Some city institutions have found ways to tackle intractable problems and bring about positive change. It raises the question: can other city institutions learn?

I think particularly of the difficulty Toronto police have delivering good, safe services to those in mental crisis. The police talk a good game, but this year, three people in mental crisis have been killed. Some hospitals in Toronto have found new ways of addressing problems that used to seem insoluble. Can police learn from hospitals how to do things differently?

The University Health Network (UHN) includes the city’s largest hospitals: Toronto General, Princess Margaret, Toronto Western and Toronto Rehab. Like other hospitals, it tries to cope with the big problem of acquired infections, such as methicillin-resistant Staphylococcus aureus (MRSA), which kill more than 10,000 people a year in Canada.

The good news is that MRSA infections in UHN have been reduced 80 per cent in the last half dozen years. The way that change happened is the big story.

UHN tried all the usual approaches. Senior officials in the hospitals gave strict orders that staff had to wash hands between patients (since MRSA exists on flesh and is transmitted by touching). That didn’t work. They gave more frequent and stricter orders. That didn’t work. Rewards, such as Tim Hortons gift cards, were offered to staff for washing their hands. That didn’t work. Compliance rates remained in the 30 to 40 per cent range. But in the last four or five years, new approaches were tried and compliance rates for handwashing at UHN sites are now 88 per cent.

“We turned everything around,” says Dr. Michael Gardam, the head of infection control at UHN. “We didn’t tell staff what to do; instead, we asked them what to do. No more orders from the top. We told unit leaders to allow front-line workers to figure it out.”

“We haven’t had an outbreak of MRSA in our organization for seven years,” he says, “although unfortunately those outbreaks still happen in other hospitals.

“And we don’t have one hand hygiene program at UHN — we have 20. Different units do what is right for them. In one unit, a senior nurse started by washing surgeons’ hands for them until doctors started doing it for themselves. Obviously you can’t replicate that in other units. But the program spread virally as one unit saw what another was doing and then made their own plan for hand hygiene.”

It was a major cultural change,” says Dr. Gardam. “We learned that to get the best results, you don’t order senior staff to tell people under them what to do. Instead, they should ask local staff what they need. Leave it up to front-line staff and the important change will happen.”

Dr. Gardam says you can take this program elsewhere successfully, and indeed he has, through Ignite, a company established for this very purpose. Ignite works collaboratively with hospitals in upper New York state. The same approach has been used there to reduce falls by patients and to reduce bed sores, again with spectacular results.

Not only does the approach solve problems that seemed intractable, the results are substantial financial savings. Apart from human costs, the financial cost of a single case of MRSA in a hospital is in the order of $50,000 or more, given the need for isolation, extra staff and so forth. Finding a way to control infections by asking front-line hospital staff how to do it not only deals with infections, but saves money and makes staff feel more wanted and useful.

Can Toronto police learn from this UHN program to reduce the killing of individuals in mental crisis, such as Sammy Yatim, and to reduce the use of conducted energy weapons (Tasers) to maintain order?

Toronto hospitals have learned that the command-and-control culture doesn’t work in getting the desired results. Can police departments learn this lesson?

It makes sense for senior management at Toronto police to talk with Dr. Gardam and his colleagues and implement some of these front-line ways of working before millions of dollars are invested in Tasers that don’t make the city safer. That would be a start.

Post City Magazines columnist John Sewell is a former mayor of Toronto and the author of a number of urban planning books, including The Shape of Suburbs.