Episode 22: Dr. Andy Smith on Healthcare as a Team Sport
Sunnybrook Health Sciences Centre President and CEO Dr. Andy Smith always reminds his staff that they should never forget why they went into healthcare in the first place and that it’s important to take care of yourself but also lift up the person beside you. That’s what makes the magic happen.
Today, Ellen Gardner and Philip De Souza, Communications and Marketing at HIROC, speak with Dr. Andy Smith, President and CEO Sunnybrook Health Sciences Centre.
Moving into management happened somewhat accidentally for Dr. Andy Smith, who began his medical career as a surgeon specializing in colorectal cancer. Notwithstanding the headwinds he faces leading a large organization, he often looks to historical leaders for inspiration and strives to set the tone for the hospital in an energetic and positive way. For him that means doing everything possible to remove barriers and give his team the resources they need for achieving the hospital’s mission of inventing the future of healthcare. Andy works hard to demystify the complex business of healthcare delivery and wants Sunnybrookers to always be asking, how can we make sure the patient experience is the best that it can be?
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Philip De Souza: Hey, listeners. Welcome back to Healthcare Change Makers. Today in our show, we're talking with longtime Sunnybrooker Dr. Andy Smith.
Ellen Gardner: From HIROC, I'm your host, Ellen Gardner, here with my producer Philip De Souza.
Philip De Souza: As the President and CEO of a large Toronto hospital, Ellen and I dig deep to find out how Sunnybrook is living its vision of inventing the future of healthcare.
Ellen Gardner: And as a devoted hockey fan, Dr. Smith brings healthcare and hockey together as Sunnybrookers focus on lifting each other up and taking care of the people who walk through their doors. So Andy, you've been in the role now for about three years, and at Sunnybrook for a number of years before that, maybe you can tell me what drew you to the organization in the first place.
Dr. Andy Smith: So I became an accidental Sunnybrooker in many ways. Thirty-four years ago I was a medical student and I was a scientist at Sunnybrook, and spent a lot of time from the mid '80s and came back and various iterations as a resident, as chief resident. And then I was ultimately hired by Dr. Sherif Hanna, who has been an outstanding mentor for me in so many ways in life in general.
But then I came back to the organization in 1999. I'd been away for a couple of years in New York City. I worked at Memorial Sloan Kettering Cancer Center. So I was drawn back by Dr. Hanna, and by the hospital vision that there was going to be a push towards the highest level of development of the cancer program, and in particular, bringing on specialized cancer surgery to augment what was already a really strong radiation and chemotherapy program.
And so that brought me back in 1999. I had absolutely no focus on the notion of being an executive. Indeed, I often quip that if somebody had have said to me, "What does a hospital CEO do?" I think my answer would have been, "Oh, they have those? Do they?" I really think that as a clinician, you are so absorbed in the busyness and the complete absorption that's required to be an excellent surgeon, in my case, that you really don't think a great deal about the working of the hospital as a business, except when for example, ORs are canceled or run late or things like that. And honestly, that's the way it should be. I mean, we need to run the enterprise in such a way that the doctors and nurses and the rest of the inter-professional team can do their thing.
I was drawn back and drawn into different roles along the way. I became an executive, I do say, in many ways, accidentally. I had successive leadership roles within the clinical domain. I'd started them at an early age, again, sort of accidentally. I was head of the division here locally, then became head of the University of Toronto division of general surgery. And then became head of the cancer program, the Odette Cancer Program here at Sunnybrook.
It was at that time that I became aware that I was a consideration on a succession plan of my predecessor. Ultimately, did make the move to apply to and take on the role as Executive Vice President, which I did for four years. And that's what brought me to this current role.
Ellen Gardner: You have been away from surgery for a few years. Do you ever miss that hands on clinical care, that direct contact with patients?
Dr. Andy Smith: So I don't miss it. What I like to say is that I loved every minute of it. And I haven't missed it a minute since. I loved being in the operating room, I loved the clinic, working with patients and their families. I absolutely loved residents and the fellows I had an opportunity to work with. It's just a great privilege of a life in medicine to do that. At the same time, it was really going from one incredibly busy life, clinically, and jumping out of one frying pan and either into the fire or at least another frying pan there. It's incredibly diverse, busy life as a hospital executive and I often reflect that you don't have a lot of time for navel gazing. It's just on to the next. So I don't miss it. I really treasure the 25 or whatever years I had actively on the frontline.
I also reflect that my wife is a surgeon. So I get to see the ups and downs of clinical medicine not only through the eyes of the people that I'm privileged to work with here at Sunnybrook, but also on the home front – the good and the big great things, the great rewarding things that happen as a clinician, but also some of the challenges that our frontline doctors and nurses provide.
My brother is also a surgeon at North York General Hospital, and I get great insight from him in watching his career continue to evolve as a surgeon. So I loved it. Do I miss it? No. It’s just been a different chapter and I've loved both the chapters.
Ellen Gardner: The vision of Sunnybrook is inventing the future of healthcare. What does that vision look like to you?
Dr. Andy Smith: I frequently reflect and often speak to the fact that Sunnybrook is blessed to have mission and vision that fit so beautifully. So our mission is to be there when it matters most Our vision is to invent the future of healthcare.
Inventing the future of health care really speaks to the ethos that suffuses all of our work here. What it means is that we need to be able to deliver great care with the best care that's available right now, but be constantly asking “What's the next best way to do it?” So there are examples that I could speak to for hours, I'm so proud of, and excited to talk about, but let me choose one that's got a lot of coverage lately. And that relates to our approach to managing diseases of the brain and the mind.
So we are living in an era where there's outstanding advances in understanding diseases of the mind and the brain. So what I mean, the brain diseases such as Alzheimer's or brain tumors, we've understand by looking at a scan of the brain, what they mean. Either there's a lump or lesion in the brain or there, for example, in the case of dementia, is the accumulation of different materials, amyloid and tau, and the name of them that give people dementia.
At the same time for diseases of the mind, for example, depression or obsessive compulsive disorder or PTSD, we look at a scan, and the scan can look completely normal. But now as imaging gets better and our understanding of the different tracks or the neural circuits within the brain becomes better, it becomes possible to say, “Well, maybe these things that we previously thought were just in the realm of psychiatric or psychological, and we couldn't understand what was happening, we can understand those in a structural way.”
So this field is evolving at a very, very rapid rate. And our special area of focus, expertise, investment and achievement has been dealing in a non-invasive way with these conditions. So, a recent great success was in the work with essential tremor – we’re using focused ultrasound without making any cuts in the skull, without opening the skull. We’re able to direct a focused ultrasound beam through the bony skull and landed in a small, small area, much smaller than a millimetre to know exactly where you need to correct the circuit within the brain.
We have numerous studies going on and a wide range of other conditions: PTSD, obsessive compulsive disorder, depression ALS. Indeed, we've even started the trial. It's just fascinating to imagine that a lot of conditions that we thought were either untreatable or we'd been trying to treat with only variable success with pharmacologic agents might actually be things that you can alleviate suffering significantly through physics approaches, through ultrasound. And what's even more important, doing so in a non-invasive way.
So, inventing the future of healthcare using non-invasive as a major theme is also so important because when a patient hears, “You've got cancer,” for example, they don't think, “Oh, could you please give me the best surgery, chemotherapy and radiation.” What their mind actually goes to is, “Oh, my God, please get rid of this. And by the way, have as little impact on my body, my life, my family's life as you possibly can.” That's what we really want.
Quite frankly, as a physician, when I have something wrong with me, that's what I want too. So I love the idea that in our push to invent the future of healthcare, there's so much emphasis on trying to do so in a ways that are less invasive or non-invasive to a person's body. It feels really futuristic. To me, the future is now, and it's happening all the time. And we have it in our brain sciences program. We have it in major focus in our cancer program, what's called the CAT Program or Cancer Ablation Therapy Program.
Our heart program has really pushed to revolutionize the management of problems that used to require open-heart surgery, opening up the breastbone and the sternum, and no longer doing so. That for me is one of the areas that I'm very, very excited about, enthusiastic about what's happening here at Sunnybrook, right now.
Ellen Gardner: Where do you look for inspiration when you think about the future and plan for the future?
Dr. Andy Smith: Really, the answer to that is a simple one. You look at your family, you look at yourself, your own frailties and concerns and things that worry you, and you look at just the people around you, and say, what's the sole purpose? Why do we exist? We exist to be able to take care of people when it matters most, when they need us, so we can get their life back on track, so that they can live the best possible life they can.
I think you really come to terms with the fact that we're here for not a long time, and the degree to which we as a team here at Sunnybrook, or across the healthcare system, can provide people the best possible health and wellness for them to be able to live that life to the best of their ability together with their family. That's really the raison d’etre as to why we're here. And that's all the inspiration, I think, I need for getting up in the morning, and coming in here and to help be supportive of delivering on that.
Ellen Gardner: It must be challenging, though, as a CEO that you're dealing with a huge number of day-to-day concerns, and yet people do look to you too as someone who's thinking about the future and planning for that future and saying, “Yes, where do we want this organization to be in five years in 10 years?” So, is that something that you try and do – tap into a lot of people outside the organization, different kinds of perspectives outside of just medicine, going to business or going to different industries? Is that something that you do?
Dr. Andy Smith: I know that one of my mentors, Ian Delaney, he's the board chair now of Ornge, and I remember one of the things he once said to me and that was, “Never underestimate the critical importance of the energy of the Chief Executive Officer.” I think about that one a lot, and I recognize that my role is to come and set the tone in a high energy, positive, indeed optimistic way, notwithstanding the headwinds that we face, because I'm surrounded by extraordinarily talented people and teams.
So if I can create the correct tone, and earnestly apply every bit of my energy towards removing key barriers or setting up some key opportunities, the abundance of talent and highly motivated people with which I and the rest of the senior team are surrounded, it's extraordinary. So I think great things are going to happen.
I think this is a really exciting time for our sector, with understanding just how important it is to move outside of our usual lanes, if you will. So obviously, health is a provincially funded and provincial line item as a business unit, but it's also meant to be a provincial concern. But having that myopic track alone is not acceptable for modern healthcare.
So I'm really proud of, for example, some of the work that our teams are doing with the municipal government. John Tory just announced a partnership with us on the gun violence issue. Another one of our clinician scientists is doing some work with seniors and advancing the way that the city interacts with the healthcare system for supporting seniors in the community. We've done some huge collaborative work with Community Health Partners, SPRINT and LOFT, with respect to kind of blurring the lines between the health system and the supportive people in the community, recognizing that wellness needs to start in the community, and we need to try to keep people well at home.
So a complete pivot here, much energy is directed toward asking, how can we not think of ourselves as just a cost centre but rather a highly important part of the knowledge economy? So I spoke about our focused ultrasound work, how excited we are? Well, we've got companies spinning off of that, we've got intellectual property that is, in many cases, unique on planet Earth, saying, “Well, this is not something that we should be hiding under a bushel, but rather, we should really be bringing this out and aggressively pushing it into the world through a commercialization avenue.”
This is something that we've really underscored as a top priority. It's always been a priority, but, now, real top priority. Our new head of research, so the Vice President of Research and Innovation at Sunnybrook is Dr. Kullervo Hynynen. This is absolutely one of his top priorities, for us to be really bullish on how we look at our IP and how it turns into commercializable products, companies, licenses, patents and to drive that forward into the world.
Philip De Souza: I like the idea that you guys see yourselves as, you're pivoting toward being sort of a startup. Last year at our conference, we had Dr. Joel Dudley from Mount Sinai in New York City, and they created a thing called Lab100. And now they're doing something very similar to what you're doing. Does that create a different sense of, not urgency in your team, but thinking outside the box or a different type of energy or innovation? Do you see that with the teams who are working on these projects you mentioned?
Dr. Andy Smith: I certainly hope that that does translate into people looking in the mirror and seeing the teams as being different. I think it's important for us to say it's not enough for us to do great science. Great science is important, but society should expect us to want to push that forward, for a couple of things. First of all, to get it to helping patients and their families as quickly as possible. There is urgency around getting that done.
But also saying we shouldn't just imagine that we're there for revenues to be derived from taxation in the public purse. Of course, that's critical. Society makes the decision to support health and wellness. And that's one of the reasons why it's the number one line item on provincial government expenditure.
But at the same time, what if we're looking for the next pablum? So pablum for as we know, is something that came out of Toronto that derives a revenue line for Sick Kids. We know, famously, insulin is something that came out of Toronto and derives absolutely nothing to us, because it wasn't handled in a commercializable way. I'm oversimplifying, but you see, I think if we look at the extraordinary talent we have within health and health research, why wouldn't we be asking how to get this to people to take care of people as fast as we can, but at the same time, saying, “We as Canadians are very proud of the great stuff that's coming through here that we've deeply invested in.” And yes, we do want and expect some return on that investment that we can reinvest into our enterprise of healthcare so that Canadians can be afforded the best healthcare on planet Earth.
Ellen Gardner: Sunnybrook has just launched the 2020 Patient Safety Culture Survey. What do you hope to gain from that?
Dr. Andy Smith: I'm very proud of the quality improvement and patient safety, both the focus that we have here and the work that we're doing in general. This is a great example where top down meets bottom up. But frankly, bottom up has been our strength in this organization. So I'm looking at the survey results just over the weekend, or at least the preliminary engagement with the survey, and I think nearly 1000 people have already provided input to it. That’s fantastic. This means that there's a number of people who are engaging and providing input into it.
I'm actually not surprised I see in our different programs the different patient safety and quality improvement collaboratives that we belong to whether it's, for example, the Vermont Oxford Network, and our women's and babies program or NSQIP, the quality improvement continent-wide initiative that our surgical teams are involved with. And the list goes on and on. But the real strength of this comes from when you have the reality of having frontline inter-professional teams that are engaged and collaboratively pushing forward quality improvement and patient safety, and asking how can we do better? How can we not only provide better quality, but also make sure that the patient experience is as best as it can be?
In fact, I like the notion that it's not good enough to just aspire to provide the best possible quality, you want to be great against benchmarks. You really want to exceed them and invent new frontiers of greatness for quality. But that's not good enough. You also want to be highly attuned to asking, how can we be providing care that feels as best as it possibly can be for patients and their family so that they feel compassionate care, they feel that they're being taken care of?
I worked for seven years in the hotel and restaurant business earlier in my life, and I know that it may sometimes be pushing it a little bit, but I frequently look at it through that lens. Once in a while will nudge the notion that we shouldn't think of ourselves as being that different say, for example, from a great restaurant or hotel. I don't mean that to sound as if I'm simplifying our enterprise, but what we do aspire for is people to come in and get great care. It may not always turn out well, you may have unsolvable problem. But if people say that they have the confidence that they had great care, but at the same time, are able to reflect on that compassionate, human experience that they had, then I know that we're really doing a great, great job.
And you know what? It's one of the most wonderful things about the CEO job is I get lots of letters in into my email inbox. Sure I get some complaints and concerns registered, but that is exceeded by the number of times I receive either hard copy letters or emails, talking very specifically about the kind, compassionate care that was delivered to a patient or a family member.
So when you ask me about the survey, I'm really hoping this is a reflection of a real focus on quality improvement, patient safety, and the patient experience. And when I see the initial high levels of engagement with that it really gives me great confidence that we do have a really humming along culture of understanding the primacy of all these things.
I must say it's also important when we have this conversation to talk about how it's important to focus on our customers, if you will, on the patients and their families, but we have to be providing equal focus on our teams and the individuals that are providing care, compassionate care, within this environment, which, while it can be the most rewarding of environments, can also be one of the most challenging environments. So that's really very critical that we kind of consider both of these when we’re in leadership roles and weight them equally.
Ellen Gardner: I want to talk to you a little bit about your leadership style. I know you're a big admirer of some of our historical leaders, people like Lincoln and Churchill, people who were leading in extremely difficult times and knew they couldn't fail. Churchill, in particular, was really great at taking a lot of detail and translating that into action. I'm sure you know he would amass tons of information, but come up with solutions quite quickly. He didn't have a lot of time to come up with those solutions. So are there any of those principles and practices that you try and apply to your own job?
Dr. Andy Smith: I do like Winston Churchill as a historical figure. I'm very enthused in general by biography. I read quite a lot of biographies. And I must say I always find them extremely interesting, quite often inspiring. I think Churchill's story, especially in the early phases of World War II is one of that's fascinating when you're facing great adversity, when it seems that everything is against you, including sometimes even from inside your own ranks. But to be able to have the courage of conviction, the resiliency to continue against extraordinary strain and stress, but still to be able to make decisions, and importantly, to be able to keep people's focus, and their mood, and their resolve as a group together to be able to achieve an end, to achieve an important goal. I think I find it unbelievably inspiring.
Just this weekend, I picked up a little book by an author Nelles. He's a professor emeritus from McMaster wrote a little book about the history of Canada. I picked it up at the Montreal Museum of Fine Arts and started reading this. I love the initial pages where he starts talking about the history of Canada, how people talk about the history of Canada being boring, because it doesn't have these kind of epic battles for survival or the stark contrast between black and white.
At the same time, you can see, he looks like he's going to build out the theme in the book, which I’ve just started, that sometimes in human endeavour, you need to look a little bit harder. But there's great lessons to be learned, leadership lessons to be learned when things are solved in a way that's not so flashy, but might ultimately be more successful, sustainable and so forth. So I do like to balance my enthusiasm for flashy historical figures with the understanding that life and human endeavour is a lot more nuanced than that sometimes.
Ellen Gardner: At Town Halls and staff meetings, what's one question that you get asked by staff a lot?
Dr. Andy Smith: I think that staff often want to know that we're going to be all right, notwithstanding the headwinds we face with regard to fiscal constraint and growing demands. They want to know that we'll be all right. They want to know that the leaders, that I and the rest of our senior team and other leaders, are putting every bit of energy that we have into working together with partners, government and otherwise, to give them the resources to allow them to do what they do so well. We need to do everything possible to be able to provide the resources and conditions to allow them to do what they're so great at, namely, provide the compassionate care that people come here so desperately in need of when they make their way to hospital. So I get, I think, different themes on that.
Ellen Gardner: Coronavirus is on everyone's minds right now, and I know Sunnybrook has a longstanding and very well-developed crisis plan that you've had to put into play many times over the years. What have you and your team learned about staying calm during a crisis and minimizing the impact of a crisis?
Dr. Andy Smith: We're at a stage with the coronavirus, right now, that I firmly believe that anyone tells you they know how it's going to turn out, they are over-estimating their prognostication abilities. So I do not know how it's going to turn out. But I do know I'm pleased with the way we at Sunnybrook, and across the province and across the country have addressed the initial stages. I think what it really calls for is for leaders and teams to be able to provide a calm, balanced, evidence-based approach to what we're going to do.
So speaking specifically about our own organization, I've been absolutely delighted with the science and the clinical expertise that's been brought to bear. And yes, we have learned a lot from the last 20 years as to how to do that increasingly well whether it's through a deal in dealing with SARS, MERS, Ebola, H1N1, and watching how the approaches to infection prevention and control have improved and our team's ability to address that.
This has made me very proud to see that. So the science has been good. I'm also very pleased with the resiliency of the teams to support one another, to realize that when a new stressor comes on, especially when it's a big high profile stressor, how do we support one another? There's really a bubbling up of these ethos around that. I can see it on Twitter, I can see shout-outs to people. I can see people in the hall recognizing the contribution, sometimes the unique contributions of different people.
Sometimes it seems to me that's when healthcare and healthcare teams are at their best when they're lifting one another up. I think of our Infection Prevention and Control leaders, Dr. Jerome Leis and the director he works with Natasha Salt. They've been an unbelievable dynamic duo with respect to giving clear confidence around their expertise as they lead us from an infection prevention and control perspective.
I also am very proud of the communications that have come out of our organization thus far, with a real effort to be plain language, balanced, transparent, and make sure that people know everything there is to know, and know it in a transparent way. But also to give it to people in a trustworthy way to avoid going off the rails with communication that can push us into disinformation and cause us to swirl and expend energy in a way that's just not useful.
Ellen Gardner: I happen to know, just from having worked at Sunnybrook many years ago, that the hospital has a very special culture. You never know really the ingredients that make it a culture special, but I know it was a much smaller hospital then. Staff really came together. They did interesting things, creating an underground theatre and there was a daycare on-site long before other organizations had such a thing. You've been around here for a few years so you understand that culture. How has that influenced you in the way you see the hospital and in terms of the way you like to preserve that kind of culture?
Dr. Andy Smith: I absolutely believe that that somewhat intangible notion of culture is so critical. It might be the most critical thing for being able to sustain you towards providing excellent care as we go through difficult times and face great challenges.
So the culture of Sunnybrook, I agree, it is unique as all organizations are, and it does attract a great many people to the organization and to stay in the organization. I like to refer to people who stay for a long time and are really deeply embedded in the organization as Sunnybrookers. It is a term that, when used within the organization, people really know what it means. If somebody really has a great understanding of what it looks and feels from a cultural perspective to be within the organization, and really gets it with respect to the mission and vision.
Ellen Gardner: So we know you're a big hockey fan.
Dr. Andy Smith: I definitely am a big hockey fan. In fact, I was just in Montreal this past weekend. Our son goes to McGill. We went down to watch the Canadiens and the Leafs. And unfortunately the Habs came back late in the third and then won in overtime. So, still a great weekend but…
Ellen Gardner: The Leafs aren't doing as well as they should be at this stage.
Dr. Andy Smith: That's right. I think we have high expectations for the Leafs at this time and they're not quite there yet.
Ellen Gardner: As a longtime observer, though, of hockey, is there any crossover to healthcare, any kind of lessons from the game that you say, “Oh yes, I could see that kind of strategy working in a healthcare environment.”?
Dr. Andy Smith: So I think you're setting me up, asking me to compare hockey and healthcare because the people who work closely with me know that I, at times, perhaps obsessively, connect the similarities between healthcare and hockey. I think there are many from a cultural ethos type of perspective. It's hard to win at any level of competitive hockey, the NHL or a kid's playing in the GTHL. And it's always fascinating to see which team ends up winning. And to win, it really requires a lot of things to go right. It's certainly not an individual enterprise to be able to be ultimately successful. You really have to have talent, but you have to have that talent of coming together and be focusing on achieving a goal. And you need to expect that there will be ups and downs. And you can't get too high, and you can't get too low, you've got to just keep going for that ultimate goal.
I do think, certainly, it's what fascinates me about team sports, but hockey, in particular – the resiliency and the resolve that's required to be able to make it through a long season and then to win the championship. So I do like the analogies to hockey and I probably overuse them. The team who works directly with me knows that it’s something I'm affectionate about.
My VP HR, Kristen Winter, she's sort of the ultimate hockey mom. And I think that sometimes when she's doing one-on-one meetings with me, she's able to convert about one third of the agenda into hockey-type analogies that I can understand and moves us along the agenda quite quickly.
And by the way, have fun along the way. Honest to goodness, I really hope that one of my great wishes for the people who come to work. It's not going to always be great and people have challenges at work, people have challenges in their personal lives. But I dearly hope as people reflect on their career in healthcare say, “You know what? I'm deeply proud of what I was able to do as an individual, as part of a team. And it's fun for me to go to work to know that I'm helping make the lives of people better in Ontario.”
Philip De Souza: I would love to hear your thoughts... If you had to give one piece of advice to all the emerging leaders out there in healthcare, no matter where they are on their journey, what one piece of advice would you give them?
Dr. Andy Smith: I would say never forget that healthcare, our enterprise, is a team sport. If you start from that perspective, a lot of things become considerations that are important. So for example, it is important to take care of yourself, but it's also important to lift up and take care of the people around you. When you do that, you move toward creating the conditions where one plus one can equal something more than two, and you can begin to incent things like joy at work, the kind of thing that we all are inspired to want to have as part of our careers.
I'd like to think about people when they went back to their decision to go into healthcare either as a young idealistic person, I mean, going in there knowing you have an opportunity to take care of people and their families. I really think that if you think of it as a team sport, and how you can both make sure you're taking care of yourself, but at the same time, take care of the person next to you, and that can make the magic happen.
Ellen Gardner: All right. It's time for the Change Makers lightning round. So we're going to ask you a series of quick questions and just tell us the first thing that comes to your mind. Who is your all time hockey hero?
Dr. Andy Smith: Wayne Gretzky.
Ellen Gardner: What are you reading right now? I know the answer to that I think.
Dr. Andy Smith: I read always a hard copy book and an audible book. My audible book right now is something called Aria, which is a 90-minute historical fiction about a young Persian woman. And in hard copy I'm reading A Life in Medicine by Michael Bliss’s look at William Osler's life.
Ellen Gardner: What is your biggest flaw?
Dr. Andy Smith: I have too many to be able to count them, to put one at the top! There’s probably a series of them. Ask my wife.
Ellen Gardner: What's your favorite thing to do in Toronto?
Dr. Andy Smith: I absolutely adore Toronto's ravines. I've been in this city for 36 years. I think it's kind of thing that takes you a while to understand and warm up to, but if you think of the river network, much of it which has been lost or buried, there's all ravines associated with it. I love the times I’m able to walk along the ravine, for example, the Don River, or I live by Cedarvale Ravine – these are wonderful spots in our great city.
Ellen Gardner: What's one resolution that you made at the beginning of 2020?
Dr. Andy Smith: I was going to try to do 50 push-ups a day. And I was going to try to not gain weight.
Ellen Gardner: How's it going so far?
Dr. Andy Smith: Not bad. It's only February.
Philip De Souza: Exactly. You'll have time!
Ellen Gardner: Well, thank you so much, Andy for speaking with us today. It was a pleasure talking with you.
Dr. Andy Smith: Thank you very much. It's been a delight to have a chance to speak with you today.
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 email@example.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.