Will tossing out the status quo bring fresh ideas and cure the ills of Nova Scotia’s largest health authority?

by Kathleen Martin

“Changing the health care system feels like boiling the ocean,” says Chris Power. “You think you can’t, so you stay with what you know. We’re a very risk-adverse industry.”

Power is the president and CEO of Halifax-based Capital Health, the largest of nine district health authorities in Nova Scotia. A confident and businesslike 31-year industry veteran, she is well-schooled in the limits of the health care system. Like her colleagues nationally, she can rhyme off endless lists of constraints and systemic problems. What sets Power apart, and has rocketed Capital Health to the cutting edge of health care administration in this country, is that she’s not buying it.

“We in health care have always blamed it on everybody else. If only we had more funding, if only the patients would, if only the doctors would…,” sighs Power. Then she adds: “This problem is nobody else’s to fix but ours. We have to make transformational change in health care.”

Power’s approach has been to think differently about health care challenges. Take, for example, the Capital Health strategic-planning process that was completed in April. “I’ve been through strategic planning so many times in my lifetime,” says Power.  “By going through the same traditional process, you always get the same kind of outcome—a strategic plan that essentially sits on a shelf. We needed different people around the table and a different approach.”

Power began with this question: What would it take to create a world-leading haven of people-centred health, healing, and learning? To find answers, she and her team decided to listen to a broad group of stakeholders.

Instead of holding traditional town hall meetings with audience members lined up at microphones, they investigated creative ways of hearing from people whose opinions they especially wanted. Over eight months they worked with more than 2,000 citizens, staff, patients, and patients’ families, using methods ranging from world cafés to waiting-room journals.

World cafés are designed to create an intimate conversation among a large number of people addressing big questions. At one session, recalls Geoff Wilson, a senior strategy advisor at Capital Health, “We had more than 80 people, all sitting at tables of four.” Each table was covered with a large piece of paper, magic markers, and Post-it notes. The participants discussed a question, then all but one got up and moved to other tables for the next question. The remaining person filled in the new table members on the previous conversation, then that new team tackled the new topic, scribbling on the same paper, making connections, and building on ideas. “You begin to see how connections happen between concepts and conversations,” says Wilson. “It helped us hold a mirror up to the organization and begin to pay attention to what was being reflected back.”

What they learned “was tough but powerful.” This included assertions that Capital Health did not have a holistic approach to health care, that it was not engaging its partners and citizens, that it was not empowering communities, and that it had lost sight of its academic mission—accusations commonly levelled at the Canadian health care system.

In Halifax, Power not only insisted on drawing out the information in an inclusive way but also used it as the basis for Capital Health’s strategic plan. Its first phase focused on improving the health and leadership skills of Capital Health staff, so they will be better poised to care for those who come to them for help.

“I haven’t seen any other organization in Canada approach this the way we have,” says Power. One result: She is increasingly in demand as a speaker across the country. “We’ve been running health care in the same way for years and years, and we aren’t making the kind of impact we should. None of the markers you would call success are evident in our health care system. This system will only change through personal transformation, one citizen at a time.”

Working with staff is part of that. “There are 12,000 people who work here at Capital Health,” says Power. “Do they all get it? Absolutely not. But that’s part of our journey too.”

Kathleen Martin is a freelance journalist based in Halifax. She can be reached at masthead@ns.sympatico.ca.