Episode 01: In conversation with Sarah Downey

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With her own special blend of strength and compassion, Sarah is inspiring the MGH community to change the face of health in East York and beyond.

Welcome to Healthcare Change Makers, a podcast from HIROC where we talk to leaders about the joys and challenges of driving change in our complex and demanding healthcare organizations.

Today, your host, Ellen Gardner interviews Sarah Downey the President and CEO of Michael Garron Hospital. To Sarah, the people and purpose of healthcare is incredibly strong and after 25 years, she still embraces the challenge and opportunity of working in this business.



Ellen Gardner: Good morning. I'm Ellen Gardner and I'm in communications at HIROC and today we have the great pleasure of talking with Sarah Downey who is the president and CEO of Michael Garron Hospital.

Ellen Gardner: What was it that actually motivated you to get into healthcare and particularly healthcare administration?

Sarah Downey: Seems like a very long time ago since I made that decision but it's one I've never regretted.

Sarah Downey: My dad would say of me that from a very young age, when he used to ask me what I wanted to do in life, I would just say, I want to run something. And so I guess there must have been some innate tendency to want to lead and as I finished a Bachelor of Science in biology, I thought, I wasn't sure that a health disciple or profession was right for me. I went to the career library, which is what we used to have to do over 25 years ago to figure out what career options might be available. I found a pamphlet about the Masters of Health Administration program at the University of Ottawa. And I thought, Ottawa's a great city. I'd lived there before. Bilingual program, which is important for me being bilingual. And thirdly, it's a business but it's a health business. And it's business with purpose.

Sarah Downey: It started me on a path towards healthcare administration that I've never looked back on. You know, the people and the purpose of healthcare is incredibly strong and I can tell you in 25 years in this business, no two days have felt the same or presented me with the same challenge and opportunity. But to serve the people who work so hard in healthcare and serve the patients and the families who need a strong healthcare system has provided me with immense motivation to keep trying to make it all better.

Ellen Gardner: I know that you lived in East York when you came to the position. What was it that drew you to this hospital?

Sarah Downey: Yes, as you say, it is my community hospital and I have used the services, my family's used the services at this hospital long before I was associated with it. And it's just an important institution in the east of Toronto that's been serving people here for over 90 years. I've been a volunteer in this community. I was a board member in a couple of community service organizations, and so I understood and appreciated the important role of the hospital in serving people here.

Sarah Downey: So when the opportunity came up, I thought, well wouldn't that be interesting. Right? To work in the hospital up the street in a way. It's two kilometres from my house, my kids were still in elementary school and at school two blocks away, and so as a community member, as a hospital leader and this is an important institution. It's been a great privilege to have been the person selected to do this job and it's provided me with tons of real life rewards and sometimes real life challenges in trying to navigate the future of a hospital.

Ellen Gardner: HIROC has a very strong relationship with MGH and we've always thought of you as a community hospital and yet we know that you're undergoing tremendous growth right now, which is great. But how are you actually working to maintain the balance of continuing with the tradition as a community hospital, but becoming a bigger institution?

Sarah Downey: So the strength of this hospital has been its roots in this community and its history there. And I think everything it's done through the history of time has been rooted in this community. From being the first hospital east of the Don River in Toronto. When it built its original wing in 1929, to have built another wing to receive the veterans who were coming home from World War II, to changing that wing to being a big obstetrical unit for the baby boom era. Everything we've done has been to adapt to the needs of this community, which is of course very different now than it was in the founding days.

Sarah Downey: So when you understand that and appreciate that the people of this community own this hospital, you can't help but continue to have roots and presence. And we spend a lot of time engaging with people who live around the neighbourhoods. The 21 neighbourhoods we serve with the leaders of organization that are equally important to us. With our patients who reflect the values of that. We serve some very young patients and some very old patients. So we have communities full of young children like Thorncliffe Park and neighbourhoods beside them that have lots of seniors like Flemingdon Park. You forever have to adapt your programs and services for that.

Sarah Downey: We are leading a major redevelopment of our facility. And from the beginning, some of the terms of this redevelopment are to be reflective of this community. Not something odd or that sticks out; the physical structure needs to reflect the design and style off the east end of Toronto. We want, when you step into our facility, to breathe a sigh of relief. That it be culturally adapted to the people that we serve. That it continue to be a heart of this community and sense of pride. And so a lot of that is in the physical elements you build but in the people.

Ellen Gardner: With larger size comes bigger budgets, more programs, more people, bigger challenges. Probably in ways you may not have anticipated when you took the job. How has that affected your formation of your own vision and staying in touch with your own inspiration?

Sarah Downey: So we have a new vision at this hospital. It's not a new concept, but our vision is Create Health, Build Community. And certainly, in a hospital like this in the emergency department, in our chronic disease clinics, we see the impacts of lives in the frequency and the rates of which people develop chronic illnesses. We know that we serve a very high proportion of people who come from low social economic status neighbourhoods. And so we get out and we partner with agencies and partner with family doctors and help advocate at the government level for programs and services that will help keep people well and successful in their local neighbourhoods.

Sarah Downey: As an example, we know that over 5,000 visits a year to our emergency department come here from a part of our community called Oakridge. Many of those visits are for people who live with mental health and addiction challenges. And so through the partnership with the family doctors who work there, we've been able to secure funding for a nurse and a social worker to help the family doctor who takes care of people in high-rise Toronto community housing apartment buildings to offer services locally to people who don't otherwise have them. We don't know if we can turn the corner on less frequent visits to the emergency department. Our emergency department is of course there to serve everybody, but if there are better local options for people, it behooves us to find it.

Ellen Gardner: I guess I'm interested in your own approach. Your own philosophy around coming up with those creative solutions.

Sarah Downey: My leadership philosophy is to empower the people I work with to go out and do the great work of this the organization. There's no standing in the way of the great people who serve this organization alongside with me. And so how do you become the greatest cheerleaders? How do you clear the paths for great and innovative solutions is something I think about frequently. Carmen Stumpo is the Vice-President, Programs here – I call him the vice president on the bike because he's always biking into neighbourhoods and working with people locally to find solutions. It's important for a leader to understand the core strengths of an organization. To be able to mobilize what the sentiment is. It’s about mission and vision and then figuring out the strategies that get you there. 

Ellen Gardner: How have your previous positions – I know you were at CAMH and at Princess Margaret –formed your philosophy today?

Sarah Downey: Yes, so you learn something in every single job you go to. And I've had the great fortune to have been mentored by superb healthcare leaders from Bob Bell to Catherine Zahn, Tom Closson. I worked at The Ottawa Hospital too before I moved to Toronto. So I've been surrounded by such incredible talents that I've been able to observe first-hand and see in action and that has certainly helped me. But I think it comes back to something I said earlier, every organization is different. They all have stories. They all have cultures. They all have ambitions. And we may call them something slightly different. Whether it's around mental illness, whether it's around cancer or in an organization like this, it's all those diseases. It's trying to keep a community healthy. It is to get out and meet the people and understand the ambition.

Ellen Gardner: You know, there's obvious stresses in the job. I know you are a very positive, optimistic person. So how do you, in the face of stress, stay upbeat?

Sarah Downey: I've actually learned a lot about that since coming to this organization where there is a phenomenal approach to physical and mental health in the workplace. Some of the things I do personally is, I can walk to work. Knowing that my children are two blocks away and still need a mom and still need babysitters and those types of things. It's been a peace of mind to know that I can run over and see a principal if I need to or talk to a teacher or drive somebody home if they're sick. It's my children who probably call me to account the most for either being stressed or not spending enough time at home. And so for me, it's being able to include them in the work and the purpose of the hospital. They’ve celebrated events with me here. We did the Remembrance Day ceremony on November 11th, which was a Saturday this year and they helped me lay the wreath at the hospital. You know, I tell them stories when I go home about the people I’ve met or some of the challenges we face and what we should do about it.

Ellen Gardner: Can you tell me about a story or a challenge that you've really had to come up against and you've really had to pull deep to overcome. Is there an incident or an event?

Sarah Downey: Of course there are many, many. Maybe the one that's the toughest these days is in fact the impact of the winter surge volumes on the morale and the volumes of care that we've had to deliver in this hospital over the last five or six weeks. Every winter is hard. We went into this winter with an additional 14 beds open. Many days that has surged up to 20. But we prepared some infrastructure this year to help us get through. It's called the flu season, but of course it's more than just the flu. And I tell you, the staff of this organization have just been working flat out. And they too have fallen sick. So we do safety calls every morning at 9:15 and we hear the status of all the units in the hospital and how they're coping with the volumes of care. There’s been an incredible surge on ICU beds.

Sarah Downey: So, how do we manage it? A, it's to be present. To stand beside people as they go through these tough times. To let them know that you're there and you understand how busy an emergency department is, how hard it's been to balance access into the ICU. We brought our MPP in to show him, to thank staff for all their work, and to get the message to government about how tight and tough it's been over the surge season.

Sarah Downey: When it settles down, there's things we can do to thank people. Like the breakfast for the A3B3 staff that the executive team is going to do (it was a United Way fundraiser that got them that). It’s important to go back out and thank people for the work they've done and hopefully build that resilience so that they can come back to work the next day and continue the very hard work on the front lines.

Ellen Gardner: So you probably know about the Patient Ombudsman’s office in Ontario. Their first annual report came out and of all the complaints, the biggest problem is communications.

Sarah Downey: Communications. Sure.

Ellen Gardner:  People feel like they want to be treated with more compassion; they want to be a greater participant in decisions. When you read that, what was your impression?

Sarah Downey: You know we get our own fair share of complaints. While not many will come directly to the CEO, I do have visibility to them. And so we have a weekly huddle, a management huddle on Tuesdays at one o'clock. We start those with a story and the face and the voice of a patient explaining to us the care and the service they received in our hospital. Our board meetings start with that video and so it does keep us grounded in their voice. We have a lot of patients who sit on committees, who sit on hiring committees, who sit on board committees, who sit on our major organizational committees. The idea of continuously bringing their voices into perspective with those we serve. They are front and centre in the conversation we have about trying to make that better.

Sarah Downey: I'm not just surprised that it's communication. This is a stretched healthcare system. And there's been, as we just talked about, a lot of demand for care, not a lot of time in which we can do that and some unpredictability of what's required when. Speak to any healthcare provider – they always feel rushed and are trying so hard to deliver as much safe care as possible. Sometimes they are unable to meet that. And I think one of the things that suffers in those moments is communication and to be able to explain to people how long they'll have to wait or what's coming up next or when they can get the tests that they need or the answers to their questions. It's a struggle in the healthcare system. It's a struggle in a community like this as well because of course, English is not always the language spoken by people or they don't understand how the health system works. And so the need for navigation is key. We try hard to find solutions to those challenges.

Sarah Downey: For instance, we are participating in what's known as a patient-oriented discharge summary. As people experience transitions in care, it’s important for them to understand when they leave this hospital, they're going to know what to do should they fall ill again, to fill their prescriptions, to get the rehabilitation care, to get the home care service they require. At those critical moments of transition, we’re trying to ensure the people understand what it is they need, which is an indication of effective communication.

Sarah Downey: The other important tool we try is the Teach-back Method. This is the idea that the patient should be able to tell you what the plan is and are they able to teach it back.

Ellen Gardner: You talked about some of the important mentors in your life. People who you feel guided you along the way when you needed that kind of help. People like Tom Closson and various people. Can you tell me what they taught you and if you can give me a specific example of one or two lessons you really remember?

Sarah Downey: There are many, many and I not infrequently hear their voices in my head in certain situations and it causes me to remember fond things. One of these I learned from Bob Bell, who's now Deputy Minister, is to be ruthlessly positive. What people need in a leader is somebody who is ruthlessly positive about the future and to make them feel like there's a strong way out of the situation they face. And so I often think about that when I'm feeling down or feeling something's really hard. All the while being realistic. You can't be positive to a flaw, you need to acknowledge how tough things can be, but then you have to find the ruthless positivity.

Sarah Downey: Catherine Zahn taught me if there is a problem, name it. Don't ignore it. Give it a name and address it head on. Don't just ignore problems as they exist but give it a name and find solutions to it. I'll give you an example. It might not surprise you that morale is low in hospitals. Our own employee engagement survey results are 10 points lower than they were three years ago. That's not a surprise. But we have to find ways to rebuild trust in organizations. And so get out there and say it. Own it. I'm in part responsible for the situation that this hospital is in. I need to be sincere in engaging people and turning that around.

Ellen Gardner: Your own persona, and I read your blog and I've seen you at many events – you’re always friendly and outgoing. I know that's your natural temperament – how do you balance that with the toughness needed for a CEO? Is it a natural blend for you?

Sarah Downey: What's motivated me in my career with people is when you have a genuine connection to people. Right? I've worked hard for bosses... I cared about them a lot and I wanted to please them and I valued the work that they'd ask me to do. Hopefully that's what motivates others, the genuine connection and connection to the leaders. While I always try to be respectful and genuine, at times you have to be clear and direct and stand in front of people and say that.

Sarah Downey: There's a lot of, I don't know if it’s grief or frustration – about what never feels like enough funds in the healthcare system to do all the work that people imagine having to do. At a certain point though, we cannot run a deficit. We have to put a lot of money aside for our own redevelopment, and so that means saying to people, I appreciate how hard it is not to be able to have all the tools and people around you that you feel you need to deliver the best care. But we have to balance the care of today with the idea of redeveloping. That’s the importance of staying strong in the fiscal side in order to have a future for this organization.

Ellen Gardner: Are you optimistic about the state of our healthcare system?

Sarah Downey: I'm optimistic. But I'm a little worried. Maybe I'm cautiously optimistic. As a taxpayer in Ontario and as an Ontarian, I wonder how much more can we put into the healthcare system. I feel on the other hand, that this hospital needs so much more money to fulfill the ambitions and the dreams of the people who work here every day. And there's a dichotomy in that. And so the question is, how do you balance it? How do you feel good at the end of the day that you've delivered the kind of care you believe you're capable of all the while meeting the goals of efficiency and access and satisfaction that everybody has in population health of the system? It’s a struggle many days.

Ellen Gardner: The large donation that came into the hospital was obviously a huge boost. Did you notice a big change in the feeling around the hospital and just the way people thought about the future?

Sarah Downey: Gifts of that magnitude, A, come in over time and B, are focused on, in the case of the Garron gift, a lot on capital equipment. Some chairs that we'll establish and a bit of innovation funds. I think people feel optimistic about that. But then immediately afterwards, you have to cost control because it doesn't fund the operations of a hospital. It’s hard to feel really positive about the new imaging equipment we're procuring, when we’re having to become more efficient or change staffing models in areas because we can't afford certain levels of care, for instance. So we’ve had to balance those two worlds. It’s great – a $50 million gift is a massive investment in a hospital like this. The largest gift given to a community hospital in Canada. It certainly secures our future differently and it’s very helpful in the time of redevelopment to know that we will be able to put new equipment in the redevelopment.

Sarah Downey: But at the same time, it's a system with a lot of stresses and restructurings and it's important to be able to explain that to people who say, "Didn't you get just 50 million bucks?" You can spend $50 million pretty quickly and not have anything left for it. Truthfully, donors don't give money to pay for things that they think the government should be paying for. They want to invest in things they know will make a difference. Communicating that message is a challenge, but we're enormously grateful for the investments by the Garron's and the future it creates for us.

Ellen Gardner: What are you looking forward to Sarah?

Sarah Downey: So many things. So I have a major redevelopment project and while the in between is not going to be a lot of fun, which is to build an eight-story patient care tower beside and connected to a living, breathing hospital. So the in-between will be a bit of a struggle, but I'm really looking forward to having the types of physical facilities that this hospital and this community really deserves. I'm excited about some of the health system solutions we're trying to work on to help communities and neighbourhoods at risk to have better access to healthcare and ultimately better outcomes. That motivates me every day. And of course, to continue to offer hospital services to those that need it. We do everything here, from deliver babies to palliative care. And if families will come here for service across generations and across their own lifespan, I can look forward to continuing to try to be an outstanding healthcare provider to the people in East Toronto.

Ellen Gardner: So you've come a long way from that early thinking around, "I want to run something."

Sarah Downey: Yes.

Ellen Gardner: How do you feel about that now?

Sarah Downey: So I love this business. I love the people of it. I love the issues of it. They're incredibly relevant, when you work in healthcare, you work with incredibly brilliant and compassionate people. Incredible professionals. And it's hard to imagine it's been 25 years already, but there's still so much more to do. And I'm so thankful every day that this is the career I chose. Because there's been so much to learn, so much to stress me, and so much reflection that I've been able to do. I just feel like there's just so much more before I really am able to run something properly

Ellen Gardner: Well, thank you so much Sarah for speaking with us today. Michael Garron is such a valued partner of HIROC. It was an honour to have you as our first guest on Healthcare Change Makers. Please join us again as we see change through the eyes of another healthcare leader.