Lessons Learned

Foreword
by Mr. Jeff Lozon
Introduction
by Chris Carruthers, MD

Chapters

Running a hospital amid one trillion percent inflation
Paul Thistle, MD
Commit to excellence
David Williams, MD
Take up the challenge — it’s worth it
Philippe Couillard, MD
Le défi vaut la peine d’être relevé
Dr Philippe Couillard
Never leave passion behind
Danielle Martin, MD
The conventional wisdom may not be all that wise
Brian Day, MD
Physicians can do it all
Senator Wilbert Keon, MD
Do what you love, love what you do
Brian Goldman, MD
Supportive colleagues an absolute necessity
Chris Carruthers, MD
Three careers —as a family
Richard Cruess, MD and Sylvia Cruess, MD
Opportunities for leadership increasing — but be prepared
Jack Kitts, MD
Be a physician’s physician
The Honourable Arthur Porter, MD
Some observations on physician leadership
Tom Noseworthy, MD
Riding the rollercoaster
Major (retired) Karen Breeck, MD
Seizing opportunities
Dennis Kendel, MD
Find an issue, become the expert, take the lead
Judith Kazimirski, MD
Balance, Balance, Balance
Dana Hanson, MD
Lessons Learned. Reflections of Canadian Phyisician Leaders.

Now available
from the Canadian Medical Association.

Foreword

When I was invited to write the foreword for this book, I was reminded that “what is old is new again.”

As a leader with more than 30 years’ experience managing academic health centres, working in government and associations, and leading in both the public and private sectors, I have worked closely with physicians in every possible role and setting.

So do they make good leaders? That question has been debated for decades. When I started my career in the late 1970s, the prevailing view on physician leadership and management was, “Who would want to do that?” Physicians were clinicians. They were above the fray.

Over the next two decades, a new opinion took hold. Getting involved in managing the system was seen as one way for physicians to regain lost ground and climb back on the pedestal their profession had always enjoyed. This leadership evolution has continued in the past decade. Now doctors are asking how they can take the lead in making the health care system work better for both them and their patients.

I dealt with many of these aspiring MD leaders during my 17 years as CEO at St. Michael’s Hospital in Toronto, and I always welcomed their ideas and input. They made St. Mike’s a better hospital.

So it was against this backdrop that I asked the editors if I could review some of the chapters that would be in this book before I put pen to paper.

To my surprise and delight, I discovered a set of reflections, prescriptions for success, and powerful and meaningful questions about physician leadership. To me, they demonstrated new insights and marked progress in thinking about the important and ever-evolving questions concerning physicians’ roles as leaders in health care—not just medicine.

And even though I have been involved in managing health care for over 30 years, I learned something while reading those chapters. In one of them, I discovered what it is like to run a hospital in one of the world’s poorest countries. Dr. Paul Thistle operates a 144-bed mission hospital in Zimbabwe that serves 250 000 people on an annual budget of $40 000. I won’t tell you what $40 000 buys at a Canadian hospital, but I will say that Dr. Thistle’s chapter showed me what happens when leadership skills are combined with personal commitment.

And then there’s Dr. Dave Williams, who proudly wore our flag on his shoulder aboard the space shuttle. And Dr. Jack Kitts, the physician-CEO who heads the Ottawa Hospital. And cardiac surgeon, Wilbert Keon, who founded a world-famous heart institute. For me, this book shows how physicians’ attitudes on management and leadership issues have evolved and matured in Canada, and done so in a very short time.

It contains excellent practical advice from some outstanding physician leaders about their leadership journeys and offers useful tips on how to craft your own career. In many ways, this book speaks to a more nuanced view of leadership then is the norm among physicians. It distinguishes clearly between management and leadership, with the former considered the bane of many physicians’ lives while the latter offers a real opportunity to improve a health care system that needs improvement. It also stresses the “soft” side of leadership—the importance of people skills, the need for teamwork. And it recognizes that leadership is about values and requires sacrifice and support, a message delivered eloquently by Dr. Philippe Couillard.

In my own career, I have had the privilege of working with excellent physician leaders and with some who were never up to the mark. In most cases, success had nothing to do with intelligence or knowledge. I found that those who were successful leaders understood human motivation and knew how to mobilize others when a major effort was needed. They knew that success involved being well prepared, then thanking those who helped overcome the challenges.

Leadership is about groups and teams, and unfortunately physicians are not effectively trained to grasp this reality—in some cases they are even discouraged from doing so. The best physician leaders understand the need to collaborate, and they seek ways to further their impact by working with professionals from different fields.

Finally, this book highlights that the road to leadership success is not straight and narrow, regardless of whether you are a flight surgeon in the Canadian Forces, a physician working as a journalist at the CBC, or a past president of the Canadian Medical Association.

Rather, the road will take many unexpected twists and turns. When leaders make the journey successfully, they provide a roadmap for others to follow. Clearly, the physicians who contributed to this book recognize this. Our health care system is better because of it.

Jeff Lozon
President and CEO
Revera Ltd.

Introduction

Although this book was published in the fall of 2009, it was actually born 18 months earlier as I was preparing to retire after 10 years as chief of staff at the Ottawa Hospital.

At the time, I was past-president of the Canadian Society of Physician Executives, which is housed at the Canadian Medical Association’s (CMA) headquarters in Ottawa. During a visit there, I ran into Bill Tholl, then CMA secretary-general and CEO, and I pointed out that the CMA had been providing leadership training for physicians via its Physician Manager Institute for 25 years. Wasn’t it time to put some of the leader- ship lessons learned during that period down on paper, I asked? Bill said, “Make it happen,” and the result is this book.

It was not an easy process. As Jeff Lozon points out in the foreword, Canada has produced countless physician leaders in recent years. How would we choose which ones to invite to participate in the project? Would they even be interested?

We needn’t have worried. Although a handful of the leaders we approached had to decline because of their workload—something any physician in a leadership role can understand—we almost invariably received an enthusiastic response, and one by one the chapters began rolling in.

Dr. Paul Thistle told us about being a leader in a mission hospital that looks after a catchment area of 250 000 people and delivers 2000 babies a year—on an annual budget of $40 000. Dr. Philippe Couillard described the sacrifices involved in his decision to leave a career as a neurosurgeon to seek election and serve as minister of health in Quebec. Dr. Danielle Martin took time from her work as a family physician—and expectant mother!—to tell us about her leadership goals and why she decided to help found Canadian Doctors for Medicare. Dr. Brian Day, a past-president of the CMA and one of the liveliest voices to emerge within our profession recently, describes the evolutionary process that has made him a leader in the health care reform movement. And the list goes on.

Our goal was not to create an academic tome on physician leadership. Instead, we wanted to provide some “lessons learned”—often some very tough lessons indeed— for physicians considering taking the leadership plunge.

These lessons vary a great deal, from the need to find mentors to the pursuit of formal leadership training. And they are provided by a broad mixture of physicians at different stages in their careers.

One of the common themes that emerged is the need for leaders to maintain their “street cred.” In other words, if you want to be listened to down in the trenches, keep working—at least part of the time—down in those same trenches. The author of almost every chapter in this book has done exactly that.

If one message emerges from this book, it is that physicians must do more than practise medicine. In earlier days, our profession largely scorned leadership roles outside our closed world of clinical practice. “We are above that,” was our attitude. “Let’s leave management to mere mortals, and we’ll handle the serious work of looking after patients.” Today, things are different. We have recognized that, if we are to look after our patients, we have to look after the health care system too.

In my own case, it would have been much easier for me to focus on being an orthopedic surgeon than to apply to become chief of staff at a very large and newly amalgamated hospital. Sometimes, on the weekly drives to Montréal to complete the MBA that was part of my leadership training, I wondered why I did it. But once I was in the post, I knew why. If you want a chance to make a difference in the medical profession, you have to lead—no ifs, no ands, no buts.

Do I have any regrets? I could have done without the added stress and demands that took away from family time, but there are no regrets. I think I made a difference. The physicians who contributed to this book can all say the same thing, and I want to recognize their contribution—this book would not have been possible if they

had not volunteered to participate in our project. I must also recognize the assistance of two people who did the legwork that led to

this book. Carol Rochefort, executive director of the Canadian Society of Physician Executives, worked diligently to bring everything together—keeping in contact with our authors and ensuring that their submissions flowed smoothly. Pat Sullivan, a former news editor at CMAJ who now helps manage member communications at the CMA, helped ensure that the editing went smoothly. And when it came to getting a foreword for the book, he wasn’t shy about calling in a favour—he and Jeff Lozon were room- mates at the University of Guelph and remain close friends.

Finally, I must also recognize the financial support from the CMA that made the book possible. The CMA has been delivering the messages that appear throughout this book to its members—the only difference is that it started doing it more than a quarter century ago.

To everyone involved with this book, I offer my sincere thanks. To today’s leaders, keep up the good work. And to tomorrow’s physician leaders, the health care system needs you.

Chris Carruthers, MD