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