Episode 16: Ensuring that Children are not Treated as a Disease Group, with Alex Munter, President and CEO, CHEO

Episode 16 with Alex Munter

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The biggest pressure on our healthcare system is not an aging population but chronic disease. For Alex Munter, putting children on the path to lifelong health isn’t just giving them the future they deserve, but will ensure the sustainability of our healthcare system.

Today, your host Ellen Gardner, Communications and Marketing at HIROC, speaks with Alex Munter, President and CEO of the Children’s Hospital of Eastern Ontario (CHEO)

One of the misconceptions people have about pediatrics, according to CHEO President and CEO Alex Munter, is that people think of it as a service line, similar to oncology or rehabilitation. This is a mistake says Munter, who stresses that being a child is not a diagnosis and that we need a unique, tailored strategy for children’s health. After 11 years on the job and watching the youth and child population continue to grow, Munter is leading the conversation on social media, and among families and staff at CHEO, about the value and necessity of investing in the well-being of children.


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 morning. My name is Ellen Gardner. I'm with HIROC marketing and communications. And today we have the pleasure of speaking with Alex Munter, president and CEO of CHEO, the Children's Hospital of Eastern Ontario. Alex, I wanted to ask you, first of all, where were you when you made the decision to join CHEO?

Alex Munter: At that time I was the CEO of Local Health Integration Network here. I had previously run Ottawa's largest child and youth mental health agency, and I actually had not applied for the job because I hadn't been at the LHIN all that long. And so I went to Dr. Keon, he was the chair of the LHIN board. And he's the founder of the Heart Institute, a real pioneer in cardiac surgery in Canada. He has always been a huge advocate for CHEO and children's health, and he was so positive and encouraging. He was also my boss, right?

The mission of this organization, it commitment to help every child and young person live their best life is so awe-inspiring. The team here is so inspirational. Job interviews are like a date, and the chemistry was awesome. It was just so exciting and the opportunity to be part of this team and part of this organization's mission. They called me back and eight years later here I still am.

Ellen Gardner: You've spoken publicly about the need for children to be part of the conversation around hallway healthcare, especially as the Ontario health teams take on this challenge. In a perfect world, what does that look like to you?

Alex Munter: One of the things that sometimes happens in the healthcare system is that people think of pediatrics as a specialty. They think of it as a service line along other service lines like say oncology, critical care, rehabilitation, mental health and so on. It's really important to remember being a child is not a diagnosis. Children are not a disease group. So when we start organizing the healthcare system on the basis of service lines or medical specialties, we really lose sight of the fact that kids are a population. They're a unique population when it comes to the healthcare system, how healthcare is delivered and who's involved. The ecology of children's lives is different and that means children's healthcare needs to be different, organized differently and have unique and special attention.

Alex Munter: The reason for that is that the child and youth population in Ontario in Canada is growing. There'll be 600,000 more kids in Ontario, 1.2 million more kids in Canada in 20 years. So we know the demand for these services is going to increase. The pay-off of these services in terms of the value to our society is putting children on the path to lifelong health.

All of that means we need a unique tailored strategy for child and youth health. When we don't, what ends up happening is decisions that may make sense for the system as a whole or priorities that might be important for the system as a whole, either simply have no benefit for kids or in an unintentional way, actually harm children's healthcare. We've seen lots of examples of that in the past.

Ellen Gardner: That's quite a positive thing that children, that our youth and child population is growing so significantly. But that actually means that as the population grows – and you've made this case yourself – we need to be making a case for investing in children's health. You've given it a name, pedianomics. So, on that side of things, what are some of the risks that we're taking by not investing in children's health?

Alex Munter: Two things. First of all, the most important reason to invest in the well-being of children is so that kids get the future they deserve. Every child is entitled to a future where they can live out their potential and their best life and investing not just in children's health, but in education and childcare and in social services for families is crucial to that.

But if you want the business case, let's look at the pressure on the healthcare system. There are lots of conversations about an aging population, but in fact the biggest pressure on our healthcare system is the prevalence of chronic disease in Canada, which is higher than in most Western developed countries. In the Ontario healthcare system, two of every $3 that's spent on treatment is spent on treating chronic disease. So if we can put children on the path to lifelong health, we give them the future they deserve.

Alex Munter: We also ensure the sustainability of our healthcare system in the long-term. Because if we can reduce those rates of chronic disease, that is one of the most significant things we can do to create capacity in our healthcare system. I often tell the story of a nurse here at CHEO – four or five years ago, I went to a retirement party for a nurse in our diabetes clinic. She had basically spent her entire career here in the diabetes clinic, and she observed the difference from when she started in 1974 to when she retired a few years ago. In 1974 the only patients in the diabetes clinic were those with Type 1 in-born diabetes. By the time she retired, a significant proportion of the patients and growing had Type 2 diabetes, typically related to lifestyle. CHEO had launched an obesity management program, our sister hospital in Toronto had a bariatric surgery program for teenagers. That's an indicator, right? If children enter young adulthood with the struggle of obesity that positions them to be using the healthcare system much, much earlier in their life for issues like diabetes or heart disease or other health challenges as much younger adults than they otherwise would if they entered adulthood on the path to lifelong health.

Ellen Gardner: We seem to be moving backwards when it comes to the incidents of chronic disease in Canada. It's a depressing fact, and it almost looks like we're failing our children right from the beginning. That is part of the struggle that you're engaged in, that we need to pay attention to these issues very early in children's lives before this becomes a chronic problem.

Alex Munter: It's interesting. If you look at a lot of those ratings, those international ratings that come out about Canada, there's lots to be proud of. They repeatedly and consistently report that Canada is one of the best places in the world to live and that's true. We're very, very fortunate here, but when you actually look at ratings around child well-being and child health, on many of those measures, we're either in the middle of the pack with a distinctly mediocre performance, and in some measures, we’re at the bottom of the pile. So ironically, and I've thought about this a lot because I think people love their children and they love their grandchildren, and they are passionate advocates for their kids. But I sometimes think we love our own kids, but not necessarily other people's kids. Because when you look at how we're doing as a country on some of these measures of children's well-being, there's a lot of room for improvement.

Ellen Gardner: Your passion comes through in so many ways. One of the ways we know you've had an impact is through your conversations with the healthcare community, with patients, with the wider Ottawa public on Twitter. What's been surprising or unexpected about being so engaged with social media?

Alex Munter: Well, social media is an interesting place. In some ways it’s the most raw and real of places, and in other ways it's a complete fantasy world. One of the interesting things that I've observed on Twitter, I would say in the last 12 to 18 months, and maybe it's always been there and I haven't noticed it, but one of the values of Twitter in particular for me, is the opportunity for dialogue to hear what people are thinking and saying. One of the things I've noticed in the last year or more is people increasingly being completely disinterested in dialogue. So if somebody tweets something to me, and they have a concern or a complaint or a problem that didn’t get resolved, my response to that is to send them my email address and say, "Okay, please send me all the details so I can look into it." I've had a number of instances where I've done that, and people haven't taken me up on that offer, but they've kept complaining. It's helped me understand that some people on social media aren't looking for solutions. Social media is just an opportunity to vent.

Ellen Gardner: Right. Yes. Would you say that most of the time what Twitter has done is kind of amplify the bigger issues as you've seen them?

Alex Munter: I got on Twitter at the encouragement of Leslee Thompson who at the time was the CEO of Kingston General Hospital and now runs Accreditation Canada. I remember Leslee saying to me that there was nothing that she had done in her role as CEO that had done more to spread the word about what they were doing in Kingston, but also give her information about what was happening in healthcare than Twitter.

I remember shortly after I got on Twitter, I saw a tweet about the nasal flu vaccine, which there had been some controversy over, but it had been approved by the FDA in the United States. I sent a note to our Chief of Infectious Disease to ask what the status was of the approval in Canada. She wrote back to me and said, “I’m always so impressed with how well read you are." I said, "Well Lindy, I'm well-read 140 characters at a time."

Alex Munter: So it's is a source of information. It is an opportunity for dialogue. It's a way to get your word out. Those are the things I like about Twitter. It's also a way to spread misinformation, a way to bully and harass. It's also a way to anonymously spread bile and hatred. And those are the things I don't like. I just saw this morning that Pinterest has taken action on misinformation about vaccination. That's a good example.

Alex Munter: When I was at my first job, when I was a teenager, I owned a newspaper, and I was acutely aware as the owner of that newspaper that I was liable for anything that was in its pages. Anything anybody wrote that was published in that newspaper, I was liable for. Any advertising that we accepted and ran, I was liable for.

Social media companies have been able to pursue the fiction that they're not a publisher. I think fixing that and making them accountable for what's on their platforms would change a great deal and fix a lot of the downside of social media. On balance though, I think there's more good than bad, and there are ways with all these platforms to try to manage the bad. That's why God invented the mute button.

Ellen Gardner: You have a challenging job, Alex. There are a lot of demands being made on you. And as you say, dealing with complaints and problems and creating a vision for the future of children's health. I'm sure there are some tough days for you. How do you keep reminding yourself of why you're in this job and what is it that keeps you inspired all the time?

Alex Munter: Oh well that's easy. You're right. If I'm in a day where you know, it's meeting after meeting and there's not enough money or this problem or that issue or this HR challenge, the kind of things that are the reality of the work and sometimes can get you down. When that happens, I just go upstairs. I just go onto the units. I talk to families. I talk to staff, see what's going on. And it reminds me of what matters. It reminds me of what it's all about. And it reminds me of the fact that this work is so important and this place is so special.

Ellen Gardner: At several conferences in the past year, you've spoken about the urgency of eliminating the harm done to the people we care for and healthcare. What is one thing that people should know about the work being done on changing the culture in healthcare to one that is focused on zero harm? I mean, how do we get to that and what should people know about that?

Alex Munter: On my very first day here at CHEO in 2011, there was a little boy in our intensive care unit who was an oncology patient. He had acquired an infection on the oncology unit and now was critically ill. He pulled through. He recovered from that infection. But on that day, on that first day that I was here, it wasn't clear that he would, and it was just such a stark reminder to me of that risk that exists in hospitals. My uncle died in a Canadian hospital of a hospital-acquired infection. So we've set a goal here of a zero preventable harm for patients, but also for staff and physicians because to create a culture of safety, we want everybody to be safe, and so that's about putting processes in place, that's about educating, that's about accountability.

Alex Munter: That's about transparency. There's no silver bullet. It really is a cultural shift and like many, many Canadian healthcare organizations, I believe there is an earnest shift underway in the leadership of Canadian healthcare organizations to move towards that zero harm goal. It requires a constant focus and dedication. I would say that some of the resource constraints we're under in our system are a challenge because as volumes grow, as acuity increases, capacity stays flat. So in the Ontario context, we have fewer hospital beds than really any other jurisdiction in the Western world, but I think our people across the healthcare system are up for it. A big part of that as well of course, is involving families and patients in the conversation and in the solutions.

Ellen Gardner: You know that at HIROC we are all about eliminating risk and reducing adverse events. We’re very fortunate to have you on our board, Alex. What's different for you sitting on an insurance reciprocal board compared to say any other board you've been a part of?

Alex Munter: The reason I joined the HIROC board was because I've been impressed with HIROC's commitment to eliminating harm. When you join the board of an organization, you want to contribute what you know and your experience and so on, but you also want to learn. And so for me, HIROC has been a tremendous opportunity to see what others are doing across the country, to obviously help HIROC drive that agenda of zero harm and patient safety, but also to be able to understand ways that we can reduce risk and increase safety in our system.

Sure HIROC is, at its core, an insurance company, but it's a nonprofit insurance company that's owned by healthcare providers who care about safety. I think it’s one of the hidden gems of the Canadian healthcare system, because it is driving that safety agenda. By pooling the knowledge and skills of all these member organizations, we're helping each other develop tools, practices, the data, the information, that cycle of continuous quality improvement that can help us achieve that goal.

Ellen Gardner: What is one thing that people would be surprised to learn about running a world class children's hospital?

Alex Munter: The first thing people tell me or ask me about working at a children's hospital is about the sadness. Isn't that a sad place to be? There are sick children and it's true. There are moments of unspeakable tragedy and pain, and the loss of a child I just don't think there's anything like that. You see the impact that it has on people. It is heartbreaking, but there is far more triumph in a children's hospital than tragedy. There's far more joy then sadness because in fact most of the time, and sadly not all of the time, but most of the time in fact, children do go home. They do have a brighter future. The impact of the care here does change the future. And so I think it is a place of hope and optimism more than it is a place of sadness. Not to underestimate those moments of tragedy – what they do is they really harden the resolve of our people to drive research, to find solutions, to do better so that all stories can have a happy ending.

Ellen Gardner: That is a wonderful bridge to our question about for you, Alex, because we know you've celebrated a few milestones in the past year, notably one of them turning 50. You're still a young, a young kid, Alex, but what for you, what are you looking forward to? What's next for you to conquer?

Alex Munter: Well, I've become a parent in the last year or so it's been an eventful year.

Ellen Gardner: That's exciting.

Alex Munter: I'm not sure I would call that conquer, but it’s certainly a lot of new skills required or new versions of old skills. I'm a remarkably blessed person. I count my blessings every day. I have a wonderful family. I live in a great community, and I work in this amazing organization with this committed group of people. So I truly feel blessed and grateful.

Ellen Gardner: You talked earlier about your first job of running a newspaper, which is actually a really an interesting job to have very early in your life, and it shows your interest in telling stories and being at the forefront of getting this story. If you were going to look back to that time and think, okay, you're still running that newspaper today, what would you be writing about?

Alex Munter: Oh, that’s an interesting question. I sometimes think when I'm tweeting that I'm writing headlines, right? Because they have the same cadence and length. So I started out writing articles, and now I'm just writing headlines without the article. I don't know. I mean there's just so much to talk about. I mean, I think back to that time. I remember in the late 80s, we got this newfangled thing called computers and pagination and laid out all our pages on the computer. I think it would have been unimaginable to think about the way technology has transformed our lives. We certainly see that in the child health world, the impact of screen time for example, and the potential. I think about that as a parent. I think about that from a child health perspective of how video games, social media can de-sensitize us to what's real. I think that's a discussion worth having and an issue worth exploring.

Ellen Gardner: I'll ask you the question then about if there was somebody in Canada or internationally who you would like to interview, who would that person be?

Alex Munter: He's still alive. He must be well into his eighties, is Daniel Kahneman, who was the Nobel economics prize winner and really the founder of behavioural science. He’s written a number of books. I feel I kind of know him a little bit through his books and the books about him. I’ve seen the movie about him, and I think his journey exploring why do people do what they do, why do we think the way we think, is fascinating.

Ellen Gardner: Thank you so much, Alex, for speaking with us today. We've followed your career with great interest. We just admire so many of the things you're doing and the big challenges that you're tackling in the world of children's health, and we just wish you good luck. Good luck as a parent, and good luck as you continue your journey with CHEO. It's been a pleasure speaking with you today.

Alex Munter: Thank you, likewise.

Thank you for listening. You can hear more of our interview on our website, HIROC.com. Follow us on Twitter at @HIROCgroup or email us at communications@HIROC.com. Healthcare Change Makers is recorded by Ellen Gardner and Philip de Souza and produced by Podfly productions for HIROC.com. Please rate us on iTunes.