Physician Leadership and Health System Transformation

I have been at two remarkable meetings that have reinvigorated my faith in the profession of medicine. This past weekend I was at the meeting of the Canadian Society of Physician Leaders (CSPL) for the first time. This meeting, co-sponsored by the CSPL and the Canadian Medical Association (CMA), had an incredible line-up of leading academics and physicians focused on healthcare system transformation and the critical role of physicians in leading change.

Key themes were that real change can only succeed with physician leadership, that we all have a role, and that leadership can be learned and developed. Another recurrent theme at practically every meeting I go to these days is that the Canadian healthcare system is among the worst in comparable western countries, given ours is one of the most expensive systems, yet challenged by poor performance and outcomes in quality, access, timeliness and safety. We are only exceeded by the USA for worst-place (see chart below, from The Commonwealth Fund 2014 Update: Mirror, Mirror on the Wall – How the Performance of the U.S. Health Care System Compares Internationally, by Karen Davis, Kristof Stremikis, David Squires, and Cathy Schoen).

 Mirror, Mirror on the Wall - How the Performance of the U.S. Health Care System Compares Internationally

Mirror, Mirror on the Wall – How the Performance of the U.S. Health Care System Compares Internationally

Despite intense effort in patient safety, adverse events have flat-lined at about 10 per cent in hospitals in our country, leading some to claim that healthcare system adverse events are third among leading causes of death. Sometimes I hear, “Why change?” If this is not a burning platform in healthcare, then what is?

Saskatchewan was well-represented among about 500 attendees (including 75 students), including our own Dr. Dennis Kendel, CEO of saskdocs and one of the founders of the CSPL, who moderated a slightly tongue-in-cheek debate about politicians as the barrier to healthcare reform. One of our students, Paule Bertholet, was sponsored to attend by saskdocs. Thank you, Dennis!

One of the world’s foremost names in leadership development, Barry Z. Posner, PhD from Santa Clara University in California, emphasized that leadership is a learned skill in his book, Learning Leadership: The Five Fundamentals of Becoming an EXEMPLARY LEADER. He offers these five core pieces of advice:

  • believe you can (you need a growth mindset)
  • aspire to excel (the importance of looking forward)
  • challenge yourself (fail fast, fail often)
  • engage support (develop confidence and competence)
  • and practice deliberately (greatness is a habit, not a birthright)

Tim Magwood, “Master Storyteller and Culture Catalyst” from Toronto, spoke about the links between leadership and innovation, while being an incredibly innovative entertainer at the same time.

Jeffrey Braithwaite, Professor and Director of the Australian Centre for Healthcare Resilience and Implementation Science—think about all that is contained in that name!—taught us how to reconcile “work as imagined” (by planners and leaders) and “work as done” (by frontline clinicians), with the only solution being our collective engagement. He also reminded us that trying to do what we do today better is not the transformation needed, and finished with that oft-repeated Henry Ford quote, “If I had asked people what they wanted, they would have said faster horses.”

Anne Snowden, PhD, from the International Centre for Health Innovation at the Richard Ivey School of Business, talked of global trends in healthcare innovation that included: empowered consumer; digital world; value focus; wellness focus; transparency; and outcome-focused funding models. She echoed Henry Ford with her final quote from R. Buckminster Fuller, “You never change things by fighting the existing reality. To change something, build a new model that makes the old model obsolete.”

In one workshop, we were asked about our optimism that physicians would engage in and provide leadership to healthcare system transformation. I was in the glass-three-quarters-full part of the room. Despite some bad spots, such as the acrimony between the Ontario and Nova Scotia governments and their physicians, I see many physician organizations putting forward very progressive positions. This includes the CMA and the great changes led by former president Dr. Jeff Turnbull and subsequent presidents since, which are spreading across our country.

Nowhere is this more evident than with our own Saskatchewan Medical Association (SMA), where we have had tremendous leadership by past-president, Dr. Mark Brown, current president, Dr. Intheran Pillay, CEO Bonnie Brossart, and her new leadership team. I attended the SMA’s Representative Assembly (RA) in Regina May 6-7 and provided an update on the College of Medicine.

One of the themes of the RA was modernization of the health-care system. The proceedings included a panel discussion on the topic and an in-camera session where physicians grappled with challenges relating to making Saskatchewan the best place to practise medicine.  In preparation for the RA, the SMA circulated a discussion paper titled The Future Physician Role in a Redesigned and Integrated Health System (scroll down in link to find the start of the paper), which I want to bring to your attention—it’s a remarkable paper, and was tabled and discussed at the meeting. This is incredibly important reading for everyone in the College of Medicine. You will see many of the same themes as at this past weekend’s CSPL meeting.

The question at that CSPL workshop is very relevant. Are physicians able and willing to lead? It is important we all engage. I believe we are nearing the point of changing from horses to cars and the healthcare system of 2030 will look nothing like that of 2016.

By the way, I would suggest you look up the CSPL or consider attending their meeting next year. Many of our faculty would already qualify for the Canadian Certified Physician Executive credential.

As always, I encourage discussion and debate and would love to hear from you. I would be happy to meet with you and welcome invitations to department meetings or any other venue.

One thought on “Physician Leadership and Health System Transformation

  1. Effective physician leadership will be critical to large scale improvement in our healthcare system. Our medical school at the U of S is well positioned to build leadership capacity among among the next generation of physicians.

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