The Interview On Leadership, Healthcare, and Innovation with Maureen O’Neil, President of the Canadian Foundation for Healthcare Improvement - Canadian Government Executive
InnovationsLeadershipPublic SectorThe Interview
June 16, 2016

The Interview On Leadership, Healthcare, and Innovation with Maureen O’Neil, President of the Canadian Foundation for Healthcare Improvement

Maureen O’Neil has been leading the CFHI since 2008, but she’s been fighting battles in the policy trenches with her signature energy and enthusiasm for decades. She most recently served as President of the International Development Research Centre, Interim President of the International Centre for Human Rights and Democratic Development, President of the North-South Institute, and Deputy Minister of Citizenship, Government of Ontario. She serves on a broad range of boards at the provincial, national and international levels. Patrice Dutil, the editor of CGE, caught up with Ms. O’Neil to talk about leadership in creating a culture of sustained innovation.

Q: You’ve been in leadership positions, and you’ve watched leaders for a long time—what do you think are the greatest strengths in public sector leadership today?  What are their greatest weaknesses?

If I think about healthcare, there are many people itching to make changes for the betterment of patient care. For decades we have talked about the social determinants of health. Improving income is key. What is an individual doc to do with that? Well, at St. Mike’s in Toronto there is a real attempt to make sure their patients are getting all their income benefits. And Dr. Ryan Meili and colleagues in Saskatoon have a program called UPSTREAM which actually clothes principles in reality. The re-discovery of the Guaranteed Annual income and the substantial policy work on the topic 40 years ago has engaged public servants (in Ontario) and the social organizations outside government looking for better ways to direct income to poor people. This social engagement and blurring of policy lines takes real leadership and I see it as very positive.

Q: Those examples are rare, though.

They are. The last several decades and have been very difficult for anyone who is inspired by a desire to see a fairer society. The pendulum swing following the 1978 Bonn summit was the beginning. Frankly it has been hard for the ordinary person to see themselves in government policy since.  Maybe that is why Trump and Sanders have been having such a run in the US primaries. Even now in Canada we do not talk about poverty. We talk about the middle class. I recently did a bit of research for a conference on basic income and it is sad to see how little progress has been made. The Ken Carter Commission on Taxation concluded (in 1966!) that the tax system placed an unfair burden on the poor. The Senate Commission on Poverty of 1971 concluded that Canada should adopt a guaranteed annual income. Almost 50 years later, we’re still talking about it like it is a new idea! The Royal Commission on the Status of Women and in the early 80s the McDonald Commission on the Economy all came to the same conclusions. I was lucky to have begun a public service career when the fashion was public and social engagement. Searching for evidence was expected, as was engaging in discussion and, if necessary, argument with your Deputy Minister or Minister (as long as you were polite and respectful). I really don’t know now. It seems to me that in Ottawa, and in most provincial capitals, those reflexes might be a little rusty.

Q: So what keeps you optimistic and engaged?

I really do believe a better world is possible. I also believe that it requires relentless effort to change anything.  At CFHI with our small budget ($17 million in the face of a $220 billion healthcare spend in Canada) we can make a difference and most importantly we are already showing that good ideas applied, tested and evaluated can be spread by willing imitators and adapters. Patient care will improve and it will likely cost less than now. Change always begins with the proverbial “coalitions of the willing.” Without them there will certainly be no transformation of anything and certainly not of Canadian healthcare.

Q: How has CFHI changed its mandate since you became the CEO?

The Canadian Health Services Research Foundation was created in 1996 through a federal government endowment that was supposed to run for twenty years.  It had a broad mandate to enhance the implementation of health services and fund some research. The main change since my arrival was to completely move away from research funding. To continue would have made no sense—it was just duplicating the work of others. When I arrived we did a tripartite strategic plan focussed on what we considered the most important goals that would influence healthcare transformation: patient and citizen engagement (a new area for the foundation), accelerating institutional change (primarily through our executive training (the EXTRA program) and policy dialogue.

Q: CFHI has been in the Executive Training business for a long time. How did it change?

EXTRA was originally created to increase understanding among healthcare leaders of how to apply research findings. It was focused on the individual. EXTRA participants brought with them change projects. We had not realised that our focus should be on the change projects and that bringing teams into EXTRA made more sense than individuals. Now very senior teams including VPs Medicine in big hospitals, Directors of Nursing and ADMs in Health ministries make up our cohorts. You get the idea. They use the program to achieve change in their organizations. EXTRA is our Petri dish for innovation.
EXTRA has long been one of very few places where frontline healthcare people get together to share ideas about improvement across the country. (There is excellent participation from Quebec as it has always been a fully bilingual program.)

Q: HC in Canada is primarily the responsibility of the provinces.

Yes. Right now, we have thirteen “natural experiments” going on in healthcare delivery. Our research shows where there is ample opportunity to radically improve Canadian healthcare with blindingly simple changes. We had Risk Analytica (a Toronto consulting firm) model out projections to show what the benefits would be if only half of Canadian healthcare institutions made the changes that five of our EXTRA projects had shown to make a difference. Their conclusion: $2.1 billion annually.
As we moved away from research funding, there were two other important opportunities, both of which helped frontline healthcare people and organizations better provide care for patients with chronic conditions.
The first opportunity was in the North West Territories where we supported regional healthcare teams to analyze and re-think (using the EXTRA approach of tailored learning and expert coaches) care. The second was the unprecedented all-Atlantic provinces collaborative on Chronic disease. Through it we met Dr. Graeme Rocker who had implemented the INSPIRED program modelled on the UK “Breathless” program for treating COPD sufferers at home. The program vastly improved their lives. We also demonstrated that care could sometimes be moved successfully out of the acute care hospital. For every dollar invested, the system saved $21.00.

However the real “Aha” moment came later when I was chairing a session at Ontario’s Health Achieve in November 2013. One of our EXTRA fellows, Dr. Marilyn el Bestawi, had demonstrated a great project. I said wistfully at the end of her presentation: “Now if only others would do that!” My colleague from the Ottawa Hospital, Heather Sherrard, came up to me and said “Well, that is unlikely.” “Why?” I asked. “No beta testing” she answered. The light went on. former Minister of Health Monique Begin used to complain, Canada is a nation of pilot projects. CFHI has proved that does not have to be the case. We embraced beta testing. We call it developing Spread Collaboratives. We have started to engage with provinces to move from spread to scale. New Brunswick is the first.

Q: So how do you move the stubborn world of Healthcare into adopting new practices?

CFHI identifies well evaluated innovation and offers the opportunity to enthusiastic health organizations to adapt and implement those changes. We create collaboratives with these teams, modestly fund them to permit some staff rotation and data collection, and support them with coaches and learning modules. We also carefully evaluate the outcomes for patients and the FISC. One spread collaborative drew on years of applied research on patient and family engagement to improve outcomes. The second collaborative originated with the EXTRA project in Winnipeg run by Cynthia Sinclair and Joe Puchniak on the reduction of inappropriately prescribed anti-psychotics to people with dementia in long-term care. (We just released the results of the 56 sites’ implementation in mid-May. They captured the national imagination. We have done more than forty interviews in a broad range of media.) Most excitingly, the province of New Brunswick has decided to scale the appropriate prescribing of anti- psychotics to all nursing homes in the province. The third is spreading Dr. Rocker’s COPD program. The others are coming soon.

Q: CFHI seems really focused on program evaluation.

Yes we are, and we don’t just talk about it: we actually do it. Data collection and analysis is an integral part of our programming. That is why we actually have results to share from the spread of collaboratives.
I have been a believer of the utility of sensible approaches to evaluation since the mid-1970s. It must be embedded in programming and actually influence management. Often organizations collect data routinely but either don’t know how to use it or don’t have it built into management decision making. CFHI is showing that spread and scale of well-evaluated local innovation can be done and should be done. Innovations start with innovators, people who see different ways of approaching problems. Old notions of giant levers for change applied top-down may work from time to time (it was a key step to have the state pay for healthcare). But achieving change in complex systems more and more requires that good ideas developed locally be tested, altered, spread and scaled. That does take a lot of leadership—first to develop the idea and then for someone to see the merit in it and test it in their own area. I learned a lot about this in my work in international development. It applies to healthcare too.

About this author

Patrice Dutil

Patrice Dutil is the Editor of Canadian Government Executive. He is a Professor in the Department of Politics and Public Administration at Ryerson University in Toronto. He has worked as a government policy advisor, a non-profit organization executive, a television producer and was the founder, and editor for five years, of The Literary Review of Canada. His upcoming publications include a book on the administrative practices of Canadian prime ministers Macdonald, Laurier and Borden, and a study of the 1917 election in Canada.

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Things just get curiouser and curiouser. Lewis Carroll (1865): ’s Adventures in Wonderland David Thompson was a British-Canadian fur trader, surveyor, and mapmaker, known to indigenous peoples as Koo-Koo-Sint or ‘the Stargazer’. He travelled 90,000 kilometres and mapped nearly five million square kilometres of . He has been described as the “greatest land geographer who...
 
As Toronto’s city staff prepares top release proposed regulations for taxis and ride-sharing services in the city, Uber Canada launched a new public relations campaign to get Torontonians to urge city councillors to support “progressive” ride-sharing rules. Toronto councillors are scheduled to vote in May on whether or not to allow ride-sharing companies to operate...
 
If the government intends to push economy-boosting measures, Canadian business leaders prefer to see the a combination of investments in either a skills and training agenda, tax cuts, as well as research and development or facilitating pipelines. C-suite executives are also strongly supportive of clean technology development and transportation strategies that reduce carbon emissions, according...
 
The Department of Innovation, Science and Economic Development (ISED) Lab is one of the few Government of Canada innovation labs with a dedicated space for collaborative work. The layout of space and furnishings reinforce the collaborative approach, with expansive writable wall surfaces, open meeting space, a variety of tools and templates reflecting design thinking techniques,...
 
Nearly half of Canadian organizations are falling behind on implementation of datacentre upgrades, according to a recent report from analyst firm IDC Canada . “Daily tasks, such a troubleshooting, and maintenance work are taking up the time of IT staff and taking the focus away from innovation,” said David Senf, program vice-president for the infrastructure solutions group...
 
The Ontario government and telecom gear maker Huawei Canada yesterday announced plans to pour some $316 million dollars into a research and development project focused on 5th generation wireless technology and positioning the province as a global tech hub. The project, called 5G Ontario, will see Huawei Canada invest a total of $300 million, over...
 
Over the last decade we have seen many changes in the datacentre. But what is still surprising is that some processes are still done manually. As the transition to automation slowly makes its way into Canadian datacentres, what can we expect in the next gen of datacentres? David Senf, Program Vice President, Infrastructure Solutions Group...
 
The idea of converged infrastructure and converged systems in the datacentre has sparked the interest of many IT decision makers over the last few years as IT budgets continue the shrink forcing many administrators to search for ways to cut cost. Essentially, converged infrastructure operate by grouping IT components into a single, optimized computing package....
 
VMware is zeroing in on DevOps and day-to-day concerns of IT shops involved in the management of multi- cloud environments with the latest release of vRealize Suite. The updates, packaging enhancements, and new pricing for the new vRealize Suite 7  is meant to address most common use cases that organizations encounter when they transition to...
 
Written by Jason McNaught It took approximately 18 years for carbon fibre to go from lab experiment to the commercial market, and at that point, if you weren’t building a spacecraft for NASA or making fighter jets for the U.S. Military, it wasn’t part of your everyday life. That came years later, when some brilliant...
 
Public sector innovation, once dismissed as a contradiction in terms, is now increasingly seen as an imperative. Last November, the Organisation for Economic Co-operation and Development (OECD) hosted an international conference on “Innovating the Public Sector” and announced that it has been building a database on public sector innovation. Many federal government departments are setting-up...
 
Changes to the Build in Canada Innovation Program (BCIP) will help guide Canadian business innovations from the lab to the marketplace....
 
Innovation (design or change) labs are the hottest thing in government. They offer opportunities to experiment with collaborative ways to speed up decision-making and take advantage of new sources of information. Design labs were started in the U.K. with the Behavioural Insights Team and have spread to other governments. Related posts: Ten tough challenges for 2015 A nudge in the right direction Changing the public service DNA...
 
The rapid growth of unmanned systems for military applications has been well documented. Whether it is aerial vehicles for intelligence and surveillance or robots for explosives disposal, the uptake has been widespread....
 
sharing and checking into Google Plus regularly; that only leaves brands to showcase along with other brands.”” Related posts: Looking beyond efficiency Constant change is the new normal Life, space and buildings: CSE’s organizational transformation...
 
The economic development agencies of 12 municipalities have banded together to bring their interests to the attention of foreign investors. The logic is that they are stronger as a team, and that they can direct investors to the city that will best meet their needs for setting up shop in the Great White North....
 
The City of Grande Prairie in Alberta has received a “green gov” award from Santa Monica-based Vision Internet, a government website developer. Related posts: Ontario flicks the switch on vehicle charging stations...
 
Governments and managers can promote innovation in Canada by crafting a culture of innovation in their bureaucratic environments....
 
Two weeks ago, CGE wrote about the selection of Toronto as a leading Intelligent Community, a recognition of its Prosperity Agenda and its innovations in technology and other sectors – despite the trials and tribulations of its mayor....
 
Despite the international media circus created by Mayor Rob Ford, Toronto has been named the 2014 Intelligent Community of the Year. The award was announced in June by the Intelligent Community Forum at the conclusion of the annual Intelligent Community Summit in New York. Related posts: Uber faces insurance woes in Edmonton, launches preemptive PR move in TO Cuts to TTC will compromise service, increase air pollution says union Building a Collaborative Advantage...
 
A regulator’s job is to fulfill its mandate in the public interest. The Canadian Radio-television and Telecommunications Commission (CRTC) has been using innovative ways to engage Canadians in public consultations. Related posts: CRTC warned of massive job losses in Canadian TV stations CRTC ruling nixes hope for lower mobile rates says small telecoms Nunavut, Nunavik, rural areas decry slow, unreliable Internet service...
 
but what does this mean when plugged back into your starting premise (we overestimate short-term impact and under-estimate long-term impact)? To me it suggests that government needs to re-engage with communities with more than just social media campaigns. They need to find ways to literally bring people together and get them talking (and not necessarily...
 
Innovate Manitoba is a not-for-profit community-based organization established in 2012 to act as a catalyst for innovation and to help close the commercialization gap....
 
Whether we are welcoming advanced technology into our homes, driving vehicles with more sophisticated safety and communications features, or taking advantage of new online services, innovation is an increasingly important measure of how well our modern economy is faring....
 
“Innovation” might be an overused buzzword in defence and security circles, but since the stand-up of the Canadian Innovation Commercialization Program (now Build in Canada Innovation Program) and the release of the Jenkins and Emerson reports, it has been central to the federal government’s message....
 
Ontario and Alberta have joined forces to encourage the development of research projects that will stimulate job growth, bring new products to market, and improve the products that already exist in both provinces....
 
For government to fulfill its mandate of serving citizens, considerable spending is continually required to support and improve current programs and services and to introduce new programs or services. Related posts: A possible counter to Canadian risk aversion The importance of thinking outside the box Enhancing business and personal lives...
 
The need to innovate has become so common a goal in government it has become a motherhood statement. However, the need to innovate is a real imperative that Alberta is making a priority, not only for its Ministry of Innovation and Advanced Education, but for the province as a whole....
 
While not all cities are created equal, great competition should bring out the best in them. More than ever cities are watching technology trends. Related posts: Pressing problems for cities require smarter use of resources A data-based approach to health care Predictive analytics for smarter cities...
 
It has long been postulated that tidy desks are more conducive to productivity in the workplace, and that an organized worker is a valuable asset to any employer. Worse, employees with messy desks are sometimes seen as lazy slobs by their co-workers. But a recent study…...
 
In “Public sector, disrupted”, a recent study published by Deloitte, a question is asked: why do organizations in the private sector offer higher quality services or products for a cheaper price, while organizations in the public sector do the exact opposite? Related posts: Capitalizing on the volunteer spirit Keeping pace: Technology's challenge to government service delivery Serving Seniors: Ongoing Challenges...
 
We are only at the first phase of the Digital Age and our efforts require concerted action to develop the know-how to take advantage of the possibilities of this paradigm-shifting era....
 
In Smarter Information, Smarter Consumers, www.hbr.org, Richard H. Thaler and Will Tucker claim that the availability of information is changing consumer attitudes, and that government can learn a lesson from this....
 
A Saskatchewan team of geologists, physicists and palaeontologists is hunting for dinosaur DNA using a cutting-edge piece of equipment located in Saskatoon....
 
The judges are in place. The clock is ticking. The best in the world have come to Canada to compete. No, it’s not the 2010 Olympics in Vancouver. It’s Worldskills 2009 in Calgary....
 
At first glance, federal defence scientists focused on research supporting the Canadian Forces and geoscientists collecting scientific data on the Arctic seabed may seem like an unlikely pairing....
 
What is British Columbia doing to change its approach to scientific research and innovation as a result of the signals sent in the federal budget?...
 
In a knowledge-based global economy, continuous innovation is crucial to enable effective and efficient service delivery in the public sector and competitive advantage in the private....
 
There is no reason for Canada to be an innovation and productivity laggard. Governments can and should play a leadership role, and it is not all about spending…...
 
Saskatchewan’s Ministry of Environment is leading a new approach built on results-based regulations to enhance environmental protection while encouraging innovation....
 
Governments have long known that although across-the-board percentage cuts may meet fiscal targets, such cuts can harm ministries and departments for many years....
 
CGE Vol.13 No.4 April 2007 Education, creativity, research and innovation play a crucial role in Canadian society and Canada’s...
 
CGE Vol.14 No.3 March 2008 Innovation is one of those concepts talked about so often and yet realized so rarely that the word has...
 
CGE Vol. 14 No.5 May 2008 Ontario Premier Dalton McGuinty spoke with editor-in-chief Paul Crookall, as part of our series on the relationship between political le...
 
Today, thanks largely to the internet, the kind of creativity and innovation that used to take place primarily within the confines of corporate walls now occurs across large, loosely connected networks of firms and individual entrepreneurs....
 
When William Eggers wrote his landmark book, Government 2.0, in 2005, he predicted that governments around the world would have to embrace the information age, abandoning industrial age management concepts of hierarchy, specializati...
 
What exactly is hunger and why is it an important global issue?...
 
En décembre 2008, la fonction publique de la Colombie-Britannique a lancé Spark, un site Web interne visant à susciter la collaboration constructive au sein de l’organisation....
 
La fonction publique de l’Ontario œuvre dans la lutte contre les incendies depuis la fin du 19e siècle....
 
The Ontario Public Service has been in the business of putting out fires – literally – since the late 19th century....
 
In December 2008, the BC Public Service launched Spark, an internal website for constructive collaboration within the organization....
 
Once seen as stable, even glacial, the public service is now in a constant state of flux, adapting to new business models and an economy that is a moving target....
 
D’abord vue comme stable, même figée, la fonction publique connaît maintenant des changements continus et s’adapte à de nouveaux modèles d’affaires ainsi qu’à une économie en constante évolution....
 
Au cours de ma longue expérience auprès de différents ministres d’allégeances politiques diverses, je n’en ai jamais rencontré un seul qui aurait voulu qu’on lui mente ou qui ne se souciait pas de l’int&e...
 
Le leadership au sein des organismes du secteur public est l’un des acquis les plus importants du Canada. L’Institut d’administration publique du Canada (IAPC) et Deloitte ont salué fin novembre ce qui se fait de mieux en la...
 
CGE Vol.13 No.8 October 2007 A modern public service is one that is relevant, flexible and effective in dealing successfully with...
 
Quote of the week “An innovative APS starts with individual public servants wanting to try new ideas.” — APS Innovation Action Plan Editor’s Corner...
 
Le plus souvent, toutefois, nous devons nous affairer activement à trouver une solution nouvelle....
 
Sometimes innovation happens serendipitously – a Eureka moment, when the answer drops out of the sky. But more often, we have to create a novel solution. And for that, like any craft, it can be helpful to have tools....
 
2012 has the potential to be an important year for Canadian science and innovation policy, one to be remembered for many years....
 
As the Ontario Public Service readies for its involvement this April in Creativity and Innovation We know that today’s employee, our clients and Ontarians are demanding change. They are looking for us to be accountable, transparent and they need us to be more effective and efficient with their tax dollars....
 
TED is a non-profit community devoted to the theme of “Ideas Worth Spreading.”...
 
Becoming an innovative organization takes more than a call to “be innovative” or an invitation to submit ideas. What are you doing to lead innovation on your teams?...
 
Thousands of other research projects in Canada have become a reality – in large part due to investments made by the Canada Foundation for Innovation (CFI)....
 
Conducting a large number of detention reviews under difficult conditions and tight timeframes required leadership, a collaborative effort and support from all IRB personnel....
 
How can we increase productivity, build resilience and enhance quality of life in the rapidly changing 21st century?...
 
Innovation is critical and urgent as public servants continue to improve the quality and efficiency of public services while responding quickly to changing social and economic conditions....
 
To the reporters who’d gathered in the Alberta Legislature press room, the blue plastic bucket in reserved seating may have looked more like a janitorial oversight than the starring act of a new workplace safety ad....
 
Robert Louis Stevenson a déjà affirmé que « la politique est la seule profession où la formation n’est pas jugée indispensable ». Il avait tort....
 
You’ve made a good choice. If you’re in the public sector right now, you’re at the centre of the action....
 
CGE Vol.13 No.10 December 2007 David Crombie, former Toronto Mayor, Conservative Cabinet Minister, and Chancellor Emeritus of Rye...
 
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A single team or lab could never create the volume of ideas needed to make hundreds of small improvements in all aspects of a complex organisation. That became obvious to me while working for the New Zealand Post. I was in the Total Quality Service team, which had a year to develop comprehensive strategies to...