Webcast Forum Notes: Healthcare Leadership Forum

The Healthcare Leadership Forum in Montreal, was hosted by the Canadian Foundation for Healthcare Improvement (CFHI), the Canadian Association for Health Services and Policy Research (CAHSPR), and the Canadian Health Leadership Network(CHLNET) and was available via live webcast, which I watched. Here are the notes that I kept.

From the welcoming remarks:

The Triple Aim

• Improve patients’ experience (including satisfication and quality)
• Improve population health
• Reduce costs
  • in Canada, many feel we should add “equity” as a goal

We need leadership:

• clinical leadership – those who understand the clinicial issues
• policy leadership – making decisions about financial, etc.
• executive leadership – running their organizations, often have to work in policy arena too
• patient leadership – growing in Canada
• leadership without position – those who don’t formal leadership positions, e.g., policy researchers, health services researchers, patient advocates, journalists, etc.

Leadership is about:

• managing people
• strategy
• execution
  • it’s all about getting results

We need to build leadership capacity.

Panel Discussion: Setting the Stage: Why Leadership Matters

• JOHN ABBOTT, Chief Executive Officer, Health Council of Canada
• JEAN LOUIS DENIS, University of Montreal
• GRAHAM DICKSON, Royal Roads University and CHLNet

John Abbott

• we aren’t seeing the results we want in health in Canada (e.g., relative to other countries)
• equity is a big concern
• we need leadership
• with the knowledge and skills we have, can we not have the best health system to give Canadians the care they deserve?

Jean Louis Denis

• what is leadership?
• traditionally, position leaders as individuals – leader attracts attention to self, chariasmatic individual
• one of the big changes in health today = seeing leadership as a collective, as a system = plural leadership
• Baker & Denis, 2011 – 10 themes of highly performing health systems
  • quality & system improvement as a core strategy
  • leadership embraces common goals & permeates the organization
  • ?
• different types of plural leadership (Denis et al, 2012, Academy of Management Annals)
  • sharing leadership – sharing leadership and collaborating
  • pooling  leadership – pooling at the top to lead others
  • spreading leadership – networks, interorganizational – the more we talk about chronic disease management, the more we talk about this
  • producing  leadership – leadership as emergent property of relations

Graham Dickson

• physician engagement is key
• very challenging to do long-term change with the high leadership turnover that we have (whereas clinicians tend to be in the system for a long-time, and they see this churn of leaders and question the commitment)
• leadership has to be collective (instead of the traditional notions of individualism in leadership) and patients need to be at the forefront
• we need national standards for what good leaders do
• “Canada has a succession planning model called “I quit!”” – we need concerted leadership development and succession planning

Some questions raised during the Q&A:

• We know it’s valuable to engage patients, so why don’t we do it?
• How do we change culture?
  • we need to surface culture so we can see the”rational and irrational aspects” of how we work and talk about how to change culture
• physicians often seen as leaders by virtue of their role as a physician but they often aren’t trained to be collaborative leaders and they aren’t engaged with the system in which they are working

What I have Learned About Leadership

• after 40 years in the field of child health, seeing kids who come to the acute care system – 70% of whom shouldn’t need to be there – you learn that we have to be concerned about population health, about what’s going on at the community level
• we have evidence of what we need to do for child health – if we do those things, then in 20 years we won’t be having these same conversations we’ve been having for the past 30 years
• we need to be OK with leaving our silos – I’ll learn from you and you’ll learn from me
• we have to be bold and courageous and be clear on the priorities for Canada
• are we measuring the right outcomes?
• it costs much to train people in leadership and it needs to be sustained – she found a donor and created a leadership endowment to ensure there will be sustained funding for leadership training
• we need a culture where everyone is empowered to lead in their practice, wherever they are in the system, and that leadership is respected and valued

Clinical Leadership – The Challenge and Promise of the Next Generation

• aging population: multiple chronic diseases, social frailty, functional impairments – are we set up for these
• but remember that many of our older adults are actually quite healthy and not using lots of healthcare resources
• less expensive to care for people in the community than in hospitals
• how we set out our healthcare budgets (e.g., acute care vs. community) is an expression of our values
• we need to understand each others’ perspectives (e.g., clinicians learning about financial statements and the issues that administrators have to deal with)
• clinical leadership and administrative leadership need to work together – “how can the head do anything if it doesn’t know if the feet are ready to walk?”
• succession planning is an issue that’s coming to the fore because there are mass retirements looming – some quick wins: current leaders can think about what helped (and hindered) them to become leaders and pay that forward; do some job shadowing
• then an audience member pointed out that we need to hear from emerging leaders about what they need (don’t want to be locked into old biases) – mentors learn from their mentees

Leaders without Borders

• JOE GALLAGHER, Chief Executive Officer, First Nations Health Authority
• GRAEME ROCKER, Clinical Improvement Advisor, CFHI
• LESLEE THOMPSON, President and CEO, Kingston General Hospital

How to spot great leaders outside borders (from Forbes article):

• focus on people
• the art of “not or” – don’t fall into either/or thinking
• ubiquity – every person must lead
• not tone deaf – tuned into emotional & cultural aspects
• willing to take the hit – about courage and accountability
• understand compromise – moves the needle forward
• no paralysis – live outside the comfort zone – leadership without results is meaningless
• alignment – best leaders operationalize values, vision, mission, and strategy – understanding shared purpose. With no purpose, there’s no passion. With no passion, there’s no leadership

Joe Gallagher

• differences in perspectives on leadership
• have put together a vision of what health and wellness means for First Nations people – holistic, including spiritual and emotional, connection with land and resources
• leaders need to live a healthy life too
• BC is moving towards a more preventative system instead of just a “sickness system”

Graeme Rocker

• traditional medical system has not considered context of patients’ lives
• e.g., COPD – doing poorly in this area of care
• people don’t know about their own disease, don’t want to burden anyone, no plan in place about how to deal with it – end up in ER in much worse state than if they’d had support before this, and then we give some emerg care and discharge them back into the broken situation from which they came
• need conceptual change – asset thinking (we are all in this together, what can we do to improve things) instead of deficit thinking (problems)
• change from thinking about volumes to
• high impact leadership (person centred, relentless focus, boundariless, etc.)

Leslee Thompson

• we often focus on the barriers and we were taught to “colour within the lines”
• instead of “burning platforms” – foster “burning ambition towards a common purpose” – learning about where everyone is coming from
• moving from an “ego system” to an “ecosystem” of healthcare
• leadership is not about you (as the leader)

Patients Canada representative noted that the experts in crossing borders are the patients/families. Also noted a speaker talked about borders not as “barriers”, but as “seams”.

What Policy Leadership is required to achieve the Triple Aim?

• LUC BOILEAU, President, National Institute of Public Health of Québec
• LINDA MATTERN, Health System Accountability and Performance Division, Government of Alberta
• SHELLY JAMIESON, CEO, Canadian Partnership Against Cancer

Linda Mattern

5 conditions to achieve social change

• common agenda- takes time to learn each others languages, etc. to develop a common agenda
• shared measurement systems
• mutually reinforcing activities
• continuous communications – not getting a report every 6 months to the funder; it’s communications in a timely manner to the organization so we know where things are going
• backbone support organizations
• we’ve had a business approach to leadership, but need more of a social change approach

Shelly Jamieson

• as civil servants, we often wait for politicians to ask us to look at things and when politicians do ask for it, we say “we’ll look at it and get back to you in 2 years” – but that’s too long, so they go get an “answer” from someone else and tell civil servants to implement that
• many stakeholders just stand in line asking for money (saying “people will die if we don’t do X”); a better approach is to know what you want to do and know what the government wants to do. Can tell government “This is your problem. This is how I’m going to solve it. And this is what I need to be able to do that.”

Luc Boileau

• Every day, Canadians life expectancy increases by 6 hours. The only country that does better than us is France. But this improvement is coming from things other than healthcare (i.e., social determinants of health)
• Used to think the Deputy Minister had the most power, but the Minister really does have a lot of power

What Do We Need To Do To Build Stronger Leadership For System
Transformation in Canada? Bringing it All Together

• how do we build, spread, diffuse the many great things going on in Canada? Things can’t just be handed over – needs to be adapted to context.
• we need to understand each other’s complex systems in which we are working so we can work together

Link to the program for the forum.