Each month, Heather McPherson, President and CEO of Women’s College Hospital shares some of her thoughts and ideas about our hospital, our health system, her views on leadership and innovation, and the things that inspire her to create a healthier, more equitable world.
Healthcare and Climate Change: What Can We Do?
October 31, 2019
Climate change has been identified as the 21st century’s greatest threat to global health. And like many other sectors, healthcare delivery contributes to this growing problem. Canada’s healthcare greenhouse gas footprint ranks 21st in the world – behind countries like the USA, Belgium and Japan. Internationally, health system leaders are setting new and ambitious plans in place for a healthier future.
A 2017 Health Canada poll found that 79 per cent of Canadians accept that global warming is happening, but only a little more than half think it’s a health risk right now. Between 2030 and 2050, climate change is expected to cause roughly 250,000 additional deaths per year, from malnutrition, malaria, diarrhea and heat stress. Vulnerable populations are particularly at risk, including the poor, the elderly, the young, those who are chronically ill and those living in vulnerable geographic areas like the North.
So if climate change is one of the greatest threats to population health this century, we need to think about what we can do to reduce some of these risks. Health systems and hospitals have an important responsibility to develop smart strategies and solutions to mitigate and reduce greenhouse gas emissions, to adapt to shifts in patterns of illness related to climate change and to lead by leveraging social capital for collective action.
At Women’s College Hospital (WCH), we’re working to be a more environmentally friendly organization. Our hospital building is Leadership in Energy and Environmental Design (LEED) Gold Certified, which means we’ve incorporated environmentally sustainable construction practices and an energy efficient design. An example of this is our green roof, which helps with water retention and management.
In addition, we developed a Sustainability Plan to identify ways that our organization can reduce energy consumption and the amount of waste we send to the landfill on a monthly and annual basis. We are integrating the principles of sustainability and sound environmental practice into all functions and operations within our hospital. Our aim is to reduce our environmental footprint at WCH. To do this, we’ve implemented a series of actionable strategies to minimize our greenhouse gas footprint and we’re committed to adding to this list every year. To reduce paper use, we’ve installed new printers with default double-sided printing. To minimize energy use in our building, we’re working in partnership with Black and McDonald, our building management company, to make necessary changes. To reduce the use of bottled water, we are installing more filtered water stations throughout the hospital. To implement an organics recycling program, we’re introducing the use of organic bins in our lobby and in staff lounges. On an annual basis, we will produce a sustainability report that measures year-over-year results of our initiatives. There’s a lot we’ve done and even more we need to do, but I’m proud of the strides we have made to shrink our hospital’s carbon footprint.
Locally, WCH has joined the other academic hospitals (Toronto Academic Health Sciences Network) and the University of Toronto’s Centre for Sustainable Health Systems to create a community of practice who will collaborate on shared quality initiatives that will add momentum to implementing change.
Climate change isn’t tomorrow’s problem. For the health of our patients, our communities and our world, we need to take accountability and action today.
Reproductive Rights: We’re Not Done Yet
September 30, 2019
We are fortunate to live in a country where sexual and reproductive healthcare rights are ingrained in law – it’s been 50 years since contraception was legalized in Canada and just over 30 years for abortion. However, we can’t take for granted the progress that has been made. In most places around the world – including many developed countries – reproductive freedom is still a major health issue and we only need to look south of the border to know that reproductive health rights for many people are precarious.
There have also been more recent advancements. In 2017, Health Canada approved the use of Mifegymiso, also known as the abortion pill – a global, gold standard of care that has been available throughout Europe for decades – with the intention of increasing accessibility to safe, effective medical abortion, particularly in rural and remote communities where hospital and physician services can be difficult to access. However, there were many onerous prescribing restrictions that were mandated for Mifegymiso - specialized physician training, mandatory ultrasound and requiring patients to take the first dose in the presence of their physician - as well as complicated dispensing practices, so this slowed the uptake of Mifegymiso and did little to improve access. Although these barriers have since been removed, the usage rates of Mifegymiso continue to vary considerably from province-to-province and are still limited, particularly in community care settings.
Physicians at our Bay Centre and scientists at our Women’s College Research Institute were instrumental in the Canadian approval of Mifegymiso. In less than two years at our clinic, approximately 55 per cent of all abortion care is now done medically rather than surgically.
As early adopters who believe in its efficacy and safety, clinicians from the Bay Centre are also training and supporting community primary care physicians in rural communities including Thunder Bay, Sudbury and Orillia through e-consults and telemedicine to increase their understanding and confidence while growing their capacity to prescribe Mifegymiso to their patients. Next they are turning their attention directly to patients in rural communities to provide abortion care using Mifegymiso using virtual care and digital health tools.
Although in Canada, on the surface, it might seem like access to abortion care is readily available for people who want to exercise their legal right to make decisions about their sexual and reproductive health, you don’t have to dig very deep to truly understand that for many this still isn’t the case. Geographic, financial and cultural factors play a large role in a person’s ability to access the care they want and need.
As the CEO of a hospital that has been an advocate for reproductive health for 136 years, and Chair of the Board for Planned Parenthood Toronto, I have spent a considerable amount of time thinking about these disparities and how we can work to fix them. Lack of access to reproductive and sexual healthcare is most prevalent among people from marginalized communities who are disproportionately effected by the social determinants of health. Geographic access also poses a barrier for those who are required to travel for hours to reach their nearest clinic because their community does not have the resources to support them. So as we are developing solutions to meet people’s healthcare needs, it is imperative to take into account not only their clinical needs, but also the stigma and societal barriers that can have an equally significant impact on their ability to be healthy.
A New Era of Sex and Gender in Health
August 26, 2019
Women’s College Hospital is a long standing leader in sex and gender in health. Throughout history we have uncovered, advocated and worked to improve the significant population-level health inequities that exist simply on the basis of sex and gender. Recently, we have seen more conversations about sex and gender officially enter the mainstream, and, whether it be through social media campaigns like #MeToo, heated debates about health and wage gaps for women, or embracing gender neutral bathrooms and pronouns, we are undoubtedly in the next sex and gender revolution. We will continue to be at the forefront of this revolution in health research, education and clinical practice, as well as leading the way in shaping our own organizational environment and culture.
Together, we have done critically important work highlighting and addressing how healthcare and health research for men and women differ. Did you know that up until as recently as the 1990s, women were not included in most health research? Or that women are more likely than men to experience serious mental health issues, yet they are three times more likely than men to experience barriers to accessing care. Sex and gender influence our risk of developing certain diseases, how well we respond to medical treatments, and how often we seek care. The more we understand about how sex and gender affect health, the more we can do to improve health and well-being for everyone.
But the health gaps between men and women don’t tell the whole story. Growing recognition of diverse gender identities is not only changing public policy but pushing healthcare and health research to be more inclusive of previously unheard voices—including those of transgender, non-binary, and Two-Spirit individuals. We know that even today, trans and gender diverse people are typically not included in health research and continue to face barriers to accessing healthcare.
Our society, and perhaps especially the health sector, likes to sort by checkboxes: male or female, gay or straight, single or married. However, growing numbers of people don’t fit into these boxes. Being at the forefront of sex and gender in health means transforming and evolving beyond our traditional binary world views. Gender-transformative approaches are improving the way we design, implement and scale-up novel health interventions. Women’s College Hospital has been working toward a world where sex and gender – all genders – are integrated as key considerations across healthcare, research and its applications.
Women’s College Research Institute (WCRI), promotes the use of SGBA+ (sex- and gender-based analysis plus) across all health research; acknowledging that both biology (sex) and society (gender) influence our health and well-being in distinct yet interrelated ways. The ‘plus’ in SGBA+ points to the many other social determinants like stable employment, safe housing and food security that can impact a person’s health. These ideas are at the heart of the work our team of WCRI scientists are doing; from research design to measurement, analysis and implementation. We know that health research that includes sex and gender is more scientifically rigorous and responsive to the diverse health needs of people in Ontario, across Canada and around the world.
A focus on best clinical practice, specialized care and training of health professionals are all essential components to advancing the health of women and gender diverse people. Alongside our many other world-class clinical programs, we are the first public hospital in Canada to offer a transition-related surgical program that will increase access to medically necessary surgical procedures for transgender people. As a component of our strategy, we are hard at work to establish a new Sexual Health Centre that will be focused on addressing sexual and reproductive health gaps for women and gender diverse people.
We continue to coach and train our physicians, staff, learners, and volunteers to deeply understand and consider sex and gender as vital to health and well-being. We continue to investigate and address biases in the structure of our clinics, forms, electronic medical record systems and aspects of our physical environment, like access to all-gender washrooms, in order to ensure a safe and welcoming care experience for everyone who visits our hospital.
To achieve our bold vision to revolutionize healthcare for a healthier more equitable world, we will continue to push boundaries. This is who we have always been and I am incredibly proud that this is who we still are today.
It’s All about the People
July 29, 2019
It’s hard to believe that four months have already passed since I became President & CEO of Women’s College Hospital (WCH). It’s been the most energizing four months of my career and I have learned so much. Many of you know that I like to listen, learn and see firsthand what is happening across the organization and beyond our walls – I’m naturally curious about what people are doing, what they are thinking and how they are feeling. Our people are our most important resource and it is important to me that our teams appreciate and share the meaning and purpose of their work. A positive work environment strengthens the delivery of high-quality care to patients and creates the right conditions for innovation and ideas to grow.
So, in these first four months, I’ve hit the ground running to try to better understand what is motivating our people to deliver on the new strategy, where are they facing barriers, and how might we support and engage them more. This has meant many one-on-one meetings, team and departmental visits, leadership walkarounds and my personal favourite, a new monthly Coffee & Catch-up Session where I invite 15 people from across the organization to meet informally with me to share their ideas and inspirations. I have met with more than 300 people and I’ve heard about all the ways teams across the hospital are hard at work putting our hospital strategy - Healthcare Revolutionized - into action and creating positive change. Here are just a few things that people who work at Women’s College Hospital say matter to them:
"Patients matter. That is why we come in to work and give our best every day. But we know we will never see every patient. So what is different here is that communities and citizens also matter. We bring them into how we are delivering care and services."
"At WCH we do change well. Change is never easy but we have a special ability to appreciate and embrace continual improvement and innovation – and this is what the health system requires."
"Inclusiveness matters. This inclusiveness extends across our teams and programs to our shifting patient population. This is an organization that lives the values of equity, diversity, and inclusivity."
"Being part of an organization that has the courage to reimagine the way care is delivered is amazing. That we will lead the way in virtual care is exciting and it really feels like WCH is living and leaning into the future."
I heard common themes about what excites people most about our strategy; resoundingly people talked about virtual care, innovation, equity and partnerships – tied together to impact our communities and patients we care for.
I also took the opportunity to ask people why they stay at WCH and in almost every conversation people told me that the culture here is why they stay. The culture they describe is one of respect, inclusivity and a feeling of ‘family’. As a leader, and on a personal level, these are wonderful things to hear, and I also know there is always room for improvement. People believe we can make WCH an even better place to work with more opportunities for professional development and clearer lines of communication across teams. This feedback is consistent with what we learned in our 2018 Engagement Survey.
We have taken all of this information – anecdotal feedback, our survey results and best practices – to create our new People Strategy. Our People Strategy is our commitment to our staff, clinicians, scientists, learners and volunteers. It provides focus and direction for creating support systems and programs that will help everyone contribute their very best to WCH and realize their full potential at work. Research has shown that hospitals whose staff and clinicians feel engaged and empowered lead to better health outcomes for patients.
Our People Strategy has five areas of focus:
- Total rewards
- Human capital planning
- Equity, diversity and inclusion
- Leadership and talent development
Each of these areas have distinct goals, objectives and measurable outcomes. As we finalize the programs and tactics within each area of focus, there will be additional opportunities to provide feedback and share your thoughts.
As a leader, I deeply believe in the power and promise of people. At WCH, we are fortunate to have exceptional teams providing exceptional care. Healthcare is all about people – whether we are clinicians, frontline staff or in administration – we are all here, doing our best each day to support patients and make our hospital and health system better for everyone.
What I’m Learning about Indigenous Healthcare
June 25, 2019
June is Indigenous History month and June 21 was National Indigenous Peoples Day – a celebration of Indigenous Peoples’ culture and heritage. This date was chosen because it corresponds with the summer solstice, the longest day of the year, and because for generations, many Indigenous Peoples’ groups have celebrated their culture and heritage at this time of year. The day celebrates the unique heritage, diverse cultures and outstanding achievements of Indigenous Peoples from across the country. So, for my blog this month, I’d like to share what I am learning about Indigenous communities and how we thoughtfully shape our organization to better meet the health needs of Indigenous Peoples.
A few weeks ago, I had the honour of participating in my first Indigenous Ceremony. Alongside Marilyn Emery, members of the Indigenous health team and community members, I took part in a traditional Bundle Ceremony lead by Senator Constance Simmonds. The ceremony was meant to celebrate Marilyn’s work with and support of the Indigenous community throughout her time as President & CEO of Women’s College Hospital and recognize my new leadership and our ongoing commitment to create an inclusive and accessible healthcare environment for Indigenous patients, staff, physicians, learners and volunteers. The bundle now resides at WCH – a meaningful symbol of this connection to community and our commitment to Indigenous health.
This ceremony was one of many firsts for me as I continue to learn about Indigenous communities, traditions and right to healthcare experiences so vastly different than what has occurred through history. We can do better. We must do better.
Canada’s Indigenous community has been underserved and poorly served by the healthcare system for too long. So, in collaboration with Indigenous communities, we are committed to implementing Wise Practices for Reconciliation, where programs to meet specific community needs will be developed. Wise Practices for Reconciliation means we are signaling that our hospital is a safe space – we’re doing this through the installation of Indigenous art, by including books and articles in our health sciences library written by Elders and other experts in Indigenous healing and by offering a place for people to smudge before their appointments. You will also start to see Indigenous health content on our website, in our new patient handbook and in this year’s annual report magazine. Starting in July, there will be an Elder in Residence one day per week. Indigenous healthcare is one example of how we’re putting our health equity strategy into action and improving care and the care experience for Indigenous communities.
I also want to acknowledge the recent release of Reclaiming Power and Place: the Final Report of the National Inquiry into Missing and Murdered Indigenous Women and Girls. The report outlines 231 recommendations that must be acted upon to put an end to the sustained and ongoing genocide that is happening in this country. I encourage everyone to read the full report.
Through our Education Department, we are also offering a new online learning opportunity called the SAN’YAS Indigenous Cultural Safety Program. The course offers eight modules designed to provide training and information about Canada’s Indigenous communities for healthcare providers to improve patient experience and health outcomes. I recently completed the course and one thing that stood out to me was the impact of intergenerational trauma on Indigenous Peoples. It reinforced for me the importance and need for Trauma Informed Care as a key competency across our organization.
It is very important to me to continuously learn about the diversity of communities of patients we serve and ensure we are finding new ways to best meet their unique healthcare needs. I invite you all to join me in expanding our knowledge and developing our resources. It is critical that we listen and learn from Indigenous Peoples – we need to get this right. We may not always have all the answers immediately, but by working and learning together, we will make our vision of a healthier, more equitable world a reality.
How WCH Fits into the New 'Ontario Health' Structure
May 27, 2019
A few people have asked me about what’s going on in the Ontario health system and how does WCH fit in. So I want to share a brief overview on how the system is evolving.
There is much transformation underway in Ontario and there are many new structures and policies being implemented by our provincial government. Within healthcare, the MOHLTC (Ministry of Health and Long-Term Care) introduced The People’s Health Care Act, which aims to create a simpler, more efficient system by connecting and strengthening local healthcare services, and focusing on the needs of patients, families and caregivers.
This new structure includes the creation of a province wide “super agency” called Ontario Health. This agency will be responsible for overseeing Ontario’s healthcare system and for supporting all health services across the province. The former CEO of the TC LHIN (Toronto Central Local Health Integrated Network) – Susan Fitzpatrick – was appointed as the interim CEO of Ontario Health. Susan has been leading health system transformation in the central Toronto area for some time and this new provincial model is very much aligned with what has been happening in central Toronto.
Under the Ontario Health agency there will be a number of Ontario Health Teams (OHTs) who will organize and deliver the healthcare services within their local communities. Each OHT will be made up of various health providers including hospitals, physicians and home and community care organizations that are part of the same geographic region. These OHTs will have full responsibility for managing all the clinical services and healthcare budgets for their region. The schematic below shows all of the parts of the system that are included in OHTs:
In order to form an OHT, healthcare organizations within the same geographic region had to partner and submit their joint application and there are many criteria that need to be met in order to form an OHT. The first OHT applications were submitted on May 15th and there will be ongoing calls for more OHTs over the next few years until the entire province is covered.
WCH has been working with our healthcare partners and the TC LHIN to ensure that we are aligned with this new health system structure and that we can continue to provide the much-needed services we are known for and that meet our strategic priorities. Central Toronto is a complicated geographic region within this model because there are many hospitals in this region. So we have been working with the leadership teams of those hospitals to create a solution to this challenge. Also, we have been asked to lead a group of organizations that support women to see if we can improve care for some of the most vulnerable women in Toronto through the creation of an integrated delivery network. We had our first meeting last week and this is an exciting opportunity for us to work together in a new way with our partner organizations to improve healthcare delivery for the women in these marginalized communities.
I have been at many meetings with other hospital CEOs and government leaders over the past several weeks to ensure we are actively engaged and strongly positioned for our future. Our role in supporting primary care, improving access to specialty care and leading in virtual care is proving to be an important part in the system. We have had meetings with groups of organizations who have submitted applications for OHTs but have not signed on at this point. We have more due diligence to do in order to fully determine our optimal role.
Some of what we do at WCH is caring for our community, some is caring for our immediate neighbourhoods and some is caring for the province. This all needs to be considered in our path forward. There are many options to consider and I will keep everyone updated as our role in the system evolves.
My Next Chapter at WCH
April 29, 2019
It has been almost one month since I took on the role of President and CEO here at this wonderful hospital. And even in just these first few weeks, it has already been a stimulating and inspiring experience.
One of my goals is to encourage open communication and dialogue across this organization and to stay engaged in and connected with all our teams, programs and leaders. One way I will do this is by publishing a monthly blog post where I will share some perspectives and ideas from the various conversations and initiatives that I am a part of.
So here goes…my first blog post!
Although I am new to the role of CEO at Women’s College Hospital, I am not new to the hospital. I’ve had the privilege of working in different roles and leading numerous teams here for many years, most recently, as the EVP of Patient Care and Ambulatory Innovation. So I now have the exciting opportunity to use all the experience and knowledge I have gained in the past to help shape the future of WCH.
One of the aspects that has struck me as I begin this journey, is that even though I am very familiar with many people and programs here, being in this new role means that I am listening, hearing and seeing things in a different way than I did before. And it’s been incredibly interesting to hear people’s insights on the prospects they see ahead of us.
Last week I hosted my first “Coffee & Catch-up” meeting. These are monthly meetings that I’ll be having with groups from across the hospital to share ideas, ask questions and get to know new people. I also started having “CEO Team Visits” with different departments to learn what they’re working on and how they’re putting our “Healthcare Revolutionized” strategy into action. And I’ve been so impressed by the passion and sense of hope I’m seeing, especially people’s commitment to innovation and their desire for us to take calculated risks and forge new paths to improve our health system and developing healthcare for the 21st century.
Healthcare in Ontario is in a tremendously interesting place. Our government is building a new model for our system and we are strongly positioned to take advantage of the opportunities that this will present. I am energized by the potential that lies ahead for WCH and by the incredible chance I have been given to lead us there. I look forward to embarking on this new chapter and working together with you to create new possibilities for us all.