DHiC 11 – Bold Futures in Health Policy

This transcript was generated by AI and may contain some minor errors.

Rosalie Wyonch: What’s the risk of inaction or the cost of inaction if you don’t put the data together? How many people might die?

Katie Bryski: Hello and welcome to Digital Health in Canada, the Digital Health Canada Podcast. My name is Katie Bryski, and I am a podcaster turned digital health professional.

Shelagh Maloney: And I’m Shelagh Maloney, a digital health professional turned podcaster. Canada’s health policy landscape is dynamic, nuanced, and continuously evolving.

So what do healthcare leaders need to know about this space and what key topics are lighting up dashboards or slipping under the radar? Today? We welcome two leaders to share their. Expertise and perspectives on the opportunities to drive change in our health system and ourselves. Very pleased to welcome two great leaders to the podcast today.

Helen Angus, chief Executive Officer at AMS Healthcare and Rosalie Wyonch Associate Director of Research at the C.D. Howe Institute. Thank you both so much for being here today.

Helen Angus: You’re welcome. Great to be here.

Rosalie Wyonch: Happy to join.

Katie Bryski: So I’d love to start with some introductions. If you could tell us about yourselves, how you got to your current job and what it is that you love most about what you do. And Rosalie, maybe we’ll start with you.

Rosalie Wyonch: I won’t bore your listeners with my whole bio, but the short version is that I’m an economist by training and I’ve spent my career so far studying a wide range of public policy issues.

When I first started, it was everything from canvas legalization in the black market to that tax policy for the digital economy, but I. The important part for this conversation is I’ve spent the last six years leading the health policy research program at the cd How Institute, and I’ll say, I love what I do.

The institute has the mission of raising Canadians, living standards through economically sound public policy. So my job is really to work to improve healthcare outcomes, and that’s rewarding in itself. But I think my favorite part of the job is actually stuff like this. Get to have intelligent discussions with experts across many different fields, and then I get to share those insights with Canadian leaders and those who can affect change, but also just people that want a better understanding of why things are the way that they are.

Katie Bryski: I gotta say, I honestly, having conversations is I think why I got into podcasting, so I definitely align with you there. I’m curious, did you always know that you wanted to get into policy?

Rosalie Wyonch: I mean, I could say yes, and that I always had a passion for this, but the truth is that I started in physics. And I was so overconfident in myself that I thought I was gonna like get somewhere with cold fusion. Two years of UWaterloo physics taught me that I like learning about physics. I do not like doing physics. And then I just kind of took a little bit of everything. I wanted to work in something that makes the world better, and that kind of led to the policy space just being like, well, it’s generally public service, but I don’t know what area I want to be in.

And the opportunity for healthcare was organic. And when I took it on, I knew about as much about the healthcare system as anyone that’s grown up in this country and used it. I was by no means an expert, and the learning curve is steep, but there’s so much interesting stuff going on and there’s so much to be learned that I just am happy that all the clinicians and scientists let an economist in to complain about things.

Shelagh Maloney: I think cold fusion maybe is a little bit of healthcare. So, Helen, what about you? I suspect you probably have a fairly circuitous route as well.

Helen Angus: Yeah. Not physics for sure, but I actually trained as an urban planner and started my career in social housing, which kind of brings you to determinants of health.

And then a career in healthcare. I spent 30 years working in government, government of Ontario. That includes 10 years at Cancer Care Ontario and I probably cut my teeth on sort of tough problems and new programs, getting them off the ground from the start. So thinking about setting up like the Trillium drug program or the Ontario Renal Network, the first cancer plan, if it hadn’t been done before.

That’s kind of where I found my sweet spot. And now I’m the CEO of of an organization called AMS Healthcare. We’re an Ontario charity and you know, I’m at a different phase of career than Rosalie. So part, I guess the part of the job that I enjoy the most is really mentoring and providing supports and seeing the growth of young scientists and health practitioners who are interested in the interface between artificial intelligence and technology and the human aspects of a healthcare delivery.

Shelagh Maloney: I love that. And the AMS Healthcare mission is around the compassion with the technology. And one of the things that we’re trying to do with this podcast is really not just talk about digital health, but talk about the leaders who are making a difference and progressing in digital health. And I think we’re increasingly in the digital health space, we’re understanding how important policy is to really making change and influencing change that.

I’m not sure we really appreciated maybe even five or 10 years ago. So I’m wondering if you can comment on that a little bit and talk to us about some of the major policy shifts that you’ve seen, or policy success stories, and specifically the health or the digital health space.

Helen Angus: My sense is that the policy and the frameworks that put digital first have been impactful. I think that without policy and without then aligned funding and government and sector leadership, it’s pretty chaotic out there, right? And so policy really sets the rules of the game and gets alignment when well implemented from top to bottom so that you actually have forward mo motion on digital first being an important policy direction of governments.

Rosalie Wyonch: I generally agree with that, but. I’ve been thinking about the broader innovation and digital space and thinking that there’s, there’s kind of just too many different ways that you can possibly look at it. One of the major things I would agree is what government can really do is set the standards for.

What needs to be recorded and transmitted and actually putting it all together and either getting it out there transparently to researchers or just out to the public. And I really think that the government has a strong role around data standards convening, assisting in interoperability between the different pieces of the system.

But I would also say that sometimes the policy. Comes after the change or as a result of some disruption. And so I would also say that I think the pandemic was a particularly interesting example around digital health because we’ve been talking about getting people better access to virtual care, better real time data streams on the back end, all sorts of things.

And then at the beginning of the pandemic, all of a sudden all these things we’d been talking about for years. Went forward really, really quickly and as you say, wasn’t necessarily that careful full process because it was done so quickly. But to me, what that really shows is that there’s no excuses not to do it.

You know, if we wanted to get every person in Canada, virtual healthcare to avoid ER visits, well we’ve already done it. We’ve now gone back to the way it was before. But in short windows, you can really see when change will happen to solve a problem. And in those moments you also see proof that government can in fact move quickly and do things that are quite drastic.

So I think that just those moments to me are the proof that we could be a little bit less careful, or we could be a little bit more demanding out of our government in terms of what, what we actually want outta the system. Government policy then, like you say, sets the rules of the game and the framework that can support that.

Helen Angus: AMS’s, other areas of focus is actually in the history of healthcare and, and so the reversion back to maybe not exactly where we were pre pandemic, but there has been some shrinkage, means that some of the incentives and structures of healthcare delivery are pretty hard to move except in a crisis. And so I think those are things that we need to pay attention to.

Katie Bryski: Are there examples you’ve seen where that backsliding has been prevented or mitigated? Because yes, it’s hard to move, but to Rosalie’s point, we moved the needle once. How can we work with governments or what can be done to stop that reversion back to, if not the status quo, then quite close to it?

Helen Angus: Yeah, it’s a good question ’cause I’ve actually seen some selective carry forward of the lessons of the pandemic.

I think that there was some terrific work done on working with high priority communities, for example, and really understanding the root causes of inequities and the multilayered strategies that were used to reach those communities in the vaccine rollout. They could be well used for other healthcare issues beyond vaccine, and I’m not sure that governments and, uh, others are paying as much attention to some of the social determinants of health as was done during the pandemic.

So you know how to make it stick. I think that you probably really have to go back to what are the things that really make change happen in the healthcare system. And I think they require aligned policy, funding, leadership, and really, a clear shared vision of what is intended to be achieved. There probably are some examples, but the big ones, I see some movement back to pre pandemic patterns.

Rosalie, feel free to disagree with me if you’ve got a good example.

Rosalie Wyonch: Maybe it’s not necessarily directly in the same theme, but previous to the pandemic, I think federal, provincial. Policy was quite a bit different. And so one thing that I would say is different and has been sustained is that the federal provincial relations on healthcare shifted a bit where the provinces that are open to federal involvement are then dealing with the federal government through bilateral agreements instead of trying to get unanimous support across all provinces to move something forward.

I can’t say for sure, but I think it was partly the cooperation and the relationships that were likely generated through the vaccine rollout and the need to cooperate and that everyone was pulling in the same direction because of the crisis. That politics didn’t really matter for a little while, and that kind of broke down some of the barriers to let these maybe change the relationships for the longer term.

Now, whether or not. That will actually continue and be sustained if we have a federal election. We’ll have to see. But it was a change that has continued, and I think it has led to some good progress in the expansion of public healthcare as well as data flow between the different levels.

Helen Angus: I’ll take that Rosalie.

It’s uh, kind of ironic. I was the co-chair of the Council of Deputy Ministers throughout the pandemic, and Rosalie has just schooled me on the Fed-Prov relationships. That’s why you’re so good at what you do.

Rosalie Wyonch: Yeah. You can call me out if I’m wrong. You were sitting at the table. I’m looking in from outside.

Helen Angus: No, no, I think you’re totally right. And it’s interesting as I look forward and you sort of see some of that in the interprovincial trade barrier. Discussions, right? If we’re having this problem with the states, maybe we should actually clean up our own house around Interprovincial trade. Whether that interprovincial cooperation will then leak over into other issues like national licensure and other things, one can only hope.

Right? You know, that sort of operating principle of Team Canada actually comes together. But I think your point around also moving forward on the bilaterals makes a lot of sense to me, and I think that’s right.

Katie Bryski: I’m gonna quickly timestamp the episode here just because so much is happening in the political space that we are recording this on February 28^th.

Shelagh Maloney: 2025! And it is kind of interesting ’cause you were the co-chair, the DM, and and I was at Infoway at the time of Covid, and we saw that, right? It is like. We had this sense of urgency ’cause we were in the middle of this pandemic and nobody knew what was going on. And I remember it was the then-CIO of Nova Scotia sort of saying, we are in the middle of this great experiment.

We’ve never had this before, sort of a living lab. And we didn’t, to your point, Rosalie, like privacy is important, but you know what? We need to just get this done. And especially in healthcare where we are risk adverse and, and we are concerned about that, we always come back to some of the lowest common denominator.

And we didn’t have the luxury to do that. You know, Manitoba had a system and New Brunswick, you know, adopted it because they could and they needed to do right away. And I definitely seen, from my perspective, I did see that regress a little bit. I. But I think you’re right. And actually, I was talking to somebody about this yesterday that even we’re seeing federal organizations are working well together and some of the FPTs and it’s not, yeah, let’s not try to get everybody going.

Let’s work with that group and maybe we’ve got another sense of urgency. Well, we will come together because of our geopolitical environment right now on February 28th, 2025. And Rosalie, I wanna pick up on one of the points you made earlier. Policy doesn’t necessarily always keep up with the pace of change, particularly technology.

And we’ve seen this and Ewan Affleck and his colleagues in Alberta just published Disconnected Care, a paper talking about, you know, our health information privacy laws are hindering the ability to share information. Curious about where your thoughts, around how quickly is there an opportunity to make policy happen more quickly?

Rosalie Wyonch: Well, I don’t know. I think policy happens at the speed. Of the crisis or the priority. And so with so many different things happening, I think that direct focus on healthcare and these sort of unlimited resources for that short window isn’t likely to be what happens. It’s sort of one of those, we have to find the opportunities in a much broader form of chaos.

But I really do think that there’s maybe two parts to this, the government. Hasn’t actually forced data integration. There’s lots of ways that they could simply just force this on the industry with specific standards or interoperability. Yes, there’d be consultations and arguments, but we would figure out at least something where these data systems could potentially talk to each other, or at least once you aggregate the data up, it’s all standardized and comparable.

But that is a long process to actually getting to the end goal. So that’s something that I think needs to go on in the background and we should continue to work towards. And if we ever get to that perfect real time interoperable data system, that would be amazing. But yeah, it’s this sort of ideal state that we may never get to because.

Treatments will evolve. The types of data and information we need will evolve. Like I really think of it as more of a natural evolution where we’re, we should always be driving towards that idealistic goal. We’ll never reach, but that also, there’s tons of good information that’s generated just through clinical applications, through all sorts of things.

Yet not as a clinician, but as a patient. I have major challenges even putting together my own health record to tend take to other providers. Patients are supposed to own the data based on the policy, but there’s this lack of ability to put it together. And so one thing that I think could be really, really powerful is actually to empower patients to get access to that data and put it together themselves, because then they can do whatever they want with it.

They can give it to whatever providers, whatever researchers contribute it or not as they see fit. And I think that we need to. At the institutional and research level, there’s a lot of opportunities for AI or synthetic data sets to really take down the risk on some of the privacy concerns. And so I think we need to have some conversations about your personal data.

We’ll go into this big database, but that is not about personally identifying you. Or your information going to the government. It’s about the data set. And the data set is only valuable if we have as much like the more data we have, the better. Each person’s data is meaningless. If you wanna opt out, you can.

I think we need to change the default to, we share the data as a default. You’re opted into sharing your data as a default. If you want to opt out, you can, but realistically, our default is that the data isn’t connected. It’s housed individually and not shared. And so if we set the defaults as default yeses instead of default nos, then we could really start moving these things forward.

And that to me is the key thing for government, is changing the framework around how we manage data and our data policies. To a yes when the risk is low instead of if there’s any risk. That’s a no.

Helen Angus: It’s interesting. I wanna go back to the idea of speed of change too. ’cause I think that’s important in this space and I find it hard to keep up with the evolution of AI applications, the risks, the benefits, how to enable, what are the data sets that are required?

Where do we have proofs of concept? Where do we have real opportunities and, and real products available. What are the safeguards we need to put into place? And I think it’s very hard for policy to keep up with that speed of change. I, I think about my first exposure to chat GPT in December and by May we, I was at the digital health conference and we were seeing examples of digital scribes, and that was like six months later.

And so think about if you think that the policy and regulatory environment are gonna keep up with that acceleration of the implementation of technology. It’s pretty hard. So. What is it in the relationship between the innovation ecosystem and the policy makers? What needs to happen in order for sensible policy to be made?

Because it does run the risk of getting stuck in time and not moving at the same pace. And how do you keep a policy framework that’s flexible, that can actually onboard new good things and new good policy over time?

Rosalie Wyonch: And maybe I’ll just add a yes and you on this one. Which is that whatever rules you write, like if you’re looking at setting up a system for the technology of today, it’s out of date by the time it’s done.

So this is where I think that we should look at other areas and how they handle these, like other high risk areas, like I’ll just mention financial services. Think about how much data there is in financial services, the risk for people individually and their individual data, but how real time that data is in a lot of ways.

And there’s regulations around those data standards. What has to be transparent, what can be requested by the regulators? And it’s there. It’s just sort of one of those. There are other areas where there’s both high value and risk associated with someone’s personal data. Also that we managed to build systems that aggregate these things, or at least create signals.

And in a lot of ways, our regulations, at least in Canada, are principles based. So we don’t say, this data must do this. We set the principle, what do we want as a minimum standard? We need to ensure this level of safety. We need to ensure that risk stays within a reasonable band. And so it becomes. Much more about the principles of what you want, not necessarily setting specific structures or specific pathways to really get into the minutia mostly.

Katie Bryski: I’m so glad you brought that up because my mind was going the same way. This was reminding me very much of an episode we did a few months ago on cybersecurity, saying cybersecurity principles actually don’t change. But the technology, right? Because the principles in terms of risk management, security and roles stay the same.

It just gets applied to different use cases.

Shelagh Maloney: I also like the comment about the risk level, and so I think we’re not as good at applying that if we say it’s principle based. And I think you’re right, and I think that is helpful and that’s a great example, Katie, around cybersecurity. I. But there also is a principle around that.

Say like, if the risk is low, let’s implement this. Versus if there’s one possibility of 1% of the people in the population are going to maybe have an issue, then we won’t do it at all. So it would be nice to have that policy base and some kind of risk monitor or meter. How do we have that conversation in those discussions?

So I love that principle plus potentially a risk scenario.

Rosalie Wyonch: I’ll, I’ll, yes, and that one too before I let us move on. I think that one of the things that’s fundamentally not in the thinking in healthcare culture, but is in other economic areas is what’s the risk of inaction or the cost of inaction if you don’t put the data together, how many people might die or not be screened early?

You know, it’s not just the benefit of the eventual. Action. It’s what is the cost? If you choose to do nothing, and if you start actually thinking about the costs of inaction, it completely changes the risk calculus around whether you should or shouldn’t do something. This is my call to all the health leaders on, don’t let Perfect be the enemy of the good and think about what not doing something like what’s the negative consequence.

Helen Angus: Yeah, it’s, it’s interesting as you’re talking, I’m also thinking about, you know, privacy commissioners across the country and you know, have we got the right balance? And there’s probably a policy discussion to be had. ’cause I think there are. Some good ideas that at best take a long time to get through various privacy processes and commissioners, and how do we keep up with the realization of benefits of some of these technologies?

Shelagh Maloney: I wanna pick up on something, Helen, this sort of something that you said gets back to a point Rosalie, you made around governments pushing certain things and leaders taking action and, and leadership in general. And I know AMS healthcare is very much committed to developing those leaders and have the fellowship programs and things like that.

What are the most important lessons learned or that leaders should have now operating in this environment of pace of change has accelerated so many challenges. So Helen, I’m curious about your thoughts around leadership and what’s missing or where do we need to focus going forward?

Helen Angus: I mean, the healthcare system has always been complex and there’s lots of stakeholders to manage and if you’re in an operational organization, you know, staff board, the public patients, unions, I mean, it’s, it’s always been, I think, complicated, but I think it’s more complicated now. And I think the toolkit has to be a little bit bigger. And I think that goes for leaders at the highest level to leaders of teams in the healthcare system.

And so it’s not. Just about knowing your lane and your job. It’s actually the social wear. ’cause you can imagine that, you know, over time, you know, I’ve seen some folks speak on that. It has a lot of resonance for me and for the work of AMS is that people are gonna solve problems and work with patients, teams, and it could be that, you know, you have to work in a team that has, you know, the data analyst in a very prominent role on the team versus in a subservient role if they’re bringing the, the AI knowledge and application then to the clinicians to work differently. So I think there’s a social wear that is going to be required.

Highly developed communication skills, which is why we train people up, to learn how to communicate risk and be better at getting messages out to the public. Teams are gonna be more diverse, so managing diversity and complexity, I. I think change management always a top skill, but it’s gonna be, again, even more important because the forces that are changing healthcare are so great that the status quo is not really an option.

So you’re gonna be in the change management business as a leader regardless, and you might as well figure out how to optimize care and the mission of organizations and the benefit to the health of the population sooner rather than later by capturing some of those and then I think it needs some inspiration.

Leaders have to be inspirational and start to paint a picture of what this future state is going to be and really have a clear sense of direction because there’s a lot of noise in the system and where change is happening. It’s gets pretty tough at times and I think really being able to navigate through that and help people see what’s on the other side of a somewhat difficult process is gonna be really critical.

Rosalie Wyonch: Yeah, I’d say I agree with all of that and maybe. My other side of the coin is I’m a bit frustrated, to be honest, how much our current system depends on individual leaders to make change, like individual physicians championing, championing for a change within a hospital. Particular executives that want to do a strategic initiative and providing cover and doing that work to sort of create the vision and bring people along.

But. We don’t connect it necessarily to a role. A lot of it is a person that wants to make change. Like I guess the, I haven’t been able to find an answer to the question, who is actually accountable to Canadians for making sure our health outcomes get better? And the answer is nobody. At the end of the day, I mean, you could say it’s the provincial health minister, you could go up to the Federal Health Minister.

You could say the CEO of the hospital is responsible. But the real thing is that it’s easy enough when there is a major issue to point to these other areas as to why you can’t make change or why change is difficult or what have you. So maybe it’s a bit of a radical thought, but what if we made it someone’s job?

Or the people that are already in leadership roles, what if we gave them both some carrots and some sticks as in some funding and some incentives to reach for better outcomes. But then also if. Outcomes are getting worse. There needs to be something that actually raises that issue to a new level so we can have realistic conversations about it.

Because one of my frustrations with looking at how the system functions from the outside is that the incentives are set up to make people risk averse. And so I think that that leads to our lack of data interoperability, but also just sort of a general resistance to change if there’s any risk. The thing about innovation is it’s inherently disruptive, so there’s always gonna be a little bit of risk.

You know, you might not get the best outcomes right away. You might have to iterate the process around the tools, and so I think that we need to start thinking about ways to encourage healthcare leaders to either take a bit of a risk on some of these things, but also I think there’s that being aware. Of all of the voices for any change, somebody stands to lose something or has a reason to resist it.

And so knowing who those voices are gonna be and how you’re gonna handle them is gonna be a key factor to success because otherwise, lots of good ideas can die on the vine, even if we’re all on the same page about what the shared goal will be. I think we need to look at where things die on the vine and where they fall apart in a policy sense too, because there’s lots of good pilots that don’t become programs or we have issues with scale spread, and some of this is because individual leaders do something cool.

We write a story about it, it got funding, but there’s no mechanism at the policy level to then take that from economic development. To the health ministry, run it through the budget process, up to finance and treasury, get it funded as an actual program. That whole process is, is not creating a natural ecosystem of spreading and scaling of the good stuff that health leaders and researchers are doing, but aren’t.

Then making it across provincial healthcare systems to then benefit all Canadians. So I think we need a way to blow up these bubbles and also empower the existing leaders to take a little bit more risk or, or be a little bit more accountable for improvement.

Helen Angus: Same idea, but maybe different language from maybe a more government perspective as thinking about how do you break down the silos?

Maybe it’s not one person’s job, maybe it’s everybody’s job, or that your interest in a high performing system doesn’t stop the minute you leave your property if you’re a hospital, CEO. And how do you actually create the right incentives, metrics, performance objectives? All of the things he would have in an accountable system where it isn’t one organization optimizing at the cost of another.

It’s actually working together truly as a system. And I think that has been elusive despite efforts of lower rules. I still think connecting up providers working together so that they’re all jointly accountable. We saw that during covid. It’s another lesson going back to the beginning of the conversation where we saw hospitals deploying staff to deal with infection prevention and control and long-term care, and every hospital had a number of long-term care homes, at least in the GTA that they were taking care of.

Around infection prevention control. So they were playing for the team and they were playing for the health of the population. And it really didn’t matter who was really responsible for what. I mean there were some things we had to do in behind, but the prime directive was to make sure that we were trying to optimize outcomes and prevent illness and death, and then long-term cares, and they stepped up.

So how do you take that willingness to work across verticals and make that a regular course of business in the system and. I spent a lot of my career trying to figure that one out. I’m not sure we have entirely, but that to me is the holy grail. And then, then you’ve got an accountable structure and you’ve got performance measures and a way to figure out whether it’s actually happening or not.

So I don’t know whether it’s a, a Health Czar Plus, but I think it’s a pretty big shift in accountabilities that needs to happen. And the same inside government too. You’ve got. The Westminster model, as you know well, which has, you know, again, strong verticals in health. But when you start to have discussions about determinants of health and housing and food security and other things, it gets tougher when you have to implement all of government approaches to complex problems.

Rosalie Wyonch: Helen, I think you’re exactly right and part of what can happen within the healthcare sector, but also, you know, I hang out in an economic shop and economists have stuck their fingers in absolutely every policy pie that exists. So this is like pot calling the kettle black here. But there’s sort of this idea that we need health in all policies, or it should be framed through this social determinants of health lens, but it’s also thinking about those other areas.

If healthcare is the largest area of program spending and keeps growing, then there’s sort of this, eventually you’re cutting from the justice system, from the education system where we could potentially do some of that preventative work or have more collaboration. And so I’d just say that absolutely that’s a maybe a both.

And maybe not a health desire. So now I’m just thinking maybe we just need a powerful deputy that that isn’t associated with a minister, like a specific ministry. They’re actually connected between three and they have a strong mandate where it’s like your job is to project manage towards this goal between these three.

Uh, but I know that that can become a convoluted bureaucratic headache of itself. But I think the idea is both, but that also, when we’re thinking about the health of Canadians, there’s a tendency to focus on, on where the symptoms show up, not necessarily the root cause of the disease. And the symptom, I think is, you know, overcrowded emergency rooms, ALC patients in hospitals, the buck stops at the hospital, but that doesn’t necessarily mean the solution.

Is a hospital based solution and you know, you can take that out from a couple other layers for whether is it you, you need better public health and education about nutrition and health or better access to primary care. Like there’s not an either or. It’s more that if you take that overall look, you start to see different, different solutions than maybe where the problem is showing up.

Katie Bryski: You know, I think we’ve stumbled into a really interesting area of conversation where it’s almost asking us to think about our relationships with our own roles, right? This idea that even if I work in digital health, I don’t only work in digital health.

Helen Angus: Well, it’s interesting you’re talking to somebody who started in physics and somebody who started as an urban planner, so that lateral thinking I think is really important, and if I didn’t mention that, as you know, a, a key attribute of leadership in healthcare is being able to see opportunities differently, being able to work with diverse teams. My best policy advisor or best policy ADM ever who happens to be a deputy minister now in the Ontario government has a master’s degree in drama.

So sometimes these atypical backgrounds bring a certain creativity and there’s obviously innate characteristics around drive and motivation and other things. But I kind of like to have a diverse team of people with different kinds of backgrounds. ’cause it certainly energizes and puts things on the table that otherwise wouldn’t be there.

Katie Bryski: As I sit here with my master’s in creative writing, I’ll take that

Rosalie Wyonch: and I’d maybe add being, you know, not traditionally a healthcare person that doesn’t actually work in the healthcare system. I work in an economic shop, in a think tank that that’s actually part of what I think my role is to bring to health, healthcare, and health leaders is like that point about over in financial services regulation, there is opportunities for.

Looking for solutions in unexpected places or looking at where maybe has a similar problem been solved, even if it looks different, is there a way to maybe bring in learnings or, or change that thinking? And I would, I mean, it was good advice for my econometrics prof back in grad school. So I don’t know, just carrying it forward.

But he always said that when you’re gonna look at a policy issue. Go to the data, what information like pure information is there, and then build, like what could you model? What questions can you ask of that data set and build your idea just from pure information. What’s interesting about that is don’t read a single published piece of literature before you come up with your idea when you’re looking at the data.

Once you have an idea, then you can go see if it, if somebody’s done it already, if someone’s tested it, if it’s good, or if you’re completely off base. But by doing that, you’ve already set your framing as looking at the problem different to how everybody else has already looked at the problem. If you start with how everybody else has dealt with the problem, you locked yourself into.

A narrow solution set and you might miss the bigger picture opportunities. And so I guess I just really say that obviously we need to do due diligence and cooperate, but to solve a problem that’s been ongoing for a long time, maybe we shouldn’t just try to tweak the solutions we’ve used before. Maybe we should be a little bit more radical or take a completely different approach and see how it goes.

Of course, that being said. If you’ve gotten to the level of being a health leader, there’s a good chance that the system thinking has completely infected you already. So it might just be like going and talking to people outside the system and having them push back on some of our assumptions about what is or isn’t a manageable problem or what could or couldn’t be a barrier that we break down.

Helen Angus: As you’re talking, I’m just thinking about how many times I sat in my office and said, could you, could somebody just send me over some good transportation planners? So they actually look at the ED problem in Ontario because, uh, if you can figure out the width of the subway platforms and, uh, how flow works, you could probably, uh, be somewhat helpful to, uh, some of the challenges we’re facing and capacity in hospitals in Ontario.

Rosalie Wyonch: Or like grocery stores and the retail industry have very good, efficient, just in time inventory management systems for things that need to be kept cold or not. Obviously, the standards for regulation are higher, but it’s one of those, there’s, there’s systems out there for almost every problem. It just might not look the same.

Katie Bryski: I feel like that’s good life advice, let alone good health system advice or good career advice. And as we start to wind the conversation down, I wondered if you had any other pieces of advice or last thoughts or challenges that you’d like to leave with our listeners.

Helen Angus: I mean, I usually comment on policymakers ’cause I have deep respect for the challenges of governments and the peoples who work in them and, and understanding that, you know, they spend a lot of their time dealing with very proximate issues, right.

Issue management of the day. And so really is to build on what Rosalie said, bring them the data and, you know, help them understand that there are, there are also other challenges in the healthcare system that need to be addressed and, and helping, you know, public servants in particular see around corners, anticipate challenges, solve the the root causes rather than the symptom.

Engage in constructive conversations. Build out your relationship. I think that’s how to have impact on public policy. I just think that trying to, you know, capture their attention or their imagination, um, is important. ’cause you know, I guess I still have a great deal of faith that the people on the inside are trying to do the right thing.

Sometimes you need to help them do that.

Rosalie Wyonch: Yeah, I, I fully think that everyone does in fact, share the same goal. That’s something that this industry has, that others don’t necessarily, because it’s just, there is intrinsic motivation. And so I think that the main thing is where you can make change no matter where you are in the system.

Anything you can improve, do it if you need other people involved. Be loud about it. And to a certain extent, I think the public has a key role here because a lot of the change is that what the public wants can create the political will that then can sort of set the goals and that then gets the framework and the government machinery kind of starting to pull in that direction.

And that is the heaviest lift. I, I will admit it, but I think that’s where the biggest changes can happen. And then for the marginal change is where everyone in the system has some power to make things a little bit better. I think that there’s a lot of positive change that can be made just from the ground up within the existing policy framework, and all it takes is leaders.

That are willing to take a bit of a risk and also the empowerment of people to, to start bringing these issues forward. I mean, my job is pretty much to be a professional government nag, so my advice to everyone is get loud, start complaining, but don’t just complain. Come with a solution. Then you might actually get it done.

Shelagh Maloney: Great advice to end on. You’ve both, I think, inspired us today with, with your thoughts and your insights, so we very much appreciate you joining us. Thanks again. Really appreciate the conversation.

Katie Bryski: Well, there is a lot to unpack in that conversation. What did you think?

Shelagh Maloney: Gosh, where do I start? I think one of the things I liked about. What Helen, you know, in response to the question about what do leaders need today and she hit on, you know, interdisciplinary skills and diversity. And the larger complexity of the health system.

But she also said inspiration and I really liked that. I think in healthcare, you know, I was on a call earlier today and there was a conversation about how, you know, healthcare is in crisis and everybody’s kind of tired and burnt out and we’re saying the same things over and over again. And, and so I think that, you know, she said, paint the picture of your future state.

And I really, and I really think that. That’s important to do, right? Is to make it clear that you understand what the issues are and you understand where you are. But part of that being a leader is sort of that inspiration. And then one of the other things that related to that is this notion of.

Healthcare is an interdisciplinary sport and we’ve seen that in lots of the conversations we’ve had across all the podcasts. You need to have an interdisciplinary team. Sometimes the data analyst is the leading the conversation and just really understanding the role that everybody plays. And I, so I really like that piece of it is like, what skills do leaders need now in this interdisciplinary space that is so highly politically charged right now?

And people are a little bit anxious around that.

Katie Bryski: Yeah, I definitely agree with the need for leaders to have that inspirational quality. I’ve heard leadership described as the ability to kind of influence people towards a vision, like to work towards a vision, to believe in a vision, and something I’ve appreciated recently with leaders in other areas of my work has been just kind of calling the situation what it is.

Like saying, wow. Like it’s a hard and weird and uncertain time and people are feeling things and it’s okay. Right? Like that’s natural and not trying to hide it, not trying to say that it’s something else. And, and not to be clear causing undue panic or anxiety, but I think just that having that confidence and that respect to just name a situation.

Shelagh Maloney: But also respecting your team. Right. You know, we don’t have to sugarcoat this and we need to. Be mindful of what it is and be honest about what it is and work together towards a solution.

Katie Bryski: Something that I thought was really interesting too, and it came up talking about the interdisciplinarity when Rosalie was mentioning where she’s seated, you know, she can see what finance is doing and maybe bring lessons from there from other industries.

And it made me think, I feel like there are these sort of super connectors. Who are kind of at the edges of these networks or who sit between networks and are able to draw insights and learnings from across different communities. And it just made me think of the importance of having people like that and people in those positions.

Shelagh Maloney: Yeah, and you know, it’s kind of interesting, I hadn’t really thought about it before, but you know, the comment that she made about, it’s not a role that necessarily makes change. It’s an individual and it’s just somebody with a passion and you think of one person, you know, like I’m an urban planner and now I’m a deputy minister of health because I had a certain, like obviously a certain smarts and expertise, but also just that I feel passionately about this and I’m gonna make a difference.

And I’m a clinician champion. I’m not a champion because I’m a clinician. I’m a champion ’cause I’m this person. And I, I think it’s empowering for people to say.

And you and I have had this conversation, about a leader can be at any level in an organization, but are we overly reliant on individuals who wanna make a change versus the system and the positions taking on that.

So it, it was kind of interesting. I hadn’t thought of it that way before.

Katie Bryski: I think it’s a question of how do you make sure that the work outlasts the role? Because we’ve also seen this, where there’s one person in a role who’s responsible for a piece of work or who’s responsible for a set of relationships, and then that individual leaves.

And the work was directly connected to them and to their role. And if that role doesn’t exist anymore, or if that role is not filled by that particular person, how do you make sure that the work continues or that the relationships continue? So it’s sort of, yeah, like that continuity needs to be there.

I think within the organization, like the organization needs to step up to own the work that the individual holds as well.

Shelagh Maloney: Same with building community, right? Or involving the whole community. And sometimes it’s. I can get this done because I have a relationship. Progress happens at the speed of trust, and so if you have trust relationships in your community and external to your community and you’re building these communities, that’s very, very helpful.

As soon as you lose that relationship and and lose that trust, you sort of have to start from scratch.

Katie Bryski: Well. I’ll be curious to see what we learn about policy and other lessons learned in our next episode.

Shelagh Maloney: And we’re going international for this one.

Katie Bryski: There you go. Spoilers for next month. So we will see you next month, right here on Digital Health in Canada, the Digital Health Canada podcast. Thank you for listening to today’s episode, digital Health Canada Members. Can continue the conversation online in the Community hub. Visit digital health canada.com to learn more. Be sure to subscribe to the podcast to get new episodes as soon as they’re available and tell a friend if you like the show.

We’ll see you next month. Stay connected, get inspired, and be empowered.