In 1970, as a fledgling Acting CEO at the IWK Hospital in Halifax, I was approached by some persons from upper and western Canada who were Icons in the field of health services organization and management. Dr. Len Bradley, then Medical Director at the great Winnipeg Health Sciences Complex, and Dr. John Phin, formerly professor in the field of health administration in Minnesota. I had graduated just one year earlier from what was the Blue-Ribbon program in Hospital Administration at the University of Toronto. This was a small program available only to 18 persons per year who had had some previous experience in the health field.
My class included physicians, nurses, pharmacists, accountants….all having had just enough experience in the management positions in the health field to understand that they really needed a deeper, more rounded education in health administration. So, with superb professors such as Dr. Burns Roth, Eugenie Stuart, Dr. Peter Ruderman and many others we worked through courses in medical science, economics, human resources, health law, hospital organization and management, public health and much more.
I was one of two youngsters in the course having graduated a year prior from university with BS in Business/Economics and working as a nursing orderly then as a research assistant.
At the conclusion of two very intense years, we all emerged to enter the health care field and many of my classmates rose to significant leadership roles in hospitals and long-term care organizations. That level of education made us all thirsty for more knowledge.
My visitors from upper and western Canada came with the vision of establishing a national organization that would codify and advance the standard of practice in health administration across Canada. Consequently, the Canadian College of Health Service Executives (now Health Leaders) was born. In its early days, throughout the 1970’s and 1980’s, there was a buzz across the country as people attended national and regional continuing education programs and as other universities developed programs in health administration. The College recognizes leaders in many ways and has Certification and Fellowship programs that recognize those who are serious about excellence in health service management.
New Brunswick has been slow off the mark and has not, to this day, recognized the CCHL as a bona fide resource in improving the quality of health services management and leadership. While job ads for key positions in many other provinces often state membership in or certification by the CCHL as a desirable quality, that does not typically happen in New Brunswick.
Without essential core education and training in health service management and leadership, the hundreds of people who gravitate to these positions often find themselves struggling with basic managerial skills with little local visible resource. In health care, it is common to see great physicians given positions such as Chief of Staff, Chief of Department, Chair of a Division, or superb nurses then placed in the hundreds of key nursing leadership roles often with limited training in labor relations, budget and fiscal management, and more. Similarly, throughout the public service, there are literally hundreds of social workers do their best in what are serious leadership roles in long-term care. Now in these roles they are inundated with core issues stemming from governance, legal matters, labor relations, budget, problem-solving and more.
These all are wonderful people; I have had the honor, and still do, of getting to know many either personally or at a bit of a distance. Employing agencies, however, are derelict in their duty when otherwise superb people are placed in positions of responsibility without ensuring that they have at their disposal the best and most up to date training available. Such has been the story of health and long-term care for generations and explains much of what is witnessed at the consumer end.
The good news is that UNB is planning to rise to the occasion! In a press release dated August 26, 2020, the University of New Brunswick announces its Integrated Health Initiative focused on health education and research, coupled with social innovation and greater collaboration. The aim of IHI is to contribute to systemic health care reform in New Brunswick and Canada.
The program envisions the development of a Bachelor of Health degree along with an extracurricular certificate in health as well as Master in Business Administration in Health Administration, and a Master of Health in Public Policy. Study in these areas is critical for those who would make a serious contribution to the organization and management of health services. Success in these leadership roles comes with knowledge and understanding of how the system is constructed, how it operates, and how to change it.
A strong academic program will enable the richness of data already available in the system from the Health Council and many agencies to be organized and studied in a structured and organized manner by professors and graduate students with training. That, in itself, has been a huge missing link in health and long-term care in New Brunswick. Contrast our experiences with that in Ontario where the University of Toronto, York University, and University of Ottawa have, for decades, published policy papers that have been used extensively in influencing health services in that province.
UNB, which is rich in talent in various faculties, envisages coordinating that richness in creating this initiative. As I observed when I was part of the Queens University system in the 1980’s, excellence happens in academia and in health care when people come together across disciplines to share knowledge, wisdom, skills, and talents and such will be the case with IHI.
Earlier in my career we had a wonderful physician serving as Chief of Staff, dealing with the issues that leadership normally entails. One day he confessed: “Ken, it’s like herding cats.” So, I invited him to participate, at hospital expense, in an intense leadership program designed just for physicians in leadership. On completion, his outlook was quite different and positive. Why? Because most of the skills you need to manage and lead people are not taught in the curriculum of the various health disciplines, nor should it be. The purpose of those programs is to create superb doctors, nurses, therapists and technologists. Management and leadership can come later for those who wish to go in that direction.
Some key focal points of the UNB/IHI initiative include research and health service reform. The president was clear: “educate bold thinkers, drive excellence and innovation, lead systemic reforms.” My own career has shown that striving for mediocrity is easy and politically correct; striving for excellence take a whole different type of leadership, leadership that is not all about numbers but is truly systems and human resource oriented. The decisions that transformational leaders have to make are not always popular but are essential unless mediocrity is acceptable.
Getting Health and Long-Term Care to the point of excellence that we deserve in New Brunswick will require a path forward quite different from the path that got us to where we are. Systems research, education of the hundreds of people now in management in the system and the hundreds that will follow them, collaboration, bringing people together across disciplines.
UNB/IHI together with its partners in this bold initiative can be the focal point of serious health and long-term care reform in New Brunswick. Salute!
Ken McGeorge,BS,DHA,CHE is a retired CEO in major teaching hospitals and long-term-care facilities. He was co-chair of the New Brunswick Council on Aging and is a columnist with Brunswick News. His email address is firstname.lastname@example.org.
Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.