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In conversation with... Kathy Malas

In conversation with...

Kathy Malas, Associate to the President & Chief Executive Officer—Pole of Innovation & Artificial Intelligence in Health at the Centre hospitalier de l’Université de Montréal (CHUM) , talks inclusive innovation during the COVID-19 pandemic, and what any organization can do to drive continuous progress.

The toughest crisis can accelerate innovation in significant ways. That’s especially true across the healthcare network, where decisions must be made quickly by combining science, facts and front line experiences in near real time to improve patient outcomes, and care.

For the CHUM’s Kathy Malas, the ability to develop new solutions in the face of situations as complex as the COVID-19 pandemic ties right into this leading university healthcare centre’s existing focus on rigorous research, and innovative development. They’ve spent decades building an innovation framework grounded in science, built on ethics, and supported at every level of leadership. 

“The pandemic was an unknown dimension,” Malas says, of COVID-19’s complexities. “There were always multiple changes. We could never have [innovated] if we weren’t already open to working in this way.”

At the CHUM, every aspect of the healthcare they delivered during the crisis was an opportunity to solve a challenge. Even as their efforts were complicated by the very real fear of contracting, or spreading, the disease. From the start of the pandemic through February 2021, CHUM teams initiated more than 70 unique research projects, all reviewed and approved with the same rigorous ethical standards the university healthcare centre has always upheld.

“We built training programs, trained more than 7,500 people, and implemented so many new care protocols in about two months while facing the unknown components,” says Malas. “We needed to pull back and try new things, because we had to protect ourselves and our patients.”

That meant continuously repositioning the obstacles they faced in the daily delivery of patient care as unique chances to develop better solutions. What did that look like in real life?

Like most health networks around the world, the CHUM struggled to acquire adequate personal protective equipment (PPE) in the earliest days of the crisis. In just two days, Malas’ teams created a community of engineers, researchers, private industry allies, logistics professionals and clinicians to create their own prototype using 3D printing. Within a week, they’d developed a  face shield design that conformed to government standards, assessed its comfort and fit, and produced 600 of them for immediate delivery to clinicians on the front lines.

Those innovative efforts have been on constant display throughout the pandemic. By converting old-school monitors to IoT, the CHUM was able to continuously monitor vital signs for COVID patients while simultaneously reducing the number of patient room entrances and exits. In an environment where healthcare teams typically check someone’s vital signs six to 10 times a day, that digital shift made a dramatic impact on the amount of physical contact between patients and care providers. In the face of a disease as contagious as COVID-19, that’s made a real difference. It’s also reduced the number of human errors that can pop up in the traditional process of reading the vital signs, and then manually retyping them into a patient’s file. 

“There were always multiple changes. We’d make a decision on Monday morning, and have to change it on Monday afternoon, and then change it again on Wednesday morning,” she says. “But we learn through doing things—especially through rapid and, sometimes, inconsistent changes.”

Robotics are another area Malas’ team has explored further since the pandemic began. She’s optimistic about the ways companion robots can support (not replace) clinicians across the circle of care. The implications could be huge, from reducing physical interactions with highly contagious patients, to alerting staff when someone isn’t feeling well, or needs medication. 

Although the CHUM hasn’t rolled companion robots out just yet, Malas says they’ve purchased one and are exploring the possibilities. “It excites me, but as an academic health centre, it’s for us to demonstrate the real value. We say AI can offer preventative and early diagnosis. I believe the companion robot still needs to demonstrate value. That’s one of our missions.”

She’s equally invested in demonstrating value by pairing digital technology with the power of the human touch. “To me, it’s absolute,” Malas says. “You cannot deploy technology to better support health and wellbeing without also deploying humans.”

To that end, the CHUM has rolled out a number of different protocols and programs that combine human intervention with digital technology to combat the emotional and psycho-social impacts of the ongoing pandemic. For example, telehealth consultations existed before the pandemic, but grew from 700 to 17,000 a month between March and October 2020. By aligning a dedicated team to support clinicians in deploying platforms like this more broadly during the crisis, they were able to build on that momentum and create a host of other innovative support solutions:

  • A 24/7 hotline connected patients with loved ones to share information, and help break down the growing sense of isolation. Dedicated swat teams were created specifically to manning the hotlines, easing the burden on front-line clinicians.
  • More than 250 tablets and mobile phones with video conferencing capabilities were made available to help patients communicate and make the most of isolation-busting diversions like crossword puzzles and radio programs.
  • CHUM’s existing army of 1,000 volunteers—prevented from entering the hospital due to the crisis—initiated daily courtesy calls to isolated hospital patients. This helped bridge the gap around their needs (from something as simple as requiring clean clothes from home, to more complex health concerns). 

Poignantly, when clinicians were distressed by the idea of allowing people to pass away without their families present, the ICU team designed, tested, and deployed a new protocol to guide families safely in and out of the hospital system (when allowed), and check on them three weeks after the patient had passed. 

Of course, the possibilities that innovation—particularly digital innovation—creates can also raise new ethical questions. Malas says that responsible innovation must always consider the broader ethical implications, and prioritize robust, reliable validation of the technology, human implications, processes and evidence. “Responsible innovation needs to consider those four components in addition to sustainable development, equity, prudence and inclusion.”

To help, the CHUM is now developing a guide for supporting equity, security and prudence by design. “People want to be responsible,” she explains. “They just don’t know how. Introducing technologies for the betterment of the patients and families and clinicians needs to consider multiple dimensions.”

Most of the innovative initiatives developed at the CHUM this year originated with the people on the front lines, the volunteers and patient partners. Theirs has long been a working and learning environment where everyone is encouraged to see natural opportunities to innovate. 

“Academic health centres have a DNA of innovation. “We believe that knowledge can continuously improve things,” Malas says. “We told them please experiment, research and teach quickly and we will learn while doing. We will do it together.”

And that, Malas says, is the key. Because the CHUM already had the right pillars in place to support innovation, their teams were ready to pivot, and embrace agile opportunities to carve out something new even as the pandemic surged. Knowledge sharing then extends the investments made in university health centres like the CHUM exponentially. When a centre like the CHUM creates something new, they can send positive ripple effects across Quebec’s (or even Canada’s) broader health network. Other hospitals then build on the knowledge shared to embrace new ideas, and keep the momentum going. 

All down, Malas says, to that all-important innovation framework they started from. “In crisis, you can accelerate innovation if you have prior muscles.” 

How can organizations make innovation a core dimension of their DNA? 

Cultivate a culture of innovation supported by leadership at all levels. For Malas, this means tone from the top that’s reinforced across every team, and every function of the organization. “We’re fostering innovation at all levels, even the clinician with his own innovation project was in 2015, and even before that,” she says. At the CHUM, they accomplish this by nurturing a sense of ‘communityship’, that reinforces a shared sense of ownership for innovation. “You have a team spirit where collectively, you aim at improving something. That was already part of our innovation culture pre-crisis.” She also stresses the importance of enabling people to think outside the box by providing dedicated time to do so. “People want to innovate, but they don’t have time. You need to protect time to do research, teaching and innovation complementary to delivering care. This was something we worked on before the crisis to mobilize the team.”

Create a clear process for innovation. At the CHUM, Malas says they’ve put processes and mechanisms in place for bottom up, top down and transversal ways of innovating. They back that up by educating people on various methods for creating new solutions. Through continuous learning and training on concepts like how to use design thinking and other approaches, the CHUM enables their people with clear processes, and that allows the right parameters for innovation.

Encourage an ecosystem of open innovation. To work well, Malas says innovation must happen in an open and collaborative way. The CHUM has 200 innovation partners across professional groups in the public and private spheres. They approach innovation through the lens of co-development and co-implementation, measuring the value of tech innovation in real clinical settings with real patients. “You need a vector of commercialization. Talking about the hospital setting, 10 years ago, our CEO was a pioneer in making innovation the core mission of an organization. The CHUM is now an open innovation enterprise. That’s a trend we’re seeing more and more.”

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