Health system transformation in Ontario: leadership lessons

Grace Zhao is a third year MD/MSc student in the Systems Leadership and Innovation program at the Institute of Health Policy, Management and Evaluation.

 

Ontario is undergoing its biggest health system reform in 50 years. Under Premier Doug Ford, 20 health agencies will be merged into a superagency – Ontario Health. The rationale behind this is to eliminate duplicative back office infrastructure and administration in order to streamline work to achieve integrated and coordinated care. The functional unit would be the Ontario Health Teams, which are made up of local health care providers who work together to provide coordinated care through technology.

With much attention being placed on health systems innovation and transformation, I asked two health system leaders on their thoughts about leading system innovation and transformation and the current climate of Ontario’s health care system. Dr. Danielle Martin is the Executive Vice President and Chief Medical Executive of Women’s College Hospital. She is also a practicing family physician and the author of Better Now: Six Big Ideas to Improve Health Care for All Canadians. Dr. Catharine Whiteside is the Executive Director of Diabetes Action Canada and served as Dean of Medicine and Vice Provost Relations with Health Care Institutions at the University of Toronto from 2006-2014. Given their experience and expertise, what should we keep in mind as we move forward with health system transformation in Ontario?

There will be major challenges facing healthcare leaders

Dr. Martin believes a major challenge is building the plane while it’s flying. Remodeling the health care system is challenging when we need to ensure that the core service delivery is constantly functioning amidst changing models of care. The concept of ambidextrous organization is especially important here – the balancing act of achieving breakthrough innovations while maintaining steady improvements to an existing model.

On the other hand, Dr. Whiteside thinks that the major challenges lie in health care remuneration and informatics. Canada has a publicly-funded private system (70% public, 30% private) where the vast majority of physicians are still independent business people. In Sweden or the UK, where health care is publicly-funded, most primary care physicians are salaried. How is this related to informatics? Well, every primary care physician owning a clinic contracts their own electronic medical record (EMR), which contributes to a myriad of EMRs and a fragmented information system. There exists a need for a centralized EMR both within communities and within provinces. How can we institute coordinated care when it is not supported with information systems that enhance workflow and quality improvement?

Great ideas come from the grassroots of the organization

Whiteside had a mantra when she was Dean of Medicine at the University of Toronto.

“If you want true innovation in your education curriculum, you have to get those ideas from students and trainees.”

The same goes for the health care system. According to Martin, the perspectives of patients and frontline health workers are just as valuable, if not more, than those in the leadership team.

Self-awareness and servant leadership is critical in health systems leadership

“When you know yourself, that helps you identify your own biases, your strengths, what makes you tick and what situations are most personally challenging,” says Martin.

Self-awareness helps one be able to exercise humility and understand when to ask for help.

Whiteside echoes this sentiment. She says that the creative part of leadership is understanding the creativity one brings to understanding what is really needed and knowing how to innovate in that context.

She also believes that all effective leaders are servant leaders. Particularly in health care, there is a great responsibility that health system leaders have to the public. It comes down to serving the people that one is leading and not themselves, which according to Whiteside, results in the most fulfillment of leadership. When she was considering becoming Dean of Medicine, her mother said, “If you’re going to pick that leadership position, you better turn around periodically and see if there’s anybody following you. But, the best leaders are also those who are excellent managers who understand the importance of operational leadership.

The power of collective impact

Whiteside is a big proponent of the concept of collective impact – the commitment of a group of stakeholders from different sectors to a common agenda for solving a complex societal problem. Collective impact cannot be achieved without measurable indicators, as this allows for accountability and the creation of a learning system. According to her, both public and private sector funding is needed to get the evidence and data from multiple sectors to demonstrate and fill the gaps in the system.

Is Ontario’s health care system moving in the right direction?

Whiteside believes so, although it may take about 10 years to see the results. Whenever structural changes occur in various provincial health systems, they take a long time to restabilize.

“The health systems that have a province-wide approach, such as the one in Alberta, are making the most progress,” says Whiteside. Alberta has purchased a single informatic system (Epic) for all of its health institutions, enabling integration between the primary care system and the hospitals, ambulatory clinics and continuing care centres. They also have provincial funding for health research and innovation activity – Alberta Innovates. “Ontario is the only province that doesn’t have that.”

However, Martin cautions us that not all structural changes can lead to functional change.

Change is a door to opportunity

As we embrace the incoming changes to Ontario’s health care system, there is opportunity for system improvement by reflecting on what is needed and calling for action. Perhaps now is the time for major health system issues to be finally addressed.

And for aspiring (system) leaders, Martin suggests picking a passion project and working with others to achieve that goal. “Leadership only matters when you work on something you believe in,” she says. Whiteside recommends reading the book Good to Great by Jim Collins. She also finds it helpful to read the Harvard Business Review, Rotman Management Magazine, and The Economist. “It’s important to understand what’s going on around the world.”

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