5 Scenarios About Growing Old

A presentation made at the Markhaven Home for Seniors Annual General Meeting, May 12, 2008. The presentation explores five differing visions of society, each with distinct organizing principles and governing values, and hence, different implications for the experience of aging. The scenarios highlight the question of aging and its possible meanings in the future, as a way of focusing thought on the present and important issues of planning.

Increasing Efficiency while Improving Patient Experience: Operational Efficiency and Economies in Health Care

The presentation explores thinking and practice in health care on the problem of operational efficiency. Beginning with Frederick Taylor's principles of scientific management and their application to the assembly-line, the presentation utilizes brief case studies in which the human factors traditionally excluded from economies of industrial production, may be seen as highly relevant to the organization of health care. The case studies offer valuable comparisons between efficiency goals and unintended consequences in which 'the human factor' plays a large role. Examples range from production at Dell Computers to the very humane efficiencies of the Shouldice Hospital and their implications for practice elsewhere.

Primary Care and Uncertainty

A presentation in three parts, comprising: a collection of historical ideas about health, disease and primary care; a synopsis of our current understanding of health, disease and care; and considerations for future directions in our understanding and practice.

Reconnecting to Care: A Nursing Initiative at the Baycrest Geriatric Health System

Sholom Glouberman, Joy Richards, Marilyn El Bestawi, Rhonda Seidman-Carlson, Lorne Teperman

This paper describes and examines a change program for nursing services in Complex Continuing/Long Term Care (CC/LTC) at the Baycrest Centre for Geriatric Care in Toronto. It presents a brief history of the rise of CC/LTC services and the difficulties associated with them. In particular it claims that demographic, professional and institutional changes have produced a differentiated specialization of supports which tend to disregard some necessary aspects of daily support for patients, and devalue the role of direct care workers in these settings. The "Reconnecting to Care" (RTC) initiative is a response the to these changes by nurses at Baycrest. In detailing why Baycrest has decided to get back to basics and reconnect to care and how it has begun to do this, this paper provides an overview of the reasons for this initiative, a little of how it has been implemented so far, and some initial lessons for nursing leaders and others.

Birth and Death: The Limits of Scientific Contributions

Delivered at the Enkin Lectureship on January 24th, 2007 at the Michael G. DeGroote Centre for Learning and Discovery in Hamilton, Ontario. This presentation addresses the increase in “grey zones” in birth and death that arise from our deepening scientific understanding.

Complicated and Complex Systems

Delivered December 6, 2006 at the European Health Leadership Programme, INSEAD, in Fontainebleau, France. This presentation is based on work done for the Romanow Commission with Brenda Zimmerman of the Shulich School of Business.

In health care we might distinguish between “complicated” and “complex” problems. Although many aspects of health care systems are complicated others are best viewed as complex. The advantage of the distinction is that problems that are thought to be intractably complicated can be viewed more optimistically and often unraveled when they are seen as complex.

Performance Management

Delivered at the Insight Conference on Performance Management September 27, 2006. This presentation provides an overview of Performance Management.

International Masters for Health Leadership Module 2

The second module of this program focuses on health care systems and their complexity. The module will be directed by Antonia Maioni of McGill and Ted Marmor of Yale. The issues that face participants will be examined in the context of the systems they are in, the policies that drive those systems and the changes that have been initiated in them.

C Difficile and Complexity

Yesterday the Healthcare Commission, the major inspectorate of the NHS came out with a report on the C difficile epidemic at Stoke Madeville Hospital. The report castigates the management of the hospital for focusing only on meeting government targets and losing sight of its responsibilities for infection control.

The Chief Executive of the period was fired and a new acting Chief Executive has responded to the Commission report by agreeing with its conclusions and promising to collaborate with the commission to make sure that such breaches no longer occur.

What is interesting to me is that the commission actually does recognise that the centre has put extreme pressure on individual organizations to meet government targets and that this resulted in reducing the priority given to infection control.

International Masters Program for Health Leadership

The IMHL has begun. The first module of the first cycle was recently completed at Mont Gabriel Hotel in the Laurentians north of Montreal. It ran from June 5 to 16, 2006. It focused on presenting a very broad understanding of the health field and on how to manage oneself. Participants all brought issues they faced at work and also wrote some personal stories as material for the program. The design of the learning was many-layered and included personal reflection, writing on the issues, experiential workshops, lectures and interactive consultations. There was time cleared for relaxation, exercise and play.