Episode 19: Carol Annett, President, VHA Home HealthCare and the value of staying positive, finding good partners, and taking risks

Episode 19 with Carol Annett

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As the need for their services grows, CEO Carol Annett says the time is now to amplify  VHA’s knowledge and reputation in order to lead the conversation about the future of healthcare at home.

Today, your host Ellen Gardner, Communications and Marketing at HIROC, speaks with Carol Annett, CEO, VHA Home HealthCare.

In the 20 years since Carol joined VHA, home healthcare has gone from being an afterthought – with virtually no status or investment – to becoming an essential, influential and highly-valued healthcare service. Whether people are in recovery, living with chronic illness or want to die at home, the goal of VHA is to support them in living independently and with dignity. But leading a home healthcare organization in these times also means dealing with funding pressures, an inequitable compensation system, and a remote workforce. Still, Carol draws positive energy from the organization’s mission, the dedicated volunteer board, and the special skills and commitment of her professional staff, working solo in the community and delivering care to patients with higher acuity and complex needs.


Carol Annett: I feel people want to live at home. Many choose to die at home if they can. This to me is where healthcare can have such an impact on people's lives and their dignity and how they continue to be engaged in their communities.

Narrator: 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: Hi, I'm Ellen Gardner. I work in marketing communications at HIROC. Today we have the pleasure of speaking with Carol Annett, who is CEO of VHA Home HealthCare. Welcome, Carol. It's a pleasure to speak with you today.

Carol Annett: Thank you.

Ellen Gardner: You joined VHA in 1999. You came in as VP of Business Development. What was it that drew you to the organization at that time?

Carol Annett: I think a couple of things. One, I had moved into doing some consulting. It's interesting, in consulting, usually you can get three days of work just fine and then you have to sell yourself to get the other two. That I didn't always have the energy or the inclination to do, so I'm just being very frank here. The other thing is I needed a full-time work and this came knocking. I was recruited for this role.

Part of it is they were entering a time in home care where managed competition was being introduced. They'd had contracts. They’ve been a home care provider in Toronto for years and years since the early 1900s. It's a long organizational history. They needed someone who could come in and help them win your business because contracts were being tendered. I was intrigued by that work but more importantly, intrigued by the mission because I feel people want to live at home. Many choose to die at home, if they can. This to me is where healthcare can have such an impact on people's lives and their dignity and how they continue to be engaged in their communities.

Ellen Gardner: 1999, it's not that long ago, but I bet even at that time home healthcare looked very different.

Carol Annett: It was different because it was very certainly not well-thought of. We would have been just an afterthought in many ways. It wasn't invested in significantly. Obviously, healthcare was all about hospitals and long-term care. It was quite small and has grown steadily ever since. At VHA, the organization's roots were in homemaking and personal support. When I came, they had just a fledgling nursing division, and I mean fledgling, very small. We have probably grown in revenues six times over, you know, huge amount of staff.

I think when I came, it might've been maybe 400 staff. We're now 2,700 across the province. Huge growth and growth in the type of services offered. We also grew our nursing division. We grew our rehab, all our therapies and that's been happening, and part of that has been organic through the government's investment in home care. We’ve been seizing opportunities to build our services out where they're needed. VHA has always had a huge charitable arm. We are a long time United Way member agency.

Ellen Gardner: Starting out as a person who was actually selling the organization, selling the services. How did that start you on the track towards thinking, oh being a CEO of this organization would be an interesting job? Did you start thinking in those terms?

Carol Annett: I think the more I got enamored by the mission and the work and my colleagues here, VHA has a wonderful culture. It was here long before I came and will be long after I go. There is something in the air. People are so committed, so dedicated, earnest, positive, wanting to make a difference. I think I got sucked into the ethos of the organization. At that point, I think the more I was here in the business development role but also in the quality role. I helped them get their first accreditation through Accreditation Canada because they needed that to be competitive. The more I stayed, the more I just got deeper and deeper. When the opportunity came up, when a previous CEO left and they announced the competition, I felt I wanted to put my hat in the ring and felt that I could continue to build on the organization's strengths and take it further.

Ellen Gardner: Can you tell me about the mission? How has that mission served the organization well as time has gone on and as client groups have changed and evolved?

Carol Annett: Our current mission is creating possibilities for more independence and it is about independence. All of us want to be in control of our lives and have choice and have options. VHA's mission is about ensuring and supporting and really helping people achieve that to the best of their ability. That could be someone who is in the last days of their life and their choice could well be everything from medical assistance in dying, could be they just want an opportunity to have their dog on their lap for this hour and we'll help them do that. It could be reconnecting with a family member, whatever it is. It could be someone who's broken their hip and wants to get back to ambulate and be independent and walking. It doesn't really matter. It all hinges around ensuring people are living to their fullest, to their maximum potential, and that we're part of that. Part of that either recovery, if it's an acute condition that someone can get better. Part of their maintaining a quality of life or a quality of death. I think all that, who wouldn’t be excited about that privilege to help people live as independently life as possible.

Ellen Gardner: Did you have an experience that made this kind of work personal for you?

Carol Annett: I have been a caregiver. Both my parents, we were able to bring to our home to die. That was very interesting and we wouldn't have been able to do it without family. Everybody pitching in to do what we could. Also, the public supports that are available. Home care is about families because they are truly the backbone of home care. They are what keep people at home. I see VHA and other home providers as we're kind of, how do you call it? The back brace. We will add or enrich or support or teach or coach, but we are not the ones that keep people at home. Some without family, yes, but it's mainly family. Yes, we've had that personal experience and it's very humbling.

Ellen Gardner: Can you tell me what's changed or become more challenging about the client groups that VHA serves?

Carol Annett: Since I've been here, what is changed is the acuity of the clients we see and the complexity of their care needs, which really translate into not only more care but riskier care. For example, we would see infants in the community that would never have gotten out of ICU before. We would be doing treatments that would only have been done in acute care before. You're putting a lot of responsibility on the professionals who are going into the home. The challenge in home care of course is you cannot yell down the hall for someone to come and help you. You do have a phone and you can pick up your phone and you can call for help. We will have someone here 24/7 to support our staff. It's a very different environment when you're working solo and when the needs are so acute and so complex and you have a lot of pressure because you're not also just going to one workplace, you're traveling through the day. 

For many staff, that's on public transit, not necessarily a car, and so you're racing from client to client. All different, never knowing what will be behind that door when you open it. The work environment itself is different. Going back to your question, it is acuity, complexity. I think the big thing that's changed is the speed in which one has to do their work now. A number of years ago, personal support workers would tell me, Carol, I used to have time to sit down and have a cup of tea with Mrs. Smith. I'd have a cup of tea then we'd have her bath and then we chat for a bit. Their visits would be two hours or more. Now, it's an hour on average and sometimes 30 minutes. It's just a race. The demand is more and the churn is more. That joy and intimacy with a client and it's probably the most intimate you can have if you're doing all the personal care, bathing, dressing, toileting, is not always given the time. Part of that is pressure on funding. How much funding do we have to spread around and there's a huge need.

Ellen Gardner: One of the challenges with working with complex patients like you just described is maintaining a group of well-trained staff and not letting them be pulled away to other, maybe higher-paid organizations. How does VHA manage that challenge?

Carol Annett: It is a challenge because it is a reality. There is not equitable compensation across our healthcare system. Acute care is paid more than long-term care, which is paid more than home care. There is a hierarchy and it's a challenge and one that needs to be addressed. I'm hopeful that we will be able to do that as we move into a new health system transformation period.

I think one way we certainly attract and retain staff is the environment that we create here both in having a safe as possible workplace, but also one that we put a lot of emphasis on continuing education. A lot of emphasis on support and creation of teams and team spirit. There are people who are attracted to work in the community. It is a different breed who likes to work in emergency departments versus ICU or home care.

There's a lot, but that only goes so far. You still have to pay your mortgage and put food on the table. We do lose folks. We lose, for example, stellar pediatric nurses who will go to Sick Kids or a pediatric unit in an acute care hospital. There's also more control. They have more control over their work environment and their work hours, those kinds of things. The other plus that community offers is great flexibility so that staff here can give us their availability. It might be someone who wants to only work part-time, we can create that for our employees and that's a plus. It's just at some point we have to figure out how we can be equitable with others because it is a shrinking pool of resources. I actually think working in community is extremely difficult and I think people underestimate the clinical skills and sophistication of our staff.

The other challenge though, talking about community, is how you create that culture when they don't work in a building, they're not contained by four walls. That is a huge effort, one that I still try to figure out. How do you do that well? Actually, some of these great new startups and different things are doing these, all these remote work cultures and trying to create new things. I've been reading a bit about that. It is something we have to always keep in the front of our mind. I do periodic voicemail call outs and shout outs. We have different newsletters. I do out-in-the-open boss and try to shadow folks. I need to understand their work, their pressures, their challenges if I'm going to be a good ambassador and good advocate for their work.

Ellen Gardner: In terms of investment in this business, in terms of home healthcare, do you think about different kinds of partners and maybe moving towards talking to startups and forming alliances with non-traditional partners? Is that something that you think about?

Carol Annett: Yes, in fact it's in our new strategic plan. Spot on. First I would say VHA has a history of being a good collaborator. I could probably give you a list of over a hundred partnerships and alliances we're in already, but with more traditional partners. I think where we can go and if we look at different types of care, like virtual care. Certainly, there are vendors who want to partner with us who are looking to VHA as a living lab to test out new products and new ways to either monitor folks' health at home, or new ways to support their independence at home.

Ellen Gardner: Is there a partnership that you think about or that you've been involved in that is a great example of how this is working in practice?

Carol Annett: With the introduction of Ontario Health Teams, VHA is a partner in a number of teams. There are a few that I think have more traction in that we have a history of working with some of the players for many years and there's great trust in how we might do things differently. The example I'll use is with East Toronto with Michael Garron Hospital, WoodGreen, South Riverdale Community Health Center, Unity. We did something really interesting last year. The CEO of Michael Garron has surge dollars given to the hospital, winter surge, where flu season is up and everybody's landing in emerge. Sarah Downey, who's the CEO, turned to her partners and said, how could we use these surge dollars differently rather than just staffing up the emergency department.

We worked together and it's everything from ramping up a drop-in centre for urban folk with mental illness who end up in emerge. We started a new program called Home Today for folks with COPD, normally who'd stay in hospital seven days, but we've got them out in day or two. We did extended walk in clinic hours, more flu shots. To me it was such a creative way to take a little bit of money and try to kickstart projects and initiatives in the community that would keep folks away from emergency. We evaluated it. Certainly, some are more successful than others, but we have a whole other group of surge projects going this year. They’ve been started earlier, we had more time to get going and there's lots of new partners involved. Those are the kinds of things, they're not rocket science and they're simple but can have really meaningful outcomes.

I think the other thing is people can't be risk-averse. So often, and part of it is I think is the not-for-profit mentality. We are risk-averse and that isn't going to work. People have to be willing to fall on their face, make mistakes, try different things. It's that sort of “try many things, fail quickly and get up and move on”. I think that is the attitude of a good partner because if you're always worried about the risks and the downside, you don't do anything. It's like in life you don't do anything. I feel strongly about that. Again though, you can only do that with trusted partners who you know are also okay if something flubs. You move on.

Ellen Gardner: 2020 is important year, it marks the end of your current strategic plan and you're moving onto launching your next strategic plan. When you and the board sat down to work on the next plan, did you have some key priorities in mind?

Carol Annett: What we wanted to do was change it up. We wanted to find a way to engage more voices in setting our direction. By more voices, it meant also our clients and caregivers and families we serve. It meant our partners, obviously our staff and our service providers. I think the only preconceived thought was one, let us do a wider net in trying to create our next five year vision and our focus.

Also, we were excited about the timing of the plan. It was great to be doing this at a time when the government has thrown everything up on its ear and is trying to move the health system forward. It's kind of a no rules, right? No prescriptive environment at the moment. I think that will change shortly, but that's a great time. I love, I absolutely love where the vision is going with the Ministry of Health. It is the right and good thing to be looking at Integrated Care and how we can make the care experience better not just for those we serve but those who provide the service.

Ellen Gardner: Is there anything in it that you think, oh this is really different? A really new step in a different direction, something that makes you excited and you think is going to excite the organization?

Carol Annett: You know what? Excitement with this one is different. VHA traditionally, we have been what I would say a good earnest partner and provider. We have a great reputation but we hide our light under a bushel. We are not always as front and center. We're just so drawn and do good work. Interesting part of this strategic planning was interviewing many people. I interviewed a number of partners. I would say we're not loud but we have substance. I think the exciting part about this is we really want to take our knowledge and push our thoughts and have influence on the future of healthcare at home. We are experts and we know a lot and our clients and families know a lot. I think the difference in this plan for me is the decibels, it's is more about leading and influencing and being a thought leader in many ways in this arena.

Ellen Gardner: Well Carol, you've made it a point in your professional life to be very active in a number of spheres. You are a peer reviewer with Accreditation Canada. You stay active with Schulich, and you just joined the Sunnybrook Health Sciences Centre board. How do those activities enhance your life as a leader?

Carol Annett: For me it is about learning and I see life and my work as endless curiosity. The more I can learn and the more I can think differently, I think all those experiences you've mentioned and others have really allowed me to see organizations in different lights. I'll take my experience as a surveyor for Accreditation Canada. It is a real privilege to be able to enter into an organization and see marvelous work being done. Also, hoping I'm helpful and leaving them with some new ways of approaching or thinking about something. I always get more out of it I'm sure than they do. I think because what I learned, whether I transfer it here, use it here, it's just widening my brain space and the same as any volunteer work, which I do.

Again, you're just learning a new part. Sunnybrook is a new part of the healthcare system. It has to be my community hospital. I feel I've got lots to learn and hopefully I can share what I have that would benefit their strategy and where they'd like to go.

Ellen Gardner: You're going to have time for all these things?

Carol Annett: Of course, what do they say – give a busy person at another job! I get energized by it. I would get bored very easily if life wasn't constantly changing and new challenges and opportunities.

Ellen Gardner:    One of the things I didn't ask you that I want to touch on is the risks in this kind of work and the fact that often providers are going out alone, that higher acuity in clients and even the physical risks of going into someone's home. You worked in quality so you understand the importance of these things even before it was a major issue. What does VHA do to protect employees and minimize the risk of adverse events?

Carol Annett: It's a really good question. Safety of our workers is front and centre, and it is as you say because of the nature of the work environment, you can't control it at all. You open that door and you might see, which we have seen, somebody has a huge reptile collection and a snake is slithering on the front steps or the dog that's going to bite them on the ankle, or the smoke environment. It's so hard to control. 
Like every other organization, we have a very robust occupational health and safety program. We do a lot of education and training and the biggest thing is helping staff learn to report, because when they're out there they must feel comfortable picking up the phone and reporting or leaving the house if they ever don't feel safe, you get out of that environment. Now, it’s very difficult to leave someone alone in a house, but they get out to the safety and they call 911 or they do whatever because as I say, it is always a surprise.

There is every different house imaginable out there. I've been to many of them. I think that's number one is really about staff realizing their safety. It's like on the airplane, right? You get your oxygen on first before you give it to the person in the seat beside you. That is emphasized. One thing we also do is physical readiness testing before anybody works with us. Depending on the job, it's their ability. That's about the ergonomics again. There's a lot of lifting, a lot of unsteady patients you're dealing with. Homes are ripe for environmental accidents, slips, trips and falls is our number one injury and that's not just in the home, that's on the way to it. We provide grips for all our worker's shoes for the winter to be safe. We have a program that we're starting up and doing some research on for folks with cognitive impairment and responsive behaviors. Giving our personal support workers strategies to manage those behaviors.

It's interesting we talk about physical safety. I think the other piece is the emotional safety and the mental health of our workers. We look at healthcare these days and we see the strain that it is placing on caregivers. I'm talking paid caregivers, not family caregivers. I think VHA also pays attention to that. Everything from our employee assistance program to we have an emergency staff fund. We have another fund that I love – it’s a Simple Comforts Fund where staff can make a decision, they have the autonomy. Anything under a hundred bucks a client needs, they can get it, which gives them power and control in the home. If they see a bath mat in shreds, they can replace it.

Ellen Gardner: You have very high empathy, Carol. I can tell that that's part of your character and yet you as a CEO you have to balance that with the business side of you, which you knew going into this. Is that sometimes a challenge to be the bottom line person as well as the person that is thinking and caring about employees?

Carol Annett: It is a challenge because obviously we had to make hard decisions and decisions that no one likes to make. You know, if we're having to cut back services in certain way, it's a challenge but I'll say the strength in that is that I don't do things alone. I have a very collaborative style of leadership. I have a fabulous senior team and leadership team here at VHA so that no decision is done lightly. No decision is done without good consultation. Ultimately, the buck stops with me. I totally get that. I take full responsibility but I think when you do it in a very thoughtful, reasoned way, and if you're making hard decisions that impact people that we all do, we also always have a plan in how we're going to do that, how we'll communicate, how we'll do it. Do we make mistakes? Do we do it perfectly all the time? No, we don't. I think there is a willingness to do the best we can when we have to make difficult decisions.

Ellen Gardner: Well, Carol, you must think about the next generation of people coming up. You are a person who is truly a change maker in terms of how you've made changes at VHA and that you bring a lot of energy and enthusiasm to your job. I wanted to ask you how you feel about the next generation coming up and how do you nurture the next group of leaders who are going to be coming into the organization?

Carol Annett: I am just in awe at the younger generation, new leaders coming into healthcare here at VHA and elsewhere. So bright, so talented, so keen to make a difference. I get energized by their energy and their questions. I just had a wonderful young man who was doing an internship at a hospital and his VP asked if I'd speak with him. Again, I just love having those conversations because I learn so much from him and more about the things he was thinking about, his questions were very insightful. To me, if I can help shape or influence a way, an approach, because I think probably having a few miles on me, it's easier to admit mistakes. I don't have much of an ego in this and it's easier to help people look at different approaches to challenge probably because what I like are the challenges. To me, there's nothing insurmountable. You can figure out a way. It might take time, you might have to go in a few different doors.

You might have to look at a different partnership, but nothing's surmountable. Maybe it's optimism, I have such a strong belief in one being positive. That may be what you pick up at times. There is no point in living life unless it's a positive life and to make other people feel that positivism is important to me, and where I got it from is probably my parents, right? The mantra of being positive because I don't see life in any other way. Not that that's a Pollyanna look because there's a lot of sorrow and hardship, but it's what you do with that and how you try to shift it for people.

Ellen Gardner: You've been in the job for 15 years now. I'm sure that leads to a certain amount of reflection and introspection. What is it that you feel proud of as you reflect on your career here and what do you still feel like you want to accomplish?

Carol Annett: I'll go with the pride first. There's so much to be proud of, but it isn't mine for the taking. The pride is around building a team that is just second to none. I think it's important to come to work because you want to come to work and it's a fun place to be and it's not that it isn't difficult, but that it's fun to be. We have created a team, and certainly I'll speak to the leadership team here that is healthy. People want to do a good job, care passionately about the work, help each other. There's no power in politics here. There just isn't. How can we help each other? How can we engage differently? What do we need to get something done? We all just jump in and do it.

I think we've started a variety of programs that are unique and interesting. Everything from our extreme cleaning program, which is to prevent eviction and homelessness, to a play date program for children with medical complexities that just never get to play and we need nurses there. Half of them are on trachs or vents or feeding tubes.

We've created some really interesting programs. I'm so proud of this research arm that has been growing here. Again, thanks to awesome leaders, not me. I think the other thing is we, although I said we'd been quiet, we have put a spotlight on a few things that I think are important. One is the 12 caregivers that I talked about earlier. VHA created now I think 12 years ago, a Heart of Home Care Award, which recognizes family caregivers and what they do to keep their loved ones at home. They will on our website, we have the videos from these past 11, 12 years, and they make me cry every time. It is so powerful. When we first started that award, it was called heroes in the home. When we started it, nobody was talking about family caregivers. Nobody was recognizing what the sweat equity they put in to keep their loved ones at home.

I can now say we don't need to do that at all. We even talked about do we need to do this award anymore. There's lots of attention on family caregiving now. Great, what's the next area that nobody wants to talk about or nobody is acknowledging is important? I feel really good about being able to raise attention to an important issue.

Ellen Gardner: You have a lot on your plate, Carol and you're looking ahead. Yes, you're launching the new strategic plan, new partnerships on the horizon, and continuing to engage and energize your employees. We wish you the best of luck and it's been a real pleasure speaking with you this afternoon.

Carol Annett: Thank you. Well, fun for me too.

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.