Insights December 2016
Open Letter

Emotional Courage: Reversing Gravitational Pulls That Subvert Real System Change

Hugh MacLeod

As we pause publishing “open letters” for the holiday season before re-launching with new open letters in January 2017, it is fitting to reference a passage from the first open letter in this series… “When I think about the future of Canadian healthcare, I wonder, ‘What would Tommy Douglas think?”  As the father of universal healthcare and a staunch social advocate for Canadians, I would love to hear his perspective on today’s dynamic and challenging times.” 

Today we have:

  • Hundreds of provincial and national councils, institutes, associations, agencies etc. with mandates to lead improvement efforts
  • Library shelves stacked with research studies, books, articles and papers on healthcare leadership and transformation
  • Inboxes with course and work shop materials from the leadership development and transformation industry
  • Boardrooms with transformative ideas
  • Leadership change conferences and symposiums filled with brilliant minds
  • Improvement insights from care providers
  • Patient-centered care experiences from family members, and
  • Contracts with consultants for analysis and tools to improve and transform healthcare

Why it is difficult to have performance improvement changes in healthcare notwithstanding the availability of financial firepower, requisite skills, influence and determination? The answer is a know-do gap ~ the significant difference between knowledge on leadership and what the leaders do. It is known that managers thrive on a multi-dimensional chessboard with new objectives, policies, divergence, and participants. Their acts always relate to conflicts, priorities misplacement, the state of affairs in fights, and opinion battles. The audacity of emotions is the most difficult thing in leadership. It drives their tendency to experience certain phenomena such as risk, discomfort, and doubt that accompany decisions taken by leaders.

Emotional bravery may mean keeping some distance from the rest while not necessarily detaching yourself from them. It means remaining firm in the face of doubt, being authoritative and putting up a productive response to political resistance. People look for confidence and anticipation of the readiness of the leaders to restore emotional bravery to the following three (3) interconnected areas:

1. Process structural advancement versus Tools

For the most part, Canadian healthcare is still defined by reports like the “commonwealth report” which basically report on and reinforce a “sickness model” versus a “wellness model.”  A model where hospitals with health specialists equipped with advanced healthcare equipment wait for patients to arrive.

People yearn for a medical care “wellness” system change. That transformation will only occur if there will be actual re-assessment of the health care processes. These processes include the place of care delivery, the healthcare specialist, and the amount of healthcare provided to the seekers. People like the shiny healthcare equipment and have channeled a substantial amount of resources to their improvements. However, the desired result will only be realized when a balance is struck between the tools’ significance and processes and the skills, talents and potentialities of all involved. With this rebalance we can overcome the intellectual, emotional and systemic barriers standing in the way of innovative care and wellness.

2. Interests

The current healthcare “sickness model” is a business that consists of a massive labour force worth billions of dollars. In addition, the “sickness” business has spawned ancillary partnership foundations, councils, institutes, agencies, associations etc., all with a mandate to promote the billion dollar business.  In addition, there have been billions of dollars spent on retrospective sunk cost investments on healthcare facilities including infrastructure. These successes set up a status quo mindset and passive aggressive behaviour that block or undermine work to develop or use innovative approaches to render upstream wellness changes. Many are either emotionally attached or more likely financially connected to the old models.

3. Payment methods

The system of payment should be defined by factors like patients' experience, safety scores, readmissions, and well-being. Emphasis should be on delivering quality services as opposed to assuming that the annual proportions will increase without putting up a performance that shows the possibilities of attaining such standards. The chances of introducing a new payment system are minimal, and it is also likely that the physicians may not accept such changes. The situation is explained by the existence of barriers such as the over-concentration in equipment and the retrospective costs related to the outdated care system.

Addressing these three areas is crucial because the power of the consumer has arrived, is growing and will become loud. Together they are a rich mosaic of individuality, and their collective energy will be electrifying. They will not wait for a professional to arrive and flip on an engagement switch – they will be in control. Empowered not through permission of others, but with technology and self-confidence. They will behave as experts in their own lives; stars in their own show. They are already living the future we were trying to create.

Are healthcare leaders ready to acknowledge that in the future, everything is portable? Location doesn’t matter, presence does. Connections with patients, families, community services, peers, specialists and even hospitals are dynamic. Health and wellness becomes the prize. Patients, residents, clients have a seat at every table that is making decisions about them. “Nothing about me without me” is no longer a philosophy we aspire to, it becomes a reality of day-to-day practice, organizational design and policy making.

In reality, people are aware and are in agreement of what should be done to bring the desired changes. The society does not lack individuals who can initiate the shifts in the healthcare sector. What is amiss, however, is the readiness and audacity to perform as a system. The following passage from an article by Michael Fenn sums it up best…”Leaders within individual healthcare provider organizations (physicians, nurses, hospital presidents, long-term care operators, pharmaceutical firms, and so on) are adept at making direct and individualized approaches to political leadership and to senior ministry executives. Not surprisingly, these political and bureaucratic entrees frequently favor the individual case and the one-off arrangement – always for laudable goals of achieving something seen as beneficial to their organization and its patients/clients, or for a particular clinical, teaching, or research activity within their organization.” The question remains whether the emotions and the anticipations will continue to undermine the experiences of patients. 

We hope the first set of 2016 open letters and the ones to follow in 2017 will trigger discussions and put the hypothesis on trial.

About the Author(s)

Hugh MacLeod…Husband, Father, Grandfather, Brother, Patient, Concerned Citizen.


Sharkey, S. 2016. “Community and Home Care the Digital Age”. Longwoods Open Letter Series, September 07, 2016

Smythe, R. 2014. “Why Changing Health Is Hard”. Forbes Web Site, February 24, 2014

Thompson, L. MacLeod, H. 2014. “If We Had A Magic Wand”. Longwoods Essay, December 11, 2014

Fenn, W.M. 2006. “Reinvigorating Publicly Funded Medicare In Ontario: New Public Policy and Public Administration Techniques”. Canadian Public Administration Journal, Winter Volume 49. N 4.  


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