Children and Youth as the Future, with Bruce Squires, President of McMaster Children’s Hospital

Title card for Episode 35 of Healthcare Change Makers with President, McMaster Children's Hospital, Bruce Squires

(Access show transcript) Empowering people to be part of the solution is a core component of leadership for Bruce Squires, President of McMaster Children’s Hospital. Bruce believes in listening to the voices of children, youth, families, and healthcare staff, as we focus on post-pandemic recovery and look to the next chapter. 

Show Summary

Today we’re talking with Bruce Squires, President of McMaster Children’s Hospital and Vice President, Women’s and Children’s Health at Hamilton Health Sciences. 

In this episode, we talk to Bruce about preventable harm and his approach to turning the corner on patient safety. Bruce says it’s important to be explicit when talking about harm, sharing a realistic picture with clinical leads and teams. 

Like many leaders, Bruce is focused on health human resources. He speaks to the need to build immersive learning environments, where staff have the tools and support from leaders to identify opportunities and act on them. 

Bruce also speaks to the impact of COVID-19 on children and youth, describing it as disruptive and tragic. The measures imposed to keep our kids safe affected their physical, mental, and emotional health – effects that are most concerning for vulnerable children and youth. 

But Bruce is ultimately optimistic. In looking to the next chapter of children’s health, he believes the dialogue should be driven by the voices of children, youth and families – they are our future. 

Mentioned in this Episode

Transcript

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 health care system.

Philip De Souza: Welcome to Healthcare Change Makers, a podcast produced by HIROC. I'm Philip De Souza, HIROC's director of Communications and Marketing. Today we're talking with Bruce Squires, president of McMaster Children's Hospital and vice president of Women's and Children's Health at Hamilton Health Sciences. Our partners at Children's Healthcare Canada will be hosting their annual conference this November, and we learned that Bruce and a number of other healthcare leaders will be sharing knowledge with the emerging leaders. So we wanted to chat with Bruce to learn more about the session, as well as hear more about his passion for safe care. A little bit about Bruce, he is an accomplished leader in the healthcare sector and an advocate for patient safety and quality improvement.

Prior to joining Hamilton Health Sciences, he was vice president of People, Strategy & Performance at the Children's Hospital of Eastern Ontario, CHEO. And prior to that, Bruce was vice president of Corporate Affairs at the Canadian Medical Association and CEO at the Newfoundland & Labrador Medical association. Today, he is chair of the board of directors of Children's Healthcare Canada, and board member with the Ontario College of Family Physicians.

Welcome Bruce, we're glad to have you on the show. How are you today?

Bruce Squires: I'm great, thanks. Thank you very much for having me, very excited to have a chat with you.

Philip De Souza: Excellent. So at this year Children's Healthcare Canada conference, you're taking part in a networking session for emerging leaders. What's one piece of advice you would give to health leaders who are still looking to gain their footing?

Bruce Squires: Well, I'm really excited about that networking session, and I think the title actually speaks to that piece of advice. We've called it building leadership skills through volunteer and governance opportunities. And so, the piece of advice that we're looking to share really, is that you really can bolster your skills, your experience, and certainly your connections to others, through things you can do sort of outside the core of your regular day-to-day role as a healthcare leader. I think what, particularly new leaders, sometimes do is underestimate the value and the demand for their help that's out there. And so, I'm really looking to share some of my experience, but encourage young leaders to think about how they might step outside locally, regionally, provincially, even nationally and internationally, to share their time and what they may not recognize as their valuable skills and valuable experiences.

I know that I really enjoyed the opportunities that I've had throughout the 30 years that I've been kind of working in healthcare to see an organization or to see a mission that resonated for me and to put my hand up and say, "Hey, can I be involved?" And really be struck how often the response was sort of, "Yes, please," and very welcoming. And then, once I got around, say a board table or a working group on a particular issue, I just learned so, so much from folks from other backgrounds, and from other experiences, and other roles also sitting at those tables and being equally interested in sharing and in also learning. So we're going to talk about that at our networking session, and I hope maybe that this little chat prompts a few more people to join us.

Philip De Souza: Most definitely. I'm more already looking forward to it. I really appreciate the fact that you mentioned step outside and when you're at those other tables, absorbing what others are saying and their experiences. Where did you learn that from, did a mentor tell you to do that?

Bruce Squires: Going all the way back to growing up, and if you like, the kind of mentorship you get from parents, and friends, and neighbors. And my parents always really encouraged me to try other things and to not get sort of caught in one comfort-zone area that sort of inhibited the interest in stepping outside. And that led me as an individual to pursue a liberal arts degree at a small university, Mount Allison University, where again, the attractive thing was you could try so many different things and have so many opportunities to work with others. And so, I think I found that really rewarding as an experience and then so nourishing as in terms of kind of the go forward building of skills and perspectives. So yeah, I probably wouldn't attribute it to any one mentor so much as kind of the environment in which I was raised and that I learned.

Philip De Souza: No, I like that a lot. And you're absolutely right, when you are around and exposed to different things, it actually makes you that much a better individual, well rounded. So yes, I encourage everyone to attend the session with yourself at the Children's Healthcare conference later this month.

Bruce Squires: Yeah. And, you know, Philip, one thing I just, it does prompt me on one other thing that I'd share, that I think is so important to remember when we're working in healthcare, healthcare organizations, hospitals in the case where I work are such incredibly complex organizations. And so, perspective is on its own really, really valuable because there are so many different variables, but then when you really think about the core of healthcare is around patients and families, and they are always going to be different from you. So the more that you've kind of nourished your skill to see, to appreciate, to listen to, and to empathize with multiple perspectives, I think the better you're going to be able to fill that mission of delivering quality healthcare.

Philip De Souza: No, you're absolutely right. And one of the pillars of HIROC's current strategic plan is working with yourselves and other subscribers across the country, all to turn the corner on patient safety. So from a child health perspective, what's one thing organizations can do today to drive safety and quality improvement?

Bruce Squires: Well, I think that improving, it goes back to the old mantra of, "You can't improve what you can't measure." So it really starts with committing to understand where you are in terms of your quality and safety performance. And that requires a little bit of humility. That can be hard, particularly when working with children and youth and their healthcare. And that's admitting that what we do, we still do preventable harm, or we still create preventable harm. And so, we need to be explicit, I think, internally and externally, so with our own teams, but as well as to the public, and specifically to children, youth, and families to say, "Yep, we're still a place where preventable harm happens and we've got work to do to eliminate that harm." And so that initial step, it sounds very basic, but in my view, unless you do that very, very explicitly and with a level of priority and of urgency, then it's going to be much more difficult to really, as you said, to turn that corner on patient safety.

And so, I think wherever I've seen kind of breakthrough performance, it's where the organization has made that explicit commitment to improving safety performance, if you like, to driving to zero harm. And in making that commitment, of course as I say, you're also publicly acknowledging that you're not there yet.

Philip De Souza: Oh, I like that expression you use, breakthrough performance. It's something I feel that we should add, if you could add some elements of that to our strat plan so that people can identify them like, "Oh, how do we get that breakthrough performance?" And like you said, it's through self, well, not self, I guess it's through that kind of realization and that reflection as an organization. So I appreciate you said that as well. And so, how do we as leaders focus on everything you basically said just now, you said it so eloquently, focus on all of that when some would say the adult system has so many challenges?

Bruce Squires: Yeah. Yeah. It's so hard. And you have to acknowledge that there are more worthy priorities than the system has resources, in particular the time, and the bandwidth, and the energy, and the emotional and spiritual reserves of our people. And so, when I try to answer that question, it has to be with tremendous humility in terms of my thoughts on where to focus. With all of those dimensions, and pressures, and challenges, and potential priorities, I think you can't help but recognize that the answer that I'll give can still seem a bit trite and can seem unrealistic, let me phrase it that way, as you juggle. Having said that, it brings me back to around the notion that what we name is our priority and what we live is our priority is really the signal around what is important.

And so, if you're going to focus on safety as a healthcare priority, you have to name it and you truly have to prioritize that. You need to make it the core mandate. Now, the thing I'll say is that in some ways, that's the easiest dimension of quality around which to mobilize healthcare teams. If you start to share with clinical leads, with clinical teams that there's still direct harm happening to patients and families that is preventable, that's a lot more motivating towards action than when you share that there might be some financial waste in the system, or there might be some deviations in how you do things that kind of affect the amount of resources, or even that maybe affect just the general patient experience.

But as soon as you start to point to actual harm, I've found that that's more effective in mobilizing clinical teams. Our physicians, our nurses, really everyone, never want to feel like they were part of a harm to one of the patients under their care. So again, that really takes me back to if we name it as, if you like, the first and most important dimension of quality and then truly prioritize it, then that will often pull folks into the focus, pull the teams into the focus that you're looking for.

Philip De Souza: I feel like maybe a hidden talent of yours is marketing because your catchphrase is like, "Name it and live it." I can totally see that on a t-shirt, Bruce. And so, creating a healthy and supportive learning workplaces is a big part of health human resources. So what is your strategy at your organization?

Bruce Squires: I have to answer with a significant amount of humility in acknowledging that I think at McMaster Children's Hospital and Hamilton Health Sciences, the organizations in which I work, honestly, we're still struggling with this in the current context. I think that many of our team members would say that right now it doesn't feel too supportive. And they're worrying about their own and their team's wellness, and the extent to which it really is a healthy environment, and I share that worry. I would say though, that I still think that at least for us, our core working system, our continuous quality improvement system and processes that are anchored at the front line, and that are really targeted to valuing individual initiative and perspective, and encouraging that individuals to identify opportunities, to improve their own work environment, and to participate in activities, to act on those opportunities.

That to me is the core to a real lived, daily, immersive learning, and learning workplace, learning and environment. It will really feel that way to individuals if on a day-to-day basis they feel empowered to recognize, but then to identify where, something could be better here, and then have the tools and the support from their leaders, from their teams, from their organization, to then kind of act on those. So identify deficiencies, if you like, those opportunities and to make them better. Now, to really make that happen, you need to have good processes and structures, you need to bolster the environment with training for leaders, but also for everyone at the front line. And you really, really need to have leadership presence to kind of support that sense of recognized individual initiative and recognition.

And I won't say we're perfect at that yet at all. I think we have many, many opportunities to do that better in our own children's hospital. For me, that really is the most valuable place to make change. There's lots of things that you can do outside and there's courses folks can take, and there's other pieces of recognition that are very, very important, and certainly very valuable. But if you don't have at its core a frontline situation, a day-to-day at the worksite sense of an element of control over your own work, and an opportunity to improve, then it's not going to be healthy and it's not going to support learning.

Philip De Souza: That's great. I like the fact that you mentioned people, just kind of understanding that they can be part of the solution. And I also get the sense just from hearing your passion about it, that you want to help your team be part of a learning organization where everyone, I can tell, learn from each other. And that also then I guess, kind of permeates throughout the organization and not only does your team see it, but patients and their families feel it, the community feels it. And it also sounds to me, it helps with psychological safety. And I think that you gave some really good elements that people could take to their organizations as well.

Bruce Squires: Yeah, I hope so. And I think you've heard it on some of the core pieces of that approach and why I think it's so critical, because ultimately the people that are going to understand most clearly where we have challenges, are our patients and families, and then our frontline teams. And so, the only real way to listen to them to make improvements is to empower them, encourage them, support them, enable them to identify those issues, and then to create the solutions. And again, as an individual, if it doesn't feel like you can do those things, it's bound to feel less supportive and less healthy. When we don't feel in control and we feel powerless to address our challenges, we're much more likely to experience stress and despair, and ultimately to want to be somewhere else. So that's the aspiration, not without tremendous challenges in these extraordinary times.

I'm still hopeful that it's one of, really, the most important ways we can look to support our teams through all of this and to really give them a sense that not only are they part of something that's so important, which they all know, but also that they're glad to be there, and that it's good for them as well as being good for the community.

Philip De Souza: No, absolutely. And what you speak to also touches upon ensuring that one's own mental health is, that they're taking care of it. And so, I guess I'll ask you, if there's something you do to ensure you practice good mental health, we were talking to somebody at our conference every weeks ago and they mentioned you practice mindfulness, and so we often ask leaders who we interview, what you do just to stay motivated, energized?

Bruce Squires: Yeah. Thanks. I think there's a few things that I come back to most often to help me with, I suppose, my own mental health, and to support me through what can feel like, sometimes, some pretty challenging times. And they really start with self. So they start with how valuable kind of time is with my family and support is with my family. So, if I need to recharge, I'll go first to my wife and my children, and also our family pet, because they know you best, and they can find that, well, do two things. They can find the great balance of being a listening ear, but also they present kind of a different priority and a different focus for your energies that can create a lot of resilience. The second thing I'd really highlight for me, for sure, a little bit of exercise on a regular basis, whether it's an early morning run or even just a short workout session, or a bike ride, sometimes even a bike ride to work, that is really helpful for me because that combination of physical activity, perhaps while even still thinking about work, I think really, really helps.

Maybe there's this kind of balancing of emotional content when there's kind of physical activity happening at the same time. And I suppose the third thing... So family and fitness, and maybe it's still an F, but the third thing I'd say is kind of family and patient voice. And it's easy to get out of this, but ensuring that I get out and have at least a bit of an opportunity to engage with the children, youth, and families in our hospital and across our sites, that always, I think, helps to ensure balance. And maybe it's because it's a little bit of perspective, ensuring that you understand what's important, or maybe it's to the same point, but from a different dimension, maybe it's just helping to keep a focus on the priority is their health.

And so all these other challenges that may get in the way, yes, they're still challenges, but still seeing that goal, which is individual and collective around supporting those patients and families, can actually help to get out of the difficult focus on the challenge that maybe can create stress, and bring it back up to a level of, "Okay, we're doing great work here. You're really, really lucky to be part of it. So just keep doing what you can."

Philip De Souza: No, I like that. I like the fact that you, again, I really do think you are a marketing expert because you have family fitness and feedback, that's what I wrote down as you were speaking. And I like the fact that, yes, you take time for yourself and you kind of recharge and I like the fact that you use the word resilience. But then, I think we all say, "Oh yes, I want to totally detach from work." But I think, you're doing that, but then there's elements of you getting those ideas from when you are on the bike, and then of course getting that feedback and that focus from patients and their families, and you may not be strategizing the moment because you're being an active listener, but then you're taking that back after and thinking, "Well, how can we replicate this, or how can we spread this across the whole organization, or how could we do better here?" Etc. So I like the fact that you mentioned all three. And in your point of view, what do you feel is the impact of the pandemic, I guess generally, on children's health?

Bruce Squires: Yeah. In my view that impact was tragic and extremely significant. It was the measures more so than the virus, the measures that we put in place to manage the virus were tremendously disruptive to many of the foundations, to the future of individuals, children, and youth. The easiest one, of course, to sort of grasp a hold of was time. Across many jurisdictions in Canada where schools were closed to in-person learning, and so children didn't have that time with peers and with educational mentors, and with a broader scope of folks who are really focused on watching for key developmental milestones with children, and supporting the identification of where individuals, individual children and youth, can benefit from an intervention, or even from a further kind of assessment to support every part of a child's development, to support their education, but their physical development, their mental health, their spiritual development, their emotional needs.

And so, unfortunately what happened and the impact there, was most concerning for vulnerable children and youth. So those who are vulnerable, because they do have greater physiological needs, but also, and this is really clear, the pandemic and those measures had the greatest impact on children and youth from equity-seeking groups, be it racialized communities, be it children and youth experiencing gender identity, children and youth with physical and mental abilities challenges. All of those groups are already, before a pandemic, experiencing greater challenges in our level of support for their health and their wellbeing. But then, when the measures came in place, that took them out of in-person school, that sometimes put them back into vulnerable situations in the family, that denied many of the community-based interactions that support them. Well, we're now bearing the responsibility to address those challenges and the cost and the concern of those pieces.

So, I'd say that I am extremely concerned about that impact on the health of children and youth. I'm optimistic that with sufficient societal, and certainly governmental, and child health leadership attention to those impacts that they can be addressed. And I'm really, really motivated to call out the importance of prioritizing that focus, if you like it, on child health recovery, post-pandemic recovery for children and youth that I want to call out, that I really want to emphasize when we talk to the public, when we talk to government and to politicians, when we speak to the future. These kids and their importance in recovery needs to be prioritized.

Philip De Souza: I like the fact that you mentioned that you're optimistic, that together we can all prioritize recovery and think about the future. And actually, as I was putting it all... Listen to what you were saying just putting together as well, that the theme of the Children's Healthcare conference this year is The Next Chapter, so it leads right into that Next Chapter. And I guess, you kind of answered already when you said you're optimistic about it, but what do you want to see in The Next Chapter, in addition to that focus on recovery, and all the parties coming together to support children. And like you said, the community, and the healthcare organizations, and government, etc. Is there anything else that you would love to see in The Next Chapter?

Bruce Squires: Yeah, I think I'd focus on a stronger and more recognized voice, actually I should make it voices, stronger and more recognized voices of children, youth, and families driving our dialogue in Canada. And yeah, what do I mean by dialogue? I mean everything. I mean federal, provincial, local politics, and political discussions. I mean, what we talk about in the media, and I certainly mean what we talk about as just citizens. And I'm hopeful, again, about this, but I would hope to see that we really have transitioned what we talk about to be more clearly focused on our future, on children and youth. And I'll maybe close that by saying I'm inspired by what we've seen in terms of the leadership of much of the dialogue around climate change and climate action coming directly from youth, coming from those who have the clearest interest in our future. And so, I look at that and I think that it's both intricately tied to, and indicative of where we can be with the voices of children and youth in relation to their health and wellbeing as well.

Philip De Souza: Oh, absolutely. It's great to see there's a whole new, I wouldn't say movement, so to speak, but you can feel that energy around young and old coming together, but you're right. Driven a lot by young people to ensure that our environment, our physical space, the air we're breathing, how we're getting around, what we're consuming, everything is being kind of like looked at like, "Hmm, can we do this better? Can we do this differently?" And I like the fact that you brought that up, and you tied that all back to our elements of how we live and how we live better. I like that.

I guess with that said we can move into, I think we call the lightning round, I ask you a couple few questions and you just give whatever comes to mind, top of your head. And they could be one word answers, whatever you feel like. So, Bruce, what's your best time of the day?

Bruce Squires: Evening with the family. And first thing in the morning for focusing on tasks ahead.

Philip De Souza: I like that you mentioned that. So, in the morning when you get up, what's the very first thing you do? Do you check your email first or no?
Bruce Squires: Oh, no. First thing I do is, usually, I like to jump in the shower because it works, honestly.

Philip De Souza: That's where I get my ideas from.

Bruce Squires: Yeah.

Philip De Souza: Are you more of an introvert or extrovert?

Bruce Squires: I am an introvert who loves the experience once I get with people.

Philip De Souza: What's your favorite meal?

Bruce Squires: Yeah, I think my favorite meal does change over time, but right now it's honestly a nice steak with asparagus and lightly roasted baby potatoes.

Philip De Souza: This is really good. And for our listeners, we're actually recording this just before dinner time. What's on your nightstand right now?

Bruce Squires: Back on my nightstand is Homo Deus, by Harari. Yeah. Based on the past, but recognizing where we stand, what are our thoughts around the future.

Philip De Souza: And you said, "back." Is this your second time? Are you revisiting it?

Bruce Squires: Yeah, it is sort of a revisit after having looked at it and read it a few years ago. And honestly, I'll say, other than when on vacation, I do have challenges these days in spending much time on nighttime reading. I'm pretty much a head hits the pillow and straight to bed, to kind of maximize the amount of true shut-eye before starting up the day again. But it is sitting there, it does get opened every once in a while because it's one of those books that every piece that you read will trigger a thought and a perspective, so it's not that you need to read from start to finish to appreciate it.

Philip De Souza: I love those types of reads. You don't feel rushed, for me anyways, you don't feel rushed to finish it because you continually are... Kind of new thoughts come into your head and new ways to take what you've absorbed. So well, Bruce, we've come to the end. Thank you so much for taking time to chat with us today. You provided a great deal of insight and we're very passionate about hearing your passion for children's health. So thank you.

Bruce Squires: Well, thank you. And maybe just let me take this chance for whoever listens to this, first of all, congratulations, if you can listen through it, but also recognizing that that means that you probably have something to do with healthcare. So a huge thank you for all that you have done. Every single person working in this area, boy I know, has sacrificed a lot personally and professionally and has helped us through in extraordinary times. So thank you.

Philip De Souza: You've just been listening to our interview with Bruce Squires, president of McMaster Children's Hospital. For more information about HIROC, and to listen to other episodes of Healthcare Change Makers, go to our website HIROC.com. Thank you for listening.

Thank you for listening. You can hear more episodes of Healthcare Change Makers on our website HIROC.com 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 communications@hiroc.com. We'd love to hear from you.