Lean Training

Anna D’Ambra

About Anna

Anna D’Ambra is the Executive Advisor of the Clinical Informatics workstream within the Directorate of Digital Health at the CCOMTL (Integrated Health and Social Services University Network for West-Central Montreal). Anna is also the Strategic and Clinical Lead for Virtual Health at the CCOMTL and acts as the Provincial Telehealth Clinical Pilot.

Anna was essential to the rapid and efficient stand-up of the CCOMTL’s telehealth program since the beginning of the COVID-19 pandemic. Today, thanks to Anna’s valuable contribution, expertise, and leadership, telehealth is an operational modality of care delivery, allowing the CCOMTL to provide “Care Everywhere”, thus offering patient-centered and value-based care to its users.


This large health and social services network is located in Montreal, Quebec, and serves a population of 345,000 people who are served by more than 30 healthcare member facilities. This includes one of Montreal’s leading hospitals and an interlocking array of specialized hospitals, local community service centers, rehabilitation centers, long-term care sites, day centers, and several affiliated research facilities. Treatment and care are provided by more than 12,000 staff and over 600 doctors. The CCOMTL leveraged telehealth as a response to the COVID-19 Pandemic.

Lean Healthcare Black Project Background and Overview

As part of its Lean Healthcare Black Belt program assessment, Leading Edge Group requires participants to complete a workplace improvement project. In this regard, Anna’s project was undertaken in 2020-2021 and focused on a multi-site (>30 sites), pan-organizational continuous quality improvement (CQI) telehealth deployment.

Virtual health (telehealth) was scarcely used in Quebec prior to COVID-19. Though it was on the roadmap for CCOMTL, it had to be quickly stood up and deployed as a response to the pandemic. Ambulatory/Outpatient services were closed or limited during the first wave of the pandemic, upon global declaration. Virtual care services (VCS) were rapidly put in place to:

  • Ensure continuity of care
  • Decrease Emergency Department (ED) visits
  • Provide care for the most vulnerable clientele who would have likely ended up presenting or being transferred to the ED
  • Keep providers and users/patients safe and away from healthcare sites to help decrease the spread of the virus

Virtual care has been adopted strategically as part of the organization’s service offering to complement in-person traditional care. Supporting a hybrid model of care delivery has now become the current state but much room for improvement existed and still exists. One of the main areas of focus for Anna’s Black Belt project was to illustrate what value-based healthcare looks like using a virtual health modality to provide “Care Everywhere”.

The reopening of services after the first wave of the pandemic provided a great opportunity to go back to Gemba in the organization and refine the processes and strive for continuous quality improvement (CQI) and sustainability. It was also the perfect opportunity to initiate preparedness in anticipation of a potential second wave of the virus. In addition, during the rapid virtual health stand-up, a BYOD (bring your own device) policy was initially supported as clinicians worked remotely from home. However, as they began returning on-site (some remained remote), the team had to ensure that all providers had the right tools to conduct virtual visits. Workstations and clinical teams needed to be “Telehealth Ready”.

Anna’s comprehensive final project report navigated through the numerous CQI milestones throughout the past year. Given the size of the organization, for reporting purposes, specific clinical areas were used as prototypes and examples to demonstrate the work that had been executed across the entire organization during the telehealth CQI deployment.

Though many deliverables were attainable, some elements remain challenging to measure and quantify due to the many variables posed by the pandemic. The return on investment (ROI) and value on investment (VOI) will be much more obvious as VCS matures over the years – not only in this organization but provincially.

Anna’s project demonstrated that a successful virtual care model requires a clear strategy, strong partners, and well-defined goals. While various health systems will measure overall success differently, each needs to develop a thorough evaluation program for their VCS. From launch through maturity, consistently evaluating performance against stated goals is critical to understanding and ultimately achieving success.

Estimated Benefits

Anna demonstrated hypothetical estimated annual cost savings of approximately $35M for one example and cost avoidance of over approximately $18M by using a VOI approach for one specialty. Estimates are hypothetical due to the many variables generated by the COVID-19 pandemic and the fact that VCS costing methodologies were still being determined by the Quebec Ministry of Health. In addition, patient/user satisfaction and experience surveys demonstrated a positive experience and great satisfaction using VCS at the CCOMTL.

In addition, to achieve the Quadruple Aim – the panacea of value-based healthcare – VCS (telehealth) continues to fit the bill perfectly as the right modality to help achieve the four (4) main pillars set forth by the organization’s President and CEO:

  1. Accessibility to care
  2. Appropriateness of care (right care, provided by the right provider(s), to the right patient, in the right place, at the right time)
  3. Resource allocation (human and/or material)
  4. Cost avoidance, reduction and/or containment

To learn more about our Lean Healthcare Black Belt Program, see here.

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