Episode 27: Dr. Ronald Cohn, President and CEO, The Hospital for Sick Children is never far from his research or his patients

It often surprises people to find out that Dr. Ronald Cohn, CEO of the Hospital for Sick Children in Toronto, sees patients and is still very engaged with the hospital’s clinical mission.

Show Summary

Today, Ellen Gardner and Philip De Souza, Communications and Marketing at HIROC, speak with Dr. Ronald Cohn, President and CEO of the Hospital for Sick Children.

Early in his medical career, Dr. Ronald Cohn was on a tourist bus in Toronto and as it drove up University Avenue and by SickKids Hospital he told his wife, that’s one of the world’s leading children’s hospitals and I will probably never work there. Proving that life doesn’t go where you predict, in 2012 Dr. Cohn accepted a position as Chief of the Division of Clinical and Metabolic Genetics, Co-Director of the Centre for Genetic Medicine, and Senior Scientist at the SickKids Research Institute.

Even as he leads the hospital, staying true to his identity as a physician and a scientist is essential for Dr. Cohn, who still sees patients and is very active in the lab that bears his name. Most recently, his laboratory started to investigate the application of a new genome editing technology, CRISPR/Cas9 that holds the promise of correcting genetic abnormalities that lead to muscular dystrophy.

Today he is guiding the hospital in a new strategic direction called Precision Child Health. The campaign is built around the concept of individualized care tailored to each patient’s unique characteristics, from their genetic code to their postal code.

Mentioned in this Episode

Transcript

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 leaders about the joys and challenges of driving change and working with partners to create the safest healthcare system.

Ellen Gardner: Welcome to HIROCs podcast, Healthcare Change Makers, I'm Ellen Gardner with Philip De Souza. Today, we're speaking with Dr. Ronald Cohn, President and CEO of The Hospital for Sick Children, a position he has held since 2019. Dr. Cohn joined SickKids in September 2012 as the Chief of the Division of Clinical and Metabolic Genetics, Co-director of the Center for Genetic Medicine and Senior Scientist at The SickKids Research Institute. Dr. Cohn received his medical degree from the University of Essen in Germany.

After doing a postdoctoral fellowship at the Howard Hughes Medical Institute, he moved to Baltimore where he was the first combined resident in pediatrics and genetics at the Johns Hopkins University. Even while performing his duties as CEO, Dr. Cohn is still very involved in the clinical mission of SickKids. He sees patients and oversees a research lab that is focused on the genetics of muscular dystrophies.

In recent years, Dr. Cohn started getting interested in the concept of Precision Child Health. The concept is now a powerful movement within SickKids, leading the shift from a one-size-fits-all approach to individualized care, tailored to each patient's unique characteristics from their genetic code to their postal code.

Ellen Gardner: I wondered what your motivation was for joining SickKids when you did in 2012, what were you thinking at that time?

Dr. Ronald Cohn: I came from Johns Hopkins and was actually quite happy there and was then contacted by the previous chair of the department of pediatrics to look into the chief of genetics position that was open, actually for a while. And so when I told him, I will be interested to talk to you, then his first question to me was, why are you talking to me? And I said, "Well, if a world-class institution like SickKids knocks on your door, you at least have to open the door and see what's behind me." And that was really the beginning of the journey. I came then here to SickKids for the first time, and I will tell you what I was almost mesmerized with. It sounds a bit dramatic, but really what I was taken by was there is an aura in our institution of the people who work here, who love working here, and that is true for every single person who works here, whether that is a physician, whether that's another healthcare provider, whether it's an administrative person, whether these people who keep our space safe and clean.

Dr. Ronald Cohn: Everyone loves working here and you feel this, like when you spend a day or two here, you feel this.
So I remember going back home telling my wife, I think this is actually interesting. And then when I looked at the opportunities, SickKids, particularly in genetics, having had a longstanding history of being a leader in the field, I felt this is an opportunity that I could not pass on. And here I am. There's a cheesy part of this, which I'm going to tell you, which I actually completely forgot about, but my wife reminded me. Twenty-eight or 29 years ago now, when we went on honeymoon, we went to New York City and then rented a car and also came to Toronto and as part of our visit to Toronto, did a bus tour, looking the inner city.

Dr. Ronald Cohn: We drove by SickKids and she told me that I told her, apparently, that this is the SickKids Hospital, one of the best children's hospitals in the world, which is a place I probably will never work at. Although I forgot about it, I shamelessly used it in my interview, for my chair of pediatrics and CEO position.

Ellen Gardner: What was one of the first things you learned about the hospital when you started?

Dr. Ronald Cohn: To tell you the truth, what struck me most in my early days was the enormous, almost like a gold mine of complexity, of medical issues that the patients had. I have always, very early on, enjoyed the challenge of medically complex children and their families. I always felt that it was, I think being a physician is a privilege altogether, but I think being a physician for children with very medically complex problems is an even bigger privilege. And also a responsibility, as you often meet children and their families in such vulnerable times that I think that's a challenge I was always willing to take on.

Ellen Gardner: SickKids has traditionally divided care into two types, inpatient and outpatient. And of course, the pandemic changed all that, as the hospital moved quickly to respond to consumer demands, using new technology and virtual care. Your new vision is SickKids care, anytime, anywhere. I want to ask you how difficult it was to pivot, to providing care that truly transcends physical and geographic boundaries?

Dr. Ronald Cohn: People are trying to find silver linings of this pandemic, which is undoubtedly difficult. But I would say that one of the silver linings of this pandemic has been that we were literally forced to move into the virtual care concept for most of our outpatients in a record time. I think what probably would have taken us at least I would say 18 months, if not 24 months, literally happened within a week and then obviously we build on it.

I think this is just the beginning of virtual care, the way how we are positioned right now with many of our out-patients is a first step. We are just about to launch a pilot project for a virtual urgent care in order to potentially reduce some of the flow of patients who come to our emergency room. Then there is an additional step moving forward under the concept of SickKids anytime anywhere, is that we hopefully will have monitoring opportunities of children at home that would help us reduce the time they actually have to stay in a hospital.

Ellen Gardner: What are some of the things that you and your leadership team do to help you stay connected to the amazing work of your staff across the whole organization?

Dr. Ronald Cohn: I personally try to interact with as many people as possible, whether this is through going through the hospital, visiting different areas of the hospital. We have what we call Executive Rounds that are more geared towards identifying potential opportunities to improve our safety measures in certain areas of the hospital.

And another interesting development just over the last few months has been obviously a very important need for communicating all the changes that we had to go through, update people within the institution about what has happened, what's the status quo, what are we anticipating to happen. So we started these virtual town halls and as much as I miss actually speaking in front of a group of people, looking into their eyes, seeing who's listening to me, who is maybe not listening to me, we are reaching an enormous amount of people through the virtual town halls.

Dr. Ronald Cohn: I mean, I think our record number was over two and a half thousand people at some point during the pandemic. And we at least have several hundred, if not over a thousand people, every time we organize our town halls. And I can tell you, I've received a lot of feedback from members all across the institution, how much they value that we are trying to be transparent and communicate as much as possible, whether it's through the town hall or I send out all staff emails on a regular basis with important updates. So there's the personal connection that we are trying to seek as much as possible, but through the pandemic now, the virtual connection is something that we have leveraged quite a bit.

Ellen Gardner: When you think about SickKids, you think about a place that's alive with people and activity and children and families and the community, a colourful, lively place. And yet I'm sure all that's changed now. And I wonder how you've been able to really pay attention to maintaining the culture, that very special culture of SickKids?

Dr. Ronald Cohn: You were talking about families and children, I can tell you that the single most difficult change we had to implement initially and although we have been able to loosen some of those restrictions, but it's still restricted, is to limit the amount of caregivers who can be with their children. From the other hospitals and long-term care facilities, that are doing, beginning of the pandemic and some hospitals now have restricted visitors completely, which obviously in the children's hospital, you cannot do. We know how challenging this was for the kids and the families, but also for us as staff members to tell parents, sorry, only one of you can be here. It's important to emphasize how difficult that was.

Ellen Gardner: I'm sure there've been many tough days for you and your leadership team and the staff at SickKids. And for you, what do you do when you have those tough days and you really need a reminder of why you're doing this work, is there a story that you reflect on?

Dr. Ronald Cohn: I will have to say that I never need a reminder for why I do what I do. But if I tell you the truth, the reason for what I'm doing is actually very personal in nature. So when I was in medical school, second year medical school, our closest friends had a child who was back then diagnosed with, which was called a mitochondrial disease. I need to have you and the listeners go back to almost over 20 years, where there was no internet so you couldn't Google what this was. So I opened my dictionary back then, and the definition of a mitochondrial disease was it's a disease of the mitochondria, which I only could say, duh, I figured that much. And then I went to the professor in pediatrics in Germany who made this diagnosis of our friend's child and I told him, I want to write my medical thesis about this. And that was really the deciding moment in my career, when I knew I wanted to be a pediatrician with a focus on neurological and genetic diseases.

Dr. Ronald Cohn: And just to round this out, he didn't end up having a mitochondrial disease and one and a half years ago now, last summer, after over 20 years, we finally made the diagnosis through genome sequencing, which obviously back then we didn't have the opportunity to do. And that was probably the closest I will hopefully ever get to understand what it means for some of the parents I have been taking care of in providing them a diagnosis that many of them have been looking for many years. So when I spoke to the mother of the child, we were both crying on FaceTime. She lives in Switzerland, so it was a FaceTime conversation.

Ellen Gardner: There's a lab at SickKids called the Dr. Ronald Cohn lab. Can you tell us a little bit about the lab and the kind of work being done there?

Dr. Ronald Cohn: Yeah, I'd love to. So for many years in my scientific career, I studied the underlying mechanisms of muscular dystrophy. So my specialty is children with neuromuscular disorders. And for many years I worked on animal models for muscular dystrophy, trying to understand the pathogenesis. There was actually a time where I did hibernation research on hibernating squirrels, because they go into hibernation, don't move for six months and then just wake up and move, like if nothing would have happened. So we were looking into why can they preserve muscle like nobody else. But then when I came to SickKids, coincidentally, it was the time when the first publication about the genome technology CRISPR came out, which is this genome editing technology that for the first time put a concept forward that would allow us to even begin to conceptualize or think about how you can actually fix a genetic mutation.

Dr. Ronald Cohn: So I remember I was here one year, just had a small group of lab members assembled, and I had a lab meeting and I told everybody, look at this exciting research, I want us to drop everything we are doing right now, and are you willing to go with me on a journey, trying to use this technology as a way to identify neurotherapeutics for muscular dystrophy back then, and now we're doing this for many different disorders. I have the best group of scientists, some younger ones, some more experienced ones, who were also excited like I was.

So we switched completely and became a genome editing CRISPR lab now and are working on muscular dystrophy and a few other neurological disorders and some immunodeficiency disorders. Really trying to work on how can we develop therapies for these genetic disorders in a way that literally by the time I moved here, nobody could even think about.

Dr. Ronald Cohn: So it's very exciting what we do in our laboratory. And I'm very excited that I have my lab constructed in a way that I have a leader who is responsible for the day-to-day activities, so that I didn't have to give it up when I moved into my role as CEO.

Ellen Gardner: Well, I guess you do try and drop in there as often as you can?

Dr. Ronald Cohn: Once a week we have lab meeting, it's the holy time. And my assistant knows this time can only be violated if maybe the ministry or somebody else needs to speak to me!

Ellen Gardner: But really it must be difficult to leave or at least put in a more limited timeframe, the research work that you're so attached to.

Dr. Ronald Cohn: I will tell you, honestly, I made it very clear when my board chair approached me about two and a half years ago and encouraged me to apply for the position as CEO. I initially told him no, because I told him I do not and cannot lose my identity because my identity is being a physician and a scientist. And then he told me, "Oh, you can do anything you want as a CEO." So I went through a very intense thought process of six weeks to think about, can I really pull it off and do at least a little bit of the other things? Of course, I have to reduce it and I do much less of it now, but I continue to see my patients in clinic. And I continue to see patients as an inpatient, ward attending about a month out of the year. And that's critical to me.

Ellen Gardner: The past few months have been watershed moments for many organizations in terms of equity, cultural safety, and racism issues. How has SickKids tackled these very challenging issues?

Dr. Ronald Cohn: Yeah, I agree with you. I think the time when George Floyd was killed literally in front of millions of people and the entire movement that has started after this, was an additional challenge. I will say we have already put an emphasis on equity, diversity inclusion in our strategic plan that we publicized literally two weeks before the pandemic was declared. But I think it helped us to really refine our focus in various aspects. So, number one, initially, we were planning to hire a director-level person to create what I want to call the EDI directorate. And throughout the summer in conversations with my senior management team, we decided to elevate this position to a member of the executive team simply because we felt like it was important to have somebody at that level, overseeing equity, diversity inclusion within our institution. We made a number of other short term commitments. Like for example, we are about to create a safe space for the Black members of our staff, where they can come together with an external facilitator, speak about the experiences they have, the challenges they face.

Dr. Ronald Cohn: And hopefully come to a point where then with the external facilitator, people like myself and others from our senior executives can come and listen and engage into a dialogue. We have a physician who is the associate chief of equity, diversity inclusion with department of pediatrics, Dr. Indra Narang, who started an allyship program within the department of pediatrics that we are trying to institutionalize now all across of SickKids. In line with this, I have asked my team to identify EDI champions all across each one's portfolio.

So we are just beginning the search process for this executive lead of EDI and how it will have an army of the willing assembled by the time the person starts. I think it's a difficult journey, it's a journey that will never end, but I'm glad we made it a pillar of our strategic plan. And we have full support from literally everyone, at least at the executive level and the director level, to bring some real change.

Ellen Gardner: Dr. Cohn, SickKids is dedicating itself over the next few years to a movement you call, Precision Child Health. It's built around the idea of healthcare that's individualized to each patient's characteristics. Is this unique to SickKids? And why does it represent the future of care?

Dr. Ronald Cohn: The way how we are trying to approach this is fairly unique. And I tell you why. When you look at other institutions who talk about, they call it Precision Medicine, then almost always the entire focus is on genomics and genetic genomic medicine. What was really important to me is to begin to think about the individualized medicine in the individual concept of providing care in the entire context, from the genetic code to the postal code. There are so many important data in between those two, including those two, obviously, and the postal code obviously has shown to be more important than ever during this pandemic right now. That I think in order to truly provide an individualized approach to the diagnosis and management of each patient that is in front of us. When we see a patient, we need to include the entire concept and data sets that we sometimes have at our fingertips and are just not utilizing enough. How can these data sets allow us to potentially predict certain responses to therapy, certain responses to different challenges, as well as some preventative measures, then you can take on?

Dr. Ronald Cohn: So I give you one example from our intensive care unit, where we have, our team has collected literally trillions of data in terms of blood pressure, heart rate, and CO2 concentration, and all sorts of different things you measure literally every second in the PICU. And they've used these data to design an algorithm that helps you predict whether somebody is going to have a cardiac arrest, five minutes out of time. And if you think about having ever watched something on a TV show, what it looks like when you have to call a code blue, because somebody has a cardiac arrest until everybody is around the bed, takes some time. And in here you have an ability to know this five minutes ahead of time, and at least have everybody there before it happens, and maybe even go as far as trying to prevent it from happening all together. So that's just one of the examples of where we are trying to really look at the very broad data set and then leverage the technology in order to think about prediction as well as prevention.

Dr. Ronald Cohn: Our goal is to really change the clinical paradigm by combining all of those aspects. And really at the end of the day, move away from this so-called one-size-fits-all approach to a truly individualized approach of the patients and families we are taking care of.

Ellen Gardner: What do you think are three things that every leader, no matter what sector they're working in, should try and learn?

Dr. Ronald Cohn: So I think number one would be self-awareness. I think you need to know what you know, and you need to maybe more importantly, know what you don't know. And identifying the areas where you maybe have some weaknesses and then not being shy in asking for help from individuals who are very good at that. So I think that's one, it's part of a bigger picture of self-awareness because ultimately, part of being self-aware is the willingness and the necessity to take responsibility for your actions. But I think you can take that only if you're very self-aware of where your strengths and weaknesses are.

I think you need to learn and demonstrate agility and maybe adaptability, if you want to say. So I think what I mean by that is I think you need to be willing to think how to create change and how to implement change. And in my own little microcosm, we talked about my laboratory where I told you, we just completely changed directions of our research based on the opportunities that were at hand. At an institutional level, no matter which sector you're in, there are always opportunities for change and you need to see them, you need to identify them and then you need to help implement them.

Dr. Ronald Cohn: And maybe the last piece is I would say around cultural intelligence. We talked about equity, diversity inclusion, and I think that is so important probably in every sector. In our sector it's so important to understand where our patients are coming from, where the family is coming from, where are our staff members coming from. Because I think without having the knowledge about different cultures, different sensitivities, you're just running the risk of being not nearly as successful as you could be.

Philip De Souza: I really liked your three lessons, I wrote all, I was taking lots of notes! You mentioned some great points there, was a masterclass for leaders. But one thing I really liked what you had to say, a couple of things about you didn't want to lose your identity. You said it so proudly and eloquently, you didn't want to lose your identity. Is there something that triggered you to say that to that individual you're speaking to, is there some advice you can give other emerging leaders like, "Oh, here's something, you could do to not lose your identity?"

Dr. Ronald Cohn: So I give you a two-part answer to this, number one, I have to preface this by being in my current role only for, a little bit one and a half years. So I think you probably need to ask me the same question in five or 10 years again, whether I can maintain my clinical activities and my research activities. I can tell you so far, not only that I've been able to maintain it, what I didn't know and didn't realize because I was doing this really for me, but what I realized is that my colleagues appreciate that I still take the time to see patients and take part in our clinical mission. And that is something I was surprised to see, but has been probably further encouraging me in my journey to try to keep my identity. It took me about six weeks to think about, is this a position I would like to apply for?

And during these six weeks, I think my wife put it best, when I was privileged to become chair of pediatrics and pediatrician in chief here, I personally felt like I've reached the pinnacle of my career. I was so happy, honestly, and from the very first day, and my wife said it, you put on a suit, it fit you, and you just ran with it. And during these six weeks, she said, you need to see whether there is a suit, whether you can tailor it to yourself that you can still run with it. And that's what happened in the thought process. I remember taking a walk with her one day with our dog, talking about some of the ideas I had, particularly around the strategy. And she was looking at me and telling me, I think you're choosing the colour of the suit. And that was really the process I went through, could I see myself in this role and not give up who I really am? And once I was able to see it from myself, then I got excited and then I decided to apply.

Philip De Souza: I think we should be interviewing your wife as well!

Dr. Ronald Cohn: You probably should.

Ellen Gardner: I did have one last question, which yes, it's more of a reflection on your part, Dr. Cohn. You spent a number of years in the States at some very fine institutions. And I just wonder coming to Canada and being here, you've been here for a few years now, but are you reminded all the time of the differences between Canada and the United States? That experience in the US must've given you a certain view to very high level medical care.

Dr. Ronald Cohn: I can tell you that that was one of the best decisions of my life to move here. And I can tell you it was a difficult one because my children, at the time we moved here were 15, 12, and four, so my little one at four, probably didn't care so much as long as he had a ball to play with, but my daughters, moving my daughters out of their environment in schools was something that I was very worried about, that we were very worried about as a family, but they have integrated here so quickly within the first year. And we have really individually, as much as a family, been thriving here in Canada in every aspect, not just professionally. Obviously, I had a very fortunate career path at SickKids as well, but even just living in Toronto, in a truly multicultural city has been the best move I think that we have made, and we made a few moves throughout our life. So was the best part so far.

Ellen Gardner: So we're moving into the lightning round. So I'm just going to ask you a few questions and don't think too much about the answers. Just give me the first thing that pops into your head. So what was your first job?

Dr. Ronald Cohn: My first job was working as a, let's maybe call it something equivalent to a nurse assistant in an emergency room, in a community hospital in Germany.

Ellen Gardner: What's the last thing you do before you go to bed at night?

Dr. Ronald Cohn: Usually I read various, scan through various newspapers on my phone.

Ellen Gardner: What's one thing you're doing differently in your life since COVID-19?

Dr. Ronald Cohn: I do think it has given me personally a new appreciation of how lucky and privileged I am, my family is, and how many individuals are not as privileged and lucky as we are.

Ellen Gardner: What's your go-to resource for when you're stuck and you need an energy or a creative boost?

Dr. Ronald Cohn: My family and my wife. I mean, if I have a very technical issue in terms of, if there is a problem that I cannot solve, it requires somebody with a specific knowledge or skillset, I go to that person, whatever it is. But if you talk about energy and creative boost, it's honestly my wife and my family, my kids.

Ellen Gardner: What's your worst habit?

Dr. Ronald Cohn: Driving too fast and parking in bad spaces!

Ellen Gardner: Can you finish this sentence? If I wasn't in healthcare, I'd be working as a_______________?

Dr. Ronald Cohn: Rabbi. That probably requires an explanation, right? And I'm not saying this because I'm overly religious, but a significant portion of what I do as a physician and what I think most of us as physicians do is to be involved in counselling and teaching. And sometimes speaking to other people, trying to convey an idea or message. And I think I may have become a rabbi otherwise.

Ellen Gardner: Dr. Cohn, it's been such a pleasure talking to you. We really appreciate your time and just yes, wish you all the best.

Dr. Ronald Cohn: No, thank you. This was a lot of fun. And thank you for having me.

Thank you for listening. You can hear more episodes of Healthcare Change Makers on our website HIROC.com and on your favourite podcasting apps. If you like what you hear, please rate us or post a review. Healthcare Change Makers is recorded by HIROC's Communications and Marketing team and produced by Podfly Productions. Follow us on Twitter at @hirocgroup or email us at communications@hiroc.com. We'd love to hear from you.