‘What we achieve, we achieve through people’

He’s no stranger to this province, the QEII Health Sciences Centre or to health care, but Dr. Brendan Carr is new in his role as president and CEO of the Nova Scotia Health Authority. The QEII Foundation recently sat down with Dr. Carr and got his thoughts on the road ahead.

Q: You are entering this new role at a time where health care is a hot topic in Nova Scotia. In your opinion, what are some of the biggest challenges?

A: I think there are a couple of big challenges and priorities for us. One is peoples’ ability to access services, in terms of primary care and emergency services in rural communities. Related to access is flow and how the system is organized. It seems that a lot of people are going to emergency departments because we haven’t designed a system that has multiple access points for different things.

Access is not about just having more human resources; it’s also about the way we construct the system so that people can get what they need, maybe without having to line up. These are big challenges but represent huge opportunities for us to re-think the way we organize the system and the way we deliver care.

It is pretty clear through engagement surveys and the media that the tone of communication is negative. Some of that is understandable. We are a big organization that has gone through a tremendous amount of change in a relatively short period of time. We are at a natural point where people are feeling a bit disconnected, having been through a lot of change and disruption with changes in leadership.

As a leader coming into the organization, it is something that I will put a lot of energy into because, at the end of the day, our mission is about supporting people in health, being here when they are not well. Everything that we do, we do through the people that come to work here every day.

Personally, for me it’s about people being connected to their own sense of purpose. And that is truly the greatest asset we have as a province and a system. We can’t deliver excellent health care and create an excellent experience for people if the people who come to work every day aren’t feeling that connection.

Q: What do you see as some of the good news in health care?

A: I think the good news is that we have amazing, extremely well-trained people. We have put significant investment in collaborative teams and that is critically important to where we need to go as a system. There is significant commitment to modernizing the system and putting in place the critical infrastructure to make that happen. There is a commitment to adopt technology in a way that will significantly advance health care in the province.

QEII New Generation, to me, has special significance. Not only are we building state-of-the-art infrastructure, we are connecting innovation and discovery around the province and really accelerating it. I think it will create a hub, an anchor point.

I am particularly excited about the opportunity to intentionally create, in that hub, a connection for unusual partnerships. Bringing different people into the healthcare machine in a way that allows us to create new approaches. If we bring other partners to the table, from other industries with other perspectives, they may be able to help us see sooner where real opportunities are. This is what I get most excited about.

Q: What have you learned as a family and emergency care physician — and as a senior healthcare leader in Canada — that will influence you most in your new role?

A: Number one, both as a frontline provider and as a leader, I am firmly rooted in the philosophy of what we achieve, we achieve through people. It is fine to have great vision, strategies and plans, but at the end of the day, we have to be able to connect that to people. If we can connect that to peoples’ own internal sense of purpose, that’s where the real magic happens.

The great news is that most people who come to work in health care do it because there is a great sense of purpose in it. It is the great privilege in what we get to do.

As a senior leader in a big system like this, we absolutely need to have clarity on our priorities and what we are trying to advance. We all need to be rowing in the same direction. And the leaders can’t figure out what we need to do without engaging people at the front line.

I have learned that my job is not to come up with the answer. My job is to create an organization that sees its role and tries to find solutions and keep iterating on those solutions. There will never be a single answer to the complex problems we are dealing with. We need to continue to learn and advance.

Q: With a big job ahead of you, what does the first six months look like for you?

A: The first six months will be bringing focus to some of the challenges, immediately trying to get those issues on the table in a way that we can start to make some progress. We made some big changes to the organization’s structure, so building that leadership team is critical for me. 

The other big category is about creating relationships and listening and learning. A lot of my focus will be on getting out into the various communities, meeting with providers and other people in the communities who have an interest and perspective on health care. Because I am from here, I have a familiarity with the system.

But I am going to be very mindful of approaching it with real curiosity and not assuming. There is a huge risk if I come into this with big assumptions and they are not right.

A lot of my focus will be on getting out into the various communities, meeting with providers and other people in the communities who have an interest and perspective on health care.

– Dr. Brendan Carr

My hope is that we can get beyond the hot topics that are worrying people. I do totally get that people are worried and I expect to hear about that. But my hope is that we can go beyond that and hear conversations about what really matters to them. If we assume for a minute that we are going to be OK with the big issues, what would matter to them for the future? Not just the burning issues of today, but the important conversations about health and how we are doing as a province.

Q: What healthcare advancements would you like to see in the next five or 10 years as QEII New Generation evolves?

A: The infrastructure pieces are critical. It’s so important to build state-of-the-art infrastructure, designed to enhance what we are doing today and catapult ourselves into the future. This represents a huge asset to us to move health care to a different place in the next five to 10 years. And part of that is the adopting of new technology.

We do need a single system of information in this province that actually capitalizes on all of the information that exists in bits and pieces. OPOR (One Patient, One Record), like it or not, is an important piece of strategy for us and we do need to find our way through it. I understand how challenging that will be, but it is the right thing to do. It has huge implications on safety, system efficiency and, most importantly, how people experience their care.

It’s so important to build state-of-the-art infrastructure, designed to enhance what we are doing today and catapult ourselves into the future.

– Dr. Brendan Carr

Connected to that is virtual care. Most other systems in the world have moved beyond this notion that the only way people can access care is one person at a time, face to face — and the idea that you need to line up. Most other systems, other industries and other things in our lives, work on creating simple tools that allow people, in a convenient way, to get contact with a system.

By way of example, other countries have created virtual triage systems whereby people don’t show up at the hospital for triage. Their first point of contact is electronically, through a tablet or phone, where they interact with someone for a triage process. People are sorted into different stages — for example, an ambulance is phoned or patients are told to see a primary care provider or told to come into emergency and the current wait is three hours. The dispatcher schedules a certain time later in the afternoon. Systems are doing this now. But we are still saying show up at emergency and wait in the waiting room.

It’s not a criticism of what we are doing today. It is simply acknowledging that the way the world is changing, how technology is changing and what people expect is changing and we are not delivering. QEII New Generation creates an opportunity for a hub, a catalyst and anchor point for the whole province.

Q: How will you work with the QEII Foundation to drive change forward?

A: I hope to be very connected to the QEII Foundation and all foundations in the province. Where I just came from, the CEO of the foundation was a senior member of my team. We didn’t have a strategic conversation where our foundation wasn’t involved. The leaders of foundations have huge experience, not just with philanthropy, but insight from the community on how we can deal with complex issues.

I think for the foundation to do their job well, they need to be part of the conversation from the very beginning. The foundation plays a pivotal role in helping to change the narrative of health care. Foundations are uniquely positioned to host some of the new conversations, around dreaming big and questioning ‘What if?’ That really excites me.

Q: What is your message for Nova Scotians who are worried about the future of health care?

A: I understand and share your worries. This is my home and just like any other citizen, I understand how important this is. But I do want them to feel hopeful and even a little bit excited about the future. All of the pressures that we are feeling actually create an opportunity to look at how we could do things differently. I want people to have optimism about change and how it is within our reach and how it will impact their lives in a meaningful way.