Adam Topp: Transformation and Service as Anchors to Success

Cover art for Episode 53 of Healthcare Change Makers, with headshot of Adam Topp, CEO of Shared Health Manitoba

As Chief Executive Officer of Shared Health Manitoba, Adam Topp is no stranger to system transformation. Adam gives us a window into developing the unique health system in Manitoba, and what he’s learned from other provinces along the way.  

Show Summary

System change is a big topic across healthcare in Canada right now. HIROC’s Catherine Gaulton sits down with Adam Topp to learn about the transition undertaken by Shared Health Manitoba, and the importance of engagement at every step along the way. 

Adam also touches on his organization’s approach to the current HHR crisis – having good practices in talent management, retention, and embedding a people leader in senior management. 

Stick around until the end to hear about Adam’s past life as a DJ – we promise it’s worth it. 

Mentioned in this Episode


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 leaders about the joys and challenges of driving change and working with partners, to create the safest healthcare system.

Philip De Souza: Hey listeners, it's Philip here from HIROC. First off, thank you for listening to Healthcare Change Makers. Your enthusiasm for each and every guest we have on the show means the world to us. We would've never imagined hitting over 50 episodes when we started this journey and here we are today and with so many of you joining us for the ride, thank you so much. Speaking of Journey, our guest today, Adam Topp dives deep into his journey in healthcare. As we kick off this episode, Adam is the Chief Executive Officer at Shared Health Manitoba. Listen closely as he offers up a vivid snapshot of what healthcare transformation looks like in the province. And you’re in for real treat as HIROC CEO Catherine Galton steps in as host. So take it away, Catherine.

Catherine Gaulton: Good morning, Adam. It's great to have you with us. We've just been a leader in a few provinces. Of course you were originally associated with HIROC in Ontario and now you're in Manitoba. So wondering if you could just tell us a bit about how you've gotten to hear and really, because you've been in these different systems, it would be excellent to hear what your approach is to leadership of a system.

Adam Topp: Thanks very much Catherine, and it's really nice to be here in chat. So my journey has been an interesting one. Certainly not one I predicted, but I started out in healthcare at Sunnybrook in Toronto and that seems like a very, very long time ago, but it was a great experience. I learned an awful lot there as there for about 10 years and I had a great opportunity to learn from several excellent mentors and understand the healthcare system and work with government on Ontario and it was an excellent opportunity and that really set me up for moving back and forth between healthcare operations and consulting. I went into the consulting world after Sunnybrook with the Hay Group, then I came to Winnipeg to be the CEO of the Health Sciences Center here. And then I went back into consulting again with the Hay Group, did some private sector work in pharmaceuticals.

Started my own consulting firm when the Hay Group disbanded and now I'm back again into an operational role. So it's been back and forth and that's given me a great opportunity to see how things are done well beyond Ontario and Manitoba, I've had the opportunity to work I think in every province. I'm missing two territories that I really haven't done any significant amount of work in. And I've also had the opportunity to work overseas a little bit. So I've managed to be able to see many healthcare systems from a few different perspectives and I think that has served me well in terms of trying to understand what works and what doesn't.

Catherine Gaulton: Well look, you're a dream come true for the consulting groups that you've been with because having that actually have to make something happen in the system provides a whole new lens on what you're doing when you do consulting work. And of course then for the system to actually have the benefit of that broad experience. If you think about that as a trajectory, how has that informed how you lead? And particularly when you're leading in transition and you're leading in a pandemic.

Adam Topp: I laser focus on doing one thing at a time I think is probably the best approach to transformation and to leadership that I've come across. I think we can get overwhelmed by the changes that we'd like to see or the challenges that we have in the system, understanding the risks that we're facing, the risks that our patients are facing and really being brutal about prioritizing what to do has served me well. And I think it's certainly served well in the pandemic as well. I wouldn't suggest transformation in the middle of a pandemic, so that's not a good idea. Manitoba had undertaken a very significant transformation, and no sooner did we initiate some of the major changes and really dismantle the system than the pandemic hit, which was certainly a challenge because we never got the opportunity to rebuild following some significant changes. So we were running through the pandemic kind of half built, which was a very much a struggle.

I think we managed and we managed well, but that was not a good way to set it up. But that does emphasize the need though, to prioritize. You need to look at what the risks are and what you need to do first, get it done and move on to the next challenge. And I think that sets you up well for how complex our system is because when you make one change, there's certainly a ripple effect that goes through the system. So it does change the risk profile for more than what you anticipate. So it does also allow you to move in an incremental way dealing with the biggest issues as you understand them first.

Catherine Gaulton: Part of the observation that I would have is Manitoba has, it seems to, looked at the different modeling across the country and really thought about is there some amalgam of those that's actually going to work better in our context And all of that to say your organization is quite unique. People might point to organizations in other provinces that they think are the same, but I do think it's quite unique. And so I'd love to have you share with our listeners that what Shared Health is, in fact, how it's different and how that's geared around health system transformation. So for example, in Nova Scotia, I was there, we were going to one health authority or at one and the IWK, there was a real lens that perhaps the tertiary and ER level services in the province should be their own health authority and that wasn't the model that was followed there, but Manitoba's done something that's a bit like that while not exactly that. So just really interested in that modeling because I think as we go through the crises we're in, I think many jurisdictions are thinking about modeling and how best to deliver on their mandates. So tell us a bit about Shared Health and just that different approach to how to implement system change.

Adam Topp: We did a lot of looking across Canada and globally at the arrangements of different health systems and tried to think of a structure that would achieve what we wanted to achieve. And I think it's important to set our goals out at the outset and that really was a sustainable, more integrated patient, patient-centered system. And I know sometimes people might think that those aren't kind of broad nebulous words, but sustainable integrated in the sense that the patients can move as seamlessly through the system as possible and patient-centered keeping the patients well in mind in terms of their experience in the system. So those were our goals at the outset and we looked across the different systems. We tried to get an evaluation of what they were all about, how they worked, what their pros and cons were. And we did come up with a fairly unique approach.

So what we've chosen to do, we chose not to go the route of Nova Scotia or Saskatchewan or Alberta and now recently Newfoundland in terms of a single provincial authority. That decision was made because we felt that some of the governance of the operations needed to be as close to the patients as we could get them in a very vast geography. We didn't want the Thompson Hospital to feel that they were being operated out of Winnipeg, felt it was much more important that their government's governance in their operations was just a little closer to home than that. Having said that, we do have five regional health authorities that are still in themselves just given our geography have a very broad and geography that they're responsible for. But we felt that that was better than a single health authority to really try and understand the needs of the patients and what are five fairly unique geographies within Manitoba.

So that's why we didn't go with a single health authority. We did however, recognize the value of and the economies associated with doing things provincially where it made sense to do that. And those decisions were predominantly made in terms of economies of scale, economies of scope and where it really didn't make sense for a health authority to duplicate what another health authority is doing. So we did create a provincial health authority, which is Shared Health, but it does not operate the healthcare system in the regions. It does operate a provincial hospital, the health sciences center in Winnipeg. And it does provide provincial administrative services and provincial clinical services. And the choice of what became a provincial clinical service or a provincial administrative service continues to evolve and is always a bit of a debate as to what is beneficially operated at a provincial level. Manitoba also has fairly, in Canada, we're kind of middle of the pack in terms of a population.

We've got 1.4 million people, roughly a 10th the size of Ontario. So when we look at economies, there's only so many economies you can get. So it does make sense to do some things provincially. So some of the things that we do provincially are diagnostic services in terms of both labs and diagnostic imaging and ICT. We do operate the provincial emergency response services. We run the health sciences center, which is where the majority but not all, but where the majority of the programs are in the province or at the health sciences center. And we do run a provincial mental health and addictions program, which was taken over by from rather the Department of Health that was Ontario did that in the nineties when they transferred the provincial psych hospitals to the health system. So we actually just did that very recently. We also run administrative services that are weather's economy.

So we are moving towards a provincial payroll system. We run a provincial supply chain system, we run capital planning for the province. We have shared legal services for the province. So many of those more I guess high transactional administrative areas we do for the province, the transactional human resources, accounts payable. So we have a number of shared services where you can see some of those economies also. And there's a distinction between operating things and a lead and coordinate role. We do things like provincial MAID is done at Shared Health. We have a provincial float pool, which is a unique operation that really allows us to have some economies in a float pool that can move around provincially to where the needs are. That's something we actually learn from COVID. We do do a provincial patient flow group that we lead. We don't actually operate flow within the regions, but the integration is very important.

So we operate flow among the regions. So we've got a very diverse approach to a provincial health authority and it is a very active discussion and debate when we choose to do something provincially. I think it's worked out quite well. It does force all the regions to work together where it makes sense to work together. It does force discussions about an integrated patient experience, yet it does also allow the actual operational governance to be closer to the patients that are being served and responsive to those patients. So it is an interesting mix. It's an interesting mix of, I think of all the provinces because I think we've learned something from all of them.

So the other thing that we do that I think is very novel is that we do provincial planning. So all of the regional health authorities, CancerCare Manitoba and ourselves have put together an approach to create a provincial clinical and preventative services plan. So a clinical services plan for the province. And we put that together as a group. Shared Health has been delegated that authority from the government to put that plan together and we really oversee putting that plan together. But it's not our plan. It is a plan for the province. It's a plan that's owned by all of the health regions, CancerCare and ourselves. And that plan really it is a population-based plan. We look at the services that we do, how we provide them, where they need to be provided to meet the needs of the population. And it becomes one plan that we all adopt as our strategic clinical services plan. And that's a bit unique, but given the size of the province, I think that it's much better than having the individual health authorities do their own. So what we try to do is learn from the benefits that we've seen in the other provinces and take the best of those and put them into a system that is really patient-centered.

Catherine Gaulton: The work around provincial planning is, at least in my little experience, is so hard, so hard to accomplish because there are diverse interests, but also I think we all know what we know well and therefore that makes system change even harder. I think change is hard, this kind of big system change even harder. And just wondering any thoughts you have on how you bring people along from for that journey?

Adam Topp: There's been a need to do this with everybody engaged and I think that's really important. But I think the way that we've managed to bring people along, and I won't pretend that it hasn't happened without hiccups, it certainly has. We've had a few and we certainly have disagreements and discussion and I think that's very healthy and good, but agreement on what we want to achieve is certainly very, very important. And there was a universal need among the stakeholders in the health system to really achieve a level of integration that the house system hasn't been able to achieve. So with that as a goal, working together becomes a bit easier. So when we look at what should be done provincially, we don't do everything provincially in many cases we'll set standards. There's a number of areas where we take that lead and coordinate function so that we're really facilitating the other health authorities and being a service provider to them.

There was great debates about whether or not the other health authorities reported to Shared Health and I'm strongly emphasized that they do not. They have their own board and they are independent corporations from us. They don't report to us in any way. The integration approach has really been one where we agree on what would be beneficial provincially, and we're actually a service provider to them. So we see them as our clients and a strong service performance framework and standards and goals and deliverables. And really in that way it's not that different than HIROC where you have your owner subscribers and people expect a service from you. And I know you've got a very strong service orientation and we do too to our regional health authorities. So there was a resistance. There is resistance, but the goal was not to reduce the autonomy of the regional health authorities.

It was really to facilitate so that they could focus the efforts on operations and we could do the things that would help them do that. I think a real commitment to that has reduced some of the resistance to change and that's a commitment that we have to renew regularly and we have to revisit and emphasize and it's certainly been a change for Shared Health. I think people are not used to necessarily being a service provider in that regard, but it's become and will continue to become part of our essence as an organization because I don't think we won't be successful without that orientation. And I think that has minimized some of the resistance to change because people see the value in doing things provincially where it makes sense to do that and the value of being engaged. And I guess that would be the second thing is a really big effort to engaging people in what we're doing.

So when we are setting provincial standards, when we are doing a provincial plan, when we are providing a provincial service, whether it's a clinical service or administrative service, we do it with the regional health authorities engaged in it so that we make sure there's an open door where they're making a change and it affects a change in diagnostics. We work very closely together to make that happen together as an example. And we make sure that we are open to the feedback from them as clients. So we've got two client groups, the other service delivery organizations as we call them and our patients. And it has taken a very and will continue to take a very strong commitment and constant renewal of that approach in order to create an integrated system. So we need to listen well, we need to serve well, we need to engage. What we do needs to be owned by the other regional health authorities. They need to own it. They need to know that they've had an input into it. It's not us doing something to them. And that's been very, very important and right on. We won't be successful unless we continue down that path and strengthen it.

Catherine Gaulton: And you talked briefly about some of the modeling that Shared Health has been able to put in place and around things like a provincial float system and that type of thing. I just really, I think given the pressures in the system right now, we couldn't end this conversation without speaking about the current health human resource crisis and the different approaches to it. And I have to say that as I work across the country, I worry about the extent to which we learn from each other. And so I'd be really interested in hearing your thoughts about what Manitoba's doing or what you consider to be some of the things we should be looking at going forward on this topic.

Adam Topp: Health Human Resources has been perhaps one consistent thing throughout my career now it's certainly more of an acute issue now than it has been. And so we do need to do something about it. I think we've taken for granted, if I can be so bold as healthcare, as a healthcare system so people can disagree, but I think we've taken for granted that there are people out there that want to work in healthcare. And it does continue to amaze me when I see significant health organizations who don't have a leader of people in the sense of a, whatever you want to call it, a VP of People or a Chief Human Resources Officer or someone on the senior executive team who's responsible for people management. That's a regular deficit in the organizational structures of our healthcare system in Canada that I see. And I think that's not everybody, but there's many that don't put that executive emphasis and leadership on the management of people, which is interesting given that we're a service organization and depending on the organization, 70% of our expenses are on people.

We don't have good human resources practices in terms of talent management, talent acquisition, retention, talent development. It hasn't been something that the healthcare system has focused on. And I think we are living with the results of that now. So a major focus on human resources that goes beyond simply labor relations, that looks at how we develop our people, how we support our people, the work environment that they're in, how we retain them, et cetera, is a really big need in the healthcare system and one that I don't think I've seen well-developed in any of the provinces that I've worked in. So I think that needs to be the approach. We have turnover as much as we have gaps in positions like people unfilled positions, but our turnover is also very high and there's got to be a reason for that. And I think it really is a lack of focus on the people management issues. So that's something that we need to do better in healthcare and that's a part of the approach that we're taking in Manitoba.

Catherine Gaulton: From my perspective too. I think we have such a focus on the people who are frontline delivering care and then I think we're also facing a crisis in relation to the leadership in the system and probably a lot of it for the same reason, but it's an interesting conundrum. So to your point where we most need leaders who are really phenomenal on this front is also the time when perhaps we're losing some of our leaders. So a focus on that as an overall topic as you say. Absolutely, absolutely agree.

We're coming close to our time, I think Adam, but I cannot resist the opportunity to ask you your thoughts in relation to HIROC and its priorities. We've just been so fortunate to have you associated with closely with us for many years, including as our chair before I was even with HIROC. So interested in hearing your views on how you are seeing it and really what we need to be remembering if we're truly wanting to follow through on that goal of being responsive to the needs of our subscribers.

Adam Topp: Thanks for that question. I did have the opportunity and privilege to be engaged with HIROC quite early on. It was a great experience and I think at that time when we were looking at how HIROC can serve its subscribers, we did a very explicit and intentional strategic and a shift away from seeing ourselves as an insurance provider and really seeing that we could have a dominant role in risk management. And we developed and worked on the moreOB program and the creation of Salus at the time and really emphasized the role of the annual risk management conference and tried to emphasize that. And I think that's really important because it wasn't simply a focus on doing that to reduce our insurance premiums. The focus was really to do that to serve our patients better. And I think that was a major strategic change that HIROC undertook while I was involved in the board.

And I certainly tried to champion that. I stepped away after a while and I'm just getting back involved a little bit now as a subscriber and trying to understand where you are going. But I think from a subscriber's perspective, I've seen that you've developed the risk management tools much more than they were when I was engaged. And that's really good news. I think there's an awful lot of organizations and groups that talk about being associated with quality of care, but I think it's really important that HIROC continue its work towards improving the quality of our healthcare system to reduce our insurance premiums, but also because all of your subscribers goals are to provide healthcare. And I think while it serves the purpose of reducing in premiums, it also serves our purpose to provide our patients better service. So I think a continued move in that direction as a subscriber would be really, really important.

Catherine Gaulton: I'll say probably the most thing that interested me most about coming to HIROC was that we know that if we actually are working with our subscribers on their goals of how to enhance quality and safety for patients, that the rest will actually take care of itself. And without that sort of needing to know that the goal is around is quality and safety, irrespective of what it means for premiums, but frankly it will take care of itself. The cost of the system will ultimately be reduced because we have done the right things in relation to patients and in our case for subscribers who are making that happen. So it's great to have someone who's stepped away and come back to provide some input.

Hey, let's take a mini break from the episode so I can tell you a little bit about HIROC's upcoming annual general meeting and conference. We are excited to come back together this year to break bread, have coffee and connect in person at the Toronto Congress Center on April 24th with the option to register virtually. Of course, this event is exclusive and complimentary for HIROC subscribers, so head on over to HIROC dot com for all the details and information on how to register. We hope to see you on April 24th.

Catherine Gaulton: Are you interested in just a fun lightening round, Adam, just to take down the stress of these hard questions I've been asking you?
Adam Topp: Sure, of course. That sounds fun.

Catherine Gaulton: Okay, so tell me, what was your first job ever?

Adam Topp: My first job ever. I was a barn boy. That's what they called me. I think I was eight, I was working on the barn of a food farm. So I have a farming background that many people don't probably realize.

Catherine Gaulton: Good. A nice starting service orientation for sure. If you could have dinner with any three people alive or dead, who you know or don't know, who would they be and a quick thought on why?

Adam Topp: Yeah, that's an interesting question. I think would, number one might be Barack Obama. I think he's led an awful lot of change and had an incredible vision that has driven him and I think he achieved some of what he wanted and didn't achieve other things that he wanted. And I think he would be very interesting as a bit of a trailblazer. I think I'd also probably like to speak to some trailblazing artist of the past as well. So I think they have a different maybe perspective on the world and I think that might be either Tom Thompson or Emily Carr because I'm a homer and I like Canadian art. So those were both trailblazers in that field. And then someone who's gone through an awful lot of change. I think our society is going through an incredible amount of change right now. It's difficult to deal with and I'd love to learn the lessons of someone like a Big Bear who went through an incredible amount of change in his life and challenges and I'd love to hear some lessons from him.

Catherine Gaulton: Yeah, absolutely. It's interesting. I visited Haida Gwaii recently and at one point I was standing in a location where when I turned my head it became an Emily Carr. It was a phenomenal, phenomenal experience. Best piece of advice you've ever received from a mentor.

Adam Topp: I think that the best piece of advice I got pretty earlier on related to his very specific experience, but the comment was along the lines of, "Takes you a lifetime to build integrity in a second to lose it."

Catherine Gaulton: What song is your go-to to focus or energize yourself? This is the most telling one, Adam.

Adam Topp: Well, I don't know. This one's a strange one for me because I was a DJ for 10 years.

Catherine Gaulton: Oh wow.

Adam Topp: So songs to me are, I love music. I have a little studio in my basement and I can appreciate just about any type of music just because I was doing that for such a long time. So there's all kinds, there's all different ones, but maybe the one that I find most energizing when I need to be energized is the prologue from Hot August Night by Neil Diamond.

Philip De Souza: Before you go, Adam, I have to tell Catherine, we're going to definitely hire you to DJ services for future events. That's a good fun fact. But I did want to ask, you have a really keen, I can tell, focus on just on setting priorities and being goal-driven, and I just wanted to know, did you learn that from somebody in your past, like a loved one or parent or grandparent or so I guess feel that you have a connection to just having that focus?

Adam Topp: I would say that that was certainly part of my upbringing. Work hard, don't have too much fun, and it was a big piece of culture in my upbringing. So that's probably where that comes from. So that would be my dad and my grandparents. So there you go.

Philip De Souza: I can just tell from the beginning of your conversation with Catherine that you have that work ethic and I think it's important for people to know that it's in your roots and I can tell just when you were talking about the focus and priorities and goal driven for your organization. So it's excellent.
Adam Topp: I can tell you that my dad was not too impressed that I wanted to be a disc jockey or do music that was not. So he said, "Fine, you're going to do that, make a business out of it." So I actually had a recording studio, this jockey business, and a record store when there was vinyl in the world when I was in grade nine.

Philip De Souza: What? Wow, that's amazing.

Catherine Gaulton: Thank you so much. I think it is phenomenal to hear from a leader in assistance taking a different course. Phenomenal to hear from a leader who's been both in and out of the system. I think it just is a phenomenally great perspective to bring and will show itself as we keep an eye on what's happening in Manitoba. Thank you again, phenomenal to have you, and I hope you have a great rest of the day.

Adam Topp: Thanks very much, Catherine.

Thank you for listening. You can hear more episodes of Healthcare Change Makers on our website and on your favourite podcasting apps. If you like what you hear, please rate us or post a review. Healthcare Change Makers is recorded by HIROC's Communications and Marketing team and produced by Podfly Productions. Follow us on Twitter at @hirocgroup or email us at [email protected]. We'd love to hear from you.