevenson. Bishop's was once regarded as a standoffish, somewhat snooty institution by residents who lived close to the school in Lennoxville and nearby Sherbrooke, relates Stevenson. Scott set out to change that perception, building links to local newspapers, the chamber of commerce, business boards and community groups. "He really opened up Bishop's to the local community. That was something we badly needed. Now when people who live around here talk about Bishop's, they talk about it with a sense of pride, and that's his accomplishment," says Stevenson. Scott also helped organize a successful $10-million fundraising campaign for the university. During his time as principal, the student body grew from 1,200 to 2,000 students even as admission requirements were made more strict. After Bishop's, Scott became the executive director of the Royal College of Physicians and Surgeons, the body that oversees the setting of standards in all the specialized disciplines of medicine. And then came the phone call for the MUHC position. When asked if it wasn't unusual for a medical professor to accept the job of principal at a university like Bishop's that has no medical school, Scott smiled. "Maybe a training in medicine is a preparation for more than just a medical career. There is this automatic assumption about medicine that you're trained to do a very specific job -- it's almost like studying for the priesthood. Nobody would say that about law, for instance. There are a great many people who graduate from law schools and go into very different sorts of careers -- some don't even bother with their bar exams. "One of the things about being a clinician is that you really get to know people -- you see them at their best and at their worst. If you don't learn something about human nature while working as a clinician, well, you've really missed your chance," says Scott. He has more than just a casual interest in the workings of the human mind: he completed a master's degree in educational psychology. The topic of doctors taking on administrative responsibilities is an important one for Scott. "Physicians have to be involved in the running of our health institutes." He approves of a recent trend in the U.S. in which hundreds of doctors have earned MBAs to accompany their medical degrees. "I know there are doctors who say, 'I didn't go into medicine to become a bean counter,'" states Scott. "But when you look at every-thing that's happening to health care these days, I think it's essential that doctors take on more responsibility." Otherwise the changes that are made in hospitals and other facilities might only be driven by financial considerations, without proper attention being given to the medical implications of those changes. "We're living through a strange period. Governments were worried about deficits -- with good reason. Clearly there were adjustments that could be made to health care, areas where money could be saved. But the governments went too far. In their rush to get rid of the deficits, health care got scooped up in the process more than it should have been. Now in Alberta, we're seeing money being put back into health care, so I'm hopeful that things will improve soon." The MUHC has made significant headway in recent months. Scott is now in place in the executive director's chair. The planning process is completed and the planners' major recommendation -- that the MUHC be located in a single new structure -- has been formally relayed to the provincial government. The MUHC has successfully undergone its first review as a single entity by the Canadian Council on Health and Services Accreditation. With all that accomplished, Scott says it's now time for the MUHC to really focus on establishing a single identity for itself -- it can't function any longer as just a coalition of four powerfully distinct teaching hospitals. "We have to develop a common culture for the MUHC and we have to start right now. I'm not thinking of multiculturalism as a model either. I'm looking at the melting pot approach." He wants everyone at the Montreal General, the Royal Victoria, the Montreal Children's and the Montreal Neurological hospitals to take careful stock of their institutions' identities. "Ask yourselves: 'What are the things we have to preserve and what are the things we can do without?' If there are things about your hospital that are really fine, we should try to spread those qualities around. "For instance, look at the Montreal Children's Hospital. It has a lot to teach the rest of us about how to involve a patient's family in the decisions concerning their medical treatment. Their patients are children, so they've had to learn how to function that way." What changes can people expect to see as the MUHC's members move towards establishing a common culture? "I'll give you an example of the sorts of things we need to think about," says Scott. "One of the challenges we face has to do with keeping track of our ambulatory patients as they go around to our different sites. The obvious solution would be to have one patient number for all our hospitals. Why can't we use the number on the patient's Medicare card? Maybe there's a good reason why we can't do that, but if people argue against changes solely on the basis of 'We've never done it that way before,' that won't hold water. "One of the first things I'd like to do is to change the vocabulary around here," says Scott. "I don't want to hear people talking about if we move to a new building anymore. We have to talk about when we move to the new building. We must have confidence in ourselves. There is no time for a fainthearted approach." The hospitals that comprise the MUHC have other concerns to deal with. Many of the institutions have deficits that they'll have to try to rid themselves of. "It's not going to be easy, but we must not feel sorry for ourselves," says Scott. "We haven't been hit as hard as the universities, for one thing. There might be some attrition. We will have to take steps towards becoming more efficient." Scott points to the example of the Queen Elizabeth II Hospital in Halifax which recently effected major savings by whittling down its suppliers from 1,200 to 80 and negotiating better deals. That might be one strategy for the MUHC to follow, but Scott knows it wouldn't be an easy sell to his fellow physicians. "Where do we draw the line between physicians' preferences and economic self-sufficiency? We could ask our doctors to choose from a limited number of technologies and drugs, for instance. But one of our specialists might turn around and say, 'No, I use this kind, I think it's the best and that's that.' Then we might have to say, 'Okay, but we can't afford that model unless you see fewer patients.' There are going to be some difficult choices." Many are still wary of the MUHC process -- they like their teaching hospitals just fine as they currently exist. They suspect that the MUHC is purely and simply the creation of a budget-cutting process that doesn't hold high-quality medical service especially dear. Scott understands these concerns, but says they're misplaced. "There are really two forces at work. Much of what is happening is technologically driven. It simply doesn't make sense to duplicate equipment that costs millions of dollars. It doesn't make sense for us to have four identical pieces of sophisticated equipment in four sites if, for the purposes of patient care, we only need one. "We're also working in an era of ultra-specialized medicine. We're seeing the emergence of specialties within specialties. Orthopedic surgery was already a subspecialty, but now, if you really want to be able to do world-class work, you need people with specific skills to operate on hands or on the spine. We need to have all those specialists working together in one organization." Come 2004, what sort of training would Scott like to see McGill medical students receiving in the new MUHC building? One that isn't all that different from the one he received as a Royal Victoria resident. "I'm hoping that the nuts and bolts of it will be what they've always been at McGill: working with and learning from medical experts who are at the top of their fields; an environment that includes professors and students who come to McGill from around the world; and a heartfelt commitment to patient care. On top of that, we'll be able to offer the latest technologies -- computer simulations of medical procedures, access to people and medical facilities in other countries through video or computer links, things I can't even imagine yet." And once he's satisfied that all is in place, he'll retire from the MUHC a happy man.