Editorial: Beyond resilience
Sharron Spicer, MD, FRCPC, CCPE
Note from the editor
This issue of CJPL marks a transition as its founding editor, Dr. Johny Van Aerde, passes the baton to the next runner. Many of you will know Johny as a pioneer in physician leadership in Canada over the past two decades. Like me, some of you will also consider him a mentor and friend. With much-appreciated encouragement and support from Johny, I humbly accept the baton and step into the role of CJPL’s next editor-In-chief. We’ll continue to see much of Johny as he continues as executive medical director of CSPL and on the Editorial Board of CJPL.
I thought I’d share with you a little of my background. I have practised pediatrics in Calgary for over 20 years and have held various leadership roles in ethics, quality and safety, and physician health. I teach ethics at Calgary’s Cumming School of Medicine and serve on the Committee on Ethics of the Canadian Medical Association. I am a collaborator with Well Doc Alberta and worked with the Alberta Medical Association’s Physician and Family Support Program for five years. I am now a medical advisor in professional affairs with the Alberta Medical Association. I received the Canadian Certified Physician Executive (CCPE) credential in 2017. Having recently discovered a passion for writing and editing, I am pursuing a Professional Writing Certificate specializing in business and technical writing from the University of Calgary.
The pandemic experience has been a marker in time in all of our lives. In this issue, I share with readers my family’s journey of illness, written one year ago as we were watching the pandemic gather speed around us (see “Career interrupted”). I had taken a leave from work, stepping into unknown territory. One year later, I’m grateful for my spouse’s good recovery and the opportunity for me to return to work – although admittedly, becoming the editor-In-chief of CJPL was nowhere on my horizon at that time! Well, much can happen in a year.
I hope that you enjoy reading the articles in this issue as much as I have. I encourage you to write with your ideas, comments, and articles. I also hope to see you virtually at the 2021 Canadian Conference on Physician Leadership!
In organizational leadership, we are fond of the adage “Never let a good crisis go to waste.” (Like many clever quips, this one is ostensibly credited to Winston Churchill.) One year into the COVID-19 pandemic, we are still responding to its disruptive change. Similar to other world events in the past — wars, 9/11, major natural disasters — the destructive effects are felt both individually and collectively. Its impacts will continue to appear and evolve over the next decades. One thing is certain: things will not go back to the way they were.
The pandemic peeled away the surface veneer of our health and social systems, revealing fragmented systems with gaps in services, coordination, and responsibility. The most vulnerable members of our society not only faced their ongoing struggles but also bore an uneven burden of pandemic-induced hardship and loss. The disparities in wealth, social advantage, and access to health care that were long recognized had never been fully addressed. The pandemic has given us a sobering awakening to the needs for urgent long-term care reforms; recognition of poorer outcomes of marginalized populations; demands for improved working conditions for front-line and entry-level workers in health care; and greater advocacy for public health measures. To address the disparities in health outcomes, we need to deliver health and social services in vastly different and innovative ways.
We discovered, too, that the way we interact with patients — and how patients connect with their own health care information — has changed. We have seen the importance of improved system integration of health data across regions. We have witnessed the vast uptake of virtual health and e-prescribing. We note that patients need to have better access to their own health records. We have seen the resilience with which health teams have pivoted from providing one type of service to another. And we have humbly watched the enormous sacrifices of many health care workers as they substitute themselves for loved ones at the bedsides of the elderly and the dying.
Innovations in science and technology have emerged. Remarkably, in just one year, we have seen the successful development and launch of totally new types of vaccines. International cooperation in genetics, epidemiology, virology, vaccine trials, and supply chain management have created a remarkable roll-out of therapeutic and preventive strategies for managing COVID-19; these will have lasting impacts on various clinical fields for years to come.
Transformative change like this is difficult to enact and is often preceded by a crisis event. In a 2016 article in CJPL, past editor-in-chief, Johny Van Aerde, shared an elegant panarchy model showing the renewal cycle of complex adaptive systems such as health care (Figure 1).1 He further explained how the health care system in Canada had predictably become stuck in a “rigidity trap” and that some form of internal or external pressures would create a crisis to release the current state and create the conditions for change. Three years before COVID-19, Van Aerde noted that “the ultimate external crisis can be triggered at any time by an economic collapse or a global pandemic disease.”1 Further, he described, “Health care leaders, particularly physicians, need to… ensure that the substance of health care is not lost but renewed. As in a forest fire, creative destruction is designed to release nutrients so that new life can indeed emerge. Therefore, creative destruction is positive and not synonymous with devastation.”1
Similarly, author Nassim Nicholas Taleb describes the outcomes of so-called Black Swan events — large-scale, unpredictable, and irregular events of massive consequence; in real time, they are experienced as random and disconnected, but in retrospect, we can see patterns, identify cause-and-effect relationships, and create predictability. Taleb coined the term antifragile. “Antifragility is beyond resilience or robustness. The resilient resists shocks and stays the same; the antifragile gets better.”2
Crisis creates needs that require us to respond with urgency and innovation. The wind-down of the COVID-19 pandemic is a time for us to re-imagine and bolster our health and social systems. In this window of opportunity, let’s not just return to normal — let’s build better. Top
1.Van Aerde J. Panarchy, the collapse of the Canadian health care system, and physician leadership. Can J Physician Leadersh 2016;2(4):103-9.
2.Taleb NN. Antifragile: things that gain from disorder. New York: Random House; 2012:3-11.
Sharron Spicer, MD, FRCPC, CCPE, is a pediatrician at Alberta Children’s Hospital, Calgary, Alberta.