We asked CSPL members who are Canadian Certified Physician Executives (CCPE) to tell us something about their “path” to leadership:  what inspired them, how they succeeded, what they’ve learned.  We hope that their experiences will provide you with food for thought on your leadership journey.

 

Journey into the unknown

Gary Ing, MD

 

I had a dream the other night. Around 2 a.m., I received a call from an Emergency Department physician. He said all 30 ED beds were filled with patients. Several were admitted, but there were no beds available in any of the nursing units. Another 20 patients were in the waiting room. One or two of these patients had chest discomfort as their presenting complaint. The after-hours manager was actively deploying nursing staff from other areas to provide support to the ED. Patient flow had stopped and the situation was untenable. The ED physician said that if hospital officials did not provide an immediate solution, he would not accept liability. Furthermore, he contemplated leaving the department because of the unsafe environment.

 

I woke up in a state of panic. It was not a dream. The situation was actually taking place. Does this scenario seem familiar?

 

In the 1990s, I attended a leadership conference in Toronto. A session entitled “Why do you want to be the chief of staff” captured my attention. The speaker pointed out that, as we venture into the “dark side of medicine” (i.e., leadership), there are many unknown and unpredictable consequences that may have a profound impact on our careers. On reflection, these words remain true.

 

Back in 1979, six months after I began to practise medicine, I became chief of the Department of Emergency Medicine at Windsor Western Hospital Centre. I was appointed, not because of my qualifications, but rather by default, as no one else was available. Hence, my journey into the “unknown” began.

 

Until 1995, Windsor had four acute care hospitals, but financial challenges led the Ontario government to launch a “hospital restructuring” program across the province. Its objective was to merge hospitals and create “centres of excellence.” This process created a great deal of uncertainty and stress for both professional and hospital staff.

 

In late 1994, I received a call from our CEO at the Metropolitan General Hospital. He asked me to serve as the interim chief of staff for the merger with Windsor Western Hospital Centre. I thought that it would be an interesting experience and it was for a short term; therefore, I accepted the hospital’s offer.

 

As a result of the merger, I became chief of staff for the new Windsor Regional Hospital (WRH). The other two hospitals came together as Hôtel-Dieu Grace Hospital. I found myself managing professional staff from different cultures, who had also been very competitive before the merger. As many of the medical leaders were senior to me, it was difficult to gain their trust and respect. I had many sleepless nights while praying for miracles to assist me in my job.

 

I realized that I was not adequately trained to manage a staff of 350 during that merger process. I began to attend courses offered by the then Physician Management Institute (PMI). I also registered for sessions on presentation and facilitation skills at the University of Western Ontario. Top

 

Over the next 5–6 years, I witnessed a significant change in attitude and behaviour among our professional staff. It was amazing to hear some of them use the term “we” instead of “I” and “you.” I have learned a great deal from everyone whom I worked alongside during that challenging period and I consider them mentors: board members, CEOs, VPs, directors, managers, and professional staff leaders. They taught me how to view a complex situation through different lenses and that together we can develop effective solutions. I also applied what I learned in the PMI courses — i.e., leadership awareness, negotiation, conflict resolution, etc. — in everyday situations.

 

If you are interested in my advice, I would like to offer the following points.

Respect the team members you work with, especially the ones with whom you might come into conflict.

Keep calm even in chaotic situations. Everyone around you watches you closely. How they react may be dependent on the signals you send them.

Never disregard an idea from a member of your team. Sometimes, an innocent thought may turn out to be a game changer.

Negotiate only when you are prepared and compromise whenever appropriate. Keep in mind the other party has to save face.

Lead with flexibility in style. Consensus-building, a team approach, and lead by example are common strategies to gain trust and respect. However, in critical or urgent situations, do not be afraid to take charge. Being a “dictator” for a short period may yield a prompt resolution to your problem.

Be humble in your successes, accept failures, and learn from them. Don’t be afraid to pat yourself on the back once in a while!

 

In October 2013, our hospitals in Windsor underwent a realignment process, with the result that WRH assumed responsibility for administering all acute services in Windsor and the surrounding area with a population of close to 400 000. For me, this is déjà vu à la 1995.

 

My journey into the unknown has been full of surprises and challenges. I have no regrets, because my life has been filled with gratifying unique experiences. Yet, I still have a few more miles to go in this journey.

 

Author

Gary Ing, MD, FCFP, CCPE, is a family physician and chief of staff at Windsor Regional Hospital.

Correspondence to:

Inggrace2@gmail.com

 

My leadership journey

William Sischek, MD

 

My journey as a physician leader really began with the arrival of the Health Services Restructuring Commission (HSRC) in 1996. That commission, struck by the Ontario government to address ever more challenging problems of health care delivery in the province, eventually recommended and caused a large number of fundamental changes.

 

The HSRC was my real initiator into the world of leadership. Recommendations of amalgamation, closure, and rationalization of hospitals and other facilities, visions of interconnected regions with improved communications, overhaul of primary care, and better defined academic health sciences networks were the foundation of my early years in physician leadership.

 

I had joined an academic department of anesthesia in January 1988 during a period of seemingly unlimited resources and possibilities in provincial health care. Soon, though, fiscal realities were being identified, which caused many to stop and ponder the way forward. By 1995, it was evident that the system was due for a major redesign. The conversations had turned to increasing demands on services and personnel with a diminishing ability to fund the enterprise, not only in Ontario but across our country, where similar exercises were underway.

 

One of the earliest impacts on health care in my world was the formation of the London Health Sciences Centre (LHSC). The previously independent University and Victoria hospitals were brought together as a single corporate entity in 1995 just before the formal establishment of the HSRC. New challenges of previously separate hospital departments under the common umbrella of the then University of Western Ontario medical school brought realities of wholesale change. New governance structures, lines of accountability and authority all presented in a flurry of activity as the two hospitals worked toward a common future.

 

I found myself engaged in discussions of the changes and emerged at an early career stage as a site chief in the combined Department of Anesthesia, responsible for operational and personnel activities of an approximately 20-person subgroup department of the LHSC. Like so many other physician leaders of the time, I had no formal training, experience, or mentoring to help me perform the tasks at hand. I had barely begun the job when the HSRC arrived and shortly after mandated further wholesale changes to our region: closure of hospital sites, new construction of others, redesign of mental health care services, resiting of clinical services, and closure of units along with other changes. The stage was being set.

 

I engaged in my new role and sought the skills I needed by turning to the Canadian Medical Association’s Physician Management Institute (PMI). At the time, it offered four programs of learning, covering change and conflict management, negotiation, governance structure and influence, as well as finance basics. I found I was not alone. The many colleagues from across the province and country who participated with me formed a base for both learning and support. I was able to draw on that base from time to time, sometimes for advice and, at other times, simple support.

 

The network I joined was a growing one. It provided me with guidance and access to resources; it was also a place to exchange information and insight. I was able to share information and I learned to anticipate some major disruptions, including shortages of physicians then nurses across our system. Increased demand for clinical services during a time when there was an increasing desire to raise the bar of credentialing for many health professions posed its own challenges. There were so many skills to be acquired, all while still trying to maintain a busy practice of medicine, not to mention helping my wife raise our growing family!

 

In 2011, the ongoing hospital systems restructuring in London necessitated that St. Joseph’s Health Care London divest itself of obstetrics and its neonatal intensive care unit. It was to assume its long-term role as a primarily ambulatory medical and surgical care centre with limited inpatient capacity. By this time I had left the site chief position at LHSC behind, had engaged in its Medical Advisory Committee as the chair, and participated on the LHSC Board, where I had worked with operational and governance changes related to restructuring. Top

 

In 2011, I helped create and then filled the position of city-wide clinical coordinator of our now Department of Anesthesia and Perioperative Medicine. The tasks at hand involved full integration of three previously separate departmental groups and development of common policies and approaches to work load, including integrated call and fair treatment financially, all while trying to nurture and grow the academic life of the department. There was a need to ensure that the system flourished while no one was allowed to quietly “de-skill” in the new ambulatory care unit.

 

The focus of my administrative work was the operational aspects of fostering city-wide integration of the department while tending to its human resource and personnel challenges. I worked with our chair/chief and the other two site chiefs, with the site chiefs overseeing the operational details of the LHSC sites and helping support the city-wide efforts. Skills in organizational change management, fiscal responsibility, influencing and guiding systems and the people running them, maintaining standards of professionalism, and managing disruptive behaviour — all learned years earlier — were brought to bear for nearly six years.

 

The constant need to remain vigilant and attentive while anticipating new challenges meant revisiting earlier lessons learned and eventually creating some new ones of my own. I was presented with opportunities for ongoing learning and administrative skill acquisition in many ways, including availing myself of the CMA’s Physician Leadership Institute (PLI) programs, which had replaced the old PMI. I reconnected with and rejoined the Canadian Society of Physician Leaders (CSPL), a society I had been exposed to in my earlier administrative days. There, I again came to see the value of networking and support, which peers and colleagues can offer as no one else can. I occasionally undertook a new role, the mentoring and guidance of fellow leaders who might benefit from lessons learned along my own path.

 

It has been 14 months now since the planned “wind down” of the city-wide clinical coordinator change position I occupied. I am pleased and proud to observe the effects I have had on the systems that I engaged with. I have been able to champion a city-wide approach to the care of surgical services where the same anesthesiologists who practise superb subspecialty academic patient care also provide excellent clinical care to our ambulatory patient population. I have been part of a system that encourages surgical services to use both of the major tertiary hospital sites and the state-of-the-art ambulatory facility at St. Joseph’s. Our department has fostered and helped grow a strong chronic pain program that is flourishing on the SJHCL site and providing opportunities for multidisciplinary care of that patient population. I have helped develop innovative approaches to sedation services for the ambulatory care population’s invasive services.

 

After 25 years in leadership roles at the local, provincial, and national levels, I realize I’ve learned many things that guide me as I work. For example,  nothing can surpass planning. It is so important to clearly identify goals before beginning any task or filling any function. Keeping those goals in mind, it is important to identify both the system components and the people who will be keys to the effort, plan the needed conversations, and establish healthy relationships and open channels. If the conversations are “difficult” or have a negative aspect, as they sometimes will, it is even more important to plan them thoroughly. It not only helps me navigate the problem, but, more important, it also provides clarity and support to the people whom I address as they go forward. Most important, I have learned that engaging the system and those around me is paramount. Paraphrasing a sentiment I frequently hear in my home and family, you don’t get to comment unless you’ve gotten involved and try to help out.

 

These things, along with many other achievements, have given me great satisfaction and continue to encourage me to apply myself as a university-based clinician-administrator, as a clinical academic physician, but, most important, as a physician leader. I continue on my leadership journey at this time, in new roles again, looking forward to the next opportunities, challenges, and achievements that our health care system presents to me.

 

Author

William Sischek, MD, is a senior physician leader with a focus on operational management and system change. Top

 

Correspondence to:

william.sischek@lhsc.on.ca

We asked CSPL members who are Canadian Certified Physician Executives (CCPE) to tell us something about their “path” to leadership:  what inspired them, how they succeeded, what they’ve learned.  We hope that their experiences will provide you with food for thought on your leadership journey.

 

Journey into the unknown

Gary Ing, MD

 

I had a dream the other night. Around 2 a.m., I received a call from an Emergency Department physician. He said all 30 ED beds were filled with patients. Several were admitted, but there were no beds available in any of the nursing units. Another 20 patients were in the waiting room. One or two of these patients had chest discomfort as their presenting complaint. The after-hours manager was actively deploying nursing staff from other areas to provide support to the ED. Patient flow had stopped and the situation was untenable. The ED physician said that if hospital officials did not provide an immediate solution, he would not accept liability. Furthermore, he contemplated leaving the department because of the unsafe environment.

 

I woke up in a state of panic. It was not a dream. The situation was actually taking place. Does this scenario seem familiar?

 

In the 1990s, I attended a leadership conference in Toronto. A session entitled “Why do you want to be the chief of staff” captured my attention. The speaker pointed out that, as we venture into the “dark side of medicine” (i.e., leadership), there are many unknown and unpredictable consequences that may have a profound impact on our careers. On reflection, these words remain true.

 

Back in 1979, six months after I began to practise medicine, I became chief of the Department of Emergency Medicine at Windsor Western Hospital Centre. I was appointed, not because of my qualifications, but rather by default, as no one else was available. Hence, my journey into the “unknown” began.

 

Until 1995, Windsor had four acute care hospitals, but financial challenges led the Ontario government to launch a “hospital restructuring” program across the province. Its objective was to merge hospitals and create “centres of excellence.” This process created a great deal of uncertainty and stress for both professional and hospital staff.

 

In late 1994, I received a call from our CEO at the Metropolitan General Hospital. He asked me to serve as the interim chief of staff for the merger with Windsor Western Hospital Centre. I thought that it would be an interesting experience and it was for a short term; therefore, I accepted the hospital’s offer.

 

As a result of the merger, I became chief of staff for the new Windsor Regional Hospital (WRH). The other two hospitals came together as Hôtel-Dieu Grace Hospital. I found myself managing professional staff from different cultures, who had also been very competitive before the merger. As many of the medical leaders were senior to me, it was difficult to gain their trust and respect. I had many sleepless nights while praying for miracles to assist me in my job.

 

I realized that I was not adequately trained to manage a staff of 350 during that merger process. I began to attend courses offered by the then Physician Management Institute (PMI). I also registered for sessions on presentation and facilitation skills at the University of Western Ontario. Top

 

Over the next 5–6 years, I witnessed a significant change in attitude and behaviour among our professional staff. It was amazing to hear some of them use the term “we” instead of “I” and “you.” I have learned a great deal from everyone whom I worked alongside during that challenging period and I consider them mentors: board members, CEOs, VPs, directors, managers, and professional staff leaders. They taught me how to view a complex situation through different lenses and that together we can develop effective solutions. I also applied what I learned in the PMI courses — i.e., leadership awareness, negotiation, conflict resolution, etc. — in everyday situations.

 

If you are interested in my advice, I would like to offer the following points.

Respect the team members you work with, especially the ones with whom you might come into conflict.

Keep calm even in chaotic situations. Everyone around you watches you closely. How they react may be dependent on the signals you send them.

Never disregard an idea from a member of your team. Sometimes, an innocent thought may turn out to be a game changer.

Negotiate only when you are prepared and compromise whenever appropriate. Keep in mind the other party has to save face.

Lead with flexibility in style. Consensus-building, a team approach, and lead by example are common strategies to gain trust and respect. However, in critical or urgent situations, do not be afraid to take charge. Being a “dictator” for a short period may yield a prompt resolution to your problem.

Be humble in your successes, accept failures, and learn from them. Don’t be afraid to pat yourself on the back once in a while!

 

In October 2013, our hospitals in Windsor underwent a realignment process, with the result that WRH assumed responsibility for administering all acute services in Windsor and the surrounding area with a population of close to 400 000. For me, this is déjà vu à la 1995.

 

My journey into the unknown has been full of surprises and challenges. I have no regrets, because my life has been filled with gratifying unique experiences. Yet, I still have a few more miles to go in this journey.

 

Author

Gary Ing, MD, FCFP, CCPE, is a family physician and chief of staff at Windsor Regional Hospital.

Correspondence to:

Inggrace2@gmail.com

 

My leadership journey

William Sischek, MD

 

My journey as a physician leader really began with the arrival of the Health Services Restructuring Commission (HSRC) in 1996. That commission, struck by the Ontario government to address ever more challenging problems of health care delivery in the province, eventually recommended and caused a large number of fundamental changes.

 

The HSRC was my real initiator into the world of leadership. Recommendations of amalgamation, closure, and rationalization of hospitals and other facilities, visions of interconnected regions with improved communications, overhaul of primary care, and better defined academic health sciences networks were the foundation of my early years in physician leadership.

 

I had joined an academic department of anesthesia in January 1988 during a period of seemingly unlimited resources and possibilities in provincial health care. Soon, though, fiscal realities were being identified, which caused many to stop and ponder the way forward. By 1995, it was evident that the system was due for a major redesign. The conversations had turned to increasing demands on services and personnel with a diminishing ability to fund the enterprise, not only in Ontario but across our country, where similar exercises were underway.

 

One of the earliest impacts on health care in my world was the formation of the London Health Sciences Centre (LHSC). The previously independent University and Victoria hospitals were brought together as a single corporate entity in 1995 just before the formal establishment of the HSRC. New challenges of previously separate hospital departments under the common umbrella of the then University of Western Ontario medical school brought realities of wholesale change. New governance structures, lines of accountability and authority all presented in a flurry of activity as the two hospitals worked toward a common future.

 

I found myself engaged in discussions of the changes and emerged at an early career stage as a site chief in the combined Department of Anesthesia, responsible for operational and personnel activities of an approximately 20-person subgroup department of the LHSC. Like so many other physician leaders of the time, I had no formal training, experience, or mentoring to help me perform the tasks at hand. I had barely begun the job when the HSRC arrived and shortly after mandated further wholesale changes to our region: closure of hospital sites, new construction of others, redesign of mental health care services, resiting of clinical services, and closure of units along with other changes. The stage was being set.

 

I engaged in my new role and sought the skills I needed by turning to the Canadian Medical Association’s Physician Management Institute (PMI). At the time, it offered four programs of learning, covering change and conflict management, negotiation, governance structure and influence, as well as finance basics. I found I was not alone. The many colleagues from across the province and country who participated with me formed a base for both learning and support. I was able to draw on that base from time to time, sometimes for advice and, at other times, simple support.

 

The network I joined was a growing one. It provided me with guidance and access to resources; it was also a place to exchange information and insight. I was able to share information and I learned to anticipate some major disruptions, including shortages of physicians then nurses across our system. Increased demand for clinical services during a time when there was an increasing desire to raise the bar of credentialing for many health professions posed its own challenges. There were so many skills to be acquired, all while still trying to maintain a busy practice of medicine, not to mention helping my wife raise our growing family!

 

In 2011, the ongoing hospital systems restructuring in London necessitated that St. Joseph’s Health Care London divest itself of obstetrics and its neonatal intensive care unit. It was to assume its long-term role as a primarily ambulatory medical and surgical care centre with limited inpatient capacity. By this time I had left the site chief position at LHSC behind, had engaged in its Medical Advisory Committee as the chair, and participated on the LHSC Board, where I had worked with operational and governance changes related to restructuring. Top

 

In 2011, I helped create and then filled the position of city-wide clinical coordinator of our now Department of Anesthesia and Perioperative Medicine. The tasks at hand involved full integration of three previously separate departmental groups and development of common policies and approaches to work load, including integrated call and fair treatment financially, all while trying to nurture and grow the academic life of the department. There was a need to ensure that the system flourished while no one was allowed to quietly “de-skill” in the new ambulatory care unit.

 

The focus of my administrative work was the operational aspects of fostering city-wide integration of the department while tending to its human resource and personnel challenges. I worked with our chair/chief and the other two site chiefs, with the site chiefs overseeing the operational details of the LHSC sites and helping support the city-wide efforts. Skills in organizational change management, fiscal responsibility, influencing and guiding systems and the people running them, maintaining standards of professionalism, and managing disruptive behaviour — all learned years earlier — were brought to bear for nearly six years.

 

The constant need to remain vigilant and attentive while anticipating new challenges meant revisiting earlier lessons learned and eventually creating some new ones of my own. I was presented with opportunities for ongoing learning and administrative skill acquisition in many ways, including availing myself of the CMA’s Physician Leadership Institute (PLI) programs, which had replaced the old PMI. I reconnected with and rejoined the Canadian Society of Physician Leaders (CSPL), a society I had been exposed to in my earlier administrative days. There, I again came to see the value of networking and support, which peers and colleagues can offer as no one else can. I occasionally undertook a new role, the mentoring and guidance of fellow leaders who might benefit from lessons learned along my own path.

 

It has been 14 months now since the planned “wind down” of the city-wide clinical coordinator change position I occupied. I am pleased and proud to observe the effects I have had on the systems that I engaged with. I have been able to champion a city-wide approach to the care of surgical services where the same anesthesiologists who practise superb subspecialty academic patient care also provide excellent clinical care to our ambulatory patient population. I have been part of a system that encourages surgical services to use both of the major tertiary hospital sites and the state-of-the-art ambulatory facility at St. Joseph’s. Our department has fostered and helped grow a strong chronic pain program that is flourishing on the SJHCL site and providing opportunities for multidisciplinary care of that patient population. I have helped develop innovative approaches to sedation services for the ambulatory care population’s invasive services.

 

After 25 years in leadership roles at the local, provincial, and national levels, I realize I’ve learned many things that guide me as I work. For example,  nothing can surpass planning. It is so important to clearly identify goals before beginning any task or filling any function. Keeping those goals in mind, it is important to identify both the system components and the people who will be keys to the effort, plan the needed conversations, and establish healthy relationships and open channels. If the conversations are “difficult” or have a negative aspect, as they sometimes will, it is even more important to plan them thoroughly. It not only helps me navigate the problem, but, more important, it also provides clarity and support to the people whom I address as they go forward. Most important, I have learned that engaging the system and those around me is paramount. Paraphrasing a sentiment I frequently hear in my home and family, you don’t get to comment unless you’ve gotten involved and try to help out.

 

These things, along with many other achievements, have given me great satisfaction and continue to encourage me to apply myself as a university-based clinician-administrator, as a clinical academic physician, but, most important, as a physician leader. I continue on my leadership journey at this time, in new roles again, looking forward to the next opportunities, challenges, and achievements that our health care system presents to me.

 

Author

William Sischek, MD, is a senior physician leader with a focus on operational management and system change. Top

 

Correspondence to:

william.sischek@lhsc.on.ca

I had a dream the other night. Around 2 a.m., I received a call from an Emergency Department physician. He said all 30 ED beds were filled with patients. Several were admitted, but there were no beds available in any of the nursing units. Another 20 patients were in the waiting room. One or two of these patients had chest discomfort as their presenting complaint. The after-hours manager was actively deploying nursing staff from other areas to provide support to the ED. Patient flow had stopped and the situation was untenable. The ED physician said that if hospital officials did not provide an immediate solution, he would not accept liability. Furthermore, he contemplated leaving the department because of the unsafe environment.