From the desk of Dr. Michael Gardam, Health PEI CEO
Hi everybody,
One thing the Change literature says is that the messages need to be repeated many times in many different ways for people to start noticing them. Given that we are on a bit of a “change roll”, I wanted to follow up with another message that I hope will resonate with many of you.
Three weeks ago we launched our combined physician/administrator leadership development program with MSPEI and CMA Joule where 32 current and future leaders will learn together with the aim of improving collaboration within and understanding of our Island healthcare system.
This has been a dream of mine for 5 years believe it or not—my first work on the Island was with physician leadership education for MSPEI. At that time, I was keen on the idea of having doctors and other professionals learning side by side to try to start breaking down the silos I have been hearing about my whole career i.e. Doctors often don’t think much of “administrators” and vice versa! We are finally doing it and I am very thankful that we have such a willing partner in MSPEI to try innovative things like this. Believe me, not all medical societies in Canada get along with their health authorities like we do here!
I kicked off the program with a short talk on complexity science, my favourite topic, , and how it not only explains our current system but offers approaches on how we might improve. One of the exercises we did was discussing the concept of “fractals”, which are repeated patterns of behaviour and actions that exist at all levels of the system.
The class includes a good mixture of perspectives and backgrounds, yet there was clear agreement within the group that they felt the following unhealthy patterns exist throughout our system:
- Lack of clarity on who is in charge/who makes the decision, resulting in finger pointing and lack of follow through;
- Hearing only one side of a story and running with it—we have heard this a lot the past week with groups saying “nobody from Health PEI talked to us” and this gets repeated in social media, the media, the legislature, and pretty much everywhere else and accepted as truth;
- “Leap frogging” where individuals will bypass their leader (or leaders!) and go right to the CEO/Minister/Premier with their issues;
- A historic lack of evidence-based decision making. Rather decisions have historically been based on expediency, regional politics, personalities, and “who yells the loudest”;
- Pervasive negativity despite evidence that improvement is happening—we are not perfect of course, but we are better than we were;
- “boundary violations” resulting in far too many cooks stirring the pot. This also relates back to #1.
These 6 behaviours and actions certainly resonate with me and I noticed them within a couple of weeks in this role. Uncovering this list is crucially important because identifying and naming our challenges allows us to start addressing them.
One of my favourite sayings back in the days when I was a free-wheeling, care-free consultant, was “a fish doesn’t know it’s in water”, meaning that for those who have been in our system for a long time, these behaviours/actions are just the ways things are and not even noticeable. This explains why individuals joining the system from elsewhere will notice them much more readily than those who have worked in the system for a long time. This is the main reason we hire outside consultants to help us with really challenging problems—they see things from a different perspective. This is why inviting in patient partners is so important.
None of these behaviours or actions are anybody’s fault—they just are. But they hurt us and don’t need to stay the way they are—this is why I am sending your this note today.
Given that fractal #2 is being heard all over the airwaves this week, I would like to delve into it a bit more. We have heard that “nobody from Health PEI” talked to the internal medicine doctors about their concerns, nobody spoke to nursing staff at either hospital, and nobody spoke to the Union. Of course, we don’t generally put out media releases when we engage people and we certainly don’t post our work on social media, especially not about human resources issues. Do we ask ourselves, could there be another side to this story?
It has been interesting to tease out what people mean when they say “nobody from Health PEI”. Since we all work at Health PEI and many meetings and conversations have been had about PCH internal medicine, that can’t be true so perhaps they mean senior administration? The CEO? The CMO? The Board? I’m not sure, but we have ample proof of lots of engagement. Perhaps things were different in the past, but we try very hard to engage the people who are impacted by changes.
We are not perfect of course, and I wonder if sometimes front-line staff are not being updated by their local leaders—something we need to work on and support leaders in doing
Is it possible that people were engaged but they didn’t like what they heard? Nobody likes the PCU ICU challenge we are facing and could it be that people are engaging in fractal #3 to try to change the plan? It has sometimes worked in the past.
What happens when these “truths” are widely shared? It undermines all of us, makes it look like we are incompetent, and reinforces the old myth that Health PEI can’t be trusted to do its job. Ask yourself, as someone looking to move to the Maritimes, would you want to work for such an organization?
Again, I am not blaming, we need to start acknowledging these behaviours and I want us to change.
As we start to notice these behaviours/actions, we can start to work on changing them by developing very explicit strategies to move in other directions. For example, if we start to go down the road of making changes based on personalities rather than data, we can call it out, and wait for the data to help guide our decisions. We can hit pause and get more information when we hear that health PEI leadership did something we don’t like and try to understand the other side of that story.
As you have seen this week, I am ready to acknowledge when we got something wrong. Addressing these patterns and creating new ways of working together will get us to a better place.
I am curious what you think of this list!
Thanks,
Michael
Please send questions, comments, or submissions for these notes to emclean@gov.pe.ca, subject line “Notes for Michael”.