Episode 28: Dr. Lisa Calder, CEO, CMPA

As the first ‘virtual’ CEO for the CMPA, Dr. Calder is focussed on communicating three themes to her members: we’re here for you; we’re going to modernize the CMPA; and we’re going to do it in a collaborative way.

Show Summary

In this episode, we’re speaking with Dr. Lisa Calder, CEO of the Canadian Medical Protective Association, known as the CMPA. She stepped into the role in August last year and is the CMPA’s first female CEO.

Dr. Calder studied medicine at the University of Western Ontario and did an Emergency Medicine residency at the University of Ottawa. She has a Master of Science degree in Epidemiology and was an Associate Professor at the University of Ottawa in the Department of Emergency Medicine.

Dr. Calder pursued her passion for patient safety by completing two additional fellowships: the Patient Safety Fellowship in Emergency Medicine from the Society for Academic Emergency Medicine and the Emergency Medicine Patient Safety Foundation, and the American Hospital Association’s Fellowship in Patient Safety Leadership.

She spent more than a decade practising as an emergency physician before joining the CMPA in 2015 as the Director of Medical Care Analytics.

When Covid 19 hit, Dr. Calder and her leadership team moved quickly, using a variety of tools to support their physician members during this tumultuous year. She credits her own experience as an emergency physician for teaching her disaster training and how to live with unpredictability.

Today Dr. Calder says the mission of the CMPA has never been more important - to protect the professional integrity of physicians and promote the safety of medical care.

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 Healthcare Change Makers. I'm Ellen Gardner with Philip De Souza. Today we're speaking with Dr. Lisa Calder, CEO of the Canadian Medical Protective Association, known as the CMPA. She stepped into the role in August last year and is the CMPA's first female CEO.

Dr. Calder studied medicine at the University of Western Ontario and did an emergency medicine residency at the University of Ottawa. She spent more than a decade practicing as an emergency physician before joining the CMPA in 2015 as the director of medical care analytics.

When COVID-19 hit Dr. Calder and her leadership team moved quickly using a variety of tools to support the physician members during this tumultuous year. She credits her own experience as an emergency physician for teaching her disaster training and how to live with unpredictability. Today Dr. Calder says the mission of the CMPA has never been more important, to protect the professional integrity of physicians and promote the safety of medical care.
We spoke to Dr. Calder in December at her home in Ottawa.

Ellen Gardner: Welcome Dr. Calder. Great to have you on Healthcare Change Makers.

Dr. Lisa Calder: Thank you so much for having me today. I'm looking forward to this.

Ellen Gardner: Dr. Calder, you stepped into your position of CEO at the CMPA in August in the midst of the pandemic. How did you prepare yourself for working in an atmosphere of heightened caution and anxiety?

Dr. Lisa Calder: I think that one of the things that has served me so well as CEO is actually my training in emergency medicine. In emergency medicine, we are trained to be prepared for the unexpected. We are trained to anticipate worst case scenarios, and we actually also do a fair bit of disaster training. So for me, the concepts of being able to rapidly gather information, set clear priorities, and make sure that first and foremost, we're looking after our team. That we have a sense of what's changing in the environment, how to respond and do our best to try and be proactive and anticipate those are all skills, I was able to bring to bear and were really transferable skills for me.

Ellen Gardner: So learning to live through a disaster and coping with a disaster, any kind of disaster might have certain characteristics, but a pandemic is different. I mean, have you felt like it's a very different kind of disaster or difficult scenario to live with?

Dr. Lisa Calder: I think for everyone who is living through this, this is exceptional. No one has the life experience to say, oh yeah, been through this before I know exactly how this is going to unfold. There's no question though that it is very uncertain. There are lots of new stresses. And I think for me, one of the observations I would make about the pandemic that I think is particularly challenging is, there are things that we can see that are right in front of us and are being reported in terms of numbers. But there are impacts that are more subtle on our well-being, on the way that we work together. And those are the ones that I find tricky to put my finger on and understand – what are the more subtle or changes that are happening to our society, to our way of working, to our ways of living that we need to also attend to.

Ellen Gardner: You've probably been hearing about those more subtle kinds of impact from your members and from staff. What kind of impact are you hearing about from them?

Dr. Lisa Calder: It is fundamentally changing the way we deliver healthcare and for our physicians that creates both a great deal of stress and anxiety, but also I've been so inspired by the physicians who are also finding new opportunities as well. I think that there are some very real challenges for our physicians in being able to provide the care that they want to provide in these really extreme conditions. There have been some really great stories of innovation in terms of how physicians are using virtual care in ways that we have never done before. And also how to maintain connection with their patients, how to look at managing wait lists and wait times in innovative ways, and really thinking about how to help mobilize teams to be responsive and provide the best care that they can in these rapidly changing conditions.

Ellen Gardner: Have you made it a point to try and uncover these stories?

Dr. Lisa Calder: Absolutely. And I think that one of our really key roles at the CMPA is to really listen to our members and I have the opportunity to connect with our members in so many different ways. At the CMPA we have a telephone line, which is available to our membership and we receive up to 200 calls a day from our physicians asking for advice. And that has been a very valuable source of information and data for us to understand what are the concerns foremost in the minds of our physician members.

You'd also mentioned our staff in that first question, and there's no question that our staff at the CMPA are being impacted by the pandemic as many people are. And I have definitely heard stories of our staff in terms of how they are experiencing the stresses of the pandemic. The one thing that I think has been really heartening are the number of employees who have told me how well supported they feel by the CMPA during this time of uncertainty, which has been really encouraging and very much our goal.

Ellen Gardner: A big part of your mission is helping physicians reduce their risk, so has that changed a lot since COVID-19?

Dr. Lisa Calder: You're absolutely right. It's our prime mission is to protect the professional integrity of physicians and promote the safety of medical care. For our membership, I mean, it's never more important than now. I think for our physicians it really helps them to know the CMPA is there for them and we have their back. One of the things that we did that was really appreciated by the membership was we created a COVID-19 hub on our website. It posted a lot of the most frequently asked questions that we were receiving to address a lot of the concerns physicians had about what was happening both early and subsequently in the pandemic.

Dr. Lisa Calder: So we have had questions around, what do we do about accessing personal protective equipment for ourselves and our staff? What do we do about flu vaccinations during the most recent second wave of the pandemic and making sure that we can provide flu vaccinations to our patients? How do we handle challenges with providing care in long-term care homes? So those are all the types of questions our membership are asking us. What we did, which was new for us was, we really took those questions and reflected them back to our membership in a way that was easy for them to access.

Ellen Gardner: The CMPA is noted for having strong medical legal data. How is this data used?

Dr. Lisa Calder: Yeah, we do have actually the largest physician medical legal database in the world. And we use these data in many ways. First and foremost, we use this data to manage cases as they come through for our members. But I mentioned the advice calls that we receive on a daily basis. This is a very rich data source for us to really keep an eye on emerging trends and concerns that are top of mind for our physician membership when it comes to medical legal issues or patient safety issues. So we regularly look at this data and use some innovative analytic techniques to pull out some signals from all of those calls that we receive. We also then use our case data to be able to inform all of the products that we create to help physicians manage their medical legal risk.

Dr. Lisa Calder: And this extends from articles we write and post on our website, articles that we write and publish in our Perspective magazine, education sessions that we used to provide in person, but that we are now rapidly pivoting to provide virtually, we do podcasts. We also have infographics that we are issuing via social media. We present abstracts and we publish manuscripts and peer review journals. We also have opened a member data request service where physicians can ask Jessica a question, a research question or a question related to educational presentation. If we have the information and the resources to answer it, we will share an analytic report with our members so that they can actually access some of the data that we have.

Ellen Gardner: Are there any limitations to using medical legal data? And do you think there are any ways that could be improved?

Dr. Lisa Calder: I'm very passionate about looking at how we can leverage our use of medical legal data to improve the safety of medical care in Canada. I think there's tons of opportunity there, but as a researcher, it is always really important to understand the nature of the data and the limitations inherent in it. And in this instance the challenges that we have are that this is not a comprehensive sample of all the patient safety incidents that are happening across Canada. It really is a tip of the iceberg type of sample.

What's interesting though, is at first, when I first came to the CMPA, I wasn't sure how representative the medical legal data would be of patient safety issues. But when you look at what's reported in the literature and what we see in our medical legal files, there's actually very close alignment there. But the other limitation is that we're always, when we look at medical legal data, looking back in time, trying to reconstruct events that occurred.

Dr. Lisa Calder: And so we're limited by what's actually documented, and that's a significant limitation because we know that a lot happens in the moment when physicians are making critical decisions that does not get documented. And so what that means is that we can try and draw lessons learned based on what we read through the record, but it doesn't substitute for really understanding what was going on in that physician's mind in the moment and helping support strengthened decision-making the next time around.

Ellen Gardner: How do you change that or how do you actually develop an understanding of what physicians are thinking and how you're helping them in terms of reducing harm and costs?

Dr. Lisa Calder: One of the things, again, as a researcher that I always really valued was looking for multiple sources of data and triangulating what you're seeing. So we'll see certain signals in medical legal data. For example, to say that physicians are challenged with the informed consent process of how to surgery. Sometimes that can be very challenging when you're working in a resource-restricted environment. So we note things around communication related to informed consent. Well, that's based on our sort of detective work through the record. The next part then is when we engage in our education sessions with our physician members, it's an opportunity for a dialogue. So we can say to them, hey, here's an example of a case we've seen where it was clear the physician was challenged with this informed consent discussion. Have you ever seen this? And if so, how have you approached that? And what do you find works?

That dialogue that we have on an ongoing basis with our members through our education efforts allows us to not only validate the findings that we see in our research with our medical legal data, but also help generate some of the solutions and ways that physicians can improve care. So there's a great opportunity for us to work with our membership, to help us understand what we're seeing in our data. Other organizations who have complimentary data sets can also help to fill out that picture.

Ellen Gardner: I think we've recognized that communication has fundamentally changed since COVID, and that there's really more awareness of being compassionate, being transparent, being open. Or maybe you can tell me one or two things that you've changed or are working on changing in the way CMPA communicates with its members?

Dr. Lisa Calder: What I have seen, and I agree with you that I've seen this amongst other medical organizations, and I've been proud to see this through the CMPA. And I give a lot of credit to the leadership and our communications team as well, which is that a lot of organizations in the past sometimes, and I'm, as a physician, I belong to a number of organizations. I received communications from different organizations. Sometimes the communication was pretty formal and pretty corporate and dry. And I've seen a real shift, which I think is hugely positive, to more of a personal tone to the communication, a more of a sharing struggles and a willingness to be humble and authentic on the part of leaders and to reach out and basically say, look, I care about you and what you're going through. I know that it's hard. That personal aspect to how we communicate with our members, I think is tremendously important.

Dr. Lisa Calder: It's interesting, and in myself and my own network of physicians who I know personally, people who perhaps in the past were either someone you saw as being unflappable or someone who you felt even was perhaps a bit jaded or cynical, all of these folks are vulnerable, and they're expressing it. And I think that there is a silver lining there because if we are willing to share our vulnerability, there actually a strength and courage in that. And I think that it does break down some barriers between people when they're trying to communicate, share how they feel and support each other. So that, and I hadn't really thought about it that way before, but I do see that if we are able to be more vulnerable with each other and support each other better, it might actually help us communicate better. And for physicians to communicate with each other better and with their colleagues better and with patients too.

Ellen Gardner: We understand that you recently started a Listening and Learning Tour with each of the CMPA departments. What are some of the questions you're asking?

Dr. Lisa Calder: This is something I'm really excited about, and it's such a unique opportunity and a great opportunity. I'm the first virtual CEO of the CMPA since I, as you pointed out, started at the end of August. In my head, I had envisioned that I would be able to walk around the building and meet people and talk to them. And obviously that's not possible since we're all working from home. So we launched this virtual CEO Listening and Learning Tour. The three areas of focus for me as a CEO that I've been communicating consistently with our teams and with our membership is I'm really focusing on the three themes of: we are here for you; we are going to modernize the CMPA; and we're going to do it in a collaborative way.

Dr. Lisa Calder: So my questions, I actually sent a survey out to all staff ahead of time. And then my questions in this tour are really along those three themes. I want to know from employees, what does it mean when we say we are here for you? What does that translate to for you in tangible terms in your day-to-day work? And what does it mean to modernize the CMPA? Where are the opportunities there? And then lastly, how do we collaborate especially now? We had ways of collaborating very effectively pre-pandemic. Now that we are in this, and we are looking at new ways of working together, how do we collaborate? How do we effectively achieve our goals?

I just had my last stop on the Listening and Learning Tour yesterday. And I have to say, it's just been such an energizing and positive experience to hear people's enthusiasm and willingness to share their ideas and suggestions. It really inspires me in terms of how innovative we can be as an organization when we have so much talent and so many employees who are engaged and care about what we do and how we support our membership and how we support each other. So it's been a really fantastic experience and I'm going to use all that information to shape our next strategic plan.

Ellen Gardner: Have there been any kind of stand-out moments or comments you've heard on the listening and learning tour?

Dr. Lisa Calder: The standout items for me are a real desire to look at what does flexible work look like now and post-pandemic. This has again been a unique opportunity for us to, first of all, discover the potential of what we can do, that it turns out we can all work from home and achieve our deliverables as an organization. But the next stage is what parts of those do we preserve and help us enhance our work, and what do we need to reconsider.

So I really heard a desire on the part of a lot of employees to say, please keep the flexibility that you have brought in in response to the pandemic, because we find that so helpful to manage your work-life balance. And I think in terms of the modernization theme, really exciting stuff about how do we use technology to create new ways to interact with our members. And this is anywhere from an app so that our members can access CMPA information at the bedside, at their fingertips to what does our member portal look like, where we can actually push to them information that they need. Really focus on the user experience to make that a seamless experience whenever a member wants to interact with the CMPA, lots of exciting potential there.

And then also loud and clear, and we're not alone in this. I know other organizations are struggling with this, but when it comes to collaboration, so many people are missing the informal chats. They'll walk down the hallway and seeing someone from the department saying, hey, what are you up to or bumping into the elevator or in the cafeteria and we don't have any of that. So right now, you have to schedule a meeting or you might do a chat through one of our platforms, but it's not the same. So how do we cultivate some of those really valuable informal conversations which facilitate collaboration? And so we're going to have a close look at that.

Ellen Gardner: There's many advantages to working from home, but I think the lines get blurred between personal life and work life. How have you, Lisa, maintained your own health and well-being during this time?

Dr. Lisa Calder: I've been really fortunate, I think to go through my own sort of health and wellness journey and to identify practices that I know that I need for my own wellness. And very much to what you said about the boundaries between work life and home life. Those are really important for me. I engage in a number of practices that help me preserve some of those boundaries. I'm also a big fan of mindfulness. I know it's not for everybody, but it definitely is for me. So, I do yoga practice every morning. I'm fiercely protective of my lunch break every day. I need time away from my computer, and I use that time to go for a quick walk around the block and then to meditate. And then, at the end of the day, as this has been actually one of the silver linings of the pandemic for me, my husband and I both go for a walk at the end of the day.

Dr. Lisa Calder: That for me is very much about, it's my opportunity to just kind of debrief with him, and then after that we come home, my work is done. So I really use that as a line and a boundary. And I feel quite strongly about this and in the signature line of my email, I have a line that I learned from Dr. Mamta Gautam, who is an excellent coach and just wellness expert, and the line is, I do not expect a response from you in evenings and weekends. I've been working really hard with my team to reinforce that, which is that if some people feel like they need to send an email in the evening, that's fine, but sometimes we unwillingly create expectations in doing so. So if I send an email to my team at 10:00 at night, they might be like, holy cow, I should answer her right away.

That's not the intention, so I've said it explicitly in my signature line, it says it is that I don't expect a response then. My team knows how to reach me urgently by text if they need to, but I really do my best not to check my email in the evenings and weekends to preserve some of those boundaries, and I think that's quite important.

Ellen Gardner: Have you, in your career as a physician and as a researcher and an educator, have you taken in a lot of lessons from other leaders who you've been exposed to in your life?

Dr. Lisa Calder: So many. Yeah. I was very lucky to be able to do a patient safety leadership fellowship. So I did a fellowship in leadership and I had the opportunity to, through that fellowship, pick the brains of some really preeminent thinkers and leaders in patient safety in North America. I learned a lot about psychological safety, how it is important to establish that with teams and cultivate that. That's something I speak about a lot as a leader. I also learned about situational awareness and the importance of that and the mismatches situational awareness between leaders and teams and the pitfalls that can come into play there.

I've learned a lot about transparency and also about modelling. And that last point is linked to your previous question about wellness, which is that I think if we want to cultivate the next generation of leaders, we have to model a model of leadership that is appealing to other people.

If people see leaders who are burning the candles at both ends and not taking care of themselves, that doesn't motivate people to say, that's what I want. So if we can find a way to create models of leadership, which people look at and say, Lisa looks like she's taking care of herself and enjoying herself, and maybe I could too? I mean, that's, I think that can be very powerful.

Philip De Souza: I really appreciated your points, Dr. Calder on the leadership lesson on vulnerabilities. I really appreciate that, and I also appreciated your point about how our staff are not able to have those moments of serendipity, walking around the office. And I know we have struggled. I've been trying to find ways to make those happen, and we've introduced something called The Collision Chats, where we pair up staff randomly and they meet up for five, 10 minutes, and that's just a way of having those kinds of hallway conversations online if possible.

Dr. Lisa Calder: I love that idea, Philip. Thank you. I'd read about, and I've been pitching that as well. I'd heard about the random mixer where people sign up for it, but then you just randomly allocate them for a 20-minute coffee break to chat so, and I've certainly heard some enthusiasm for that. But I'm really, I love that you guys – Collision Chats are an awesome tag nickname for that. I love that idea.

Philip De Souza: And then after the chats happen, people talk about it on our Intranet saying, oh, who did you collide with today?

Dr. Lisa Calder: That's cool.

Philip De Souza: It's very fun and people love it. And it's also really helpful for new staff. We have on-boarded a bunch of new staff during the pandemic as well. And it's important to let the new people see and feel and learn about the culture of the organization. So I totally agree with you at that point of trying to find those moments, it's very important. So I know that HIROC has had a long relationship and also more so now, with Salus Global and CMPA, SOGC, and of course HIROC. I wanted to know why do you and the team at CMPA value partnerships? What do partnerships mean to you?

Dr. Lisa Calder: One thing that is abundantly clear and not just in COVID but prior to this. Anytime a national organization wants to advance our mission of protecting professional integrity of physicians and advancing the safety medical care, we can't do this alone. We're one organization and there are so many others who care about this mission, and we have overlap in terms of our goals and what we're trying to do. So, the power of the collective is huge. Anytime that we have the opportunity to partner with others who share our goals is often very synergistic. As a new CEO, that I'm really seeking more of those partnerships and more of those opportunities for us to work collaboratively with others.

Dr. Lisa Calder: Because I really do think that especially when you look now that the challenges ahead for the healthcare system are huge. So we will need more collaborative approaches to address these and siloing organizations, everyone kind of doing their own thing, I don't think is going to advance us where we need to be.

Ellen Gardner: I was wondering Dr. Calder if you find that social media has been a very effective way of communicating with your physician members?

Dr. Lisa Calder: I am so fortunate to have an amazing communications team at the CMPA. And they actually trained me on how to use Twitter when I first joined that CMPA, which I really appreciated because I'll be honest, it was not an intuitive platform for me. There’s a very active medical Twitter community in Canada, and it's a great way for us to engage and exchange ideas with our physician members and share some of our resources. So that is one of the things that I have asked for as a new CEO is, we’re developing a social media strategy, so that we will have even more ways to be innovative and share with our membership some of our ideas and have a dialogue of some of the some of the challenges that our physician members are facing when they're trying to provide safe medical care.

Ellen Gardner: So we are moving into the lightning round part of the interview, Dr. Calder. And I'm just going to ask a few quick questions. Just give us the first thing that comes into your mind.

Dr. Lisa Calder: Sure.

Ellen Gardner: So first question is what was your first job?

Dr. Lisa Calder: Selling windows. It was awful.

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

Dr. Lisa Calder: I have a gratitude practice. So I always think of three things that I'm grateful for before I go to bed.

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

Dr. Lisa Calder: Well, I often find it really helpful to go for a walk outside. That always energizes me and clears my head and sometimes things come to me. But also I find during meditation, sometimes things float to the surface when you actually quiet your mind and you've been banging your head against a certain problem.

Ellen Gardner: What's a surprising thing most people don't know about you?

Dr. Lisa Calder: Hmm. That's a hard one. I mean, some people know, but most people don't know that I love to dance.

Ellen Gardner: What's one thing you've learned or a new skill you've honed in 2020?

Dr. Lisa Calder: I would say recording videos of myself. As again, a virtual CEO, I've been embracing using video messages, short videos to share with our staff. And that definitely was a new skill for me. And it took me a little while to get comfortable with that, and I'm becoming more comfortable, but that's been an interesting new challenge. And thankfully, so far, it seems to be going well. And I think I'm gradually getting better at it.

Ellen Gardner: Finish this sentence. If I wasn't in healthcare, I'd be working as a…?

Dr. Lisa Calder: Researcher. But that was my plan before when I applied for medical school, my backup plan was to become, do a Masters of epidemiology and work as an epidemiologist. Now I did end up doing that. In my residency. I did my Masters of epidemiology and I did end up becoming a researcher, but even if I didn't get into medicine, I knew that was something I was passionate about was just being curious and being able to answer compelling questions.

Ellen Gardner: Is there an interesting alignment there between emergency medicine and epidemiology?

Dr. Lisa Calder: For sure. Definitely there is. With epidemiology there're so many aspects, but one of the things that really helped me in my emergency medicine career was learning to evaluate and be critical of evidence. So, a lot of the times we look to evidence to support decision-making in medicine, and we don't have evidence for a lot of what we do, but for a lot of the contentious and challenging decisions that we make in emergency medicine we seek out evidence. And then when you have a whole bunch of studies, it's like, well, what do you do with that? And how do you decide how you're going to practice? So epidemiology really helped me sift through that evidence and have the confidence to be critical of what I was reading and make sure that when I was attempting to practice evidence-based medicine, that I could be confident that I had the skills to appraise that evidence effectively.

Ellen Gardner: I really want to thank you, Dr. Calder for speaking with us today, it was just a pleasure talking to you.

Dr. Lisa Calder: Thank you, Ellen. The pleasure was mine. I really enjoyed it too. Thanks for inviting 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.