Insights (Essays)

Insights (Essays) February 2019
Breakfast with the Chiefs

The Rule of Three

Philip De Souza and Michelle Holden

Kevin Smith 


For Dr. Kevin Smith, President and CEO of the University Health Network (UHN), good things come in threes – the rule of three in fact. During a recent Breakfast with the Chiefs hosted by Longwoods Notes, Dr. Smith referred to “the three” as an organization’s main priorities – having more can sometimes challenge focus and direction.

Even Dr. Smith’s presentation that morning followed the rule of three. His focus was on patient engagement, staff engagement, and system-level engagement as integral to improving quality and safety in an overburdened healthcare system.

As a partner of Longwoods and the January 23 event, HIROC is no stranger to the act of engagement. HIROC works with healthcare organizations across Canada to advance safety and risk management.


“Patients are the best measure of quality,” said Dr. Smith who believes that when patients are engaged in quality assurance, we have better outcomes. One method of engaging patients that Dr. Smith stands behind is the patient portal. During the talk he cited a New England Journal of Medicine report which named portals one of the most effective engagement tools.

One concern that we have with portals, understands Dr. Smith, is that patients may misinterpret their results before having a conversation with their healthcare provider. But Dr. Smith says a simple phone call with the provider is all that we need to quell this concern, “They [the patients] call, ask questions, and get clarity.”

Another engagement tactic is having patients at the table. Once they take a seat, he says, “Invite patients to every committee… invite patients to hiring panels.” At UHN, 150 carefully selected patient partners sit at the table – “It’s immeasurable feedback,” said Dr. Smith.

But essential, in Dr. Smith’s view, is hardwiring engagement to every healthcare delivery process. He feels success can be realized through time investment by the healthcare team. This is about interconnectedness and ensuring that patients are ready to adopt new processes. There must also be openness to change at the provider level.


“What are some of the things we might take off of our plates for a while?” Dr. Smith says we should be asking questions like this to staff to maintain a focus on the important objectives. It all comes back to “the three” – are we having too many meetings, does every step in the process have a purpose. If there are things that are taking time away from the three core goals, we need to move them out of the way.

Read more here.


About the Author(s)

Philip De Souza is HIROC’s Manager, Communications and Marketing. Michelle Holden is Communications and Marketing Specialist.


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