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EXCELLENCE, INNOVATION, PARTNERSHIPS AND INTEGRITY : REVITALIZING, REBUILDING AND RENEWING OUR DEPARTMENT
Nick Kates, MB.BS, FRCPC MCFP (hon)
Acting Chair, Dept. of Psychiatry and Behavioural
Neurosciences
I’ve appreciated the I’ve appreciated the assistance and advice assistance and advice
I’ve received…I’ve received…
“Here is Edward Bear, coming
downstairs now, bump, bump, bump,
on the back of his head, behind
Christopher Robin. It is, as far as
he knows, the only way of coming
downstairs, but sometimes he feels
that there really is another way, if only
he could stop bumping for a moment
and think of it”
A.A. Milne 1926
Illustration E.H.Shepard 192614
Where are we today?Where are we today?
The Challenges We Currently Face Stabilising our finances
Not yet out of the woods Tough decisions to implement Requests of Physicians Repayment of the debt
Engagement of faculty, staff and learners Morale Many feeling alienated Identification is often local (program, group, location) Some of us have “given up” on the Department
Recruitment and retention
The Challenges We Currently Face Our management processes need to be
improved Inefficient / wasteful Inconsistent Not transparent Not always responsive to the individual
Our structures are not designed to help us with our current tasks or directions
Our reputation
The current fiscal climate
The Challenges We Currently Face Our academic directions and priorities are
not clear and are not driven by a shared vision or values
Re-establish community partnerships
Take advantage of the resources we possess
Keep everything going
Need to strengthen relationships Between programs / divisions
Basic Scientists and Clinicians
GFTs – GPTs
AFP – Department
Within the Faculty
With the community
5 Areas
Finances
Organisational functioning
Relationship and Morale
Partnerships
Academic mission and focus
But we have a lot going for us Our faculty and staff Many strong and creative programs We’ve continued to be productive The support of the Dean and the Faculty of
Health Sciences The partnership with and support from St.
Joseph’s Our reputation Our desire to put the last few years behind
us – we all want things to be better
And we also have an opportunity to
Start afresh
Build on our strengths / what is working
Identify and redesign what isn’t working
Put everything on the table
And this is where I And this is where I came in….came in….
I arrived in 1978
Came for 1 year!!
Truly a New World
Melius est Urinam Facere quam Amovere!
I’ve had many different roles Resident Program Director Acting Chair Vice-Chair Clinical Faculty CBS group studies Faculty CBS family studies Acting Chief SJH Acting Director EPT
And the opportunity to start new initiatives
ERMHS Mood Menders Proposal for COAST Regional Psychiatry Program Hamilton HSO Mental Health and Nutrition program Hamilton Family Health Team Quality Improvement and Innovation Partnership
(QIIP) CPA / CFPC National working group on Shared Care
Involved in local, provincial and national planning for both primary care and mental health redesign
My Journey
General / Community and social psychiatry
Administration Interface mental health and primary care Primary Care Transformation Quality Improvement
And along the way….And along the way….
Some of the things I’ve learnt along the way
Care needs to be person-centred and recovery focused
The importance of involving families
Changes to models of care need to be driven by the experience of people using the services
The importance of child health / early intervention
The opportunities for prevention with seniors
Some of the things I’ve learnt along the way
Importance of building from within Residents Junior faculty Retention Mentoring Preparation for leadership roles
The benefit of partnerships and collaboration
High quality care requires high-performing teams
Innovation / thinking differently / ideas ideas ideas
We have no money, so we must think
(differently)
Some of the things I’ve learnt along the way
Mental health care only plays a partial role in good mental health – we also need to address external factors in our plans
We need to think about the well-being of populations as well as individuals
We are part of our community – need to be active partners
We have a responsibility to contribute to our local and global communities – giving something back (Code Red)
We have to focus on prevention and early intervention, as well as treatment
The Second Stage of Medicare
“To alter our delivery
system to reduce costs and put an
emphasis on prevention”
Many of the problems we encounter Many of the problems we encounter result from the way our systems of result from the way our systems of care are organisedcare are organised
“Quality problems in health care occur
typically not because of failure of good will, knowledge, effort or resources directed to
health care, but because of fundamental shortcomings in the way
care is organized” Don Berwick – Chasm Report NIM
2001
Systems are designed perfectly to get the results they achieve
Thought for the Day
“Insanity is doing things the way we’ve always done them, and expecting different results”
New solutions are there: we don’t always see them
To get better To get better outcomes we need to outcomes we need to redesign the ways our redesign the ways our
systems (and our systems (and our department) is department) is designed…….designed…….
....these changes need ....these changes need to be driven and to be driven and measured by the measured by the
desire to improve the desire to improve the quality of the care we quality of the care we
provideprovide
So back to the So back to the future…. How do we future…. How do we revitalise and rebuild revitalise and rebuild
our Departmentour Department
We have 3 broad goals
1. To enhance our scholarship and our productivity
2. Optimise the experience for our learners and consumers, and for our staff and faculty
3. To do it in a cost-efficient and sustainable way
We need to begin by We need to begin by understanding some understanding some of the causes of our of the causes of our
current problemscurrent problems
How did we get into this situation – one root cause 40 years ago – cohesive, small, common ideology
Systems, community, family Since then – many new priorities - Mood, Anxiety,
Schizophrenia, Child Many emerging programs – but many missed
opportunities Significant growth in number of
Programs Expectations Sites Faculty
A Different Way of Thinking About Who We Are We’ve had individual programs transplanted
onto our base Base has gradually been eroded Less sturdy foundation Increasing fragmentation – silos Individuals feeling less connected to the whole –
what is the whole? Were we trying to be something we weren’t Need to
Redefine / strengthen the base Build from the bottom up Rediscover the “heart” of the department Look for commonalities / integrating concepts These will become drivers for our work
VALUEVALUESS
BELIEFSBELIEFS
INTEGRATING PROJECTS / INTEGRATING PROJECTS / CONCEPTSCONCEPTS
Where we were
VALUEVALUESS
BELIEFSBELIEFS
INTEGRATING PROJECTS / INTEGRATING PROJECTS / CONCEPTSCONCEPTS
Externalinfluence
Externalinfluence
Newprograms
Newprograms
More faculty
More faculty
More locations
More locations
NewExpect-ations
NewExpect-ations
Where we are
Programs increasingly define our Department
VALUEVALUESS
BELIEFSBELIEFS
INTEGRATING PROJECTS / INTEGRATING PROJECTS / CONCEPTSCONCEPTS
Where we could be
Shared values and beliefs define our programs
Specific Tasks
1. To redefine our values and the kind of department we want to be (vision)
2. Put the foundation in place Finances Processes and functioning Collegiality and relationships Partnerships Our academic mission what can we be that will
distinguish us
3. Redefining our academic mission and priorities
4. Address fundamental long-term issues
FINANCES
RELATIONSHIPS
STRUCTURES / PROCESSES
ACADEMIC MISSION
OUR OVERALL APPROACH
WHAT KIND
OF
DEPARTMENT
DO WE WANT
TO BE
ENHANCED SCHOLARSHI
P AND PRODUCTIVIT
Y
ENHANCED EXPERIENCE
OF BEING HERE
SUSTAINABLE AND
EFFICIENT
MAKING A DIFFERENCE
PARTNERSHIPS
Our workplan for the Our workplan for the next 6 months / 18 next 6 months / 18
monthsmonths
Step 1. What kind of Step 1. What kind of department do we department do we
want to be want to be
Vision
Based on our values
How do we want to be
What do we want to accomplish
What do we valueWhat do we value
The President’s letter - Principles Cultivation of the human potential, which cannot
be realised in isolation from each other, their history or imagined future, the society that surrounds them or the physical universe that sustains them. Our programs and activities will reflect this comprehensive view
Multi-disciplinary approach
Our future continuous with our past. Foster the distinct identity of this institution, while recognising the importance of collaboration
The President’s letter - Principles
The highest value on original thought and innovation
Radical questioning at the heart of the academic enterprise, and ensure integrity by bringing a critical view to all our practices
We will reduce or eliminate obstacles to co-operation
We will seek to integrate in all our work and in ways appropriate to our field, an obligation to serve the greater good of the community – locally, nationally and globally
Values that matter to me
Excellence Innovation Integrity Inclusivity The needs of the, person, the family and the
community are at the heart of all we do Partnerships and collaboration Respect and transparency Maximising the potential of our learners and
ourselves Giving something back / Making a difference
Know where we’re Know where we’re going and then going and then
determine where the determine where the pieces / activities fitpieces / activities fit
So what is our So what is our (shared) vision?(shared) vision?
““Pre-eminent Pre-eminent Department of Department of
Psychiatry in Canada”Psychiatry in Canada”
Vision
A place we’re all proud to be part of
A place that brings out the best in all of us
A place that everyone in Canada would like to be part of
We need to reaffirm We need to reaffirm our current vision our current vision
statement (slightly statement (slightly amended)amended)
Improving the prevention, Improving the prevention, early detection, and early detection, and
intervention of mental health intervention of mental health problems across the life span problems across the life span through the advancement and through the advancement and
integration of innovative, integration of innovative, person and family-centred person and family-centred
clinical care, education, and clinical care, education, and research. research.
Guiding Principles – Our current mission statement To promote psychiatry as an integral part of medicine in
which there is a dynamic relationship between mind, brain, and body
To respond with compassion, dignity and respect to the needs of our diverse community, with particular attention to vulnerable, underserved populations
To develop and evaluate innovative treatments that focus both on early intervention and recovery
To contribute to a better understanding of the causes of mental illness through the generation and integration of knowledge across disciplines
To ensure that evidence-based knowledge translation and dissemination informs practitioners and policy makers
To create a culture that is inspiring, collaborative, and supportive for faculty, staff and trainees
To provide a vibrant educational environment in which to train future generations of mental health experts and scientists
Step 2: Building Step 2: Building the foundationthe foundation
Priorities for the Next Six Months To create a sustainable financial base
Develop efficient, productive and transparent processes and structures
Build a vital, stimulating social and professional environment to work within
(Re)Build Partnerships
Define what will distinguish our work
Priorities for the Next Six Months 1994!!
Tasks for the next Tasks for the next six monthssix months
1. Financial 1. Financial sustainability – sustainability –
Balancing our BudgetBalancing our Budget
Create a sustainable financial base for the department Re-organisation of the CPP Re-allocate secretarial costs Implement a contribution from GPT
physicians Review and improve our financial processes Develop new sources of revenue Implement other cuts
Then address the debt
Create a sustainable financial base for the department New business model
Pay for costs Remunerated primarily for work done Eliminate inefficiencies and waste Hold vacant positions open
Short-term reliance on soft funds to support the MET budget as we emerge from our deficit AFP CPP
2. Overhaul our 2. Overhaul our Administrative Administrative Processes and Processes and
structures and make structures and make them more efficientthem more efficient
Develop efficient, productive and transparent processes and structures They need to support our academic aspirations /
directions Processes to look at
Department calendar Structures and governance, including divisions Staff / Faculty involvement in decision making Administrative processes Department meetings Communication strategies
Vertical integration to horizontal integration
3. Enhancing the 3. Enhancing the experience of being experience of being
part of the part of the DepartmentDepartment
Build supportive, stimulating social and professional relationships and environments to work within
Building relationships Rebuilding morale Learning about what each other do Social activities Engaging and involving faculty, staff and residents Ways to help retention Interdisciplinary practice Integrating new members of the Department
Creating productive work environments Building teams Celebrating our successes
4. (Re)building 4. (Re)building partnershipspartnerships
(Re)Building Partnerships
Outward looking Interdisciplinary practice Can increase our learning and enrich all our
activities Often an enabling role Can provide additional resources
Within the Faculty of Health Sciences Across the University With our Community With other institutions / organisations
5. Define what will 5. Define what will distinguish our distinguish our
activities activities
Define what will distinguish our work Department’s academic identity
What makes us different How will we apply our values to our work Strengths and opportunities What can we learn from what’s working
well / not working well Affirm / adapt our Mission
Step 3 : Define our Step 3 : Define our strategic prioritiesstrategic priorities
Strategic priorities
Strategic Directions Integrating concepts
Address key questions related to the future of the Department such as Size Balance between GFTs / GPTs Where to invest Accountability The role of Neurosciences
Some opportunities – next 18 months
Move to the new facility Identify integrating concepts / opportunities
Early detection and intervention across the life span
Maternal – child mental health Consultation – Liaison / Primary Care Mental health of immigrants Global mental health Innovation in Education Innovation in mental health care Addictions
How do we get How do we get there?there?
Principles to Guide our Work Everything is on the table The steps we take are part of our overall plan Draw on our collective resources Bring people together Everybody has something to contribute – we
need to learn how to listen Engagement of all Ownership by all Promote ideas from everyone
Meeting with Admin Team 40 minutes 29 ideas 28 worth pursuing!
Timmins – 2 focus groups with primary care patients
124 ideas 91 could be implemented without any
new funding
General approach
Define what it is we need to address Identify / Measure what the current state / issues are Analyse why this is Identify the root causes Determine what we need to change
Decide what we want to accomplish Identify how we will know a change is an
improvement Introduce changes – test small sequential changes
(Plan Do Study Act cycles)
“Big changes in small steps”
Enablers
Communications Retreat Plan that will follow Department meetings Social media Creating a culture of improvement and
innovation
Building a culture that Building a culture that supports supports
Improvement and Improvement and InnovationInnovation
Culture of Improvement and Innovation Our goal is to improve, not to blame Everybody feels empowered to suggest
improvements Willingness to think differently New ideas are being introduced and tested
regularly A culture of sharing People able to support each others ideas,
learn from each other Takes time to achieve
Planning Framework – next 6 months
Task Force will continue to meet till June Career Reviews Planning group for the retreat Survey Retreat – part of a process
Vision and values Foundation Principles to guide our academic activities
Organise findings into a plan Working groups – focused / time limited following the retreat Start to introduce changes Strategic directions and longer-term discussions
Some priority Tasks
CPP / secretarial costs / contributions Recruitment and retention Faculty development / Mentoring /
Grantsmanship Relationship with the AFP Sources of new Revenue Engagement of part-time faculty
Immediate changes
Career reviews Department meetings Enhance the Department’s office area Survey Retreat Newsletter Evaluation
of the Chair’s performance Of our progress in meeting our goals
Role of the ChairRole of the Chair
The Role of the Chair
To Represent / advocate for the Department
To Direct the department Define the parameters and the path Ensure people are meeting their expectations
To Support the Department To make it as easy for people to do their work
To inspire the Department
My Expectations of the Department Fresh start – willingness to put the past
behind Participate in the discussions / work Contribute your ideas Patience Let me know what you’re thinking
Lets have some fun
““Leadership is getting Leadership is getting people to do what you people to do what you
want, because they want, because they want to do it”want to do it”
““Dwight Dwight Eisenhower”Eisenhower”
Lets not waste any time
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