Insights May 2023

Strategic Opportunism and the Moral Imperative to Grow

Kathryn Nichol

Kathryn Nichol 

Having recently marked two years as the president and CEO of VHA Home HealthCare (VHA), I have been reflecting on the constructive tension between strategy and opportunism in the healthcare sector today.

The changing landscape of healthcare in Ontario is rife with opportunities to pilot new projects and test fresh ideas. Despite the pandemic-related challenges that persist, healthcare partners across the province are stepping up to deliver on the vision of integrated care and every new idea is tempting and full of promise.

As a not-for-profit homecare provider operating in communities across the province, VHA is a member of 18 different Ontario Health Teams (OHTs). With so many partners, our team could become overwhelmed by the many opportunities to collaborate, pilot and innovate – exciting as they all are. To avoid being reactive, we have embraced strategic opportunism. 

One might think of being “opportunistic” as seizing any promising opportunity while being “strategic” means carefully selecting and pursuing only those projects that support established strategic goals.

But I have learned that being strategic also includes scanning for opportunities and responding to the right ones. Mastering the balance between being strategic and being opportunistic demands that we take an intentional approach to designing our desired future. For this, we must develop a clear understanding of how each opportunity might move us down our chosen path.

Is it counterintuitive for a not-for-profit to have a business growth strategy? Not in my mind. If we believe that there is a need that our services can uniquely fill, growth becomes a moral imperative.

VHA's growth strategy is centred on expanding integrated service delivery through hospital-to-home programs and direct support in communities. We have defined specific areas of focus for 2023, and we know that opportunities that align and stray from these areas will present themselves. We will decide on a case-by-case basis, provided the projects we take on advance our goals and fit within our strategic priorities.

There are other considerations. Is the project helpful (or, at the very least, neutral) to the people we serve today? Is it right for the people who work for us? Will it generate new insights and data? Does the potential impact outweigh the investment? Is it scalable? Are the right partners involved? Is it a model others could adopt?

An example is our involvement in University Health Network (UHN)’s Integrated Care program. In this program, hospital patients who may require post-acute home care are offered the opportunity to receive this care through an integrated team and a special care pathway. With this model there is one team, one funder, one medical record, and one 24/7 phone line. The opportunity to be the lead homecare agency for the UHN Integrated Care program is highly aligned with our growth goals. Strategically, it advances integrated care models; operationally, our service geographies are aligned and we know that we care for many of the same clients and families; and from a values’ perspective, the program will offer better healthcare experiences for Ontarians and for the health service providers who look after them. The program is both scalable and sustainable. 

We are also partnering with the Hospital for Sick Children (SickKids) to provide personal support services on 16 in-patient units. This partnership provides much needed capacity for the hospital, supportive care for children and families and attractive employment for personal support workers (PSWs). While the current partnership is very positive, I envision it could be even broader. Imagine if those young clients and their families had the option for the same PSW to follow them home after discharge? Even if the PSW only visited the home for a few days after discharge to help the client settle in and, perhaps, train a family member while waiting for regular homecare services to be put in place. The continuity of care and continued connection to the hospital could reduce readmission rates and enhance patient outcomes, be comforting for the child and build confidence in the family as they navigate the transition. I have no doubt our PSWs would love it as well.

Overall, why did these opportunities make strategic sense for VHA? Projects like these have the potential to take home care – as a clinical specialty – in a new direction. They allow us to explore and test ways of integrating home care and acute care and smooth the transition experience. SickKids and UHN happen to be the right partners at the right time. 

And here is something else: a sort of "x" factor that is hard to define. Will the project be fun for the people who will lead it?

Maybe it is just VHA, but I suspect not. Ontario’s healthcare leaders are passionate. They are also stretched to the very limit of their capacity as are all the front-line workers who deliver care. Giving leaders a chance to be a part of something new, challenging and full of potential where they can apply their intelligence and skills to design the future can only energize them and keep them functioning at their best and happiest. And that is good for everyone.

Pursuing new opportunities can be a big lift, but it feels terrific to shoot for the stars once in a while – when it makes sense.

About the Author(s)

Kathryn Nichol, president and CEO, VHA Home HealthCare


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