EDITORIAL: Integrating diversity by developing coalitions

Johny Van Aerde, MD

 

In this issue of CJPL, we celebrate the success of the 2019 Canadian Conference on Physician Leadership (see Pat Rich’s article1 and CCPE recipients2).

 

The theme of this year’s conference focused on the leadership challenges surrounding diversity, inclusion, and engagement in the health care system. The first step toward diversity is an awareness of subconscious and conscious biases, then managing those biases and taking action for change toward inclusion and equity. While a successful multidisciplinary team builds on the diversity of its members and their skills in the context of distributed leadership, a different kind of diversity exists at the system level. That systemic diversity is often isolated within the boundaries of “silos”; it lacks integration and has contributed to multilevel fragmentation of the Canadian health care system.3

 

Constitutionally, there are at least 15 delivery systems, with provincial, territorial, regional, Indigenous, and military elements that remain disconnected. Canada’s huge size leads to geographic fragmentation, with communities ranging from highly urban to remote and rural locations. Structural fragmentation is further aggravated by different degrees of regionalization and provincialization. Top

 

Functional silos exist for patients who require continuity of care: adolescents or elderly may transition between age groups, patients move from hospital to community care. Similarly, navigating the health care system is difficult for patients with multiple chronic ailments. This functional fragmentation goes hand in hand with professional fragmentation because of an increasing number of subspecialties and programs. The absence of essential elements, like pharma- and dental care, from the Canadian “universal” health care system further adds to functional fragmentation for patients and providers. Finally, the uniquely legislated and structural role of physicians makes many of them independent practitioners with a business based on fee-for-service payments, while many other caregivers are salaried employees.

 

To cross boundaries and integrate the richness of this diversity, coalitions can be formed. Coalitions are strategic (purposeful) temporary or permanent relationships established between organizations, societies, community agencies, or other independent bodies to work together toward achieving a common purpose. The four capabilities in the Develop coalitions domain of the LEADS framework4 can help improve the chances of success.  Top

 

Purposefully build partnerships and networks for results

 

Depending on the level of commitment, interdependence, power, trust, and willingness to share, coalitions range from networking to merger, with coordination, cooperation, and collaboration lying between those two extremes. The type of coalition and its purpose also determine whether the relationship is permanent or temporary. At the early beginning, the type, purpose, and objectives of a coalition must be carefully determined and agreed on. Only then can it move on to conversation and agreement on outcomes; a strategy; sharing of resources, benefits, and risks; and building and maintaining trust. A second step is formulating a written agreement with defined responsibilities and accountabilities, reducing the risk of conflict and improving the chances for success.

 

Mobilize knowledge

 

This capability comprises several aspects of knowledge: the knowledge of self and others, skills to communicate that knowledge, and the mobilization of knowledge generated in the context of the coalition’s purpose. Each partner has to be clear and transparent in terms of assumptions about self and others. Each participant must possess the skills to engage in dialogue to explore possibilities and discussions to converge on action and outcomes. Honest and frequent communication is an essential building block of trust. Knowledge mobilization for the purpose of the coalition is sometimes called knowledge arbitrage: a process of collectively exchanging, transferring, using, and creating knowledge across organizational boundaries to create new outcomes that benefit all partners as assessed by agreed upon performance criteria. Top

 

Demonstrate commitment to customers and service

 

There must be a clear view of who the customers are and what services are to be delivered. Although our initial response would likely be that the patient is the customer and caring is the service, in some cases others are the primary customers, depending on what type of coalition is proposed and what its purpose is. With the widespread burnout of professionals in the health care system, for example, those professionals might well be the customers. Sometimes, the government or Canadian citizens in general might be the customers. Top

 

Navigate the sociopolitical environment

 

Lack of attention to this capability might represent the biggest danger for coalitions. Groups may see sharing information as a security threat.5 Any coalition potentially challenges the identity of each partner, which is why the differences between partners must be recognized and valued as assets. Reaffirming legitimacy by publicly acknowledging the importance and differentiated value of each group should lead to a win–win attitude. The biggest threat might come from control overlap between parties, which is why both the areas of autonomy and of shared control should be delineated within the context of defined success, not only for each party, but also for the coalition. Fear of domain encroachment is another threat.  Once more, communication skills to allow dialogue and conflict management are of utmost importance and increase trust.

 

Integration of diversity across silos will increase the strength and value of the health care system and improve care delivery. Using the four capabilities of Develop coalitions increases the chances of success.4 In a similar context, Dr. Marc Bilodeau, CCPE and CHE, and John Crook, CHE, wrote a paper for this CJPL issue suggesting a coalition between the Canadian College of Health Leaders and the CSPL.6

 

If CSPL was to choose a coalition with another organization in the future, further research and exploration along the four capabilities would be required. They would help define the purpose, objectives, and duration of a coalition for the organization, its members, and potential partners.

 

The CSPL membership is strong and growing, as are the number of physicians currently holding a CCPE designation. CSPL wants to continue being vibrant and maximize the value for its members. Carefully negotiated and structured coalitions will add strength and value for our members by increasing diversity. You are CSPL, I am CSPL, and together we are CSPL. Therefore, we invite each of you to send your thoughts, ideas, and suggestions. As a respected and valued CSPL member, we want to know what you think. Please let us know. Top

 

Connect with CSPL and your colleagues

 

https://www.facebook.com/groups/CSPLDocs/

 

@CSPLeaders

@NEON8Light

 

References

1.Rich P. Can J Physician Leadersh 2019;5(4): . 192-193

2.CCPE Can J Physician Leadersh 2019;5(4): .230-235

3.Van Aerde J, Dickson G. Accepting our responsibility: a blueprint for physician leadership in transforming Canada’s health care system. Ottawa: Canadian Society of Physician Leaders; 2017. Available: https://physicianleaders.ca/assets/whitepapercspl1003.pdf

4.Dickson G, Tholl B. Bringing leadership to life in health: LEADS in a caring environment. London: Springer; 2014.

5.Kwan L. The collaboration blind spot. Harv Bus Rev 2019;97(2):66-73.

6.Bilodeau M, Crook J. Breaking health care leadership silos (perspective). Can J Physician Leadersh 2019;5(4): .

 

Author

Johny Van Aerde, MD, MA, PhD, FRCPC, is editor-in-chief of the Canadian Journal of Physician Leadership and executive medical director of the Canadian Society of Physician Leaders.

 

Correspondence to:

johny.vanaerde@gmail.com

 

 Top

 

EDITORIAL: Integrating diversity by developing coalitions

Johny Van Aerde, MD

 

In this issue of CJPL, we celebrate the success of the 2019 Canadian Conference on Physician Leadership (see Pat Rich’s article1 and CCPE recipients2).

 

The theme of this year’s conference focused on the leadership challenges surrounding diversity, inclusion, and engagement in the health care system. The first step toward diversity is an awareness of subconscious and conscious biases, then managing those biases and taking action for change toward inclusion and equity. While a successful multidisciplinary team builds on the diversity of its members and their skills in the context of distributed leadership, a different kind of diversity exists at the system level. That systemic diversity is often isolated within the boundaries of “silos”; it lacks integration and has contributed to multilevel fragmentation of the Canadian health care system.3

 

Constitutionally, there are at least 15 delivery systems, with provincial, territorial, regional, Indigenous, and military elements that remain disconnected. Canada’s huge size leads to geographic fragmentation, with communities ranging from highly urban to remote and rural locations. Structural fragmentation is further aggravated by different degrees of regionalization and provincialization. Top

 

Functional silos exist for patients who require continuity of care: adolescents or elderly may transition between age groups, patients move from hospital to community care. Similarly, navigating the health care system is difficult for patients with multiple chronic ailments. This functional fragmentation goes hand in hand with professional fragmentation because of an increasing number of subspecialties and programs. The absence of essential elements, like pharma- and dental care, from the Canadian “universal” health care system further adds to functional fragmentation for patients and providers. Finally, the uniquely legislated and structural role of physicians makes many of them independent practitioners with a business based on fee-for-service payments, while many other caregivers are salaried employees.

 

To cross boundaries and integrate the richness of this diversity, coalitions can be formed. Coalitions are strategic (purposeful) temporary or permanent relationships established between organizations, societies, community agencies, or other independent bodies to work together toward achieving a common purpose. The four capabilities in the Develop coalitions domain of the LEADS framework4 can help improve the chances of success.  Top

 

Purposefully build partnerships and networks for results

 

Depending on the level of commitment, interdependence, power, trust, and willingness to share, coalitions range from networking to merger, with coordination, cooperation, and collaboration lying between those two extremes. The type of coalition and its purpose also determine whether the relationship is permanent or temporary. At the early beginning, the type, purpose, and objectives of a coalition must be carefully determined and agreed on. Only then can it move on to conversation and agreement on outcomes; a strategy; sharing of resources, benefits, and risks; and building and maintaining trust. A second step is formulating a written agreement with defined responsibilities and accountabilities, reducing the risk of conflict and improving the chances for success.

 

Mobilize knowledge

 

This capability comprises several aspects of knowledge: the knowledge of self and others, skills to communicate that knowledge, and the mobilization of knowledge generated in the context of the coalition’s purpose. Each partner has to be clear and transparent in terms of assumptions about self and others. Each participant must possess the skills to engage in dialogue to explore possibilities and discussions to converge on action and outcomes. Honest and frequent communication is an essential building block of trust. Knowledge mobilization for the purpose of the coalition is sometimes called knowledge arbitrage: a process of collectively exchanging, transferring, using, and creating knowledge across organizational boundaries to create new outcomes that benefit all partners as assessed by agreed upon performance criteria. Top

 

Demonstrate commitment to customers and service

 

There must be a clear view of who the customers are and what services are to be delivered. Although our initial response would likely be that the patient is the customer and caring is the service, in some cases others are the primary customers, depending on what type of coalition is proposed and what its purpose is. With the widespread burnout of professionals in the health care system, for example, those professionals might well be the customers. Sometimes, the government or Canadian citizens in general might be the customers. Top

 

Navigate the sociopolitical environment

 

Lack of attention to this capability might represent the biggest danger for coalitions. Groups may see sharing information as a security threat.5 Any coalition potentially challenges the identity of each partner, which is why the differences between partners must be recognized and valued as assets. Reaffirming legitimacy by publicly acknowledging the importance and differentiated value of each group should lead to a win–win attitude. The biggest threat might come from control overlap between parties, which is why both the areas of autonomy and of shared control should be delineated within the context of defined success, not only for each party, but also for the coalition. Fear of domain encroachment is another threat.  Once more, communication skills to allow dialogue and conflict management are of utmost importance and increase trust.

 

Integration of diversity across silos will increase the strength and value of the health care system and improve care delivery. Using the four capabilities of Develop coalitions increases the chances of success.4 In a similar context, Dr. Marc Bilodeau, CCPE and CHE, and John Crook, CHE, wrote a paper for this CJPL issue suggesting a coalition between the Canadian College of Health Leaders and the CSPL.6

 

If CSPL was to choose a coalition with another organization in the future, further research and exploration along the four capabilities would be required. They would help define the purpose, objectives, and duration of a coalition for the organization, its members, and potential partners.

 

The CSPL membership is strong and growing, as are the number of physicians currently holding a CCPE designation. CSPL wants to continue being vibrant and maximize the value for its members. Carefully negotiated and structured coalitions will add strength and value for our members by increasing diversity. You are CSPL, I am CSPL, and together we are CSPL. Therefore, we invite each of you to send your thoughts, ideas, and suggestions. As a respected and valued CSPL member, we want to know what you think. Please let us know. Top

 

Connect with CSPL and your colleagues

 

https://www.facebook.com/groups/CSPLDocs/

 

@CSPLeaders

@NEON8Light

 

References

1.Rich P. Can J Physician Leadersh 2019;5(4): . 192-193

2.CCPE Can J Physician Leadersh 2019;5(4): .230-235

3.Van Aerde J, Dickson G. Accepting our responsibility: a blueprint for physician leadership in transforming Canada’s health care system. Ottawa: Canadian Society of Physician Leaders; 2017. Available: https://physicianleaders.ca/assets/whitepapercspl1003.pdf

4.Dickson G, Tholl B. Bringing leadership to life in health: LEADS in a caring environment. London: Springer; 2014.

5.Kwan L. The collaboration blind spot. Harv Bus Rev 2019;97(2):66-73.

6.Bilodeau M, Crook J. Breaking health care leadership silos (perspective). Can J Physician Leadersh 2019;5(4): .

 

Author

Johny Van Aerde, MD, MA, PhD, FRCPC, is editor-in-chief of the Canadian Journal of Physician Leadership and executive medical director of the Canadian Society of Physician Leaders.

 

Correspondence to:

johny.vanaerde@gmail.com

 

 Top

The theme of this year’s conference focused on the leadership challenges surrounding diversity, inclusion, and engagement in the health care system. The first step toward diversity is an awareness of subconscious and conscious biases, then managing those biases and taking action for change toward inclusion and equity. While a successful multidisciplinary team builds on the diversity of its members and their skills in the context of distributed leadership, a different kind of diversity exists at the system level. That systemic diversity is often isolated within the boundaries of “silos”; it lacks integration and has contributed to multilevel fragmentation of the Canadian health care system.3