Denise Lalanne and Carrie Ricker: A Small Change Can Make a Huge Difference

Cover art for Episode 54 of Healthcare Change Makers with Denise Lalanne and Carrie Ricker

Coming from different career backgrounds, Denise Lalanne and Carrie Ricker bring complementary expertise to IWK Health Centre, working together on the Chez NICU Home initiative. Improving patient care through innovative and strategic solutions has been at the forefront of both of their goals.

Show Summary

Denise Lalanne is the Director, Digital and Client Services at IWK Health Centre, where she focuses on delivering the best care through leading strategic and operational plans. 

Carrie Ricker supports IWK Health Centre’s Innovation and Research departments acting as legal counsel. Her passion lies in encouraging innovation through strategic business and legal advice. 

Denise and Carrie joined forces for the Chez Neonatal Intensive Care Unit (NICU) Home initiative where their mutual passion for innovation and providing high-quality care was amplified. Using technology, this initiative will provide NICU families with the education and tools needed to be fully engaged in the care of their baby. 

In this episode, Denise and Carrie touch on how the Chez NICU Home initiative came to be and how it’s improving care at the IWK Health Centre. 

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 Changemakers, 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.

Michelle Holden: Hey, listener, today our podcast is heading out east to the IWK Health Center in Halifax, Nova Scotia. From HIROC's Communications and Marketing team, I'm Michelle Holden, here with Philip DeSouza. Philip and I first heard about today's guest after reading a story on the IWK Chez NICU Home Initiative. Chez NICU Home is having such an impact on care at the IWK that we knew we had to bring it to the show.

So today we chat with Denise Lalanne, the Director of Digital and client services at IWK, and Carrie Ricker, a health law lawyer practicing in Halifax, currently on contract with the IWK, supporting their innovation and research departments. The two have a great working relationship and a real passion for their innovation work, which you'll hear on the episode in a moment. Now let's get to the show. Welcome, Denise and Carrie, can you both tell us a little bit about yourselves, where you work and what you do?

Denise Lalanne: Sure. My name is Denise Lalanne and I work for the IWK Health in Halifax. We are the healthcare center in Nova Scotia and the Maritimes for women, children and youth, as well as their families. And I am the Director of Digital and client services, which is a diverse portfolio in the operation side of things. And so innovation falls within my portfolio, as well as a number of other areas including technology, so IT and clinical engineering, food services, business development, as well as environmental services.

Carrie Ricker: And I'm Carrie Ricker. I am a lawyer by trade. I have my own firm, but I've been working in health law for most of my career, a little more than 15 years. And in a combination of roles, some in-house, some from private practice, but now my work focuses primarily on the IWK, where I am on contract with them, specifically helping in the innovation and research areas.

Michelle Holden: Fantastic. So we learned a little bit about both of you and this is how we got in touch with you from the Chez NICU Home Initiative. We read about it online as well. And for our listeners, maybe you can tell us a little bit about Chez NICU Home and how it came about. Maybe I'll pass this one to you, Carrie.

Carrie Ricker: Great. So this was an interesting one because it really came out of clinical care and out of the fact that the IWK was redeveloping its NICU and improving care for our smallest patients and their families and recognizing that while a NICU stay is often not what folks hope for, that there's a lot that can be done to try and make it a little bit less stressful, a little bit more inviting, and also recognizing that as part of that redevelopment, we really wanted to focus on the families and on creating an environment that made them as comfortable and engaged as possible.

And we knew from our researchers and our research teams that parental engagement has a major impact on outcomes, particularly for preemies. So as part of that redevelopment, we were looking for a way to combine technology and care paths and education to really, as I say, improve that parental engagement piece.

So we ended up partnering with Cisco Canada from a technology perspective, and we received funding from the federal government and from our foundation and from the IWK and really worked closely with our clinical team that included families as well in their redevelopment team. And so as a group came, together and developed the NICU Home Project to create a online parental app that lets parents both get information about the NICU journey. It lets them find out information in their own way, at their own time about everything from terms they may have heard but may not have known what it meant to where to find quiet space within the IWK that they can go and everything in between.

It also gives them an opportunity to track information about their babies if they would like, so their growth, what kind of engagement they've had with them. You can even say, oh, I got to bathe my baby today and track through this online app that you can access, both in your room and also outside of the hospital.

And then with that, we have technology, thanks to Cisco, that helps us to create a virtual experience in the room as well for parents and families and even sometimes healthcare providers who either can't for whatever reason or maybe it's not the best thing in terms of sheer numbers to have as many people in the room as possible. So it allows people to be there, if they can't physically be there.

Michelle Holden: Thank you. You spoke to a lot of the ways, I know that the program's probably helping to improve IWK. But Denise, do you have anything to add on that one, just where the program has improved care?

Denise Lalanne: Yeah, for sure. Just to build on what Carrie was saying, as our NICU really has a focus on patients and families, having this platform really has helped empower parents and their families as well too through these educational modules that we have. I mean, as you can imagine, parents don't anticipate when they deliver their baby that the baby's going to end up in NICU.

And so right off the bat, they're overwhelmed with everything and when you have a lot of information being sent at you at the time, it's not always easy to be able to digest all the information that you're receiving. And so through these educational modules that we have, it's the attempt to try and help parents who maybe when they have a quiet moment to go through it and as Carrie said, different terms that they may have, didn't quite understand, they're able to look it up.

We wanted to be able to have a platform that people can use to get information, as opposed to just going to Google and receive who knows what information that they're having. Because as we all know, a lot of the information that you do find through websites is not always accurate. And so we wanted to be able to have that evidence based place for parents and families to go.

And the other piece, just from the virtual side of things, we do know that as much as families want to be there 24/7, there are times where they may not be able to, if they have other children at home or whatever the case may be. And so having that ability to phone in and find out how their baby is doing, participate in rounds, it's really helpful and really makes parents feel like they're part of the process and hopefully alleviate some of the worry that they can't be there all the time, knowing that they have this way that they can connect in as well.

Michelle Holden: Absolutely, and that's one of the pieces of the project that really stuck out when I first read about it too, being a parent and not having had a baby in the NICU, but just that experience and wondering how it would feel and if you had to go home and that you're really thinking about all sides of this from the parent's perspective. And I really love that side of the story, so thank you for sharing that.

Denise Lalanne: One other thing to add as well too is, as the IWK, we're located in hospital. As I mentioned, we serve the maritime provinces. Often the babies will go home and end up in care obviously from somewhere else. And so being able to have that connectivity to other healthcare centers as well too is important. And so that's an added benefit that we've been able to find through this project as well.

Michelle Holden: Absolutely. Thank you for adding that. We talked a little bit a few weeks ago as well with my director, Philip, you had a chat and you were telling us a little bit about a few stories from patients and their families, the positive impacts of being connected. I know you mentioned some of them generally a little bit here in the conversation, but can you share a story or two that has really stuck with you?

Carrie Ricker: Yeah, absolutely. I'm happy to, without going into too much personal detail obviously. But we certainly had experiences with mothers who were not able to be at the IWK, particularly during COVID when folks had children who were home, they were not in school and there were restrictions and folks who had maybe to have, couldn't be fully isolated themselves because of other family commitments, didn't necessarily want to be coming into the NICU and potentially bringing a risk with them.

And so that was pretty crushing for a lot of parents and like many centers, there were also limits on number of people, but we certainly heard from folks who were able to join into the NICU and the technology has a screen up on the wall right by the head wall where the baby is and they were able to join. And we've had parents who joined daily to read their child a story. They couldn't be there, but they could have that connection.

And certainly, I think we've heard from our staff that that's been impactful for them because sometimes they struggle with engaging the parents if they're not physically there, but being able to connect with the parents that way and with the baby in the room really increases even the provider comfort level and the feeling of engagement and you get a sense of where the parent is, how they may be feeling.

And so that we certainly hear from our providers that for them, while maybe not the absolute ideal, even the virtual experience really allows for something that's approximate to that physically being there. We also on the other side, have certainly heard from our staff that the ability to do virtual rounds, so we now have folks, we have have a number of providers who are in the room with the baby and the parents if they're able to attend.

But for dad to be able to join rounds daily from work, but also for the dietician to be able to join rounds for those babies that they are engaged with, but still being able to be in their office, maybe doing other activities or popping in, has made it a more streamlined and more effective process for everybody. And just a small way, but we've heard from parents that they find the virtual room in some ways, much easier to follow and to know who people are.

People's names and their position are often on the screen with the meeting so they know, oh, that's the dietician who's speaking. I'm able to follow more clearly because you get one person speaking at a time and that in some ways the rounds have become more clear and more engaging for parents than when they maybe had eight or 10 people in a room at the same time. So it's been interesting and nice to see those benefits.

Michelle Holden: Those are really good examples and very, as you said, heartbreaking decisions that parents have to make when they go home, but then also just showing the flexibility of mom can be there, but maybe dad's at work or the providers online. You're right, it just seems like there's so much for everyone that's involved. I know when I had my son, my husband was taking ferocious notes and he would ask me later, what doctor was that who said that? And I don't remember. And so you have this ability to do this stuff online, which is really interesting. So I'm glad you brought all those points up. Thank you.

Denise, I want to pass it to you for a minute because I know you work very closely with the innovation work at IWK. So for HIROC especially, knowledge sharing is critical to ensuring that we can turn the corner on patient safety. I did want to ask you how the IWK approach works and how knowledge sharing is a part of your innovation work?

Denise Lalanne: So at the IWK, how we approach it is really focused on promoting care for our patients, as well as the experience for our families that we serve. And so we're not about keeping key performance indicators like the number of patents, the number of spinoff companies, that sort of thing. It's really focused on what work can we do to actually improve the patients and families that we do serve, as I mentioned.

At the end of the day, it's not about how much revenue we can generate potentially from a technology that we develop and grow and ideally commercialize. It's really about using that knowledge to improve what's done at the IWK and a few things that we've learned about this is, really innovative work can happen anywhere. And so it's not just in a researcher as an example. The researcher has to work with the clinical teams to make sure that we're developing things that make sense from the clinical perspective.

And then we've also learned that we have a lot of frontline care who have great ideas that are helpful to develop ideas around there as well too. And so as I said, yeah, it's not really about the number of patents or licensing that we have with different companies. It's just really about how we serve our patients and families. I think the other piece too, that we look at is doing this work also really helps with the economic development piece around here as well too, because we do have another number of trainees and researchers and students that come through that help develop these ideas. And so it really creates a nice hotspot for Halifax and the region as well, as we work to develop these things and create economic development for that piece as well too, by new positions and those things.

Carrie Ricker: Yeah, I think what Denise has really hit on too is that when we look at the knowledge sharing and innovation, there's almost different types of knowledge. There's the knowledge that comes with that particular innovation. So it might be knowledge about how to do care. It might be knowledge about a different care pathway. But then there's also the knowledge that comes with just knowing how to do and implement innovations, right? Because that's one of the challenges in healthcare is that everybody's got a lot on their plate.

And so even figuring out how to implement a new practice, how to implement a piece of technology or an approach to care, you have to be thinking about that as well. And that's where the engagement with the clinical folks comes in and the learnings and the knowledge that comes as part of clinical implementation. And then we've got the knowledge that I like to think Denise and I bring, of how to actually approach and plan and work with industry and how to do innovation in that sense because that's not necessarily the training or knowledge that our clinical folks have, although we like to think once they've worked with us on a project, they've then developed some of that knowledge and can take it out.

And so I think we think about all of those, and particularly with the last one, it really is about trying to build a culture at the IWK, where we have these projects and people get an opportunity to engage with the work in a little bit of a different way. And then hopefully they take those learnings out, and it really does create that culture of being willing to take those risks and try new things and look at new ways of doing things.

And if we do it really, really well, then hopefully we can take it out and even share that knowledge with other places and look at ways that we can scale up our work, which may be through the more traditional publications and speaking at conferences and sharing in that way, but also looking at some of those broader, almost more commercial, although not necessarily financially driven, licensing and making available some of the technologies or developments that have originated in-house for us.

Michelle Holden: Thank you, Carrie. Yeah, you just gave us a lot to think about around some of the questions other organizations may be having if they're thinking about starting or improving their innovation arm at their organization and how to get started. And as you said, there is so many different definitions or ways to look at what knowledge sharing really is.
Just follow-up on that, Denise, I was wondering if you've had any kind of overall learnings with these innovation projects. Maybe it's the Chez NICU Home, maybe it's others that you would want to share here that other organizations who may be listening can take away.

Denise Lalanne: Yeah, absolutely. That's a great question. So I think one of the things that we've learned that we need to be cognizant of is that sometimes you have great ideas and when they get implemented, they would be great, but there's a whole lot, as Carrie was mentioning, to get that implemented that you have to consider. We find there's a lot of innovative ideas that are coming forward that are technology related. And so it's about developing a new application or a new website or whatever the case may be.

And so that's great to develop that, but you also have to think down the road as well, in terms of when you implement it, how is that going to be done, how is the training going to be done? How are you going to maintain that? Making sure that frequent updates are provided on that, as the example with Chez NICU Home, as we mentioned, it's an evidence-based material in there, so to update that to make sure the latest evidence is there.

And then also from the technology side, making sure patches are up-to-date as well, considering it from a cybersecurity perspective and those types of things. And so it's really looking at the full spectrum. And the other piece too, is just what may create some efficiencies in others, you have to look at other areas around there to make sure that it's not going to inadvertently increase pressure somewhere else. By implementing this, may potentially increase the work for registration clerks or something like that, just as an example. And so you really have to think of the full spectrum in terms of to implement this, implement an innovative idea and project, what exactly is the full scope of this to get it from the beginning into the end, in order for it to be successful?

I think the other part too is we also touched on is that you can't do innovation in a silo. And so it really is a team effort where everyone has different expertise that come to the table. And so it's really engaging those teams get people's insights and really working together to help get these ideas implemented. Because that's really the only way you're going to have success at the end of the day.
And as I'd mentioned previously, is that innovation comes from everywhere. I used to only deal with really big technology innovation ideas that would take years to develop and require patents and all that kind of stuff. And you kind of realize that it's more than that. Sometimes just a small change in practice can actually have a huge difference from a patient and family perspective. And so I think really opening up your mindset that it's more innovative. Innovation can come from anybody.

And the other piece is you need to be nimble. And so as healthcare and other large organizations, we can sometimes get caught up in bureaucracy, but for innovation to happen, you really need to be nimble and being able to move forward quickly. And I know the projects that we work on with industry, that's one of the great feedback that we get from them is that we are nimble and we are able to move quickly, which I think is, it's a huge example there.

And I think the other piece too is there are definitely innovative ideas that fail, but some of them are a success. Chez NICU Home is an example. And for the people who are working on that is it's never easy, but when it gets there and you see a mom saying how wonderful it was to be able to learn something or be able to see her baby today, I mean, it just makes it all worthwhile. And so from a staff perspective and seeing these come to fruition, it's pretty great at the end of the day and very rewarding to see this happen.

Michelle Holden: Thank you, Denise. Yeah, I think you had a lot of learnings for other organizations who are listening, and we have a lot of our subscribers who listen in as well as healthcare providers from across the country, so we hope that they'll take something away from that. The last thing I wanted to ask before we move into some of our other lighter lightning round questions, Carrie, you told us a little bit at the beginning about your job and you gave us some more insight on your work on contract with IWK, but can you talk a little bit about how you work with colleagues and partners to action change?

Carrie Ricker: Absolutely. Yeah, I think it's an interesting position because it's oftentimes, legal is maybe coming in at the end or coming in at the crisis point. And I get to be there hopefully from the beginning and get to really integrate with the teams and my colleagues and help them work through the planning process. And I think that's really critical with innovation in healthcare because risk is a big deal.

We worry about risk for very good reason, but we can be a little risk-adverse sometimes. And I always say it's a bit interesting being the lawyer around the table, the one who's saying, no, no, it's actually okay. We can take some risk because the reality is, innovation brings with it some risks. Change is risky, and everything we do in healthcare has some risks associated. And as we're all seeing, there's risk associated with doing the things the way we've always done them as well.
But I think what I'm able to do is kind of help people from the beginning with that risk assessment and the mitigations of those risks, obviously, but also letting them know that it can be okay to take on some risk. Because sometimes, and you can't see me, but I'm doing air quotes of liability, becomes a real barrier. And again, for very good reason.

But at the same time, liability isn't a barrier to good clinical practice. And as a lawyer, I'm often saying to my clients, I don't want you practicing to avoid liability. I want you practicing the best possible care and the best standards because that from a legal perspective is what I want to be able to say happened. And so I think just being able to sometimes bring that perspective is helpful with my colleagues and it can give them a little bit of confidence and comfort that we are thinking about those things.

I also like to think of myself, and I've had colleagues describe it this way, as a knot untangler because I get to sit a little bit at 10,000 feet from the system and be able to see the full picture and figure out where some of those barriers are, whether it's procurement processes, whether it's intellectual property rights, whether it's just, ugh, gosh, are there compliance issues?

Are there privacy issues? And really be able to look at those and help folks work through them. And again, those are sometimes the scary bits that people, it stops people in their tracks and it can really slow things down, but if they've got somebody there helping them untangle those knots, it can help.
And I think with the partners, it's also really critical because sometimes, particularly if you're working on innovation with industry, you really do have a different language that's being spoken sometimes. And I think hopefully what I'm able to bring to the table is an understanding of what the needs and the priorities are from a healthcare perspective, whether that's related to some of the regulatory restrictions we may have that may be different than industry is used to.

Also, sometimes our speed, but then also being able so able to translate that for our industry partners, but also being able to translate for our clinicians what some of the priorities for the industry partners may be. So even understanding how financing and investment impacts a partner, is important in negotiating those rights and those project setups. And I think recognizing those and being able to address them and have open conversations from the beginning and untangle those knots effectively can be really helpful.

And I don't expect my clinical and research colleagues to necessarily have all of those understandings, although some certainly do and even more than I do. But being around the table from the beginning to help identify where maybe some of those pieces where we may not be speaking the exact same language and helping to translate and bring that together and look for solutions, to me is the fun part of my job. But I think hopefully the ability that I bring that can then help those changes and those relationships actually work and then that actions the change.

Michelle Holden: You gave us a lot to think about in the role of legal there and innovation, but project planning in general.

Denise Lalanne: Do you mind if I added a little bit to that?

Michelle Holden: Yeah, go ahead.

Denise Lalanne: I just wanted to say really for us to have the expertise that Carrie brings to the table, because often, yes, you can get legal counsel, but as Carrie was saying, doesn't necessarily understand the innovation piece, the healthcare piece, the business piece, and all that stuff. And so it's really helped streamline things as we go through. And yeah, it gave us confidence because she's been with the project since the beginning, and so we know we're not going to get to the end and say, oh, crap, we forgot about this privacy piece or something like that, because she's been along the journey with us from the beginning.

And so as a lessons learned, back to the previous question, having this role is really important and actually helps with the timing of things so that, as I said, having her along the way and being cognizant of those things has been really important.

Michelle Holden: Yeah, I imagine it helps you sleep at night as well a little bit better knowing some part of the roles that Carrie carries for you there. Before I move into lightning round, Philip, I wanted to bring you in and see if you had any questions for Carrie or Denise?

Phillip DeSouza: Yeah, hello, Carrie. Hi Denise. It's Philip here. I really value how you both brought up the importance of culture of innovation and fostering that and the ability to try new things and take some risks. I put how Carrie putting it in air quotes, some risk is, it's taking some risk. If there was an organization listening today and they wanted to implement the amazing rhythm of innovation impact you at IWK have, what's one piece of advice? What's the one thing you think that the first thing they should consider doing? Because we know it's not going to happen in a snap of a finger, but if they were to say, hey, we heard this amazing story about IWK and let's start that journey here. What would be your advice, the first thing they should do, that person listening?

Denise Lalanne: So one thing I would suggest is really start going out and talking to people, finding out where people's pain points are, asking people if they have any ideas on how to make things better. At the IWK have just recently set up a system that is designed just to do that. People put ideas forward on how things can be better within their work area or for our patients and families. And it's a way to try and tease out those ideas that people have in the organization and don't necessarily know who they should be talking to about that. And so I think that would be a first thing that would be beneficial to do, because often your best ideas are the people in your own own organization.

Michelle Holden: Thank you. So we're going to move into the lightning round right now. It's very quick. I'm just going to ask both of you the same question, give you both a chance to answer, first thing that really comes to your mind. So maybe I'll start with you, Carrie. If you could travel anywhere tomorrow with the snap of your finger, where would you go?

Carrie Ricker: It is snowing outside my window right now, and it is summer in Australia, so I would go to the Great Ocean Road.

Michelle Holden: That sounds nice. Denise, what about you?

Denise Lalanne: For same reasons, it's cold and snowy outside. I would go to Hawaii on a beach with the palm trees around me.

Michelle Holden: Oh, I'd love a beach right now. Back to you, Carrie, to de-stress after a long day or a week, some of us exercise, some read, watch TV, what's your thing?

Carrie Ricker: Oh, this is actually a tough question. I mean, I could give you my good answer, which is yoga, but that's like, once a month, maybe I actually do that. Most of the time, it's probably a cooking TV show.

Michelle Holden: Yeah, that's okay. And that's honest. But Denise, if you say yoga, you're going to sound really good right now.

Denise Lalanne: Fair enough. And yeah, I think it depends on the day for me. But I mean, yeah, it is cheesy to say, but exercise is one. I can't say that I do it enough, and when I do it, I always wonder, why don't I do that more often because I feel better afterwards. But I think really just to de-connect, hanging out with family and friends. I have a daughter who's in soccer, and so I think most days of the week I'm going with her, driving her around and watching her and her friends play soccer together, and that's a good stress reliever.

Michelle Holden: Oh yeah, that sounds nice. Sticking with you, Denise, what's your best habit?

Denise Lalanne: Now this is a tough one because it's funny, my brain kept going to my bad habits. I think really at the end of the day, I think I'm good at having gratitude for what I do have. And I think part of that is being in healthcare and you hear some really sad stories, knowing what people are going through. And so I think at the end of the day, even if it's particular hard, you have to sit back and think, I am pretty lucky. And so I think that's probably my best habit is being able to have gratitude.

Michelle Holden: That's a good one. What about yours, Carrie?

Carrie Ricker: So I hate routine of any kind, which I actually think is probably what drew me to innovation and hopefully is a little bit of a help on that front, so habits aren't really my thing. So I would say my best habit is probably that sometimes I manage not to indulge in my bad habits.

Michelle Holden: I like how you flipped it on us on that one. That's good. I'm going to go, Denise, finish the sentence. If I wasn't in healthcare, I'd be working as a-

Denise Lalanne: I would say, I'd be working in business development in a technology company.

Michelle Holden: Okay. And what about you, Carrie?

Carrie Ricker: I think I would really enjoy working in TV or film production.

Michelle Holden: That would be fun.

Phillip DeSouza: That's fun.

Michelle Holden: Yeah. Okay. Well, that's all for me. I really want to thank both of you for being with us on this show today and sharing your experience and the project with us, giving us so, so much to think about as well as our subscribers who are listening. Yeah. Thank you so much. This was excellent.

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