This letter is part of series of Open Letters from Canadian leaders in Healthcare. To see the complete series please click here

Being trusted is a precious attribute.  Trust is earned, yet fragile, since it can be eroded through an inability to advance important priorities.  The recent Brexit vote in the UK and the polarizing election in the USA demonstrate that public trust, once eroded, can create radical and unpredictable shifts in direction.  When we think of our roles as health leaders - be they at the government, governance, system or local levels – how trusted are we by those we serve that we have a plan and will execute the changes needed to improve and modernize our health systems?

It is true that we face formidable challenges in reforming our complex systems.  I’m encouraged by renewed vigour and leadership from our governments to set the course for a new health accord that will begin underpinning the vision for a modern approach to both health and healthcare.  I’m hopeful that funding commitments will be directed to areas most in need so that those areas of focus, such as mental health and seniors care, can improve.  I’m optimistic that provinces and territories will learn from studying their system’s high volume health system users and establish new and more effective care models to better meet their individual needs.  However these improvements, while laudable and impactful, will not be sufficient in themselves to modernize our systems. 

What then are key agendas we must champion as health leaders that would drive system-wide change and improvement? 

1. Evolve our organizational leadership models from top/down command and control decision-making to distributed leadership models.  Healthcare systems are complex and adaptive and as such, require high engagement and problem solving with front-line staff, patients and their families in order to design the best service solutions and improvements.  Changes that are imposed by senior leadership without engagement are at high risk of being poorly supported or too limited in design to have impact.
2. Create and nurture organizational cultures that are highly engaging and focused on quality, safety and improvement.  While change is not easy to make, the best innovations come at the front line of care through the knowledge of the care team, their interactions and ability to problem solve, complemented by the patient experience and family observations with the care process.  Improvements should be co-designed between the care team and patients/families so both perspectives are valued and learned from.

To have organizational cultures that embrace engagement, quality, safety and improvement, senior management and governance must be visible champions.  For improvement to be embraced at the front line, the care team must be supported by a present front-line manager that can problem solve, support the improvement agenda, address issues and ensure a healthy team dynamic.  Ultimately the front-line providers must view their roles as not only providing excellent service, but also being committed to improving their service wherever possible. 

1. Recognize innovation ultimately is about change.  We are markedly behind other peer countries in our ability to innovate and adopt new technologies that can improve our care processes and outcomes. This is despite the fact we are in a time of remarkable new technological capacities, ranging from the emergence of genomics and personalized medicine to big data and predictive analytics.  The knowledge leaders and investors for these technologies are primarily industry.  We must quickly evolve our procurement models to recognize value and life-cycle costs in our decision-making.  In addition, our view of industry must evolve beyond supplier to include their legitimate roles as knowledge broker, change agent, coach, and provider.
2. Our population is aging quickly in Canada and by 2030 Canada’s population will be older than many European countries. One of our major challenges is that our current system is designed for serving a younger population.  However, we can make substantial improvement in the quality of care to our senior population.

For the frail elderly we should support mandatory frailty screening as a criteria in assessing all clinical treatment options and further, the frail elderly patient and their family should be involved in all treatment decisions so they understand the impact of the treatment options on their health as well as their quality of life.  Similar screening tools should be used for patients with dementia.

For end-of-life care, patients and their families should also be involved in decision-making.  They should be informed of their overall health and prognosis and the risk/benefit of any interventions being proposed that could impact their remaining quality of life.

In models where these practices are in place, patients and families feel more engaged and satisfied with treatment decisions.  Experience shows patients will often reject proposed interventions if they are believed to not add value and adversely impact their quality of life.

1. Recognize that leadership is a practice, not a role.  Investments in talent management, succession planning and developing leadership capacity are not discretionary, but rather fundamental, to ensuring organizations have the leadership capability they require to drive achievement of their strategic directions.  There is evidence that organizational performance and leadership performance are closely aligned.

Improvement is all about leadership.  Let’s make a difference through our practice. 

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