Canadian Partnership for Progress in Health Human Resources

Health Human Resources:Leadership Rooted In Vision, Values,

Relationships

October 8, 2009Sister Elizabeth Davis

At the end of the first decade of this 21st century, we – the ones gathered in this room – are called

to see with new eyes to hear with new ears to dare with new thinking to act with new passion

if we are to help create a truly strong and responsive health system in Canada, a health system built on the strengths and wisdom of health workers.

OUR CALL AS LEADERS

TEACH THE SEA’S STRONG VOICE

Here the tides flow, And here they ebb . . .

With a lusty stroke of life Pounding at stubborn gates That they might run Within the sluices of men’s hearts,Leap under throb of pulse and nerve, And teach the sea’s strong voice To learn the harmonies of new floods . . .

E. J. Pratt, Newfoundland

TEACH THE SEA’S STRONG VOICE TO LEARN THE HARMONIES

OF NEW FLOODS

OVERVIEW OF REFLECTIONS Setting the Context Sea’s Strong Voice – Today’s

Realities New Floods – Changing Health

System, Professions Harmonies of New Floods –

Transforming Practice and Research Readiness for and Response to Trust

Given You

They areNurses, physicians, therapists, social workers,

dieticians, technologists, pastoral care workers . . .

Researchers, policy-makers . . .Managers, administrators, clerical staff, support

staff,Housekeeping, food services, facilities’

maintenance . . .Board members, volunteers Persons who make the health system work

They are persons, not simply “human resources”

WHO ARE “HEALTH HUMAN

RESOURCES”?

Planning - right types, mix, distribution of health-care providers to meet the needs of Canadians

Recruitment and Retention - encouraging more people to enter the health-care field and improving working conditions to keep them there

Inter-professional Education - changing the way we educate health workers

Healthy Workplace – integrated, sustainable, diverse, engaged, dynamic workplaces

SCOPE OF ISSUES RE HEALTH HUMAN RESOURCES

SEA’S STRONG VOICE

SOCIAL CHANGE IN WESTERN WORLD

Demographic shifts Role of women Increasing urbanization Increasing cultural diversity Impact of computerization Culture of consumerism Increasing gap between rich and poor Understanding of environment Expectations of public service Credibility of leaders

GENERATIONS Elders (pre-1946): Dedication, sacrifice,

hard work, conformity, law and order, patience, respect for authority, duty before pleasure, adherence to rules, honour

Boomers (1946-1965): Optimism, teamwork, personal gratification, health and wellness, personal growth, youth, work, involvement

Generation X (1965 – 1980): Diversity, thinking globally, balance, techno-literacy, fun, informality, self-reliance, pragmatism

Millennials (1980 - ): Confidence, civic duty, achievement, sociability, morality, diversity, street smarts

EMERGING NETWORK AGE

From the Industrial Age to the Information Age to the Network Age

Network Age Distributed culture Decentralized Citizen-centered not institution-centered

POVERTY IN CANADA

Aboriginal people Recent immigrants Non-permanent residents Visible minorities Persons with disabilities Lone parent families Unattached individuals 2006 Report Card on Child and Family Poverty in Canada

THREATS TO SECURITY Terrorism Epidemic disease Organized crime Conflict over natural resources Climate change Environmental degradation Security is increasingly interpreted as

security of people, not just territory; security of individuals, not just of nations; security through development, not through arms; security of all people everywhere – in their homes, in their jobs, in their streets, in their communities, and in the environment. Dr Mahbub ul Haq (1997)

ENVIRONMENT

The planet’s warming is unequivocal, its impact is clearly noticeable, and it is beyond doubt that human activities have been contributing considerably to it. Adverse effects include:

Agriculture and food security Oceans and coastal areasBiodiversity and ecosystems Water resources Human health Human settlements Energy Transport and industry Extreme weather events

Climate Change 2007

15

EXPECTATIONS OF CITIZENSTavistock Principles (2001)

Rights – to health and health care Balance – individuals and populations Comprehensiveness = treat illness,

ease suffering, minimize disability, prevent disease, promote health

Cooperation – with those served, with each other, with those in other sectors

Improvement Safety Openness = being open, honest and

trustworthy

NEW FLOODS

CHANGING UNDERSTANDING OF

HEALTHHealth is a state of complete physical,

emotional, social and spiritual well-being; it is a resource for everyday living.

Examples of Implications:Value of one’s own experiences Social, psychological and spiritual factors Gender as health determinantHealth of person, family, community,

population and earth

CHANGING HEALTH PROFESSIONS Move from traditional inward-looking,

reactive culture to outward-looking, proactive culture

Shift from profession-centred to patient-centred, client-centred culture

Blurring professional boundaries Changes in law re scope of

practice/responsibilities Increased expectations of interprofessional

collaboration in education and practice Focus on evidence-informed practice Increasing demands for accountability and

transparency Internationalization Loss of control over working conditions

COLLABORATION

Collaborative patient-centered practice is designed to promote the active participation of several health care disciplines and professions. It

enhances patient-, family-, and community-centred goals and values

provides mechanisms for continuous communication among health care providers

optimizes staff participation in clinical decision making (within and across disciplines)

fosters respect for the contributions of all providers

Health Canada, 2003

STAGES OF COLLABORATION

Climate of mutual respect and trust Cooperation = formal communication,

independent decision-making (shared information, consultation)

Coordination = defined roles, some shared decision-making (shared vision, goals and planning; shared resource)

Collaboration = defined roles, frequent communication, shared decision-making, one system

Teamwork – specific tasks, patient-centeredCollective responsibility – organizational

integration Shared leadership, control, risk and accountability

PRESENT CULTURE IN HEALTH CARE

PREFERRED CULTURE IN HEALTH CARE

Focus on care of individual

Focus on care of individual, family, community, environment

Lack of patient centeredness in decision-making

Involvement of patient/client and family in decision-making and care

Struggle with quality and safety, variation

Culture of quality and safety

Depersonalization of care

Personalized care

Priority to acute care interventions

Priority to spectrum of health and health care

Public mistrust of system Public confidence in system

PRESENT CULTURE IN HEALTH CARE

PREFERRED CULTURE IN HEALTH CARE

Growing distance between personal and system goals

Alignment of personal and system goals

Segregated professions Integrated but not assimilated professions

Mutual trust, cooperation and coordination among health professionals and other staff members

Collaboration among health professionals and other staff members

Workforce shortage Sustainable and engaged workforce

Workplace disquiet & stress

Healthy workplace

Leadership focus on protection

Passionate and humble leadership

PRESENT CULTURE IN HEALTH CARE

PREFERRED CULTURE IN HEALTH

CARE

Attention to formal structures, regulations and reporting relationships

Attention to group affiliation, teamwork, coordination

Attention to structural and procedural change

Attention to cultural change

Fragmentation, silos Integration

Elitist language, symbols

Common language, symbols

Hierarchical structure Dynamic, organic structure

HARMONIES OF NEW FLOODS

VISION

Had, held, shared, grown “Something significant left to

do” Vision Community

VALUES

Values are sets of freely chosen convictions which compel action as they are cherished and publicly affirmed.

Charles McCoy

ROLES OF LEADERS

Visionary

Catalyst

PartnerDecision-maker

InspirerFacilitator

Implementer

Evaluator

LEADERS AS PRACTITIONERS

Manage diversity Respond within changing social

realities Be inclusive Understand globalization and

health care reform Reintroduce values of flexibility,

discovery and innovation Tell stories Create environments allowing

creativity, questions, risk

LEADERS AS RESEARCHERS Research

Interdisciplinary and collaborative qualitative and quantitative investigative and evaluative

Input and participation at every stage of research process

Link with wider national and international professional community

Research agenda = gender-sensitive and inclusive

Recognition of diverse communities Increased number of health services

researchers Means of transforming research results

into health policy and practice

LEADERS AS VISIONARIES

Stretch into new ways of thinking Leave behind what is no longer

appropriate Interconnect practice, education,

administration, and research Value networks Re-inspire spirit

READINESS TO RESPOND

Leaders act wiselyLeaders act courageouslyLeaders act passionately

READINESS TO RESPOND

Awareness of complexity Skills development Strengths of tradition Emotional preparedness Reflection Ceremonies and celebration Symbols Confidence/conviction

BLESSING

May the light of your souls guide you. May the light of your souls

bless the work that you do with the secret love and warmth of your

hearts. May you see in what you do

the beauty of your own souls. May the sacredness of your work bring healing, light and renewal

to those who work with you and to those who see and receive your

work. May your work never weary you.

May it release within you wellsprings of refreshment, inspiration and excitement.

May you be present in what you do. May you never become lost in bland

absences. May the day never burden.

May dawn find you awake and alert, approaching your new day with dreams,

possibilities and promises. May evening find you gracious and fulfilled.

May you go into the night blessed, sheltered and protected.

May your souls calm, console and renew you.

Adapted from John O'Donoghue, Anam Cara