Abstract

Do leaders always know what they want to do, or do they find direction by mere accident? Is healthcare as a career choice their first love or a loved compromise? The editors of Healthcare Quarterly asked two such leaders: If they could start their career over again, is there another profession they would like to try? Why would they choose that field, and what fascinates them most about it?

Jonathan Lomas

Jonathan Lomas is the CEO of the Canadian Health Services Research Foundation (CHSRF). He is also an Associate of the Population Health Program of the Canadian Institute for Advanced Research, a member of the Institute Advisory Board for the Institute of Health Services and Policy Research and on the Board of Directors of AcademyHealth (formerly the Academy for Health Services Research and Health Policy). He is also a member of several advisory boards of Canadian and international journals and organizations. He has published two books and numerous articles and chapters in the area of health policy and health services research.

Mr. Lomas has been a consultant to the national and provincial governments, as well as providing research and advice to various nongovernmental organizations, task forces and inquiries. His interest in international health issues is strong and reflected in consultancies for the World Health Organization, the World Bank, the International Development Research Centre and the Rockefeller Foundation.

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When I finished university in Britain in the early 1970s, I faced a clear "fork in the road" - an internship with the Independent Television Network in London and become a journalist, or a Commonwealth Scholarship to go to "the other London" in Canada and be a graduate student in psychology.

With a newspaper editor father and a BBC journalist brother, the family gene was certainly strong and beckoning. Nevertheless, the allure of the colonies and the dismal state of Britain's 1970s economy drew me to Canada, graduate school and eventually the challenge of organizing the unorganizable - health policy.

To this day, however, I find very attractive the task of taking complex and sometimes esoteric issues and accurately simplifying them for broader access. To the extent that health policy relies on the accurate translation of complex research into useable knowledge, I do a kind of journalism with our work at the Canadian Health Services Research Foundation. The communication part of knowledge transfer is, after all, just glorified science journalism.

But I also suffer from a short attention span. Thus, I look with some envy on journalism's deadline imperative and its immediate feedback loop - write it today, and see it broadcast or published tomorrow. This excitement stands in sharp contrast to the months or, more commonly, years that under-pin the publication cycle of academia or the policy cycle of governments.

I have flirted with the field as an amateur journalist, doing occasional op-ed pieces for newspapers or interviews for broadcast media. On each occasion, I am struck by the discipline demanded by this kind of discourse. In less than the time it takes to drink a cup of coffee, you must make what you believe in compelling to a large and varied audience, and even motivate them to action. For all its shortcomings - and there are many - journalism remains the backbone of society's most effective tool of public engagement - great storytelling.


Steven Lewis

Steven Lewis is a health policy and research consultant based in Saskatoon and Adjunct Professor of Health Policy at the University of Calgary. Prior to resuming a full-time consulting practice, he headed a health research granting agency and spent seven years as CEO of the Health Services Utilization and Research Commission in Saskatchewan. He serves on various national boards and committees, including the Governing Council of the Canadian Institutes of Health Research, the Saskatchewan Health Quality Council and the Health Council of Canada. He co-edits the annual Canadian Institute for Health Information (CIHI) Healthcare in Canada reports, is an Associate Editor of the Journal of Health Services and Policy Research and is a member of the editorial board of the Canadian Medical Association Journal.

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I've always hankered to be a baseball writer. It's like health services research, only the data are better, the outcomes are clearer and players pay attention to the findings. A lot of the time nothing important seems to be happening, but drama is just around the corner. The moments of tension are unsurpassed. The field is beautiful, with perfect dimensions. There is no clock, and there are no tie games.

Unlike healthcare, baseball has walked the talk of evidence-based decision-making. Player evaluations are now much more science than art. Salary negotiations typically involve detailed statistical analyses, adjusted to take into account park effects (grass or artificial turf, batter or pitcher friendly), era effects (the offence-oriented 30s, the run-starved 60s) and changes in how the game was played (e.g., a premium on power versus speed). You can tell when a great season is probably a fluke (e.g., pitchers who begin with great win-loss records but few strikeouts are not great bets for long and successful careers). And talk about a culture of disclosure: the line score has runs, hits and errors.

Because it is cerebral does not mean that it is predictable. In baseball, the best teams win 60% of the time and the worst 40% (occasionally there are exceptions). No other sport has such uncertainty of outcome. On any given day, there is hope.

Compared to other sports, baseball has less testosterone and more wit and personality, not least because even the best players fail much of the time. Can you imagine a football trash-talker matching the quip of Steve Hovely, a ballplayer of no distinction: "Baseball is a lot like religion. Great game, bad owners"? If your workday involves watching Vladimir Guerrero throw, you've got one helluva job.