Healthcare Change Makers: Episode 02, Debbie Molloy

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Transcript: Episode 02

Imagine you could step inside the minds of Canada's healthcare leaders, glimpse their greatest fears, strongest drivers, and what makes them tick. Welcome to Healthcare Change Makers, a podcast where we talk to those leaders about the joys and challenges of driving change in our complex and demanding healthcare organizations. 

Ellen Gardner: I'm Ellen Gardner. I work in Communications and Marketing at HIROC, and today I'm talking with Debbie Molloy, who is the VP Corporate Services at Eastern Health in Newfoundland. Welcome, Debbie.

Debbie Molloy: Hi. Thanks, Ellen.

Ellen Gardner: So Debbie, maybe you can tell me a little bit about your role at Eastern Health, and approximately how many people do you oversee?

Debbie Molloy: For sure. Thanks, Ellen. I'm the Vice-President of Corporate Services and within that portfolio I have a number of different departments and programs. I have the Center for Nursing Studies. I have the Quality Patients Safety and Risk Management department. There are two Human Resources departments that report through to me. An Occupational Health and Employee Health area. The Infection Prevention and Control department. And also the Protection Services Group. I guess in all, there's about 500 people.

Ellen Gardner: That's a very large portfolio, Debbie.

Debbie Molloy: It's kind of small from Eastern Health standards, believe it or not.

Ellen Gardner: Well I was looking at the geographic reach of Eastern Health and it covers such a wide area in Newfoundland and Labrador.

Debbie Molloy: It sure does. It's on the east coast, so St. John's, which is the capital of the province, is within Eastern Health's reach. We have an urban piece and then we have the rural piece, but it's about 300,000 of the 500,000 people within the province are within Eastern Health's catchment area. I actually started my career in healthcare on the Burin Peninsula. I worked there, I guess it was around 10 years. Then I left the industry entirely and I worked in the hospitality industry. That took me out of Newfoundland into Alberta for a few years. Then when my husband and I decided to come back to the province, I actually came back and worked in the energy industry for a little while. But when the opportunity came to come back to Eastern Health, or come back to healthcare, I grabbed it. I love this industry, and I certainly, although I'm very glad for the experiences I had working in other places, I think healthcare is certainly in my heart.

Ellen Gardner: Let me take you back, then, a little bit, Debbie, to your work in the private sector, and yes, the fact that you worked in different industries. Your focus, I think, in those days was on – correct me if I'm wrong – human resources and organizational effectiveness. I really wonder what you took with you from those positions to your position at Eastern Health.

Debbie Molloy: What I learned a lot about working in those industries was that human resources and organizational effectiveness is more than just rule keepers. They actually can contribute, or that area of work can contribute to the success of an organization. I'm not sure I knew that necessarily when I worked in healthcare in the early 90s. HR tended to be the rule keepers, the policy makers, and it was all about keeping everything the same and treating everyone the same. In these other industries, it was a little more about how can you leverage people to improve the organization and achieve the goals of the organization. So, sitting at tables where you had operational people as well as HR people and finance people and everyone sort of working towards a common goal. Not that we don't do that in healthcare, but I think I really learned how to do that when I was working in private industry.

Ellen Gardner: Can you tell me just a little bit about some of the big projects that you're engaged with right now?

Debbie Molloy: I would say probably the biggest project as an organization we're in right now is embedding client and family-centred care into the organization. Trying to look at how is that the same or different than talking to advocacy groups, for example, who certainly would bring a patient and a family aspect. How do we change ourselves as an industry from one which is very provider-centred to one that is much more client and family centred.

Ellen Gardner: It's a big project, isn't it? I mean it's a whole shift in the thinking of an organization to being very outward focused.

Debbie Molloy: It sure is. You know, it's not that we, I think, in healthcare forgot about the patient. I mean we're all about the patient, and I believe I would never want to say that the patient was never at the center, but it's very different than doing something to someone and doing something with someone. I think that that's the shift that we're seeing in client and family-centred care.

Ellen Gardner: What are some of the things that people tell you, Debbie, when you're meeting with them? Do you find that people are quite open about the things that they'd like to see changed?

Debbie Molloy: I think initially people are a little shy, a little reticent. They're not quite sure what it's all about. However, usually I think if you spend just a little bit of time listening and talking, then people very quickly feel like, "Okay, I can talk to this person," and they are willing to open up and talk about what their challenges are day-to-day. We also get a chance then to see some of our corporate initiatives. We get to test that. When you're actually talking to someone on a unit, you get to test out, "Did you even hear about this?" Sometimes they haven't, but that's okay. That just tells us we need to do a little more work in terms of how we're communicating.

Ellen Gardner: Can you maybe give me an example, Debbie, of something – a corporate initiative that you've rolled out, and when you got out in the field, the feedback really affected any future direction with that kind of rollout?

Debbie Molloy: Oh, I can. I've got a great example in mind. Hand washing. I think in healthcare, hand washing is the bane of ...

Ellen Gardner: That's a big one.

Debbie Molloy: …infection prevention and control. About, I want to say, two and a half years ago, the Director and I went out and did a few walk arounds in probably three sites. We just walked around. We bought coffee for a group of people and invited them in and asked them a little bit about, "Do you wash your hands? How often do you wash your hands? Do you know that gloves are permeable?" You know, some just sort of basic infection prevention and control messaging. We had been saying how important it was, but when we were doing our auditing, we knew about 40% of people, that's all who were passing the audits. When we went out and actually talked to people, they really didn't know. A lot of people did feel that gloves were enough protection, so you wash your hands, you put gloves on, you're fine. They weren't really recognizing, say, that between patients they should wash their hands again.

Instead of saying, "My gosh, we've been saying this for several years now. There's posters. There's pamphlets. There's all kinds of information." Instead of doing that, we went back to the drawing board, and I have to give full credit to Amy Howard who was the Director at the time. She really came at it from a different perspective and said, "Okay. How can we do this differently? What we're doing is not working." We came up with a proposal and we actually have now installed throughout our entire organization, funded by our partners in the foundations that we have in our region, patient safety screens. On the screens we say, "On your unit, what is your hand hygiene rates?" Then we say what your program rates are, we say what your facility rates are, and we have that as a comparator up on the screens.

The other thing we introduced at the same time was for the people auditing to give feedback, because what people really thought was, "Oh well, that's someone coming on our unit," so when the person was here doing the audit, it wasn't me, it was someone else. Instead now we have sort of really robust feedback that, "Here's the reason why you failed that audit. Maybe you didn't wash your hands long enough. Yeah, you washed your hands, but it wasn't for the required amount of time, or we didn't see you use the pump to use gel when you left a patient room." So having that up on screens and that really fast feedback, I'm proud to say we are actually up around 90% compliance now as an organization, and that's phenomenal. That success, and that's looking at something completely differently that the way we did before.

Ellen Gardner: We look at your province with a sense of awe at just how it looks like a very difficult to live, from our perspective, just how it's a very rugged part of the country, the small towns they’re situated far from each other. How does isolation impact the work done by Eastern Health?

Debbie Molloy: That's a great question, too. I think living in a province that has some challenging weather and lots of small rural communities, we've been engaging in a conversation with patients and families about healthcare not necessarily being about hospitals, which is traditionally how everyone in our province has looked at health spending. It's about bricks and mortar. And we're trying to shift and look at it much more about the health of the individuals, the determinants of health, and those types of things, and moving things upstream, which I think everyone is trying to do. I'm not sure our challenges are so much different than others.

We have, though, also, I talked about technology earlier in terms of staff technology, but we've also been looking at it in terms of patient technology. We're heavy into a project right now with Infoway Canada around remote patient monitoring, for example, which is allowing someone to stay in their own home instead of having to travel to receive healthcare, and teaching them, I guess, that you can take charge of this yourself. Here's some great tools in order to help you do that, and spending time with people on how to do that. I think this shift away from having a place to go, to actually remotely connecting with professionals is something that's the future for us, and I think we're really trying to do it.

Ellen Gardner: There are obvious advantages to that in the sense, yes, that people do not have to travel, but what about the fiscal challenges of that, Debbie, because that does seem certainly more oriented towards the patient and probably less focused on the hospital, but does that present new kinds of fiscal challenges, or is that actually a more economically efficient way to go?

Debbie Molloy: We think it's going to be more economically efficient, and we're testing some of that. A big piece of what we haven't always done well in the past is evaluation of ... you know, we throw something new in there. It's great. It looks great. It feels great. People tell us it's great, but then we kind of let it fall flat. What we have been trying to do in these initiatives is to measure, to measure efficacy, but then also to measure fiscally is it costing us more, is it costing us less, are we coming out neutral? The challenge in that, especially in acute care, is that unless you're closing beds, you're not saving money, so can you close beds, or really are you just providing a better service or your wait list, for example, is coming down. It is a better service, but you've now added something, so it's more expensive.

So far, I think we're finding we're coming out pretty flat, so we're not saving money, but we're not spending more money either, so we think that because we're providing a more effective service, that we are overall doing better. Where we go with that in the future, we're not sure, because there is that piece that really is around, unless you're closing buildings, then they are not really saving money, but right now we're not spending more money either, so we're viewing that as success.

Ellen Gardner: I know one of your main focus areas is quality, safety and risk management. What kinds of steps have you taken to reduce adverse events?

Debbie Molloy: We're heavy, heavy into near misses, and trying to capitalize on what we can learn from something that almost went wrong. We spend a lot of time trying to promote that, so we're trying to promote people not just writing up an occurrence when something has happened, but actually telling us about when something has almost happened, and because someone was careful and was doing a double check or something like that, we were able to avoid an adverse event. I'll give you an example of that that just happened in the last couple of weeks. We had someone who went into the MRI area and they had a quarter in their pocket. That quarter came out of their pocket and it got sucked into the MRI machine and was very close to hitting a patient. It didn't happen, which is fantastic, but what also didn't happen was someone initially didn't do a write up of that occurrence of a near miss. It kind of came through, bubbled to the top, I guess, as it were, through people telling stories.

So the first thing we did was to go back with that staff and say, to reinforce, "We'd really like you to tell us when something like this happens." This wasn't something that anyone tried to do. There was no malice or intent that happened there. The person didn't normally work in that area and they just, you know, happened to walk by. They saw a quarter, they picked it up, and just forgot for an instant. Of course, we did find out, "Well, do we have things to detect metal?" We sure do. We have wands, but if you forget to pick up that wand, then there isn't something that's a metal detector that you walk through, for example, like you would at an airport. We're looking at what can we do to change that. Coming out of that close call, we have put things in place to make sure that it doesn't happen again, and to remind people, I guess, around it's not just about new initiatives that affect safety. It's also about reinforcing those things that come second nature.

Ellen Gardner: Debbie, I want to touch on your leadership style and where you draw lessons in leadership and your own inspiration. I guess I first want to ask you what is one sort of common mistake that you see leaders make?

Debbie Molloy: I think a lot of leaders are afraid to say when they make a mistake. They feel like that somehow makes them less of a leader because they made a mistake. That probably is the most common thing that I think I see leaders do, is not be human. They're still human, so you know, there's still going to be things you do really well. There's going to be things you don't do as well. That would be the piece that I see most often.

Ellen Gardner: When you've had setbacks, what do you take from it? How does it affect the way you process things and move forward?

Debbie Molloy: I always admit when I make a mistake. People might think that it's a bit of a failing, I'm not sure, but the first thing I do is I always own up to when I've either made a mistake or I've really perhaps not made the best decisions. I do talk to my team about that. I also talk a lot to my team about why I'm doing something. You can't please everybody all of the time, but what you can do is try and explain why you've made a decision. I spend a lot of time explaining, I guess, where I'm coming from. I listen a lot as well to hear if I am taking everything into account that I should be taking into account. Then, you know, I try obviously to bring us to a place where everyone is happy, I guess, and feels like we're moving forward in a good way. If I do have to make a decision as well, if I can't bring people to consensus, I recognize that I have to do that, and that's my job. I then talk about that. When I've done things that I've ... I do try then and reflect on decisions that I've made, to think about did I make the right choice when I had to make the choice, and try and move forward and learn from that when I perhaps should have chosen a different path.

You know, I do believe in bringing a lot of humor to work as well, so I think it's important to laugh occasionally at maybe what you did or what you didn't do, or sort of have that moment of levity. It can't always be head down about the work. Sometimes you've got to sort of enjoy the people that you work with as well, and connect with them as people. I really can't say enough about that. I think it's important to know who people are, not just what they do.

Ellen Gardner: Well, we know in our part of Canada that some of the best humour we've ever seen comes out of Newfoundland, so you have a reputation to uphold, Debbie, and that's something to be really proud of, that humour does seem to be a big part of the culture of your province.

Debbie Molloy: It does. It's usually dark humour, I think, but there you go. I think that comes from the weather.

Ellen Gardner: Well, it makes us laugh, that's for sure. You know, I'm always interested in what we're telling our young people, how we're preparing them for the work world. What are some leadership lessons that you try and impart to new workers and young people just coming into the work force?

Debbie Molloy: I do tell people to always try your best, but always also talk about things. If you see something, instead of just sort of accepting it, if you think that you know something different or that you could make it better, speak up. Don't be afraid to speak up and be heard. That's important, that you have voice and that you put your voice forward. Try things, and don't be afraid to make mistakes. Mistakes are okay. We don't learn unless we make mistakes, so do the best that you can, but do know that there will be times when you will second guess something that you did.

In a world, in healthcare especially, I think we're very risk averse and for very good reason. However, I do think it's important to innovate and to look at sort of how we can do things differently and do them better. Sometimes there is an element of risk that we do need to think about. If you're just joining the work force, I think standing up and being counted is probably the best advice that I would give.

Ellen Gardner: I do want to ask you, Debbie, just one sort of final question about your own kind of reflections on your career, and as you look back and you're very much in the middle of your career and you have a lot to look forward to, but thinking back now, and what you've achieved, what are you particularly proud of?

Debbie Molloy: I think I'm most proud of ... there's been two times in my career when I've had the opportunity to work with fantastic teams, and together as a team, we have really been able to do some transformative things. One of them is the team I'm on now, so I'm incredibly blessed, I think, to be on a team where we are firing on all cylinders. I think that's starting to ... the proof, I guess, is always in the pudding, and so I think we're starting to see a lot of our levers moving in the right direction. I've always been proud in my career when I could be part of a team where we were pushing that envelope and where we were truly changing, influencing change within the organization and making things better. I think that's where I am right now in Eastern Health.

Ellen Gardner: Debbie, it's been such a pleasure talking to you and we really look forward to just watching Eastern Health and where things go from here.

Debbie Molloy: Thanks so much, Ellen. I really appreciate your time today. I look forward to meeting you in person at the end of April at the HIROC conference.

Thank you for listening. You can hear more of our interview on our website, Follow us on Twitter at @HIROCGroup, or email us at Healthcare Change Makers is recorded by Ellen Gardner and Phillip De Souza, and produced by Podfly Productions for Please rate us on iTunes.