CENTRE HOSPITALIER DE L’UNIVERSITÉ DE MONTRÉAL
INNOVATING TO BETTER SERVE PATIENTS
Innovations in Patient Care: A Team Effort Research-Based Innovation 10 Innovations That Benefit Your Health
AUTOMNE 2018 - SPECIAL EDITION
Table of Contents 4
Interview with Dr. Brunet
Innovations in Patient Care: A Team Effort
10 Innovations That Benefit Your Health
10 Research-Based Innovation 12 The Teaching and CHUM Academy Directorate in Innovation Mode 14 Fondation: 20 Years of Health and Success – That’s Worth Celebrating!
EDITOR Irène Marcheterre EDITOR-IN-CHIEF Dorothée Philippon CONTRIBUTORS Laurence Grenier, Bernard Lebeuf GRAPHIC DESIGN André Bachand PHOTOGRAPHY Luc Lauzière, Stéphane Lord PROOFREADING Johanne Piché PRINTING Imprimerie JB Deschamps
CHUMAGAZINE STEERING COMMITTEE Irène Marcheterre, directrice des communications et de l’accès à l’information (DCAI) Claudette Lambert, Community and Social Media Manager, DCAI Dorothée Philippon, Communications Consultant, DCAI Caroline Loranger, Associate Director, Practice Quality and Change Section, Multidisciplinary Services Directorate Bernard Lebeuf, Manager, Centre for Learning and Technology, Teaching and CHUM Academy Directorate Nathalie Folch, Associate Director – Research, Partnership and Management, Nursing Care Directorate Isabelle Paré, Communications Consultant, Research Directorate, CHUM Research Centre Lynda Piché, Patient Resource at the CHUM Louise Deschamps, CHUM volunteer
The CHUMAGAZINE is published by the Communications and Information Access Directorate Centre hospitalier de l’Université de Montréal 1051 Sanguinet Street, Montreal, Quebec H2X 3E4 CHUM Research Centre 900 Saint-Denis Street, Pavillon R, Montreal, Quebec H2X 0A9 Articles in CHUMAGAZINE may be copied without permission, provided the source is acknowledged. Photos may not be used without permission.
The CHUMAGAZINE is published by the CHUM’s Communications and Information Access Directorate Pavillon S 850 Rue Saint-Denis Montreal, Quebec H2X 0A9
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Behind every machine, a human being
Centre hospitalier de l’Université de Montréal
Innovation, at the very heart of our mission, takes centre stage at the INNOVE-ACTION event, to be held November 13 - 15, 2018. Discover a decidedly innovative hospital and promising projects for a healthy future in this special edition of CHUMAGAZINE!
What we’re experiencing is unique! We’re building the future every day. The teams at the CHUM have reason to be proud. Dr. Fabrice Brunet Chief Executive Officer
Since its grand opening just a year ago, many technical, logistics and organizational challenges have been overcome. An innovative and decidedly future-focused hospital, the CHUM is one of Quebec’s major achievements in the health sector. CHUM CEO Dr. Fabrice Brunet shares his perspective with us.
What are the biggest challenges you’ve faced since the new hospital opened? Dr. Fabrice Brunet : The first major challenge was to provide patients and teams with a quality environment, both in terms of innovation and day-to-day operations. The other big challenge had to do with change management. With such an innovative environment, teams had to adjust – and still are adjusting – to a new physical reality, new processes, new technologies and ways of doing things. On top of this, the teams were from three hospitals, with points of reference and values that were sometimes at odds. Their ability to adapt has exceeded my expectations! And everyone mobilized! After only seven or eight months, our level of adaptation was faster than other organizations. It was a pleasant surprise. Not everything is settled, of course. There is still work to be done with regard to infrastructure, change management and supporting teams. This is completely normal for a new, innovative hospital. However, we have already achieved outstanding results.
What are the new hospital’s main innovations? F.B. : Constant change is a hallmark of the health network, taking the form of medical progress, sociodemographic changes or changing population needs. Innovation isn’t an option – it’s a must. The CHUM is based on innovation. The first major innovation is our new way of seeing patient management. It is no longer limited to an episode of care. It now continues throughout a patient’s illness until recovery. We use terms such as care trajectory or person’s life trajectory. Care has a before and after at the CHUM. We work in conjunction with many health network partners to ensure optimal patient management. The CHUM’s innovations are also human-centred. The hospital’s individual rooms have changed relationships between patients , their family and caregivers . The new hospital has enabled new practices and forms of communication. Innovations arise from our collaborations with patient partners, 1 patient resources 2 and tracer patients3 that could not have come about otherwise. These people allow us to tailor innovations to their needs. This is something we are very proud of.
Technological innovations bring about big improvements in health care and changes in the way we work, mainly through robots or new technologies. By way of example, we assembled, in a single location, all our medical, surgical and investigative specialties to perform X-rays and laboratory tests and to intervene, without the patient needing to go from one department to another.
What is your view of the future of the CHUM? F.B.: The future of the CHUM is now. What we’re experiencing here is unique! We’re building the future every day. This is something the teams at the CHUM can be very proud of. We’re building not only the future of the CHUM, but that of the health system, as well.
Three to five years from now, the CHUM will be totally different from what it is now. A whole network of partners is going to set up shop around the hospital to maximize what we are in the process of creating. The CHUM will continue to play a leading role as an innovator, by, among other things, incorporating augmented human intelligence. This will provide increased diagnostic and therapeutic capabilities for our health professionals, or allow us to provide care and services outside the walls of our hospital. The role of our caregivers will be the same, but with more possibilities. By 2023, the CHUM will probably be the first hospital in the world to use augmented human intelligence in all its sectors.
1 Patient partner: At the CHUM, patients and their families are considered health partners. Patients actively participate in clinical decisions concerning them. They are invited to inform the caregiving staff of their needs and priorities. Receiving the information and support required to make free and informed health choices, CHUM patients are encouraged to gain, at their own pace, the knowledge and skills needed to improve their overall well-being and carry out their plans for the future. 2 Patient resource: Recruited and trained by the CHUM, patient resources, at the end of one or several episodes of care, want to use their experience and training to benefit our hospital. Our patients can become resources for the organization by taking part in practice enhancement activities or by becoming a resource for other patients with whom they share a similar health care trajectory.
Tracer patient: This is a method that allows us to analyze not only patient management quality and safety throughout the patient’s trajectory in the hospital, but also interprofessional and interdisciplinary collaboration. It takes into account the experience of the patient and their family and aims to identify and implement improvement initiatives. Source: Haute Autorité de santé
INNOVATIONS IN PATIENT CARE: A TEAM EFFORT Every year, more than a half a million patients are followed at the CHUM by some 7,000 health care professionals (doctors, nurses, nursing assistants, psychologists, occupational therapists, radiologists, etc.). It goes without saying that collaboration among all these professionals is essential. This pooling of their strengths and ideas helps generate innovations, which are intensified in this age of artificial intelligence. Dr. Luigi Lepanto, Director of Professional Services in the Directorate of Medical and University Affairs, Renée Descôteaux, Director of Nursing Services, and Martin Demers, Director of Multidisciplinary Services, share with us their vision of interdisciplinarity and innovation at the CHUM.
How does interdisciplinarity contribute to patient care and services? Dr. Luigi Lepanto: Interdisciplinarity in care provision is a team effort. No one person or specific group of professionals is able to meet all the needs of patients without collaborating with other professionals. We can better meet the needs of our patients through the combined expertise of our different professionals. Interdisciplinarity is essential. Renée Descôteaux: Indeed, no doctor, nurse or occupational therapist can do it all alone. Success is best achieved by combining our expert knowledge and leveraging our talents. By consulting with one another, professionals can offer patients an integrated health care support plan. Collaboration within and across professions is essential. University hospital centres characteristically strive to continually improve patient care. Better care can also be achieved by constantly improving these collaborative efforts.
Martin Demers: Doctors, nurses and other health care professionals practise interdisciplinary collaboration and interaction throughout their patients’ care trajectory. The entire episode of care forms a whole to which each actor contributes their expertise when managing the patient’s different needs.
How does innovation get incorporated into the CHUM’s different care teams? L.L.: Innovation takes the form of new technologies and new ways of organizing activities – often both at the same time. Technology also changes workers’ traditional roles, which can occasionally create tension between certain professionals. A collaborative approach facilitates the introduction of technologies and innovative procedures. To properly mainstream innovative solutions, it’s important to understand objectives and evaluate structures, processes and actors. The mainstreaming process is successful when these three elements align. R.D.: Innovation is what drives us. It has to be part of all our actions. From management to care, we are constantly challenging our practices to be sure that they are meeting the changing needs of patients and their families. Our
One of our missions is to innovate, to push the limits and stay a step ahead of everyone else to create new ways of doing things that allow us to offer the best care and services for our patients.
—Martin Demers, Director of Multidisciplinary Services
professionals are lifelong learners and everything is subject to research. In a university hospital centre, we have a responsibility towards the public, science and the advancement of our respective fields because our goal is to be a model to follow in all these areas. M.D.: As a university hospital centre, one of our missions is to innovate. We can find inspiration in best practices, but we’re not here to stand back and watch what everyone else is doing. Managers, doctors, nurses and other health professionals all have to push the limits and stay a step ahead of everyone else to create new ways of doing things that allow us to offer the best care and services for our patients.
We can better meet the needs of our patients through the combined expertise of our differen professionals. Interdisciplinarity is essential.
—Dr. Luigi Lepanto, Director of Professional Services in the Directorate of Medical and University Affairs
How does augmented human reality help you in your patient care activities? L.L.: Artificial intelligence is also an analytical tool that allows us to make correlations in cases where there are vast amounts of data or where traditional analytical methods are much more time consuming. Data can be vast in terms of number or variety. And when human know-how is added to this analytic power, augmented human intelligence emerges. At this point in time, projects targeting health care are occasional and disparate. These projects allow us to discover certain trends in resource use and make correlations with health outcomes. The goal of other projects is to provide decision-making support. This is an emerging sector with a lot of potential. R.D.: For many professionals, health is a science and an art. For a long time, we devoted more energy to understanding the science side (data analysis, diagnoses, treatments, etc.) than the artistic side of our interventions, i.e., the human, relational and interactional aspects. Artificial intelligence may well allow us to save time and be more efficient, but it is important that it also contribute to greater humanization in patient care and services. As a university hospital centre, it is our duty to innovate in this area as well. M.D.: In certain areas of activity, artificial intelligence will be a tool that health professionals can use to facilitate both treatment and diagnosis. These different applications, part of the AI boom, will be increasingly used in the health sector to benefit patients. We will have to stay abreast of this field to be able to maximize the different technologies used at the CHUM.
From left to right : Dr. Luigi Lepanto, Director of Professional Services in the Directorate of Medical and University Affairs, Renée Descôteaux, Director of Nursing Services, Martin Demers, Director of Multidisciplinary Services, CHUM
Artificial intelligence may well allow us to save time and be more efficient, but it is important that it also contribute to greater humanization in patient care and services. —Renée Descôteaux, Director of Nursing Services CHUMAGAZINE 7
THAT BENEFIT YOUR HEALTH
Innovations are ubiquitous at the CHUM! Here are ten that have been introduced or are currently being deployed to benefit patients!
Predicting epileptic seizures the way you predict the weather
No more hospital cards!
An innovation that looks simple, but that greatly simplifies life for patients! When a patient arrives for an appointment, all they have to do is register at one of the check-in terminals located near the clinics by simply swiping their health insurance card under the terminal reader and then take the slip that is printed out.
A 3D printer for personalized radiation oncology treatments Radiation oncology patients already benefit from 3D printing. Ocular cancer patients use prototypes to immobilize their eyes during treatment. François DeBlois, Chief Physicist for the Division of Radiation Oncology at the CHUM, and his team, are also working on creating custom-designed boluses to optimize radiation therapy treatments. The goal of using this material is to fit the dose over a specific area of the skin. When it is prefabricated, it does not fit the morphology of the patient as well (breasts, face, nose, etc.). The 3D printer uses a scan of the patient to create a bolus that precisely fits the part of the body being treated. With 3D printing providing nearly endless possibilities at a reasonable cost, many applications are currently being developed.
A research project aims to use artificial intelligence to predict the probabilities that a seizure will occur, similar to the way meteorologists predict the probability of precipitation. By combining analytic software with the continuous recording of brain activity, the patient would receive a phone alert informing them of the probability of a seizure in the hours to come – enough advance notice to allow the patient to be safe. It may even be possible, in the long term, to create an intracranial system that will locally release a targeted therapeutic agent to prevent the seizure.
The Idearium: beyond ideas – a space where they can be developed Inauguré par la Direction de l'enseignement et de The Idearium, launched by the Teaching and CHUM Academy Directorate (DEAC), has just come into existence! The DEAC is proud to provide the CHUM’s professionals and partners with a meeting place for tapping into collective intelligence. The DEAC wants to invite an innovative community to find solutions to improve the health of the public.
This space will be used, among other things, to organize meetings so that the CHUM community (patients, students, doctors, clinical and non-clinical staff) and external partners (private companies and various organizations) can come together. We are pleased to announce that the first partner to collaborate at the Idearium is Hacking Health.
Artificial intelligence in patients’ plates The CHUM and Nutritek are planning to use artificial intelligence software to develop customized menus. Using algorithms, foods and quantities will be accurately selected to meet nutritional needs while keeping patients’ food preferences in mind. Nutritionists and nutrition technicians will benefit in terms of time and accuracy. They will have more time to spend with patients to provide instruction and to detect malnutrition. For patients, a better diet means better response to treatments, reduced risks of complications and shorter hospitalizations. The CHUM will serve as a model for other hospitals wanting to implement this software.
Smart watches and phones to better diagnose and treat mental illnesses
Wound care: an innovation that saves lives
Oral chemotherapy at home: training for patients
Thanks to Nathalie Rouchet, Assistant Head Nurse at the Major Burns Unit, several patients have avo i d e d a m p u t a ti o n s or more serious complications. She used the V.A.C.™ and the V.A.C. VERAFLO™, sometimes in conjunction, for new medical conditions and for extended periods, something the manufacturer had not thought of! The first machine reactivates microcirculation to rebuild tissue and promote healing. The other cleanses the wound, removes impurities and reactivates microcirculation even faster! The results are so remarkable that the manufacturer is closely monitoring every intervention. The CHUM may become the gold standard in Canada in this area.
The CHUM offers training for patients starting oral chemotherapy at home, and for family members, so that they can learn essential information to ensure safe and effective treatment. It consists of videos and a quiz validating the knowledge and skills learned. The four videos1 deal with treatment adherence, safe waste handling and management, adverse effects management and the health care professionals that can support them. Audrey Chouinard, a specialized care consultant, along with an interdisciplinar y team, designed the training program, which can be downloaded in its entirety and personalized. In addition, several hospitals are in the process of implementing it and others have expressed interest. www.chumontreal.qc.ca/patients/cicc.
Photo : veraflo.com
Our smart watches and phones record a lot of data related to our behaviours. Questioning a patient to collect subjective symptoms is too often the only diagnostic tool available in the field of mental health. Pairing a phone with a watch gives rise to a new approach: digital phenotyping. The Department of Psychiatry and the Neuromodulation Research Clinic have innovated by creating a research program on this theme: if a depressed patient exchanges more text messages, do they reduce their social isolation? If they seem calmer in the evening, do they sleep better? This technological revolution could facilitate the emergence of predictive precision psychiatry, changing our way of seeing pathologies and their treatments.
The project was made possible through funding from the pharmaceutical companies Novartis and Pfizer.
Artificial intelligence to reduce waiting time at the emergency department With more than 70,000 patients per year at the CHUM’s emergency department, patient access is a constant challenge. The CHUM and DXA are collaborating to roll out a pilot project using artificial intelligence software. It consists of a patient questionnaire whose questions change based on the answers provided to the previous questions. In the initial phase, the aim of this tool, which does not replace health professionals, is to provide as much information as possible to the doctor before seeing the patient. This allows the doctor to get to the heart of the matter more quickly, enriching the patientdoctor dialogue. The tool could ultimately make it possible to optimize a patient’s episode of care.
Hello, online appointment management! Modifying your contact information (address, phone number, RAMQ), making, changing or cancelling an appointment, checking whether you’re on a waiting list, indicating that you are unavailable, indicating that you have had required screening tests: all this can be done online! A system that ’s simple, fast and secure. https://formulaires.chumontreal.qc.ca CHUMAGAZINE 9
Whether it’s a management tool, a treatment, a device or a drug, everything we do at the hospital is the result of research.
—Dr. Vincent Poitout, Director of Research at the CHUM
The biggest medical breakthroughs are the result of research. In their labs, the CHUM Research Centre’s (CRCHUM’s) researchers, students and trainees pursue the mission of understanding diseases for better screening, prevention and treatment and for improved patient care. Passion, boldness, determination and innovation are what drive them. Dr. Vincent Poitout, Director of Research at the CHUM, speaks on their behalf during a brief interview.
In concrete terms, how does research improve patient care and services? Dr. Vincent Poitout: Through research, new treatments are made available to patients and new practices are implemented at the hospital and in the community to screen for and prevent disease and to evaluate their effectiveness and success. One concrete example is the development of new hepatitis C treatments, which CRCHUM researchers helped develop, and which significantly reduced the number of patients needing a liver transplant.
Another example is patients at the CHUM with lung, breast or prostate cancer who have access to new treatments because of our research initiatives. Spine and brain tumour surgeries are a lot more accurate because of the technological tools developed by CRCHUM researchers.
What sets the CRCHUM apart from other research centres in North America or the world? V.P.: The CRCHUM is unique in many ways. First, it is one of the largest French-language centres in North America. The CRCHUM also has state-of-the-art facilities. We have world-renowned research teams in high-profile fields such as cancer, transplants and neuroscience. Our research initiatives cover all sectors of adult health and have wide-ranging reach. This includes epilepsy, stroke, multiple sclerosis, drug addition, viral infections (HIV, hepatitis C), high blood pressure, diabetes and several cancers (breast, ovarian, prostate and lung cancer), etc. The CRCHUM’s scientific program is based on a research continuum (basic, clinical and population health research) and takes a translational, integrated approach. On the basis of health issues that we observe in our patients, we use basic research to understand pathological mechanisms, clinical
SIC H A B ARC E
V.P.: Whether it’s a management tool, a treatment, a device or a drug, everything we do at the hospital is the result of research. Research is fundamental to innovation. Research involves discovering or inventing. Innovation involves implementing these discoveries or inventions. Therefore, innovation is fundamental to applying discoveries made through research to medical practice, prevention, diagnoses and disease management.
UL AT RE IO N Hu SEARCH b
P PO T AL HE on
Why is innovation also fundamental in health research?
research to test drugs or medical devices in clinical trials, and population health research to influence changes in practices, for example, in the prevention of certain diseases.
Research Themes To find out more about activities that took place over the past year, you can read the CRCHUM’s 2017-2018 activity report: www.rachum.ca/crchum2018
The CRCHUM in a nutshell: >> 1,861 people, including >> 542 researchers >> 430 students >> 289 trainees >> 35 laboratories >> 1,688 research projects under way >> 798 clinical trials in progress >> 126 research projects with industry partners >> Ultramodern facilities and equipment (laboratories, clinical examination rooms, pharmacy specializing in research, etc.)
Source: CRCHUM 2017-2018 activity report
It could be You!
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THE TEACHING AND CHUM ACADEMY DIRECTORATE IN INNOVATION MODE The CHUM is a university hospital. Teaching and training current and future health professionals are at the heart of our mission. The Teaching and CHUM Academy Directorate (DEAC) contributes to the quality and safety of patient care and services through teaching and training activities that meet the needs of teams in the field. The DEAC has many projects under way, and offers a multitude of opportunities for innovation in the area of knowledge transfer. We sat down with DEAC director Nathalie Beaulieu to learn more.
How is the DEAC unique with respect to knowledge transfer? Nathalie Beaulieu: Our activities are centred on training the next generation. We play a direct role in training top-notch health care professionals dedicated to providing the best in patient care and services. In the last year alone, we delivered nearly 9,000 training sessions of different types â€“ classroom-based, online, simulations â€“ to students and interdisciplinary teams in order to improve communication in work teams, among other things. For example, the creation of an online training program, combined with clinical simulations specifically intended for emergency unit staff, made it possible to consolidate the work of the new teams and ensure safer provision of health care in the new CHUM emergency unit. The DEAC is also tasked with measuring the impacts of teaching and training activities on improvements in the quality of health care provided to patients. With respect to news monitoring, several links are available on our website (https:// bibliothequeduchum.ca), allowing CHUM patients and professionals, regardless of where they are located, to have up-to-date information on a range of subjects such as addictions (e.g., cannabis), cardiology or artificial intelligence in the field of health.
How does innovation manifest itself through teaching and continuing education activities? N.B.: For the DEAC, innovation mostly means experimenting with new health care training methods. We start learners off by using non-traditional learning methods. Simulation exercises are part of our teaching strategies. In collaboration with the Quality, Evaluation, Performance and Strategic Planning Directorate, we created a room of errors which allows staff to improve their health care practices, in addition to raising their awareness about infection prevention and safety issues. We also use the Emergo Train System (emergotrain.com) intended to, among other things,
test the implementation of strategic patient management in situations where large numbers of disaster victims arrive at the hospital. By reconstituting important components, such as staff and equipment, and by using avatars and figurines, we can get an overall view of how a process or situation unfolds and can then improve it. The CHUM is the only hospital in North America that has received training from Emergo instructors. In an effort to combine aspects of pedagogy and play, we have created training programs that take the form of serious games.
What role does artificial intelligence play in teaching and training? N.B.: Artificial intelligence is revolutionizing the way we work, collaborate and learn, and will continue to do so. Of all the sectors changed by artificial intelligence (AI), the health sector is possibly the one that most closely affects the public. At the CHUM, more than 85 projects seek to incorporate AI to meet the needs of improving health care and services. For example, AI is being used to improve clinical priority setting and diagnostic accuracy in radiology.
The DEAC in a nutshell:
Artificial intelligence is revolutionizing the way we work, collaborate and learn, and will continue to do so. —Nathalie Beaulieu, Director of the Teaching and CHUM Academy Directorate
The CHUM is a firm believer in AI – in fact, it launched a school for artificial intelligence in health care in November 2018. This project is a direct response to the quickly changing expectations and needs of patients, the public and health care staff. Its goal is to help the public, health care and service teams, doctors, researchers, students, managers and industry adopt AI as a new technology and to support professions, practices and the health system as it deals with the changes brought about by AI.
>> More than 5,200 trainees from 96 schools and 119 training programs every year; with the Université de Montréal as its main partner >> More than 9,000 training activities every year >> More than 200 simulation scenarios developed >> Modern facilities: multipurpose training and simulation rooms, simulated operating theatre, delivery rooms, microsurgery laboratory, etc.
The school for artificial intelligence One of the school’s first public activities will be a codesign activity. The school will address the following themes: >> Acceptability (social, legal, ethical, etc.). >> Changes to trades, professions, practices and teams. >> Changes to the organization and the health system. As of now, the school is the result of a partnership between the CHUM, the Université de Montréal and the HEC. Other partnerships are possible in the future.
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Fondation du CHUM
20 years of health and success
that’s worth celebrating! Since its creation in 1998, the Fondation du CHUM has been lucky to count on the valuable support of donors driven by a shared vision: providing the best in health care to the public! For the second year in a row, the youngest of the Fondation’s lifetime donors decided to dedicate her birthday to CHUM patients. For her sixth birthday, instead of receiving toys, she wanted a greater gift: health for everyone! “For my birthday, the nicest present you could give me is to allow mothers and fathers to get better so that they can play with their children.”
To mark this anniversary, the Fondation would like to acknowledge the valuable contributions of two of its donors. 82-year-old Andrée Dauphinais has been donating to the Fondation since it was created and has the CHUM “engraved on her heart.” “I was 9 when my mother was hospitalized at Montreal’s Hôtel-Dieu Hospital. We were a large family and my father brought me and my brothers to the hospital. I remember being very impressed by the work of the medical teams. That’s when I knew that I, too, wanted to provide care and help to people. So I became a nurse and worked at the CHUM for 40 years. During all those years I was able to directly see the hospital’s needs and the importance of supporting the health professionals. With changes in quality of care, equipment and research, the CHUM’s needs have grown. That’s why the Fondation’s support is so essential. Every donation breathes new life into the everyday work of the teams and allows them to push their limits to provide better care for their patients.”
Make a donation today www.fondationduchum.com 1 866 DON-CHUM 14 CHUMAGAZINE
Ever y day, Sofia sees her mother, a doctor in the CHUM ’s Department of Neurosurgery, working very hard to save lives. So she decided that she, too, wanted to do something at the tender age of six! Please team up with the Fondation du CHUM to offer our fellow citizens the best health care possible. We’re headed for a 20th year of success, discoveries and medical breakthroughs.
CHRISTOPHER NURSE CLINICIAN
PUSHES HIS LIMITS FOR PATIENTS
INNOVATING TO BETTER SERVE PATIENTS!