Healthcare Change Makers: Episode 03, Kavita Mehta

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Imagine you could step inside the minds of 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: Good morning, I'm Ellen Gardner, I work in communications and marketing at HIROC. Today we're very fortunate to be speaking with Kavita Mehta, who is the CEO of AFHTO, The Association of Family Health Teams of Ontario. Welcome Kavita.

Kavita Mehta: Thank you, thank you for having me here.

Ellen Gardner: Nice to chat with you. I really first want to ask you, what drew you to the CEO position at AFHTO?

Kavita Mehta: I actually had been on the AFHTO Board for about seven years working as a board member while I was the ED at the South East Toronto Family Health Team (SETFHT). AFHTO gave me that broad provincial perspective when I was down at the operational level at SETFHT. I was very familiar with AFHTO, very much respected the work that was done by the inaugural CEO Angie Heydon, and felt like the board was very representative of the members that are in the community and the members of family health teams and practitioner lab clinics.

When the position got posted and Angie mentioned that she was going to retire, I was actually in a place where I was thinking about my own career trajectory. I recognized that I was missing that broad policy perspective in the work that I was doing and I just felt like it was a natural fit. I actually started in primary care in the Ministry at a bit of a policy level in the primary care branch at the Ministry; went to an operational role at the family health team and so going back to a policy and advocacy role just seemed like a natural organic trajectory for me.

Ellen Gardner: You had been at the South East TorontoFamily Health Team for nine years …

Kavita Mehta: Nine years!

Ellen Gardner: It's a long time and you were involved in so many big projects there and got so much done. How difficult was it for you to actually leave there?

Kavita Mehta: It was difficult in that you over the nine years you built amazing relationships. Amazing community partnerships, amazing people that you work with. Your team. That was really difficult but I think it was always going to be difficult to leave a job like that when you've been there for almost a decade. But I had a bit of a self-reflection point during the year that I was thinking about leaving. I realized that yes I had done a lot, but the big position became a little bit operational and I felt like I needed to do more. And I think that really helped me in my decision-making. It wasn't necessarily the fact that I was leaving the position, it was really the fact that I was leaving the people I was working with that I found very difficult. The good news is SETFHT is a member family health team and so I actually have connections back to my home organization and so I don't feel like I've necessarily left there all together.

Ellen Gardner: In primary care as we know there's lot of focus on wait times, on recruitment, on retention and compensation. You had an inside view to those challenges when you were at SETFHT. Has your perspective changed since you've come to AFHTO?

Kavita Mehta: We were fortunate in SETFHT that... we had flexibility. We could be creative with things like compensation and we had a very engaged group of physicians who were part of the conversation. I recognize that coming here it's not all the same – we have 185 member teams and every single one of them functions very differently. We could not ... I could not put all our teams in one box. I was really trying to get to know them at the personal level. I think that helped me really recognize very early on that I could not create a collective narrative around the issues related to compensation for example without bringing various specific stories around some of the challenges of a rural team or of a northern team or of an academic team, which are very different.

Ellen Gardner: You have close to 200 member organization within AFHTO and as you say a very broad cross-section from rural to urban, indigenous, academic. How do you actually meet the needs of such a diverse group?

Kavita Mehta: Well, one of the great things of being a membership organization is that members want to be part of the conversations, the solutions, the development. And we've been really fortunate to have a number of venues to actually have member involvement. So for us to get a better lens around what's happening in the province, we have advisory councils, a lot of advisory councils. We have an Executive Director's Advisory Council where we have a rep from every LHIN, an ED from every LHIN, that's self-selected in some cases or is elected by their peers and that actual LHIN to represent them on the council and to bring forward the issues that that LHIN group is facing.

We have a Chair Advisory Council where we have board chairs coming together. They’re doing a lot of cooperative governance conversation and sharing. We have a Physician Leadership Council, where we have a very engaged group of physicians across the province who meet every quarter to talk about the issues that they're dealing with. And then we have an IHP, the Interprofessional Healthcare Providers who have their own council as well. I think that the great thing about AFHTO is that we are trying to support all team members not just your EDs, not just your boards, not just your physicians but everybody. And we are giving people a venue to actually dialogue with us – what’s   going on in your little world that we need to be aware of.

Ellen Gardner: HIROC was really fortunate last year to be at your conference in the fall and work with your membership around visioning – what will family health teams look like in 20 years, what is going be different about primary care. There were a lot of great ideas that came out of that. What ideas really resonated with you Kavita?

Kavita Mehta: First of all I want to thank HIROC. You put together a really beautiful visual of what people were talking about and I think that was great to see. And thank you also for coming to the conference, you guys are always there and that’s just great. Primary care is in a bit of a flux; we are hopeful that somewhere down the line somebody will start thinking about the long-term visioning and the visioning around of the foundation of team-based care, what it brings to a high-performing health system. For me what stood out is I think the members are there too, they're all starting to speak the language of the patient medical home – the idea of one point, one local clinic or place where a patient should be able to access their care. What we currently have is siloed care: you come in to a FHT or an NPLC for your primary care. But then you're going to get a referral, go somewhere else for your home care or your mental care.

We have a very fragmented electronic medical record system, so so when you make those referrals you're also losing that narrative of the patient story. They'll make the referral, you might get a fax back around what happens. A fax back in this day and age around what happens at that visit, which then needs to be scanned into the EMR in order to create a robust story. I think the vision that most of our members in the AFHTO have is that in ten years, we actually get an organized primary care system. I think a lot of people will say we're quite disorganized. We need to become organized. We need one voice for primary care the way there is one voice for hospitals. We need that one voice for primary care, we need every Ontarian to have a patient medical home. Every Ontarian deserves access to inter-professional team-based care. At present only 30% of Ontarians have access.

Ellen Gardner: Were you surprised Kavita by the CIHI report saying that Canada has more physicians in absolute numbers and per capita than ever before and yet it doesn't seem to be impacting access. Why do you think that is?

Kavita Mehta: So many of our primary care physicians ... family physicians may have trained in primary care in family medicine over the two years, but many of them went on to do special psychotherapy, hospital work, palliative care work, so yes, by absolute numbers we have a lot of physicians but that doesn't mean we have a lot of physicians who are working in primary care. And that is why we continue to have the issue around access. For the last four years without having a Physician's Services Agreement in place, I think the family physicians in particular are feeling very vulnerable around what does this mean for their profession? What does this mean for primary care in general because it's not looked upon as a priority?

Ellen Gardner: So let's switch gears a little bit and I'd love to talk to you about your leadership experience. Who have been the people in your life Kavita who have really influenced your leadership style?

Kavita Mehta: Depending on where I've been in my career there's definitely been different people who have influenced my style. There’s one individual who stands out and I'm going to throw his name out there, Dr. Geordie Fallis, who is a physician at the South East Toronto Family Health Team and was formerly the chief of family medicine at Michael Garron Hospital.

I met Geordie back in 2008 when I was at the Ministry and I was supporting a group of physician leaders who were thinking about developing the FHT model. We were providing advice to the Ministry around how do you engage physicians in inter-professional team-based care. He always struck me as being an anomaly in that he was more tuned with emotional intelligence than anybody I had ever met in my life. Over the years when I moved to SETFHT and he was the chair of the board, he was my go-to-person. We would have weekly meetings. One of the things that he taught me was about the importance of relationships – that in these jobs there are expectations to do so much because the deliverables are ridiculous in order to continue to get your funding. But if you don't have trust and if you don't have relationships with the people that you are trying to get things done with, you're not going to get anywhere. And what I found really great about his leadership style is, it may take a while in order to get something done, but that's cause you're investing time in the relationships with the group, with the individual, with whomever so that you can move into a trusting relationship with mutual goals.

So he has been an amazing mentor and continues to be an amazing mentor. We meet every couple of months for lunch, we call it a bit of a therapy session. He'll tell me a little bit of what's going on in his world and I'll tell him a little bit about mine, it’s great to just get that advice. And because he's also a physician and so much of what I do is working with a physician group, it's really nice to get insight as well around what's happening there. So Geordie will always be a mentor for me. The other thing I really appreciate with his leadership style – and it’s something that I also try to speak to – is the importance of your work-life balance. He is so family-centric and when I had my twins while I was at SETFHT, the joy he experienced was the same joy as my own family did, it was just so lovely to see that he was as invested in my personal life as in my professional life.

Ellen Gardner: I can tell you are always strong on relationship-building and you've been great partner for HIROC. You've really always kind of pushed us to keep innovating and we just really value the relationship with you and the relationship with AFHTO and with SETFHT too. How have those relationships and partnerships been important to you?

Kavita Mehta: Something I will say about HIROC that I really appreciate is that you are flexible to change. I think that is really great because you don't always get that; people are very regimented to their strategic plan and their goals and their priorities and they not going to sway from that, so I really appreciate that. But I do think that it goes back to the relationship piece. When you do have these conversations around what could you do differently, it's not about an agenda, it's not your agenda, it's really about what's best for the sector, it's really about what's best to advance patient safety, what's best to support our providers, the people in the field. And I think that's what I value the most, just people and organizations that come to the table with that perspective in mind.
I'm not sitting here at this table to help advance your priority number one and get green on your dashboard. We’re all coming together at the table because we recognize maybe there's an issue or a problem and collectively we're going to solve it or we're going to come up with solutions related to it. And it's actually going to be better for the patients and better for our providers.

Ellen Gardner: You talked about the importance of work-life balance. Is that an important factor in how you manage your own stresses Kavita?

Kavita Mehta: Absolutely. I had my girls a little later in life and they are now five and one thing I made very clear, I made it clear at SETFHT and I made it clear here as well, they're my biggest priority. I don't want to go through life regretting not watching them grow and they bring me so much joy. I think that's always very much the back of my mind. If I have to take a day off because they have a ballet recital, I'm taking a day off because that's so important to make those memories, those memories will stay with you forever. And I think that is what keeps me going, I think as women we always feel a little bit challenged that we want to be good role models especially if we have daughters, show them that mommy can work but she can also be home and be a mommy at the same time.

That can be quite challenging. But I try to be present when I'm with the girls. So, no work while I'm there but as soon as they're back in bed, yes the work continues. I think that is how I keep my own self sane. That little bit of time that I get to spend with them in the day, it just keeps you going for the rest of the day.

Ellen Gardner: It is a juggling act!

Kavita Mehta: It is very much a juggling act.

Ellen Gardner: You’re always trying to be present but your mind is still coming back to work.

Kavita Mehta: It can be extremely challenging for sure.

Ellen Gardner: You started out your career as a nurse and you also worked as a public health nurse for several years. How does that experience continue to impact the work you do today?

Kavita Mehta: Being in this type of profession with some sort of inter-professional scope of practice brings a little bit more credibility to the role. I'm always grateful that I went through the nursing training, it was phenomenal, it really taught me a lot about team-based care. When you are a nurse you are working within a team, so that has always stayed with me.

While working in public health I loved that because it was really population health planning. It's interesting to me that I started my career as a public health nurse in population health. And now we're moving to that as a province. We're really starting to think about population health, but it’s not specific just to public health. We're asking everybody to think about population health. I did it from the operational level as a nurse and to be able to be at the table now and start thinking about it at a policy level is really exciting. And I think that as we get deeper and deeper into it my original training is going to come in quite handy definitely. I think that nursing has definitely stayed with me in every position I've been in.

Primary care and public health are very similar in that they have never been put under the folds of the LHIN as a funded entity, so sometimes we feel like we're a little bit on the periphery. But they're both so integral to the health system as a whole and I think we could definitely do a lot more partnership work there.

Ellen Gardner: Does that bring us to, what you are looking forward to Kavita?

Kavita Mehta: Absolutely. You can always get bogged down in everything that's wrong ... people can definitely go down that path, but I think we're trying and I'm trying to really start to think about, where are the opportunities here? Where are the opportunities to actually affect change, actually bring difference, actually have our members become the focal point in the community for primary care? Where is the opportunity to actually start looking at expansion so that every Ontarian does have access to inter-professional team-based care? I think that you have to have that optimistic perspective in order continually go. And recognize there's always going to be challenges and you have to work through those challenges. I think that the election brings an interesting perspective right now as well. There'll be new policy directions here and there which brings some challenges, but also brings tons of new opportunities as well. Working through that is going to be exciting, it's never going to be boring, but it will be exciting.

Ellen Gardner: Well, thank you so much Kavita. We've always seen you as a trailblazer and we look forward to seeing where you take your energy and your ideas and your creativity. As you say, lots of opportunities ahead.

Kavita Mehta: Thank you so much Ellen. This has been great.

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 Philip De Souza and produced by Podfly Productions. Please rate us on iTunes.