Episode 06: In conversation with Karim Mamdani

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As CEO of an organization dedicated to the assessment and treatment of people living with complex and serious mental illness, Karim has created a culture built around self-care, compassion and having real conversations.

Today, your host Ellen Gardner, Communications and Marketing at HIROC, speaks with Karim Mamdani, President and CEO of Ontario Shores Centre for Mental Health Sciences.

With a strong interest in building sustainability in the healthcare system, Karim started his healthcare career working with the OHA and PwC in systems management and finance. Before coming to Ontario Shores in 2006 in the role of Chief Operating Officer, Karim worked at a number of academic health science centres – the Centre for Addiction and Mental Health, University Health Network and the Hospital for Sick Children. He was drawn to mental health as the area in healthcare where we have yet to achieve significant breakthroughs. As the 2017 recipient of the Aird and Berlis LLP Award for CEO Human Resources Champion, Karim has cultivated a leadership style that encourages open and honest conversations, ongoing training, and being as human as possible.



Karim Mamdani: Think back a year ago and what was the worst thing that you were dealing with? You go back a year ago and you think, "Yeah, you know what? We managed that somehow, right? I mean, it's a year later. We're okay."

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 those leaders about the joys and challenges of driving change in our complex and demanding healthcare organizations. 

Ellen Gardner: Good afternoon. I'm Ellen Gardner from HIROC Marketing and Communications, and today we have the good fortune of talking with Karim Mamdani, who is the CEO of Ontario Shores Centre for Mental Health Sciences.

Welcome, Karim. Karim, I want to start off really going back a little bit, and I'd like to ask you about your childhood. What was your childhood like?

Karim Mamdani: It's a story that's really quite unique, I think, and yet is so much a part of the Canadian mosaic, which is I'm a second generation immigrant, wasn't born in Canada. I was born in East Africa. My parents came over in the early '70s, escaping from a regime in East Africa that really expelled all of non-African inhabitants. We came to Canada, and I had the opportunity really to grow up as a Canadian, but with many of those conflicts that arise from being an immigrant as well as being somebody who wasn't a part of the Canadian family at the time.

Ellen Gardner: What did you learn from your parents through that experience?

Karim Mamdani: What you learn is hard work, integrity, honesty. It's about those things that are immovable in the way in which one grows up. My dad has this story – he was working multiple jobs trying to put food on the table, and then one day he was working pumping gas at a gas station. We were in Guelph at the time. He was pumping gas that day. He came home, reached into his pocket, and realized that the $10 that he had made for pumping gas that whole day was gone. It must have fallen out from his pocket, he thought.

He literally walked back to the place that he was working, looking for this $10 that he had earned that day that had fallen out of his pocket. Those are the sorts of stories that we grew up with, about the incredible hardship that comes from just working to make ends meet.

Ellen Gardner:  Your first step in your career was really in the financial area, working in financial methodologies, and working in consulting at PWC. What was it that you learned through working in those areas?

Karim Mamdani: I'll take the liberty of maybe going back one or two steps, because I think they're really relevant as to why financial services or financial modeling was important. I wanted to go into healthcare because I believe that the two most important things that you can offer any individual to make them successful, to make it possible for the next generation to be better, is healthcare and education. If those two things are available to new immigrants, to people who are disadvantaged in any way, they have the ability then to make themselves better.

When I was going through university, I always wanted to go to healthcare, but I wanted to be able to do it in a way that would preserve healthcare, so it wasn't necessarily about the individual interaction between a patient or a client and myself, but more about how do I make sure that healthcare is there for the next generation and the generation after that. How do I make sure that that incredible gift that we have as Canadians is preserved and is something that we can look forward to in the future?

I came at it from this notion of what's the sustainability of this model of healthcare, and how do I make sure that I can influence healthcare in a way that allows it to be successful? I did my undergrad at U of T, and I did it in biochemistry and physiology, that being kind of the interest that I had in healthcare and in medicine. Then I did my MBA at McMaster University, but I did it in health systems management and finance, and so bringing together the health systems component as well as the financial component. The idea was to be able to leverage that so that I could influence healthcare in a larger way.

One of the first roles I had was at the Ontario Hospital Association, and it was really working on financial models to determine, even at that time, what was the most efficient way of being able to deliver healthcare, how do you measure that, what is the cost of delivery of healthcare, etc. I was working at the Metro Toronto District Health Council on the hospital restructuring project, which at that time in the '90s was the big thing. We were all reorganizing the hospitals. I gained quite a number of skills in that work, data analysis, researching new methodologies. That was really something that PwC was very interested in.

I went to work for them and got the opportunity to do restructuring of hospitals; got the opportunity to work in First Nations communities to help them establish better financial controls over their work; to work with a really neat team, a very tight team of individuals, all of whom were high performers. We all wanted to change the world. It was a great experience.

Ellen Gardner: Healthcare has been your main career. How did you decide to make a focus around mental health, your area of specialization for many years now?

Karim Mamdani: The reality is that if you look across healthcare, we have actually been pretty successful in most areas of our endeavour. If you think about things like cancer, you can today type a tumor, you can identify exactly its genetic makeup, you can assess whether a particular cocktail of drugs is going to be effective against that cancer. We were all worried about the AIDS epidemic back in the '80s. We now have retrovirus drugs, vaccines that can be utilized to help people and manage the illness.

When Ebola was the rage just a few years ago, we were all worried about it eliminating humanity, but we figured that out. We figured out how to treat Ebola and how to take care of the population that's affected by that. But the one thing we haven't been able to figure out has been mental health. Mental health is still the scourge. It was the thing that attracted me. It was this one group of people that we still had not yet done enough for, and we had not yet achieved a breakthrough for.

Ellen Gardner: Then how can people in positions of power like yourself really have an impact on real mental health problems like suicide and depression, problems that are very prominent right now, and yet they seem to be bigger problems that society and even healthcare is having trouble dealing with? Tell me about that.

Karim Mamdani: I think this is a societal problem. Each of us has a role to play in any societal problem. Part of it is about stigma, and the reduction of stigma, and the ability to come out and have the conversation. The first place you’ve got to do that is to tear those walls down and allow people to have the conversation about what they're going through and what we as society needs to be able to do.

Ellen Gardner: I'm going to make it a little personal, then, and ask you, what have you done since you've been at Ontario Shores. You worked at CAMH. You've been working at Ontario Shores for a little while. What have you done? Maybe you can tell me a story or two about an incident or a way that you feel you've impacted the change and maybe the reduction in the stigma around mental health.

Karim Mamdani: We do a lot of work around stigma in mental health. We run a program called TAMI, which is “Talking About Mental Illness” for young people. It’s an award-winning program that originated here at Ontario Shores along with our partners in the community. What we do is we bring young people in to receive two days of training, and talk about mental illness, and look for the signs of mental illness. Then they go back as ambassadors within their schools and act to try and find and create environments within their schools that are conducive and receptive to people who are suffering from a mental illness.

We also do a campaign every year, usually around October, which is Mental Health Awareness month, where we're out there talking about some of our clients, the stories that they have to share – making that the focus to show people that recovery is possible, that people who suffer from mental illness can be very productive individuals within society. We also do a lot of work around bringing new knowledge in mental illness, whether that's in research or in knowledge translation. From a stigma point of view, that’s what we do.

What I think we also do in the area of being a good employer is we provide training to our staff. We provide training to our management team. I try to make myself as available and as human as possible, because to me hierarchies are constructs. They're not real. They're about a way that an organization needs to conduct its work, but anyone who believes in a hierarchy personally, I think, fails in recognizing the work that everyone in the organization does.

Part of the work that I try to do is create a culture where everyone can approach each other and have conversations, and so personally, we do a bi-monthly CEO forum. I do a lunch every month where we randomly select staff from across the organization and they have lunch with me. In fact, I had one just this afternoon with staff. I go and visit evening staff once a month and try and do a couple of units – we go in the evenings and have conversations with them.

All of those things are about conversation. They're not canned presentations or anything like that that. We really try and elicit conversations that people can have, so that the environment that they're working in is a healthy environment – they feel they can ask questions and get transparent answers.

Ellen Gardner: You were just awarded the Aird & Berlis LLP award for CEO Human Resources Champion, so congratulations for that.

Karim Mamdani: Thank you.

Ellen Gardner: Mike Boyce, who's your board chair, and he's our VP Claims, has said that you really look for every opportunity to engage with employees and get feedback from staff and take action. So, maybe you can tell me, what are some of the things you do every day, like that lunch you just mentioned, to help employees feel trusted and valued?

Karim Mamdani: Well, I think it's never one person. Just treat each other in a very human way. If I think about my mom, one of the jobs that she had was working in a factory. She used to pack taco shells. She used to come home and I would see burn marks on her arms from where she was burned from the oil from the taco shells. Every single person in this organization can easily have burn marks. They can carry trauma because of the work that they do, or interactions that they have, and it's important that we recognize them in the human way. They're somebody's mother. They're somebody's wife. They're somebody's daughter or sister. They deserve an environment that is a healthy environment.

Ellen Gardner: Ontario Shores is a partner and subscriber, and we were very fortunate to have somebody from Ontario Shores come do a mental health awareness seminar with our staff. Christina Fuda came, and at the request of staff we actually learned about anxiety disorders, which was very fascinating for us. In fact, we've been doing mental health first aid seminars, and it's very important to HIROC to pay attention to employee mental health. I don't have to tell you that that's an important thing. But do you feel organizations are doing enough to proactively address mental health with their employees?

Karim Mamdani: It's a tough question. First of all, congratulations to HIROC and the team there, to acknowledge and reach out and say we would like an opportunity to learn a little bit more, because education is the first step towards really trying to address issues that may exist within the workforce.

I think one of the big challenges that we have is that often people think that it isn't a part of their workforce. I would say to those individuals we know that one in five people, or one in four according to some of the statistics, suffers from a mental illness. If you're an employer that has 1,000 employees, there's a pretty good likelihood that you have anywhere between sort of 250, 300, maybe 150, but it's in that ballpark, of people who have a mental illness, or have had a mental illness, or may through their work get a mental illness.

Let's first of all not be blind to the fact that it is real, and then once you acknowledge it's real, then it's like any other disease group. If you looked at your medical claims data and realized that musculoskeletal injuries were high on your list, you might say, "Okay, I want to put a program in place to make sure that the people who are suffering that way, that we can minimize the suffering". There’s also a financial payback for the organization.

I think mental health is in the same way. We have a lot of absenteeism or presenteeism that takes place because of mental illness, and the healthier that we make the workplace, the better the likelihood of us recovering that energy and that creativity that employees bring.

Ellen Gardner: At HIROC, partnering is very important to us, and I can tell through the way you talk about Ontario Shores that partnering with other organizations is a big part of your model. Can you tell us, then, how you continue to partner with other healthcare organizations?

Karim Mamdani: We partner because it's what we need to do to deliver for our patients, and so I'll spend just a moment. Our patients, our clients, are treated through a continuum of care right across the healthcare system. Our job is really to find a way to create that continuum. The only way you can do that is by building partnerships, building relationships that allow us to be able to work across those silos and engage partners.

There's a group of four psychiatric hospitals in Ontario that are freestanding psychiatric hospitals. Many of the other large psychiatric facilities are part of other acute care institutions, but the four of us are freestanding, so that's: CAMH, The Royal Ottawa, Waypoint in Penatanguishene, and ourselves. The four of us work together. We have done work around measurement and looking at things like wait times.

Aside from just doing work that's related to measuring performance and monitoring performance, we are also now working with the government to collectively deliver psychotherapy right in the community. We have a partnership here locally with our northeast cluster which includes Peterborough Regional Hospital, Northumberland Hills Hospital, and Campbellford Memorial Hospital. We always think of people that we work with as our partners. The relationship, therefore, is deeper than a vendor relationship, or deeper than a casual relationship. It's about being a partner. It's about meeting the needs of our community and the community of the partner that we're working with.

Ellen Gardner: Your roots in this community are so deep. You're about to celebrate 100 years.

Karim Mamdani: Absolutely.

Ellen Gardner: I know you haven't been around that long!

Karim Mamdani: I hope I don't look I've been around that long!

Ellen Gardner: As a CEO, your strategic focus is usually on the future. It's on where are we going. How then, do you keep your eye on the future but also on keeping a foot in the past, and make sure employees understand that this is where we started, this is where we came from?

Karim Mamdani: I think it's about honouring the past. I think it's about honouring the great work that people did in this organization that made it possible for this organization to survive 100 years. What we were 100 years ago or 80 years ago is never what we're going to be today. As individuals, we learn, we evolve. And as organizations, we learn and evolve.

The treatment modalities 60 years ago are not what they are today. We don't necessarily need to be proud of that, but we do need to be proud of the care, because that's been something that hasn't changed and that people have always brought to this organization: incredible compassion, incredible desire to help those that are less privileged than us. But by the grace of God, right?

We know more and more that the illness is as a result of brain changes or genetic changes, and so by the grace of God, it could have been one of us, and there is incredible compassion in this organization for those individuals, and the care and the love that they give them. That's something we should honour. That's something that we should celebrate. We've got a whole year of celebrations lined up. We kick off on October the 23rd of this year. October 23rd of 2019 is when we officially turn 100.

We look forward, while we preserve the incredible legacy of caring. We start to think about ensuring that we have the ability to leverage and become better going into the future, while preserving the past.

Ellen Gardner: 100 years ago, Ontario Shores would have looked a lot different, a lot smaller, but the focus was still on mental health.

Karim Mamdani: It was very much on mental health. In fact, the history is that CAMH at the time was sort of burdened and could no longer accept any new clients, or patients, at the time. There was a desire to open up a new facility in Whitby that would allow for care of those individuals. Now, care was very different, and we had a farm and orchards. People lived here, and they lived here for long periods of time, many in fact lived out their lives here. That isn't the model of care anymore.

But yeah, we would have been larger in footprint. We would have had hundreds of acres of land. But we would have been a smaller entity because we were only looking after those individuals, and likely those individuals didn't leave the care of those people at that time.

Ellen Gardner: We know that being a CEO is a high-pressure job. I don't have to tell you that. Those pressures don't diminish over time. In fact, I think they grow. How do you, Karim, look after your own mental health?

Karim Mamdani: Yeah. I'd say maybe three things, and I hope I remember them all, to get them out. The first is somebody once told me if you're coming back from your vacation, start planning your next one. In my mind, it's recognition that you've got to put your head down and just live, breathe, and be consumed by the work during that period of time, but you see a light at the end of the tunnel.

I think the other is that you find the tools that make you grounded, that make you resilient, whatever those are. It used to be, for me, that I'd try and find opportunities for meditation or opportunities to read in quiet areas. Whatever is right for you to be able to do that work, you've got to find the tools that will help you.

Then the third thing would be don't take yourself so seriously, right? And I have two stories in that one. Somebody told me, "Think back a year ago and what was the worst thing that you were dealing with?" You go back a year ago and you think, "Yeah, you know what? We managed that somehow. Right? I mean, it's a year later. We're okay." Whatever crisis is in front of you today, a year from now it's not going to look so bad. Don't make the problem bigger than it really is. Know that you've got great people around you. You've got great resources that you can apply to solving that problem, and it'll be fine.

The other story is just you've got to have that optimistic attitude. So that means that if you have a really big problem today, when you get up in the morning it's a brand new day. That problem you just got to be able to put away. You've got to be able to say, "Where am I going to take the organization past that problem? What's that vision that I want for this organization?"

Ellen Gardner: I really want to thank you, Karim, for spending time and talking to us. Your style, your compassion, your caring, your optimism as a leader, we know it's celebrated. Thank you so much.

Karim Mamdani: My pleasure.