Building Resilience in Canadian Healthcare Through Cross-Sector Collaboration

In this episode:

Canadians are confronted daily by reports that their health system teeters on the brink of collapse. Leaders from across the country insist the status quo is untenable, and that this is a time for innovation, with potential for new processes and models of care.

With wait times for diagnostic and surgical procedures at an all-time high, provinces are considering sending patients out-of-country, hiring clinical professionals from abroad, and openly inviting private clinics to deliver the medically necessary services that are legislatively circumscribed to the public sector. A commitment to novel approaches creates an opportunity for cross-sector collaboration as a means to improve the health and welfare of all Canadians.

For this episode, we’re joined by guests: Janet M. Davidson, O.C., BScN, MHSA, LLD (Hon), Health Care Consultant; Sarah Hutchison, MHSc, LL.M, ICD.D, LL.M, Program Director, Medical Innovation Fellowship Program, WORLDiscoveries, Western University; and Matthew Lister, MBA ‘06, MHSA, Health System Consultant and Operations Strategist. Our panelists bring a valuable depth and breadth of experience in the private, public, and regulatory sectors and together discuss opportunities to innovate areas such as workforce planning, governance, digitization and the role of technology, and system financing, and further explore what these approaches could mean for our shared prosperity.

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Full Podcast Episode Transcription:

JANET M. DAVIDSON: And I often say, well unless you're channeling Tommy Douglas, I don't think he actually thought of this when he created Medicare. Medicare was created for very valid purposes of nobody should be denied hospital or doctor care. But it was not designed for any of the stuff that we're doing now.

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SEAN ACKLIN GRANT: Welcome to The Ivey Academy presents Leadership and Practice, where we discuss critical issues in business, unpack new research, and talk to industry leaders about the latest trends. The Ivey Academy and Ivey Business School are located on the traditional lands of the Anishinaabek, Haudenosaunee, Lunaapéewak, and Chonnonton nations. This land continues to be home to diverse Indigenous peoples whom we recognize as contemporary stewards of the land and vital contributors of our society.

As Canadians, we're regularly confronted by reports that our health system is approaching a tipping point. Leaders across the country are facing a growing call for innovation in traditional models of care, presenting unique opportunities for cross-sector collaboration to improve the health and welfare of all Canadians. In this episode of leadership and practice, we're joined by Janet M Davidson, Healthcare Consultant and Administrator of the Nova Scotia Health Authority.

Sarah Hutchison, Program Director of the Medical Innovation Fellowship Program for World Discoveries at Western University. And Matthew Lister, Health System Consultant and Operations Strategist. Our panelists discuss opportunities to innovate in health care. From workforce planning and governance to digitization and the role of technology, exploring what these approaches could mean for better partnerships across Canada's health ecosystem. This episode is hosted by BRYAN Benjamin, Executive Director of the Ivey Academy. Let's get into it.

BRYAN BENJAMIN: Thank you all for joining us for today's important discussion on building resilience in the Canadian health care system through cross-sector collaboration. Although it may appear to be all doom and gloom, there is also a great opportunity and many successes to learn from. I am going to ask each of our three panelists to take 60 seconds or less to tell us which best describes your organization. Private sector, public sector, not for profit got to be one of the three choices here. But I am going to start with Matthew.

MATTHEW LISTER: All right. Well, thank you. I feel this is such an important topic because having had the opportunity to work with and see several different health systems that you've mentioned, it's really inspiring to see what others are doing. It can be a little bit overwhelming at times, but it's quite amazing to see how other countries and other jurisdictions are handling the crises that they face are some of the challenges that they face in health care. I've also worked in many sectors of the Canadian health care industry in clinical and service operations strategy and system planning.

And after some time, you begin to gain a sense of what's possible and what's necessary, especially having been responsible for that change or having seen somewhere else succeed with a particular initiative that's challenging for us. But why now? Well, I think we've experienced some enormous upheaval throughout the pandemic. And I think the only thing worse than the loss and the trauma and strain that it's placed on us collectively would be for that to go in vain. So we can't lose the lessons and the opportunities.

BRYAN BENJAMIN: Thank you, Matthew. And I think it's so important. Is we can learn from the past, and if there are lessons, let's be sure to carry those forward. I'm going to go over to you Janet next.

JANET M. DAVIDSON: Thank you very much. I mean, I think particularly the last couple of years with COVID pointed out the importance of being resilient. And I think there's no doubt that resiliency, to some extent, is helped by having others with you on the journey whatever the journey might be. And so that's something that interests me.

And I've always been quite keen on looking at ways in which we can partner and collaborate with other sectors, whether it's within the public sector, whether it's public, private, or whether it's among different groups. But I think the challenge of health care is so huge. To think that one can take it on, whether it's one organization or one group, on their own, I think you're just living in a fairy tale world.

BRYAN BENJAMIN: Thank you. And Sara, over to you. Welcome.

SARAH HUTCHISON: Thanks. For me, I think our collective response to the mounting challenges in our health care delivery system is more urgent than it's ever been and necessitates a change in our approach. I think whether you're a patient, a provider, a facility, a funder, or in the private sector working in health care, you're feeling and hearing and seeing the pressures of a health care system that is extraordinarily stressed.

I believe that we collectively share in the responsibility not to fragment already scarce resources, whether those are human or financial, private or public, and we need to do this with a greater degree of collaboration, or risk progress when we need it the most. So transparency, new ways of working, new partnerships, collaborations, that's why today's conversation is particularly important for me.

BRYAN BENJAMIN: Well, that's terrific. So we've got three amazing individuals who are deeply passionate about this topic. So that is the ingredient for a great session here. So something that I found fascinating when I first connected with Matthew on this topic was just digging in a little bit more on the size and scope of the health care sector in Canada. So Matthew, if you could take a couple of moments and just help us better understand the landscape in which we're talking about and what we have here in Canada as it relates to health care.

MATTHEW LISTER: So Canada's health system, its overarching legislation is federal. And the Canada Health Act describes five operating principles and places the responsibility of administration onto the provinces. So provinces bear the lion's share of the expenditures and some of the critical roles around labor, negotiation, supply arrangements, certain medical device, reviews and approvals, workforce, standards, and credentialing, and various other responsibilities that are necessary to plan, operate, and evaluate their systems to serve the public.

So in one view, it's really a system of systems. And it often surprises Canadians to hear that, for example, British Columbia's health system is very different from Ontario's. Let's talk about privatization for a moment because that's a theme that I think has been around just as long as Canada's health system itself.

The private sector already plays a foundational role in health care, and our system couldn't operate without it. So medical devices, pharmaceuticals, infrastructure technologies, information systems, home care and long-term care organizations are some of the better known private sector businesses in our health system.

Additionally, many private individuals and corporations support facility expansion, revitalization, research initiatives, and clinical programs that help patients and professionals every day. Anyone who's ever traveled around the larger academic facilities in Ottawa, Calgary, or Toronto, Vancouver will notice names on the buildings and those reflect those private donations and support.

And I think the issue, the discussion around privatization generally refers to a particular set of services, medically necessary services that are scheduled financed, paid for, and delivered through public facilities and agreements. And so the spirit of the Canada Health Act is that no one should be denied access to the care that they need and there should be consistent standards of care. And that's a very terse summary of it. But in my mind, that's the spirit of the Act.

BRYAN BENJAMIN: I'm going to jump into my first question and then maybe when Matthew comes back-- I think that was a great overall scope and summary. And it really is so large, so vast, so diverse, which is helpful giving us some contextual pieces to it. So Janet, I'm going to go to you first here and we're going to dig in a little bit on the governance piece. So we've heard examples of how the private sector can play a helpful role, and especially over the last couple of years we've heard a number of examples. So from your perspective, what types of collaborations are truly most beneficial for the health care system?

JANET M. DAVIDSON: Well, in my view, I think any collaboration that results in improved access, improved quality, is something that should be looked at. I mean, my concern is that we have this arbitrary private-public divide. And Kirby, when he did his review, he made the comment that the meaningful involvement of the private sector in a public system is not talking about privatizing, he was talking about meaningful involvement.

And I think any involvement that the public and private sectors can have that helps advance knowledge, care, treatment, access is something that should be explored. I mean, we couldn't be without the private sector. I mean, we have individual physicians who are private practitioners. We have the pharma industry that we couldn't be without them, MedTech.

When I was in British Columbia practicing at a hospital there, I mean, one of the things that we did we contracted out surgical procedures. They were our patients in a public hospital, but we didn't have the capacity. We had no hours left to do that work. So we contracted the work out. Patients were happy. They got the surgery when they wanted, we looked after the quality, and we got volumes through that we wouldn't have been able to do otherwise.

So I think anything-- again, I would just repeat, anything that helps us advance the fundamental principles, such as they are of Medicare, and provides access is something that we should be exploring. Plus the development of new knowledge. And I do think private sector tends to be innovative because they're competitive, and I think it behooves us to learn from others.

BRYAN BENJAMIN: Oh, that's great. And I love how you talk about-- we think about public and private as these two dichotomies that either end. And how do we think about this in a more integrated fashion? Are there any examples-- so thank you for sharing the one in British Columbia. That that's clearly near and dear. Are there any other examples from other parts of the world where people have gotten this right or they've made strides towards learning and connecting with the private sector?

JANET M. DAVIDSON: Well, aside from-- we'll leave the US out of this for a moment. Because I think everybody gets the flags go up and get inflamed. But there is no other country in the world that has one single payer except Canada now. No other country in the world. If you look at how we rank, I mean, we rank one of the highest spenders in the world, but in the bottom quartile in performance.

So I have to ask the question then, are there not been examples out there that we can learn from? It's obviously-- but there are opportunities. I look at some of the stuff that's done in Australia, for instance. They're quite innovative. New Zealand, the European Union, Denmark, Belgium, they have a quite much more collaborative approach to not just private and public, but also the Europeans have an expression, which I love, which is called patients and families as co-producers of value.

And so they are actually partners in it as well. So it's not the way you get a patient rep on a committee or you talk to patients. This is actually they're involved in the design, the evaluation, the operationalization of it. So I think to not partner just doesn't make any sense in my view.

BRYAN BENJAMIN: Well, that's great. Thank you for those examples and where Canada sits within a global context. So anything else to add on that one, Matthew or Sarah

MATTHEW LISTER: I think just the comment now is tat Canada is about to spend-- we're forecast to spend about $350 billion in health care next year. That is a striking amount of money. And I think the one point that economists, politicians, and health leaders, academics have finally found to agree on is that growth is unsustainable. And we absolutely have to look at different models of collaboration.

I like to think too that maybe the task for us is that we need to find some equilibrium of what that collaboration looks like. And so that partnership needs to integrate the diverse parts of the system, and focus them onto long term population outcomes by involving patients and, as Janet says, and as families too.

BRYAN BENJAMIN: So if we think about the word partnership and collaboration, that's the red thread through all of this. What can we do to set those foundations? And we saw some great examples over the past couple of years. And individuals had to mobilize during times of crisis and unique partnerships formed. And how do we use that as a way forward to just make this business as usual?

MATTHEW LISTER: So there's a theory that hospitals were developed from small shelters that just provided care along the early trade and commerce. So business and health care share a much longer and more intimate history than lockdowns. But going back about 100 years, a lot of the innovation and collaboration in health care was coincidental rather than deliberate.

So for example, the mining industry used to retain doctors to provide primary care services to Mine Workers, but they realized, the physicians realized, that they had an opportunity to research lung and skin diseases. And in turn, that helped advance the development socialization and use of vaccines that had a much broader public benefit.

I think where things really started to get going was in the 80s and 90s, we started seeing a trend in terms of partnership by donating significant capital items. And so developing countries like the Gambia, Senegal, Lesotho, would receive, for example, an ambulance and an X-ray machine. The problem, of course, with those capital donations is that it costs money to run and maintain them.

And so I had a former colleague show me a picture of a malaria-stricken patient who had been strapped to the roof of the Gambian ambulance because the patient was not a paying customer. And so the paying customers, the paying passengers received the pleasure of driving along in the air conditioned vehicle while the patient was the last consideration because somebody had to pay for the gas.

Thankfully, times have changed, and I think what we're seeing now is an evolution of models ranging from episodic donations at one end, moving through enabler, funder, investor, supplier, provider, and partner at the other. And these have many different forms of relationship, expectations, and they manage their roles and risks and resources quite differently. I was really interested, there was a striking instance of collaboration.

And in partnership, at the beginning of the pandemic, Italy declared a ventilator shortage, which obviously, ventilators are critical for supporting COVID patients. And Ferrari and Fiat announced that they could start producing them. Nissan in turn weighed in as well and offers just started producing them. Less than a month later, with the COVID incidence continuing to rise globally, engineering schools started hosting competitions to build medical grade ventilators. It became quite common for them to produce these without the benefit of mass production and mass purchasing for about 1,000.

And so that's a far cry from the 40 to 50,000 the ventilators typically cost a hospital. Apple right now is investing heavily in health care. So this is furthering a trend of putting diagnostic tools right at the consumer or the patient's hand. And so I think things like ventilators and watches-- I mean, these are products, but we're also noticing instances where, as Janet mentioned, we're seeing some intellectual capital or knowledge skill coming in to influence how services are provided.

And the example that I find most striking and inspirational comes from India where a physician, cardiac surgeon named Devi Shetty, has employed manufacturing and supply chain principles to design cardiac care, facilities, and services that cost about 90% less than they do in Western countries, have the same outcomes, but they're radically designed. And I don't think the appetite in North America is really receptive to that procedure at the moment. Partnerships like these are all the more necessary.

Globally, we're going to spend about $17 to $18 trillion this year. That's about four times more than the oil and gas industry's annual revenue, it's about three times more than all global military expenditures, and about 10 times more than all global sports and entertainment spending. So partnerships have a lot to offer us. And it's something that we need to look at quite urgently.

BRYAN BENJAMIN: Great and thank you for those examples. And for sure, we saw a number of them early stages in the last couple of years. Great to hear about how does this just become a new normal and new way of thinking in terms of creating innovation as the right thing to do in a way that will strengthen it for all.

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Sarah, you bring a wealth of experience as it relates to technology. Matthew got me thinking about technology when you referenced Apple earlier. So maybe you could tell us a little bit about your perspective on technology as an enabler for a more resilient and sustainable health care system. What role can it play or is it playing?

SARAH HUTCHISON: Look, I think we start with the integration is critical. Systems and solutions that were designed primarily for clinicians, but 100% now considering the patient experience to improve the care experience I think continue to be game changers on the health care delivery system. I think that each sector in our health care arena has increased its digital maturity and penetration.

So there are new technologies in hospitals, whether HIS systems and the integration of peripherals and all monitoring and new tech. We're looking at the widespread penetration of electronic medical records in primary care. So the advances in public health, home and community, pharmacy, agencies. I'd say each sector is better than it was even three years ago, and I think this goes back to a little bit of how Janet and Matthew both talked about this, it is a system of systems though.

So there's a whole lot of gaps to close between those sectors in our health care system by ensuring digital integration that that health care journey for the patient and their families remains seamless as they transition across providers and facilities. And I think we've done a really good job when you stick in a sector where we're not so good as we move our patients around in their health care journey.

I think different jurisdictions in Canada have been more successful than others in delivering on this expectation of integration. I think patients would be quite distressed to understand how that integration is actually not the bedrock of our health system. So I think the one patient, one record approach and living the dream of integration is for many of us still in front of us.

Perhaps one day, we could actually say one patient, one record anywhere in Canada. Imagine the possibilities. I think again, it takes investment, it takes discipline, it takes governments to stay the course. I think that becomes a challenge again where Matthew was talking about the division of responsibilities on the structure in our health care system.

We need a shared mandate and we need collaboration between the public and private sectors to continue to make it happen. So I think our journey to sustainability, a bit of why we're here talking, has its foundation in digital integration. I mean, it's necessary, but not sufficient. And I think just even touching on some of those examples are-- thinking about our response to COVID 19, it's really highlighted the necessity to respond to this integration issue.

This division of responsibilities issue in particular, when you think about all of the complexity between the federal and provincial responses, what happened locally, regionally provincially as the auditors in various provinces are commenting on resources and alignment and conflicting mandates between public health and supply chain and access and distribution. So I think all of these things, again, link back to that initial question. I think technology is necessary, it's bedrock, but it is-- necessary, but not sufficient.

BRYAN BENJAMIN: That's great. And anything else, Janet or Matthew, that you'd add to that?

JANET M. DAVIDSON: I just say-- I mean, I agree wholeheartedly with her comments. I think the issue of integration-- I mean, in the late 80s, every single province conducted a Royal Commission or whatever they called it. And every single one of those reports, integration was the big issue that came up, every single one of them.

Now, provinces did different things. They went regional health authorities or they went-- whatever Ontario came up with, but they looked at all kinds of things. But the focus was on the structure, not what is it you're trying to achieve. And so I think for integration and collaboration to be successful, they have to be embedded into the way we do our work and the expectations and the outcomes that we're hoping to achieve. They're not right now.

It's oh, well, we've got this idea, now, who are we going to collaborate with it? I don't believe that that's the way for long term success because health care. I've always said, is inherently civilized. That's my own word. There are nurses and doctors, there hospitals, they're clinics, there's long term care, there's regional authorities, there's LIMS. So there's all kinds of things, we just tend to be like mercury.

You drop it on the surface, you get these little round balls that automatically form no matter wherever you drop the mercury. We tend to function that way. And there has to be-- it has to be a deliberate-- either, I mean, why then at some point into our DNA that collaboration is just part of the way we have to do our work and it cannot be accepted that we would do something differently.

Because when I look at, for instance, all the issues of COVID, and they talk about the-- finally, we got some collaboration. Well, I led the [? Sarge ?] initiative in. 2003. That came up then too. We did this huge review, three big reviews, wrote the reports, and put them on a shelf. So I think it's somehow the accountability for when we say things like collaboration, integration, whatever. There has to be some accountability for ensuring that is a long term characteristic of the system. Otherwise, I think it's too easy to put it-- it's easy to put it off on a shelf somewhere.

BRYAN BENJAMIN: Yeah, and thank you for referencing that. It feels like a long time ago, but boy, it's a memory etched in my mind. I was in Toronto during that period of time. And lessons learned, are they all carried forward and are we actually able to make as much progress as we need to? Janet, you use the word accountability. I'm going to open this up to all three panelists, so whoever is brave enough to jump in first gets to go.

Is what are one or two things that we could do to help ensure accountability happens or to create the foundation for this accountability so that we're not doing a live stream in 25 years on this topic saying, jeez, I wish we had learned more back in 2020, 21, 2022? Are there-- whether it's a digital lens, whether it's a governance lens, whether it's a leadership lens. How do we weave this in and get that accountability moving to create that sense of collaboration?

SARAH HUTCHISON: I'm going to start by saying I think at the macro level, I think the way that this system is organized and funded creates so many structural barriers that really have a profound impact on driving accountability. And I think the challenge is accountability often gets downloaded to the smallest node, so I think providers feel it. But actually, I think the real opportunity for us is how do we get the feds and the provinces working together to make sure that how money is moved, how priorities are set in terms of that strategy is far more aligned?

And we find ourselves in whatever is the next version of our COVID response not working at cross purposes. I mean, I think that's the indicator of success that what we've done has actually been changed as opposed to everyone's blaming everybody else. And at the end result, it's the front line that's really feeling the burden of that lack of alignment, but with full accountability.

JANET M. DAVIDSON: I mean, I would agree. In fact, I think accountability is not something we're actually very comfortable with in this country. And I would just say, you look at the events in the last couple of days with the release of the federal auditor general's report and all of this money that went for naught. And the response so far is oh, well, that's then and this is another billions of Canadian taxpayers' dollars.

So it permeates through everything, whether it's in health care. I would use the example of the provinces and territories came together in FPT meeting a few weeks ago. And I mean, having been involved in those meetings in the past, I know all of those materials are read and prepared before any meeting takes place. But the premiers decided no, they want to discuss-- they just want money with no holds barred, and that's it. Well, that message goes out.

And so if that one is we don't want to be accountable, we just want you to give us the money and then go away, then I think it's going to take a lot of hard work and some very strong leadership to drive an accountability structure that-- or just not a structure, a culture that is different from the one that we have right now.

And I think-- I mean, I'm hopeful by talking to a lot of students, graduate students going through health management type programs, that's more-- they're looking at that more than certainly they did when I was in graduate school. So I think there's more of an awareness. But I think as Matthew mentioned earlier, the amount of money that we're spending, at some point, at some point, people are going to say, what? Wait a minute. What is happening here? Because we will be in a point where we can't spend anymore. And then people are going to say, well, how are we going to make any decisions about what we don't spend money on if we don't have some sense of who's accountable for what when?

MATTHEW LISTER: Thank you, Ann. I think that there's a tendency to think that there's accountability if there's an organization that's labeled to be accountable. So there's a lot of talk right now about national dental care and pharmacare. And if you read through the recommendations, it follows a similar path. Set up an organization that's responsible for this. Have it structured and give it a certain mandate. And therefore, will have accountability.

But it's proven time and again that having an organization, having an overarching administration doesn't necessarily mean accountability. And anyone who's done planning in the private sector, like real on a strategic planning as opposed to just getting a list of priorities and projects together, but honest to God strategic planning in the private sector, would be shocked at how it's often done in the public sector.

Whereby there are endless consultations of different academic community, patient. I'm not saying those things are bad, but I think there's a different way of involving and honing decisions so that ultimately, there can be better accountability in the system. One thing I've noticed too is that we tend to think very much in those silos and continue to think in those silos.

And one of the things I found interesting in working abroad is that there have been two instances where I've had to explain home care. And this is to a group of academic and government and providers. And one of them interpreted right away. Oh, so you mean like for example, after somebody gets discharged and once they're in-- oh, the hospital already does that. So they haven't really institutionalized it.

BRYAN BENJAMIN: That's great, thank you, Matthew. And thank you all three for being brave and diving in on that question. So how do we increase cooperation and collaboration based on highest value outcomes when health care is so tied to government agendas and re-election? Anyone one want to weigh in or have a bit of a perspective on that one?

JANET M. DAVIDSON: This is the real crux, of course, of the Canadian health care system, the increasing politicization. And over my career-- I mean, I've been around longer than I want to admit, but it is increasing politicization not at the strategic level, we haven't really done much at the strategic level, but at the operational level.

And I think that makes it extremely difficult to come up with overarching principles above anything because as was mentioned earlier, I mean, the political cycle is quite short, and so to try and have any long term vision becomes almost impossible. And right now-- I mean, there are-- I often say there are 13 health care systems in this country, there isn't one. There's a federal one, and then there are the 10 provinces, and the three territories.

And all depending on where you go, it's all different, including the fundamental principles that Matthew identified earlier. They're applied differently in different provinces and it's a real challenge. So you're really going to need a very strong, I think, political focus that's visionary and is committed to some principles around health care, universal health care so-called, that people will rally around. And somebody said to me one time in Europe, they said, true transformation requires courage and leadership. And quite frankly, it's in very short supply.

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BRYAN BENJAMIN: I do want to talk a little bit about workforce planning. And obviously, given the size and the scope of what we're talking about, the people component is absolutely massive. So in order for the health care industry to be thinking, forward looking, when it comes to workforce planning, what are going to be some of the most crucial skills that leaders and individuals in leadership roles are going to be requiring? , I say moving forward it could very well be starting today as well.

MATTHEW LISTER: Do you have a time machine? Because I think these warning signals were well identified. A former colleague recently produced a report that suggested that Ontario alone would need about 4,000 PSWs per year for the next two decades to meet the needs of long term care facilities, individuals living independently at home or in assisted living facilities, or to support some of the increasingly hospital in the home type concept work.

So that's just one area, and we tend to think very much around the clinical roles that are necessary-- nursing, pharmacy, family physicians, primary caregivers, especially who have been under enormous strain right now. One thing that's fascinating is to look at the data around deployment, planning, and supply.

And so for example in a couple of areas, these are large academic places where I've worked, we found that there is anywhere from a 5% to a 30% opportunity in how the workforce is actually deployed. And so that's to say have we crudely put have we right staff right sized this particular function? If the political forces around COVID look extraordinary, the internal political forces around deployment are no less massive and influential.

So those are some of the things that come to mind. I think separately-- I'll close at this point or just after this comment, but I think too that my own experience in doing strategic and operation planning with larger centers has been that HR and Workforce is typically the afterthought. It's typically only looked at during labor negotiations or around that. And I think that it really needs to be part of the strategic planning. So often in the private sector, I hear the concepts around talent management and talent planning.

And that's a conversation I don't really hear nearly as much in health care and I think it's a necessary one. There obviously IEN, IMG-- sorry, IEN, for those who don't, are Internationally Educated Nurses, International Medical Graduates who have a lot to offer, and then the advent of machine learning and so on which we'll have some influence on how services are provided. But I think that's still a ways off.

BRYAN BENJAMIN: Your point around planning and longer term thinking feels more relevant now than ever, especially with unemployment rates so low and competition for Talent So fierce, how do we make the most of the resource pools that we have and continue to move that forward? Sarah, anything that you'd add on this very important workforce part of our conversation?

SARAH HUTCHISON: Yeah, maybe a couple of things. I think one of the areas of conversation that I think needs a lot more attention is Pan-Canadian licensure of our health professionals to make our workforce redistribution far less challenging that it has. To Janet's comments about how many systems we have running in competitive operation, the answer is a lot. And I don't think piracy is the response, meaning we need to move people to the highest bidder.

We should be working as a system that responds and allocates resources to the highest need. And you know, I see trends emerging which are suggesting we're going to bump up our salary or remuneration in such a way that we'll disrupt another area or jurisdiction. And I think I understand why, but I feel like that is going to cause a cascade of issues for us that we're not going to recover from.

So I think national licensure, whether you're a physician whatever regulated health professional, to allow that-- make it easier to move people around in the country. I think we do need many different remedies in terms of that strategy. And as I say, this inter-provincial poaching, I think, is-- it's an oh-oh as we think about that going forward.

MATTHEW LISTER: So I would agree that we did lose a patient focus from a political, lens but I saw a number of organizations do things and collaborate in ways that I found absolutely amazing. I found groups in public health, the private sector, hospitals, all coming together to figure out how they could organize an arena to provide immunizations, how to share resources and do things like that. Work with public health to track vaccination, maintain cold chains, and that sort of thing. I actually found an awful lot of collaboration on the provider side that may not have come through to the public through the media at the political layer.

BRYAN BENJAMIN: Time flies when you have a big meaty conversation and three exceptional panelists. During the pandemic, we lost the patient focus as different policies and different medical agendas began to clash. How does this affect the common vision of sustainability? I mean, we're very much aligned to that theme of collaboration and connection.

MATTHEW LISTER: Senator Colin Deakin has been doing a lot of work in competition in light of the Rogers Outage. And I found it very interesting to watch and follow. I can't help but think that some aspect of competition would be very helpful for the system also. And we speak about an innovation-- I don't think Canada has an innovation problem, I think Canada has an innovation adoption problem. Integration option-- integration issue.

And I think competition could help with that enormously. There is absolute outrage at the loss of Rogers services, but I was surprised to hear people say, yeah, it's going to be four years before I can get my knee looked at. We seem to tolerate that-- we're absolutely intolerant of eight hours of a service outage. And I would love to see some of the language come through in the thrust for demonopolizing or all the globalizing, or whatever the right word is. But basically, adding competition to a system so that we can begin to compare apples to apples and what we're receiving in terms of value for financing.

BRYAN BENJAMIN: Thank you. Janet, I'm going to go to you with this next one because you mentioned US earlier, but I think you have an interesting take on this. So the US has made some small steps towards covering medically necessary dental health care, which can help manage chronic disease outcomes. Do you see oral health getting any oxygen or is this still too far out here in Canada?

JANET M. DAVIDSON: I don't think it's too far out. I mean, dental care is on the National agenda, and at least they've now got some provided for children. I think it's just going to be a question-- it's like pharmacare. How much can we add on to the system without really looking at how effective we are right now? And that's, I think, going to be the challenge going forward.

BRYAN BENJAMIN: We thank you for that. So we have structure, we have many pieces. The performance appears to be an issue. Is this just on delivery or is there greater scope in terms of performance--

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JANET M. DAVIDSON: Oh, I would say it's across the spectrum. I don't think it's just on one particular aspect of it. We tend to hone in on things like-- well, it's got to be a simple solution to a very complex problem. So I don't think it's just one thing. I think there are a number of things that we need to look at collectively in order to-- the thing that you would do in the old days when you look at a system and say, let's chunk up the pieces and say, what's the challenges here and what are we going to do about it? We don't tend to do that very much in health care.

SARAH HUTCHISON: Yeah. And I think it's further complicated by the fact that there are significant resource gaps and significant sectors. So you want to look at quality and performance and outcomes, and yet physician practices as an example in the community just aren't resourced with the infrastructure to do that.

So there's a little bit of a conversation of you get what you pay for, but you need to think about what needs to be true in order to get the kind of measurement and outcome data that you want and whose job that is. And if it really is important in primary care as an example or other sectors, then you have to create resource capability for that to happen. So that has to be a deliberate investment, people need to understand that, and we need to carve out room for that to happen.

And I think again, to this discussion about resilience and sustain a healthier, we're asking everybody to do everything in times of-- in times of trouble and I think that is not actually sustainable. And that is why our work in collaboration with the private sector is absolutely necessary. There are tasks and jobs and opportunities that lend themselves wholeheartedly to a division of responsibilities that allow us to work collaboratively and fall forward in a much more productive way.

BRYAN BENJAMIN: Thank you for going and giving some, I think, pretty eye opening comparisons to what's tolerable and not tolerable. Why cannot Canada offer a private option?

JANET M. DAVIDSON: That's the big question, of course. I mean, why can't it? Because there is this specter that's out there that somehow private means bad, and it's just that it would destroy Medicare. And I often say, well, unless you're channeling Tommy Douglas, I don't think he actually thought of this when he created Medicare.

Medicare was created for very valid purposes of nobody should be denied hospital or doctor care, but it was not designed for any of the stuff that we're doing now. And to simply take the old model and say it's OK and just apply it to the current environment and think that that's all right-- I mean, I think the question its raising is a very good question, and a lot more Canadians are starting to ask that question.

BRYAN BENJAMIN: So I'm going to give everyone 30 seconds for one final comment. Sarah, Matthew, Janet, just to give you an order.

SARAH HUTCHISON: Look, I think the private sector brings considerable resources and expertise to the table. I think we have to create spaces to provide and support that intersection. I think there are lots of us that are in roles and in settings that can create that space to make that collaboration happen and make it easier for clinicians to reach the private sector and private sector to reach clinicians and health care delivery systems. I think that's the challenge in front of us, and I look forward to our next panel discussion about how we might actually make that happen.

BRYAN BENJAMIN: Amazing, thank you. Matthew.

MATTHEW LISTER: I think we tend to think very much a partnership in big terms, organization, organization. And that's necessary, but there are small steps too. I used to run a team of about 16 project management and lean Six Sigma folks, both in Vancouver and in Toronto. And I made a point of hiring people who had no health care experience. And they very often saw things and saw through things and saw opportunities that those who had worked in the industry who had been conditioned to certain data points or certain ways of doing things, they simply couldn't see what those barriers were all about, and managed to solve some very pernicious and persistent problems.

BRYAN BENJAMIN: Thank you, Matthew. Janet.

JANET M. DAVIDSON: I always say to people, if somebody says they can't do something, you have to ask them why not? And continue to ask that question. An advisor of mine once said, ask why not five times, up to five times if you can't get the answer you want in the first time. And then you couch it, tell me how this is in the best interest of the patient, which of course are the citizen or whatever the focus is? But I think why not? Why not? Why not? Because we always talk about why we can't get there from here, as opposed to saying, we're going there--

SEAN ACKLIN GRANT: Thank you for tuning in to Leadership and Practice.

JANET M. DAVIDSON: --now. Let's just figure out when.

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SEAN ACKLIN GRANT: We'd like to thank our guests-- Janet M Davidson, Sarah Hutchison, and Matthew Lister. Leadership and Practice is produced by Melissa Welsh, Joanna Shepherd, and me, Sean Acklin Grant. Editing and audio mix by Carol Eugene Park. If you like this episode, make sure to subscribe. You can also find more information by visiting iveyacademy.com, or follow us on social media, @iveyacademy, for more content, upcoming events, and programs. We hope you'll join us again soon.

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