Episode 11: A career defined by being open to opportunity with Rob MacIsaac, President and CEO, Hamilton Health Sciences

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Although he believes you need a plan for your career, Rob MacIsaac has found that being open to opportunity and taking chances has led him in some interesting and rewarding directions.

Today, your host Ellen Gardner, Communications and Marketing at HIROC, speaks with Rob MacIsaac, President and CEO of Hamilton Health Sciences.

Rob MacIsaac followed his father’s advice to become a professional, but after a couple of years as a lawyer, he realized he was drawn to public service. Without being a subject matter expert in any of the diverse roles he’s had – at Mohawk College, at Metrolinx, as mayor of the City of Burlington – Rob has developed a leadership philosophy built on humble inquiry and bringing people together around a vision. He is now CEO of one of Hamilton’s biggest employers, Hamilton Health Sciences, a city onto itself comprised of 7 hospitals, a cancer centre, an urgent care centre, and over 11,000 employees. For someone who loves change and rushes toward big projects, Hamilton Health Sciences is a perfect fit – the hospital is in the early stages of a massive 20-year transformation plan called Our Healthy Future.   


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. I work in marketing and communications at HIROC, and today we have the good fortune of talking with Rob MacIsaac, who is the President and CEO of Hamilton Health Sciences. Welcome, Rob.

Rob MacIsaac: Thanks. Great to be here.

Ellen Gardner: Rob, your organization is a family of seven hospitals, a cancer centre, an urgent care center, over 11,000 staff, probably even more than that. How do you stay connected to such a large group of people across all those organizations?

Rob MacIsaac: Yes, it can be a challenge, particularly because we're a multi-site organization, so you know, just leaving my office and walking around, as you might do in the context of a single site organization, isn't really as effective as it might be. We have a variety of techniques that we use. When I first started here, we began recording a series of videos called ‘Teach Rob Your Job’, which actually ended up being fairly well received. It was me going out and speaking with a frontline worker and spending an hour or two with them, and just having them explain to me what their job was and how it contributed to the organization. Then we would broadcast that across all of Hamilton Health Sciences.

Rob MacIsaac: We changed the format a tiny bit. We're now calling it ‘Three Things You Should Know’. I go out and I meet with, again, a frontline worker as a rule, and ask what are the three most important things about your job that you want me to know? Again, that gets sent out over our communications channels here at the hospital. That's a good way for me, first of all, to have kind of direct contact with everybody who cares to watch. It's also really effective because the people who I'm meeting are generally so proud of what they do.

Rob MacIsaac: Beyond that, one of the major initiatives that we've developed here at Hamilton Health Sciences since I've been here is what we're calling CQIMS, or Continuous Quality Improvement Management System, that sees each of our units who've been rolled into the program have daily huddles. In a really deliberate way, I get out to those daily huddles, not to make a big speech or anything, but really just to show people that I'm out there, I'm on the floor, and that I'm listening to people's concerns and problems as they're raised. Also, seeing the celebrations that take place in terms of the great things that people are achieving across the organization. I do think it's important for people to have some line of sight to the CEO, and those are a couple of the things I do.

Ellen Gardner: Before you came to Hamilton Health Sciences, you were president of Mohawk College. What is one thing, Rob, that you took away from the education sphere that has influenced the way you work here at the hospital?

Rob MacIsaac: You know, I think that I might generalize that question out a little bit, because across the course of my career, I have not been a subject matter expert in any of the areas that I've chosen to work in. I frequently say that the first city council meeting I ever attended was the meeting I got sworn in at. For me, I have not come to any of my roles with this huge knowledge of the business that I was going to lead. What it's meant is I've had to develop a contribution around leadership for every role that I've been in, and every role that I've been in has helped me to learn more about what it means to be a good leader. That's really what I try to bring to every job that I come to – for me, leadership is a lot about humble inquiry, it's a lot about having a vision that's developed by bringing people together and developing a strategy around that vision.

Ellen Gardner: I guess the question is why healthcare, why Hamilton Health Sciences? What was it that prompted you to move into this position?

Rob MacIsaac: You know, one person who has been pretty influential for me is a guy named Clay Christensen, who's a professor of business at Harvard. He has been a pioneer in disruptive innovation, in understanding what causes disruptive innovation in a market or in a place. He wrote a book called How You Measure Your Life. I think it's a great book for people who are just coming out of school. He talks about having a plan for your career, and the importance of having a plan, but also taking the time or being bold enough to capitalize on opportunities as they present themselves, so not being really dogmatic about following your plan. It's good to have a plan, but it's also important to be open to opportunity. That's really the way I've managed my career.

Rob MacIsaac: For sure it became clear to me early on in my career that I really liked public service, that I was really interested in public policy, but I also tried to be open to opportunities as they presented themselves. At each point in my career, I was already in a pretty good job, but I was prepared to take a chance and make a jump based on an opportunity that was presented to me. When I was President of Mohawk College, I got a call asking me if I'd have an interest in this job. Initially I was kind of stand-offish, thinking what do I know about healthcare?

Rob MacIsaac: The hospital recruited with persistence, so I said okay, I'll throw my name in the hat. I did, so it was, I don't say this in a negative way, but it was kind of opportunistic. It was something that got presented to me and I thought, you know, that's a world class organization and there are very few opportunities in one's life to really have a chance to work in a place like this where people who are literally making a difference in the world. You know, it was exciting to me to think about it and throw my name in the hat, and then when I was offered the job, well, it was sort of, in some respects it was like a dog chasing a car. Once you catch it, boy, it's not necessarily as you anticipated.

Ellen Gardner: Well, you've had a lot of change in your career, but there is a theme of public service and giving back and making change in community. One of the big jobs you had was mayor of Burlington, which you did for close to 10 years. What was that job like? You must have felt like that was a great opportunity to have an impact on a whole community.

Rob MacIsaac: Yeah. That was an incredibly fun job. You know, I think when I left that job, I had a strong sense that I'd never have another job that was as fun as that job, which has probably turned out to be true. It was a job that taught me a lot during the time, the three terms that I served as mayor of the city of Burlington. It's a great community, so to be honest, it's hard for me to think of a better place to be a mayor of because I really love that city a lot. I was there at a really interesting time in the city's history where there were a huge number of opportunities that, maybe along with the administration there, and with my council colleagues, we were able to seize upon. Yeah, I would strongly recommend that job.

Ellen Gardner: Now, being the person who embraces big change, here you are at Hamilton Health Sciences and you are in the early stages of implementing a big 20-year strategy, a strategy that is really re-imagining healthcare in this whole region. It's called Our Health Future. How do you keep people aligned around a plan that's got such a long reach, and a very broad reach as well?

Rob MacIsaac: Our Healthy Future's really part of a much larger strategy for the hospital. You know, we're really focused on four big directions here at Hamilton Health Sciences. Part of it is operational excellence, which from my perspective is very much about this idea of aligning values and systems across the whole of the enterprise towards a common objective, a common vision. We are thinking lots about systems here at Hamilton Health Sciences. The second big strategy is making sure that despite the fact that we are a collection of sites, over time a collection of hospitals in a sense, because, you know, we've formed through a series of mergers, that notwithstanding that somewhat disparate history and physical status, that we're still thinking and acting like a system.

Rob MacIsaac: The third part of our strategy is really around strategic partnerships, and that's very much about being open to new ideas from other sectors. I think that healthcare, historically, has been pretty insular. There are a lot of smart people in healthcare, and it is in fact a very complex thing to organize and to deliver, but just the same, there are lots of ideas that we can import from the rest of the world into healthcare that I think can make a big difference.

Finally, population health, which is really starting to get us to think outside the walls of the hospital, to think about our profound connectedness to what happens in the community, and to start saying, you know, we can't just be endless suppliers of health care. Could we start to influence the demand for healthcare as part of our strategy moving forward?

Rob MacIsaac: Within those four big strategies, you're right, Our Healthy Future is a very important enabling plan. It sees us over the long-term consolidating our Hamilton sites down to two sites from what started as five sites, which is very much a strategy around sustainability and making sure that we're offering the fullest suite of services we can to our patients on those two sites in a way that we could never do over five sites. I think we're communicating that out. We certainly developed that infrastructure plan both with the inside community here at Hamilton Health Sciences, which you mentioned, our employees, but we also have our volunteers and our physician groups to think about, so the inside of the house was very much a part of developing this vision, but we also went out into the community.

Rob MacIsaac: You know, my experience at the city really helped us to design a great community consultation process where we held a series of Town Halls across the whole of the city and even in outlying areas beyond the borders of the city of Hamilton, where we asked people, you know, what is really important about healthcare to you, and as we think about the future of Hamilton Health Sciences, what are the things from your perspective that we have to get right?

We were able to distill that community consultation into a number of really significant themes and pose those themes as challenge questions to the inside groups working on our plan, saying here's what our community told us was most important to them. As you develop your plans for clinical processes and so on, how are you going to make sure that you're addressing what our community said was important to them? All of that really helped us to design the outcome of all those consultations, which is the Our Healthy Future plan.

Ellen Gardner: You seem to be the guy that runs towards big change, big transformation. Metrolinx is a big project. You did a transformation of the campus at Mohawk, and now this project. What draws you to those big projects, especially when you know how difficult they're going to be to achieve?

Rob MacIsaac: Yes, well I frequently ask myself that question when I'm in the midst of starting off a new project and things are going maybe not as well as I'd like them to be. I had a public works manager when I was at the City who said to me, you know Rob, in the course of every single project you'll ever work on, there'll be a point where you look around and everything's in complete chaos and you think, we are all in a lot of trouble here, which is pretty true. That has been my experience in almost every project that I've worked in. I think, you know, you'll never achieve more than what you dream, so you may as well dream big. From my perspective, we all have a chance in life to try to leave your community a little better than you found it, and why not try to go for something as big as you can possibly hope for?

Ellen Gardner: I was wondering, there's so much diversity across healthcare leadership in the country. How do you stay connected to other healthcare leaders?

Rob MacIsaac: Across my career, I've had a series of great mentors and one of my mentors said to me that in a chief executive position, you really have three responsibilities that you always have to keep in mind. One of them is obviously to your job, that you need to do a great job. You need to make sure your board is well aligned and that you're definitely working towards a common place with your board. The second big responsibility he would say is to yourself, that you need to maintain a reasonable balance between life and work, and you need to invest in yourself by taking the time to make sure that you're resilient, to make sure you're continuing to develop your skills.

Rob MacIsaac: The third area that he said you have a responsibility towards is your sector. That sectoral responsibility of being a CEO means that you need to get involved with sectoral organizations, so I'm a member of the Board of Directors of CAHO (Council of Academic Hospitals of Ontario). I think you have a responsibility to show up, to network with your colleagues there, to learn from them, to share with them, and to do all that you can to make sure that sector or sectoral organization is working well.

Rob MacIsaac: That's at the provincial level. At the national level I'm a member of the board of HealthCareCAN, and I'm the in-coming chair of that organization, so if all goes well, I'll take over the chair position in June. It is a responsibility that I try to take seriously, and I try to give back to the sector as much as I can. From my perspective, I get a lot of value meeting as many people in similar positions to me as I can, getting to know them, sharing notes and learning.

Ellen Gardner: You've been in this town a long time. You were born here, and you built most of your professional life in Hamilton. When you look at the city now, it's undergoing an amazing growth and renaissance, with people from Toronto moving to Hamilton. When you look at the city, what is it that you're proud of and that makes you smile?

Rob MacIsaac: I think in some respects you probably answered the question in the words that you posed it in. You know, my dad came here to Hamilton in the 1950s. He was born on a farm in Nova Scotia and went to St. FX and then what's now Dalhousie to become an engineer, and emigrated here to Hamilton. When he came here, this was an amazingly prosperous city. You know, there was this huge manufacturing base here in the city, and it was a ... you know, Hamilton's called the ambitious city, and it was very true, that moniker. My dad used to say, if you stand long enough at the corner of King and James, everybody in the world will walk past you. It sounds kind of funny now, but I remember those days back when I was a really little kid. When you did stand at the corner of King and James, those sidewalks were packed with people walking around. It was a hugely prosperous, busy city.

Rob MacIsaac: Subsequently, for a variety of reasons, many of which were well beyond the city's control in terms of changes in the global economy, Hamilton started on a downward trend that went on for many decades and it was very sad to see and tough to watch. When you look at the city today and its trajectory has definitely altered upward, I think that's the thing that makes me smile the most because you can see the city coming back. It's neat to see that a lot of the architectural heritage, because of the way that that economic cycle has gone, the economic heritage, or the architectural heritage, rather, continues, and I think we're now at a place societally where we recognize the importance of architectural heritage, so I think not only can Hamilton ride this wave of redevelopment and prosperity, but it should be able to do it in a way that preserves some of those great bones in terms of the some of the really cool buildings that you see here in the downtown.

Rob MacIsaac: It's a really interesting city. It continues to be a pretty gritty city, there's no doubt about that, but that's part of what Hamilton is, so it is what it is. Frankly, it's a pretty charming place.

Ellen Gardner: What really motivates you, Rob? You know, keeps you going to the next thing and dreaming big and aspiring to continue to make change and make an impact?

Rob MacIsaac: You know, I think for me I would say one of my values is just I do feel a strong sense of duty to try to be the best you can be, to try to make the biggest contribution you're capable of making. I feel like that's an ethical duty that all of us have. Probably not everybody shares that, but for me my principle motivation is if I think I'm capable of making a positive change, I feel like I have a duty to do it.

Ellen Gardner: Tell us what books are on your night stand, Rob.

Rob MacIsaac: Well, you know once a year I try to get to a conference in New York City, which is generally about big trends in organizational leadership. It's called the World Business Forum. Last fall I attended that conference and saw a fellow named Daniel Kahneman speak, who is a Nobel Prize winning author, academic in the field of behavioral economics. He wrote a book called Thinking Fast and Slow. It's a book about decision-making and how people make decisions, how people make mistakes in the decisions that they make. That's a book that I'm currently looking at. I think it has lots of interesting lessons for those of us in healthcare.

Ellen Gardner: Can you even share maybe one of those lessons with us?

Rob MacIsaac: Well, he talks about how people make decisions and how there are really two fundamental systems for how we make decisions. One is sort of intuitive and that's sort of thinking fast, and the other is kind of calculating based on reasoning. That's thinking slow. He talks a lot about how things that seem, answers that seem patently obvious frequently are not, and the kind of traps that people fall into when they make bad decisions.

Ellen Gardner: You probably need a combination of thinking fast and thinking slow.

Rob MacIsaac: Well, sometimes you have to think fast and hopefully you make the right decision. Interestingly, he talks about how people make better decisions when they're in a good mood, so I think maybe that's the main lesson from the book.

Ellen Gardner: Well, it's been a real pleasure talking with you, Rob. Thank you very much.

Rob MacIsaac: Thank you. Thanks for having me. I appreciate it very much.

Ellen Gardner: Good luck with all your future plans. We'll be watching the 20 year plan unfold with great interest.

Rob MacIsaac: Yes. Thanks. Thanks so much.