What is best for Esther? What Canada can learn from the Swedish health care service

Ali N. Damji, MD, MSc, Göran Henriks, and Martin Rejler, MD

Health care systems in Canada and Sweden are facing increasing challenges to do with access and wait times for non-emergent issues. Both are seeing the erosion of single-payer health care systems as a consequence of these challenges, and both are emphasizing moving care out of hospitals into community and home care. Sweden has moved ahead in this area and Canadians can learn two key lessons from its experience. First, rather than thinking in terms of what’s best for the system or the provider, the Jönköping region in Sweden emphasizes the perspective of “Esther,” a hypothetical patient with a life beyond the walls of the institution. Second, viewing patients as copilots in their care has patients learning treatments, such as self-dialysis, with benefits to themselves and the system. read article

PERSPECTIVE: Breaking health care leadership silos

Colonel Marc Bilodeau, MD, and Lieutenant Colonel John Crook, MPH

Leadership is a critical factor for successful health care reform. Leadership development is, therefore, vital to ensure that future leaders have the right competencies to succeed. Building on the journey of two military health care leaders, this article argues that current leadership development frameworks and the sponsoring health care leadership organizations lack integration, considering that physicians and non-physicians are trained separately and belong to different networks. read article

An emergency department’s journey toward cultural change: a case study

Demetri Karogiannis, John Cabral, Devin Harris, MD, Doreen Perschon, MA, Laura Calhoun, MD

Peter Drucker famously said “Culture eats strategy for breakfast.” In health care, the way things are done, rather than what is done, can make the difference between an engaged workforce and an apathetic one. This case study looks at how the Kelowna General Hospital’s emergency department staff changed their way of doing their usual work and improved their engagement and, subsequently, their quality of care. The article highlights methods leaders can use to uncover previously underground barriers that are affecting engagement. We review the differences between technical problems and adaptive challenges and add to other research that suggests command-and-control leadership is rarely effective in complex systems such as health care.

read article

Patient safety in a new age of understanding

P. James A. Ruiter, MD

Engaged health care teams are necessary for any improvement in quality or safety. But health care teams will not engage simply because we ask them to do so. Any improvements in health care will require leaders to understand the why of disengagement. In the first of this three-part series — Disengagement in health care: today’s new culture — we began to understand why only 57% of health care workers are engaged and why that number is decreasing annually. We now examine how health care’s approach to safety and quality has unwittingly been complicit in building this disengagement.  read article

Professionalizing physician leadership

Johny Van Aerde, MD, PhD

There is a need to professionalize leadership development in Canada; for physicians, that need has increased with the inclusion of the new role of Leader in CanMEDS 2015. For the health care system, LEADS provides a set of standards for guiding leadership development for each individual health care worker and for all organizations. This paper addresses how to engage physicians in leadership roles and explores what professionalized leadership might

look like. read article