Jobs to be done

We live in an age of surveys, with marketers constantly asking us our age, gender and personal preferences. All the while, they hope this information will unlock the key to edging out their competitors, once and for all.

If we apply this trend to health care, we can agree that some of this information could prove useful, but is it going to help us provide the best possible experience for our patients, clients and residents? The simple answer is – no.

A favourite author of mine, Clayton M. Christensen, wrote in 2016 that instead of focusing on demographic or psychographic information, we should focus instead on what he called “the job to be done.” Simply put, it means focusing to a greater degree on what users are trying to accomplish—that is, the progress they are trying to make—in a given circumstance, versus what age bracket they fall into. For instance, regardless of age, gender or profession, anyone who visits one of our facilities for a blood test is looking for the same thing: quick, efficient and thoughtful care that will allow them to complete this task easily and with no problems.

This line of thinking reminds me of the “Empathy” video we produced when I first became President and CEO of CIUSSS West-Central Montreal. We can look at all the statistics we want, but at the end of the day, when we pause for a moment and put ourselves in the shoes of our users, we can see quite clearly what they are going through. If we understand what our users need, and if we look beyond their diagnoses, we can not only provide them with better care, but with a generally improved experience on their road to recovery.

Once we’ve done that, we won’t just have accomplished “the job to be done,” but a job well done.


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The Helpers

Like all of you, I have listened with sadness to the stories of Quebecers who have been affected by the flooding these past weeks. The loss, as we know, is widespread—from personal belongings to homes and even life.

Many members of our network’s staff come from the areas that have been hardest hit. This week, I learned of employees who have lost everything. But as I read about these tragedies, other emails started to trickle in—emails of hope. Each told of staffers who had decided to give of their time to fill sandbags, or to donate food or clothing. In other cases, staff were asking how they could help, whether by donating items or time.

When our CIUSSS came into existence two years ago, there was no way of knowing at that time how long it would take for us to start to feel like a true, cohesive network. As a result of this natural disaster, as well as the willingness across all of our sites to help one another, I have clearly seen that we are becoming a family, with staff banding together to set up donation bins across our sites, and to join the growing relief effort.

There’s an adage that encourages us when tragic events like this arise: “Look for the helpers. You will always find people who are helping.” Our staff at the CIUSSS Centre-West Montreal, are just that—helpers, and I could not be more proud.

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Grappling with the ever-increasing needs of the elderly

One day last week, while reading the morning’s top news stories, I was fascinated to discover that we’d arrived at a turning point that’s been anticipated for years. There, in black and white, were some key figures from Statistics Canada’s 2016 census: The number of seniors in our country (5.9 million) has officially exceeded the number of people 14 years old and younger (5.8 million).

Statistics Canada also projected—as gerontologists and demographers have been telling us for two or three decades—that this lop-sided situation will become even more glaring as more of the baby boom generation hits retirement age.

As a physician and healthcare administrator, I’m gratified that advances in medical science and technology are helping Canadians to live longer, better lives. But there’s no denying the fact that tending to their healthcare needs is disproportionately complicated, since each person often has multiple medical problems or conditions.

The saving grace is that our healthcare system is now better equipped to grapple with the growth of the elderly segment of our society. Ever since the creation of CIUSSS West-Central Montreal in April 2015, we have been improving the continuum of care among our facilities. That means an elderly person can move more smoothly from a hospital to a rehabilitation centre, to home care or to a long-term care facility, in sync with his or her evolving needs.

On a related note, we’ve been working toward an even tighter integration of staff across our facilities. Regardless of where they work in our CIUSSS, members of staff who have expertise in a particular field, such as stroke, collaborate to ensure the timely treatment and care of those in all of our facilities.

Interestingly, last week’s turning point brought to mind a paper from the Journal of Gerontology that I pulled from my files. Published in 2006, it examined home care programs and other services for seniors in two Montreal CLSCs, concluding that there is “potential for integrated systems to reduce acute hospital and [long-term institutional] utilization, without increasing costs or caregiver burden, while increasing satisfaction among caregivers.”

Today the dream of creating this sort of integrated system has been realized, and we’ve already begun to appreciate many of its benefits. While we’re aware of the need for further improvements and refinements, I’m encouraged by our enhanced ability to make the elderly the focus of so many of our efforts. The ever-increasing demands of our graying population will be tough to cope with, but the foundation for doing so has been laid.


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Better health care through collaboration

Last Monday, along with our partners at Polytechnique Montréal, Université de Montréal, Sainte Justine Hospital and the CHUM, we unveiled the TransMedTech Institute. This collaborative project will see us develop superior designs and methods to treat three areas that pose major health risks for Canadians: cancer, cardiovascular illnesses and musculoskeletal disorders. The Jewish General Hospital, a key facility in CIUSSS West-Central Montreal, is proud to play a crucial role in the area that focuses on cancer.

This marks not only the first time that all of these organizations have come together on a project, but the first project of its kind in Canada. From engineers to physicians, from researchers to patients, we’re not looking at issues in a vacuum; instead, we’re working together as Quebecers who know the important roles that innovation and technology play in health care. Silos have been dismantled, and instead of protecting research as if it were a trade secret, we’re sitting together to share what we’ve learned so far, and what we need to focus on next to improve the quality of care, and the way it’s delivered.

By having this varied group of individuals working cooperatively, our hope is to develop new technologies that will provide faster, more efficient care to our patients. Of the budget of almost $100 million, over half is provided by the institutions involved. This reaffirms that throughout health care and beyond, the need for new technologies is not only recognized, but prioritized.

I’ve said it before and I’ll say it again: It’s amazing what becomes possible when we work together.


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The art of the huddle

Ask someone what they associate with the word “huddle”, and nine times out of ten, they’ll say “football”. However, in the last few years, that has begun to change.

On my recent trip to Yale New Haven Health, when I received an invitation to the morning huddle, I wasn’t being asked to suit up for a friendly game. Rather, I was welcomed to participate in the daily patient safety report.

I wasn’t sure what to expect when I arrived the next morning at 8:00 a.m. As I sat there, senior leaders, nursing directors, middle managers and department chairs came in, with others joining by phone or video conference. For the next 20 minutes, the safety and quality issues of the previous 24 hours were reviewed. Updates were provided, decisions made and celebrations held. Yes, you read that right—celebrations. Whether the group acknowledged having caught a potential problem before it materialized or having solved an actual problem, each was mentioned and the teams were praised. Before I knew it, the meeting was over and people were filing out of the room, back to their work areas to tell their teams what had just been discussed.

You might ask, Is this type of huddle sustainable? The answer is, Yes. For over two years, Yale New Haven Health has used this model to provide clinicians at all levels with an opportunity to address problems quickly, face to face, and in an efficient and effective manner.

Having witnessed it first-hand, I can confirm that it’s a model that will be of benefit to our network and, more importantly, to our users. In partnership with our leadership team, I look forward to introducing huddles in the near future.

Hut, hut, hike!



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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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