Dr. Mark Wainberg: an exceptional man

For those of us who observe Passover, celebrating with family and friends is a focal point of the holiday. Together, as we sit around the Seder table, we read the Haggadah and relive the chronicle of the Israelites’ exodus from Egypt.

Our wine glasses are filled, emptied and filled once again- four times. However, at the centre of the table, one wine-filled cup remains untouched—reserved for the prophet Elijah. According to a centuries-old tradition, the contents of this special cup are never consumed. Instead, it sits ceremoniously and symbolically, representing staying power, perseverance, in anticipation of the Messianic times to come.

Sadly, this year’s holiday has been interrupted by the sudden and tragic passing of Dr. Mark Wainberg, a gifted scientist and a wonderful man who also exemplified traits of commitment and a desire to make the future better for those in distress. Through his own perseverance and staying power, he greatly changed the lives of so many through his contribution to HIV/AIDS research.

Mark was a colleague and friend to many of us at the Jewish General Hospital (JGH) and the Lady Davis Institute—in some instances, as far back as the mid-1970s. A humble, but determined man, his smiling face and desire to do and bring good to the world are typical of the values of the many individuals who built and continue to push the JGH toward new heights.

I can only hope that this tragic loss will serve as a reminder of the impact that any of us can have on the world of health care and especially on those who look to us in in their most difficult hour. As Dr. Wainberg ably demonstrated, our patients must be at the centre of all of our efforts, and it is to them that we must dedicate ourselves in providing the best possible healthcare experience.

For me, as for many of us, the untimely passing of Mark Wainberg will forever colour this holiday season. May his memory be a blessing for us all.

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The meaning of change

Ten years ago, if your family lived abroad, the only ways to stay in touch were by phone, email or snail mail. Today we can also take advantage of Skype or FaceTime to maintain or rekindle a closeness that would have been inconceivable a decade earlier.

These same kinds of advances are being made in health care. On a recent trip to Yale New Haven Health in Connecticut, I was privy to some major technological advances, including the InSight Tele-ICU. In what looked like a command centre, physicians, nurses and other healthcare staff sat at computer workstations and remotely monitored patients in all of the Intensive Care Units in the health network. From 7:00 p.m. to 7:00 a.m., with the use of cameras and live video, they we able to take a look at patients’ vital signs, test results and updates of their condition. If a problem arose, they alerted staff on the floor, while assisting them from afar.

This is an amazing advance for medical care and the future of telehealth. No longer do we need to constantly be by our patient’s side; instead, we can provide much-needed assistance from a distance, and as a consequence, on a much broader scale.

In our own network, imagine what we might do, for instance, with home care. We know that our users’ needs in this area will continue to grow. If we start to rethink the way we organize home care, as well as our use of current technology to enhance the delivery of care and social services, we can create an opportunity to expand our reach in ways that were previously unavailable to us. For instance, rather than having to visit a client’s home for every session of physiotherapy, video technology could allow us to do so remotely. This would cut down on travel time, while allowing more clients to be seen in a single day. This is just one example, but the possibilities are endless.

I am certainly not advocating the use of machines as a substitute for the compassion, insight and intuitive edge that only people can provide. But there is no reason why staying open to new generations of medical technology can’t help us make the most of our skills as healthcare practitioners.

Perhaps we need to reevaluate how we see change. Instead, we would do well to realize that the only thing more frightening than change is no change at all.

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The perennial student

It could be said, quite accurately, that I love to learn. I was a student until the age of 35, by which time I had earned an MD, MSc and PhD. Then at the age of 49 I returned to the classroom to complete a MEng in Management Science. I’m a firm believer that we should continue to learn throughout our lives, whether in the classroom, through books or from one another.

A concept that I find particularly inspiring—known as “the learning organization”—was developed by Peter Senge, a senior lecturer at the Massachusetts Institute of Technology and author of The Fifth Discipline: The Art and Practice of the Learning Organization. It’s an approach that I believe is especially relevant to the success CIUSSS Centre-West Montreal.

Mr. Senge describes his concept as “a group of people who are continually enhancing their capabilities to create what they want to create.” This school of thought not only inspires me, but is something that I’ve tried to integrate into our healthcare network.

When I became President and CEO of our CIUSSS, I gave our Executive Team a list of books that looked very much like a summer reading list. It wasn’t meant as “homework”, but as a means of introducing new ways of thinking and of broadening the way we look at health care. Instead of always trying to solve immediate problems, Senge advises us to strive to make things the way we want them to be.

This type of thinking isn’t limited to high-ranking executives, but is a perspective that I encourage whenever I meet members of staff. I phrase it in the form of an invitation: “If you have an idea on how to improve some aspect of our network, come and see me—and I mean it.” Sometimes the best ideas do not originate at senior management, but spring from sources at all levels throughout our network.

My goal is to impart an ongoing vitality to the curiosity that we felt during our academic careers, and to channel that energy into creating the best possible user experience—all without making it feel like homework.

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Let’s keep running

Not many people know this about me, but I’m an avid runner. Over the course of a week, I log a few 8k runs on the treadmill, because it’s all about staying active in body and mind. I’m methodical in my running—constantly looking to improve, but not so hastily as to open myself up to injury.

As I put on my running shoes the other day, I took a moment to reflect on what CIUSSS West-Central Montreal has accomplished over a period of just under two years. And I realized that, in many ways, my work with our CIUSSS has been, and continues to be, my greatest run.

I’ve spent a great many years in health care—over 30—as a researcher, physician and administrator, with many exceptional experiences to look back on, but these past two years are the source of some of my proudest memories.

When our facilities first merged, we faced an uphill struggle. We had to learn to work together, understand one another’s historical legacies, and gain an appreciation for the culture that makes each institution tick. We also had to give serious thought to what the culture of our new CIUSSS was going to be—not a simple task for a network that encompasses more than 9,000 employees and 34 sites.

Yet, when I look back on all that we’ve accomplished together over the past 24 months, I can’t help but think that we’re now seeing the payoff for all the effort and training that each person has put into making this one of the best CIUSSS’s in the province.

On Friday, I had my personal annual performance evaluation with the deputy minister and an associate deputy minister. There is always a feeling of trepidation in the days preceding such an encounter. But once in the room, the conversation flowed very freely and I proudly presented the many accomplishments of our CIUSSS from the past year. This was indeed an extraordinary year of accomplishment, and this was acknowledged by the ministers as I proceeded to run down the full list of our achievements.

As the famous runner, Steve Prefontaine, once said, “To give anything less than your best is to sacrifice the gift.” We’ve all given our best, and for that I am deeply grateful to our dedicated management team and staff. To them I say, “We’ve had a great two-year sprint, but we still have a marathon ahead of us. So, let’s keep running!”

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Circles vs. rectangles

In my office hangs a cityscape of Montreal, with the focal point being the landmark Orange Julep. It’s unusual shape, and bright colour distinguishes itself from any other building in Montreal – or the province for that matter. To me it is symbolic of change: when everyone else is building rectangles, sometimes you have to look at things in a different way, and build a circle.

Last Friday, I was fortunate to find myself in a room filled with “circle” thinkers. Some brilliant health care minds from across North America congregated at a morning-long conference to discuss the future of healthcare delivery.

The ideas discussed didn’t focus on quick fixes, but rather long-term steps that can be taken to improve our health care and social services ecosystem for decades to come. It was aptly pointed out, that with proper organization, integration and coordination, systems flourish and benefit not only the patient, but us all.

Additionally, we looked at how to better adopt population health management into our integration strategies and support front line clinicians in aligning their practices. Those presenting weren’t just reciting their wish list, but instead were sharing the success they’ve had in building such networks, and what is required to sustain them as high reliability learning organizations.

Change, as we know, doesn’t happen overnight. It takes time, dedication and a genuine desire to be better. It doesn’t come from policy change; it is far more complex than anything written on a piece of paper.

What kept coming back, competing with this notion of change, was how it’s easier to do what we’ve always done. It feels safe. Instead of accelerating improvements, one often delays them.
If we follow this methodology, we’ll end up living in a world of rectangles. Instead, let’s keep trying to build circles.

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Refugees

Over the last couple of months, the daily headlines have consistently focused on the stories of refugees who are making their way into Canada, whether by plane, train or the now high-profile Roxham Street in Champlain, New York.

Regardless of how a refugee or asylum seeker enters our country, many end up in the excellent care of our staff at the Regional Program for the Settlement and Integration of Asylum Seekers (PRAIDA). I want to take a moment to publicly single out the work of this supportive, informative and, in some cases, life-saving program, and its dedicated staff. Our nurses, doctors and allied healthcare professionals provide health care and social services to those who have seen and survived incredible horrors. In many instances, they have even been separated from their loved ones for long stretches of time.

I am fortunate to have been born and raised in Canada, and I can barely imagine the struggles experienced by those seeking PRAIDA’s aid. For this reason, I am proud that we can be the light at the end of a long road for those in need.

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Global exchanges

One of the great benefits of working in healthcare is having the opportunity to meet other professionals who have a willingness to share insights and trade knowledge. The result: improvement isn’t limited to one site, but is experienced all over.

For example, I’m fortunate to have had some wonderful exchanges over the past 10 days during a visit to Clalit, the largest HMO in Israel. I’ve had the pleasure of learning first-hand about their triumphs and setbacks, and how the lessons that they learned can benefit our network.

As I prepare to return home, I’m especially encouraged by the health care system focus of Clalit,and their clear determination and commitment to putting patients and users first, especially by providing care anywhere and at any time!

As well, the facilities that I visited are at the vanguard in IT and supply chain management. We, too, are focused on these fields, but we are definitely behind and need to play catch-up quickly in order to remain competitive and to sustain our drive for excellence. Looking at Clalit it is encouraging to know that a clear path to continued improvement can be mapped out.

Though 8,000 kilometers separate Canada from Israel, we face many of the same challenges. And, like us, the Israelis are privileged to have excellent staff members, who understand the importance of usercentric care. Throughout our sessions of give and take, one key fact predominated: only by working together—within facilities, within networks, through global alliances—can we continue to improve the healthcare landscape for all.

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Disney

With spring break starting this week, and many families taking off to Disneyland I fondly recall my first visit to the Magic Kingdom – 84 acres of rides, restaurants and entertainment, a fantasy land for young and old. And yet, among the throngs of people was a sense of controlled chaos, and a general feeling that this was one well oiled machine.

My fascination and admiration for the theme park stayed with me long after I’d removed the Mickey Mouse ears. The notion of putting the client first, and making sure they had the best experience, was one that has resonated with me both as a physician and administrator. The experience was inspired – from the single Disney card that provided access to all parks, to the unified vision that employees endorse. The results benefit customers and staff alike.

Now, as leader of the CIUSSS West-Central Montreal, I’m trying to invoke the wise words of Walt Disney himself as we look to the future of health care:
“First, think. Second, believe. Third, dream. And finally, dare.”

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My vision for the creation of a McGill Health Network

On October 19, at the behest of the Minister of Health and Social services and in his presence, I outlined the concept of creating an integrated McGill Health and social services network before a room full of representatives of all McGill University related health and social service institutions. The Gazette reporter was also present. The text of my presentation was widely circulated by the Ministry to all stakeholders as part of a consultation undertaken by Dr. Arvind Joshi at the request of the Minister. In that context, I recently took the initiative of summing up the content of this presentation in a letter distributed to all employees of our CIUSSS with a view to enabling them to have an informed understanding of my vision.

My proposal of re-establishing director general positions in major institutions is specifically linked to the creation of a fully integrated McGill health and social services network, an integrated system more fully adapted to the needs of the population. The question is not about “undoing” the present networks, I never said or implied anything of the sort, but about evolving to another type of organization. Bill 10 is predicated on the need to establish networks of care by bringing together institutions under the direction of integrated health and social service centres. In my view we now have the opportunity to move forward and advance quality and access by bringing the two CIUSSS and the MUHC together in an integrated system covering the full range of services people require. This would call for different governance and organizational structures.

What we have today are two CIUSSSs and the MUHC, all under the McGill University umbrella, all serving the same population, but operating independently from one another. Patients need to go from one to another to get all of the services they require, and they have to adapt to each institution, rather than the institutions adapting to their needs, as they should. Services and patient files are often duplicated and fragmented.

We can do much better. We have the technology, the resources, the know-how, the competence required to create a seamless integrated health and social services system where patients entering from any service point would be directed to the nearest available resource required by their condition. This is the essence of the concept of creating truly integrated health and social services systems focused on access, value and quality for the user. It is the direction in which health and social services are moving throughout North America.

Describing this concept, I said the following on October 19:

“In such a network consisting of a substantial territory and population, and encompassing the complete range of operations with an operating budget of some 2.5 B$ it would be necessary and desirable to empower decision-making at the operational level in order to be responsive to local needs and circumstances in a timely manner. In this regard, in my vision I believe there should be director generals in the major institutions in order to ensure that these local considerations are managed according to the needs of the community level.”

As for the councils of physicians, dentists and pharmacists (CPDP), local CPDP sub-councils are possible under Bill 10. In fact, we have created them in our CIUSSS and they work well. They are effective and the preoccupations of each establishment are taken into account. I said all of this in my October 19 presentation, clearly stating that this feature should be carried over in the McGill network concept.

To be clear, in an integrated McGill health and social services system, our current establishments would continue, they would have local management, but they would also have common standards of care and performance. The focus would be on the user and the obligation of the system to enable them to move through it seamlessly.

Our healthcare institutions must adapt to changing times. These are vitally important matters that require informed, in-depth discussion. I welcome any opportunity to further this discussion.

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A voice on the inside

Health care is so ubiquitous and ever-changing that the latest news pops up on TV, on Facebook, in the newspaper—practically everywhere you look. But those voices come from the outside, not the inside.

I’d like to introduce a new voice to the mix—my own, a voice on the inside. Every Monday, I look forward to sharing my thoughts and reflections with you about the healthcare landscape, what we’re doing to improve it, and what lies ahead for us.

My reflections will be about us—the patient, the resident, the caregiver—and what inspires us all to keep going. As the great Vince Lombardi once said, “Perfection is not attainable, but if we chase perfection, we can catch excellence.”

Lawrence

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