Episode 30: Moving This Mountain Is Going to Take All of Us With Jennifer Zelmer, President and CEO of Healthcare Excellence Canada
The scale of the challenge in health and safety is significant and Jennifer Zelmer knows the scale of solutions must match those challenges. Seeking solutions in the context of healthcare transformation is what drives the newly appointed CEO of Healthcare Excellence Canada.
Our guest today, Jennifer Zelmer, is the newly appointed CEO of the organization formed through the amalgamation of the Canadian Foundation for Healthcare Improvement and the Canadian Patient Safety Institute. It’s called Healthcare Excellence Canada and we were fortunate to speak with Jennifer on the exact day the organization officially opened its doors, March 3.
Jennifer did her undergraduate degree in health information science at the University of Victoria and did several work terms in India, Australia, Denmark, and Canada. Those experiences awoke her interest her healthcare transformation – and since then she’s been dedicated to finding ways of making care not just better and safer, but how to scale those improvements so everyone can benefit.
Jennifer joined the Canadian Foundation for Healthcare Improvement as President and CEO in 2018 and was previously president of the Azimuth Health Group where she was a strategic advisor to leaders who sought to advance health and healthcare at local, national, and international levels.
Although they didn’t plan to bring the two organizations together in the midst of a pandemic, Jennifer is excited by the possibilities. “Amalgamation is a process, not a journey,” she says and knows change won’t happen in a day. But she’s dedicated to leading the organization in helping shift the conversation in healthcare in some simple and profound ways. It starts with asking not “what's the matter with you” but “what matters to you”.
Mentioned in this Episode
Jennifer Zelmer: This was an amalgamation that we chose as organizations to embark on. So quite different context from automations where that choice isn't yours and something where, as we've talked about, the scale of the challenge in quality and safety is significant. Everyone in Canada deserves excellent healthcare, but we're not there yet. And so the scale of our solutions also needs to match the scale of the challenge, which is why coming together as organizations just made sense.
Narrator (Intro): 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, a podcast from HIROC. I'm Ellen Gardner with Philip De Souza. Our guest today, Jennifer Zelmer, is the newly-appointed CEO of the organization formed, the amalgamation of the Canadian Foundation for Healthcare Improvement and the Canadian Patient Safety Institute. It's called Healthcare Excellence, Canada. And we were fortunate to speak with Jennifer on the exact day the organization officially opened its doors, March three.
Ellen Gardner: Jennifer did her undergraduate degree in health information science at the University of Victoria, and did several work terms in India, Australia, Denmark, and Canada. Those experiences awoke her interest in healthcare transformation, and since then, she's been dedicated to finding ways of making care, not just better and safer, but how to scale those improvements so everyone can benefit. Jennifer joined the Canadian Foundation for Healthcare Improvement as president and CEO in 2018 and was previously president of the Azimuth Health Group.
Although they didn't plan to bring the two organizations together in the midst of a pandemic, Jennifer is excited by the possibilities. Amalgamation is a process, not a journey she says, and she knows change won't happen in a day, but she's dedicated to leading the organization in helping shift the conversation in healthcare in some simple and profound ways. It starts with asking not ‘what's the matter with you,’ but ‘what matters to you’?
Ellen Gardner: I want to start by asking you, who were your professional role models when you were growing up?
Jennifer Zelmer: Such an interesting question because I was lucky. We moved around a lot when I was young, so I got to meet lots of different people. So obviously family were professional role models, given the work that they did. Someone else who was really a special mentor to me growing up was a man named Myer Horowitz, who was my mom's boss at the time. He was the president of the University of Alberta, and I used to go to my mom's office after school. And he was the president of the university, but he was never too busy. When a little kid came around, he would proudly display the pottery I'd made. And even to this day, he sends personal notes, and I know I'm not the only one he does them too. Anytime something special happens in your life or something's going on. He always reaches out, so a really special person.
Ellen Gardner: Were you living in Edmonton at the time?
Jennifer Zelmer: I was when I knew him, yes, but earlier on, we'd moved around a fair bit when I was a kid, so I got to know people in all sorts of different places.
Ellen Gardner: You've held an impressive number of positions in healthcare organizations that are really focused on health care transformation: Canada Health Infoway, The Canadian Institute for Health Information, The Canadian Foundation for Healthcare Improvement. What is it that attracted you to this work
Jennifer Zelmer: I think fundamentally at the core, it started with seeing people's experiences of healthcare, growing up seeing different family members who had different experiences and seeing the possibilities for doing things differently. And so looking for opportunities for, where were some of those levers of change and how could you put them together to make transformation happen?
Ellen Gardner: Was this an area that you studied in school? How did you find your way to this line of work?
Jennifer Zelmer: I did actually do my undergrad in health information science, so definitely included questions about opportunities for making care better and also making health better, broader population health questions. So definitely had that exposure. I'd also had some exposure as a younger kid. Both my parents worked vaguely in the health sector, my dad more in education than in health, so I'd had some exposure as a child to the sector as well.
Ellen Gardner: What work were your parents doing?
Jennifer Zelmer: Well, mom was a nurse and then taught nursing in university and then went into university admin. Dad did all sorts of things. He was an educator by training, including a lot of work internationally, so in different contexts, in different environments.
Ellen Gardner: Did you see other parts of the world through his work?
Jennifer Zelmer: I did. We lived in India for a while when I was little, and then in the Maldives Islands, and then my father continued to work internationally, even though we didn't live overseas. And then, actually, my parents moved to Australia just as I graduated from high school, so I then got to have a series of experiences via them and by work terms in my undergrad in India, in Australia, in Denmark, and in Canada. I did do one here, so I was very lucky to be exposed to a very different set of contexts for health and health care.
Ellen Gardner: I'm sure it was very interesting living in India, living in Australia. How did those experiences affect your perspective on healthcare?
Jennifer Zelmer: I think probably most importantly, it made me realize that things don't have to be the way they are. It's that classic of you don't always know what you don't know, and so having seen that things could work differently, made it maybe a little easier to check my assumptions about how things did work or how they could work. And, that's been a super helpful perspective in thinking about healthcare change and what's possible.
Ellen Gardner: We've been through a huge year of change and transformation, and in fact, one of the things that's often done is that we've become very international in looking at how other countries have managed during the pandemic. And I'm sure that's been very interesting for you when looking at Canada, looking at the UK, looking at the United States. How has that figured into your thinking about the pandemic?
Jennifer Zelmer: It's been so important. This is a challenge we're all facing, and so that exchange of information very early on, I had the opportunity to talk with both folks from China and folks from Italy before really there was a big uptick of cases here. So helpful to understand their perspectives. And now of course, to be following what is happening in different contexts. And again, it's a great example, isn't it, of illustrating what the art of the possible is and where there are opportunities to learn from each other. Nobody's best at everything, nobody's back of the pack at everything, so we've all got an opportunity to both teach and learn.
Ellen Gardner: When you look at the Canadian situation, what do you think we've done well?
Jennifer Zelmer: I think there's a number of things that we've done well, but interestingly, the situation in Canada, it's not one size fits all, is it? And so the pandemic situation is actually so different in different parts of the country. I was talking with someone yesterday who lives in the North and their experience has been fundamentally different than my friends in downtown Toronto. So I think even within the country, it actually reflects back on what I was saying earlier that, this is a situation where there are a lot of learnings across.
I think there are communities that have done an amazing job from a public health perspective. And there are things to learn from that even in terms of preparedness in advance. So some of the work that we've been doing in long-term care highlighted for us, that even well pre-pandemic, there were some communities that were doing tabletop outbreak exercises so that long-term care facilities and public health and other stakeholders in the health sector in those communities had pre-planned, should a major outbreak happen. So they were just in a different situation. We need to learn from some of those preparedness pieces, as well as from the response during the pandemic.
Ellen Gardner: Last year, you were named CEO of a new organization formed through the amalgamation of the Canadian Foundation for Healthcare Improvement and the Canadian Patient Safety Institute. How did you feel about overseeing the coming together of two distinct and connected organizations, each with their own unique culture
Jennifer Zelmer: Super fortunate to have the opportunity. This was an amalgamation that we chose as organizations to embark on. So quite a different context from amalgamations where that choice isn't yours, something where, as we've talked about, the scale of the challenge in quality and safety is significant. Everyone in Canada deserves excellent health care, but we're not there yet. And so the scale of our solutions also needs to match the scale of the challenge, which is why coming together as organizations just made sense.
I'm not sure anyone would have voluntarily chosen to undertake this kind of work in the middle of a pandemic, but obviously we didn't know that that was what was going to happen when we started down this path. And so it's definitely been a journey. Amalgamation is not an event. It is a series of things that you need to do over time and a series of steps to take, but I feel so fortunate to be working with the people I am, both within the organization and outside as we go through this journey.
Ellen Gardner: Both organizations do have, as you say, that strong history of focusing on safety and quality, and there's been amazing progress, but it's a long and difficult journey. In fact, I remember last year on World Patient Safety Day, Chris Power told us that patient harm still results in 28,000 deaths per year in Canada, so that's a daunting statistic. I mean, when you think about that, what still needs to happen to change that pattern?
Jennifer Zelmer: Super important question. And I think, as with all major transformation, the answer is never one thing. As an organization, we were in the middle of developing our new strategy, and we've been thinking really about four paths that are important going forward. One: to identify the innovations and innovators who are working on challenges. So those points of light where someone has identified a different way of doing things, a different approach that is seeing improvements in safety improvements in quality.
And then the second is, once they're proving innovations, either in safety or quality, to spread and scale. So look at, how can we make sure those innovations are not just available to the lucky people who happen to be in the practice or involved with the hospital or community where the innovation occurred, but rather to get them to everyone who can benefit.
Jennifer Zelmer: But equally we think of the third area: it's not just about individual innovations. It is also building our capacity for fostering excellence in the health system. So growing that muscle as health systems to be able to change, to ensure we've got strong-lived experienced voice, to ensure we've got the tools in our toolbox to be able to make those changes.
And then last but not least, looking at how do we shape the policy and structures that make the right thing to do the easier thing to do. And so whether that's work around anti-racism or work around different approaches within the health sector, value-based healthcare, a number of different areas that really make that glide path easier for local teams who are doing improvement work. So those are the four areas we're concentrating on right now, and there's obviously plenty of work to be doing in each, and they're very interrelated as well.
Ellen Gardner: Well, one of the boldest steps taken by CPSI was bringing patients into the conversation. And we certainly know now that successful and safe care does hinge on knowing what patients need and what they're experiencing. And certainly some studies have shown the benefits of that, how important it is. But some even those that were done when you were at Azimuth Health Group have found that patient-centred care is still, in many ways, an elusive goal. Why do you think that is?
Jennifer Zelmer: I do think that there is fundamental work to do in shifting a conversation from just what's the matter with you to what matters to you. And that shift in conversation sounds like it's just a few words, but it's actually quite profound in terms of the ways that we shape health systems, the ways that we shape healthcare and the outcomes that those systems have. So I think that's not something that's going to change overnight. As a former colleague of mine would have said, it didn't happen in a day, it's not going to change in a day.
But that's important work that we need to do collectively to really refocus where we're at. We need to do that in the pandemic context, too, even around things like essential care partners and their ability to be present with patients, with residents as they're going through their care journey. Right now, obviously, the context is a bit different than pre-pandemic, but we need to look at how do we ensure that that's possible safely right now, and that we're supporting that kind of approach to care as well.
Ellen Gardner: How big a role do you think culture plays in patient safety?
Jennifer Zelmer: Culture is fundamental to patient safety. It influences the structures, the processes, the environments, the relationships, the interactions, all of those things that we know matter to safety. So it is very hard to have safe environment without a culture that enables and supports safety.
Ellen Gardner: Do you think about it in the same terms as mandatory reporting, that this is something that needs to fall within the culture of patient safety? What are your feelings about mandatory reporting
Jennifer Zelmer: I think mandatory reporting can be a tool. Like other tools, it's a tool that needs to go as part of a broader intervention strategy. You know, if you have mandatory reporting and then you don't have action on that mandatory reporting, it's not going to be that helpful. So we need to think about what are all the pieces of the puzzle that need to come together to make a difference. It's never just one thing.
Ellen Gardner: Being a leader in health care is a challenging job, and you always need to be thinking ahead, you need to be focused on what's happening today, but also have a vision for where the organization's going. I think the challenges for leaders in recent times have just grown, and I'm sure you've felt that yourself. So one of the areas that leaders always try and get better at is connecting with employees and really understanding what they're going through. Has your approach to connecting with employees evolved since COVID-19?
Jennifer Zelmer: I mean, evolved implies like this sort of trajectory fundamentally changed when we closed the office! For sure. You know the sort of classic just dropping in, checking in, those kinds of things just had to be done in a very different way, particularly early in the pandemic. We had a much more intense series of regular check-ins and huddles. We've evolved that during the pandemic based on what staff have indicated is helpful as we go, but it's also a different environment, right? So how do you find that balance between conversations that you might normally have had in a more casual versus more formal context? And they're now all happening from my living room via Teams or via phone.
So, absolutely there's had to be that adjustment just in terms of the how, but also I think in terms of the nature of the conversations – our worklives and our personal lives have become so much more entwined during the pandemic. I've now met a whole bunch of people's kids and pets who I hadn't met before. I know much more about some of the pressures that people are facing outside of work and how that's interacting with their work and their ability to work in ways that we used to. We've tried to bring in as much flexibility as we could during that time, but the need for that connection has never been more clear. There's absolutely no substitute for just spending that time to be able to connect, even if we're connecting in different ways.
Ellen Gardner: We had to figure it out pretty quickly, as you say. Do you feel now that people are used to it, that things have gotten easier.
Jennifer Zelmer: Some things certainly have. We've developed new ways of doing some things. We've all gotten more experienced. No longer is anybody trying to figure out Zoom, although there's certainly still plenty of times when I got caught on mute. So I haven't fully figured some of the mechanics of that yet. I think it's still a work in progress, and I think it's going to continue to evolve. We've been having conversations about what does it look like when we could reopen the office? Does the office look the same, and the answer's no, right? Do interactions look the same? No. So I think this will be something that probably also, because now we're a newly-amalgamated organization so we're also figuring out who do we want to be as we grow up as an organization. But that combination of things, I think, is going to keep this pretty dynamic for a while to come.
Ellen Gardner: Jennifer, how do you maintain balance in your own life?
Jennifer Zelmer: Yoga is a big part of my life, and that's important to me. Connections with family and friends are also important to me, even if right now, they basically have to happen virtually. And I've really found during the pandemic that just being outside, particularly outside under trees, in the snow, or when it was warmer, by water, makes a huge difference. And so it's that combination, I think, of different things that keep you grounded in any one time.
Philip De Souza: We have so many synergies between our organizations and kind of our values and our vision etc. What do you think about...what do you think it takes, it will take, or how are that trajectory to turn that corner collectively on patient safety?
Jennifer Zelmer: I mean, the first thing I think is it'll take all of us. And so including all of us and, as IHI would say, shamelessly stealing ideas from each other. So I can't claim credit for that switch of turn of phrase from what's the matter with you to what matters to you, but boy, is it powerful? And so I think that will be part of turning that corner is saying, okay, we need to take the best ideas and we need to really move to scale. So yes, absolutely. We need to test them out through pilots, we need to do that initial work, but then once we've identified, and we've been thinking about it in terms of spread stage where you're testing, does that initial idea work in other contexts and what adaptations need to be made to make it work in different contexts
Jennifer Zelmer: And then at a scale stage, you're moving to how do you get this to everyone, with the adaptations that they need in their context? And so I think using some of the evolving knowledge around implementation science, using that fundamental commitments that I think has arisen at a societal level through the pandemic. There's never been more focus on healthcare than now in my lifetime, at least. So where are those opportunities really to say, okay, here, now we can move together, and we can move this mountain together? It's going to take all of us. It's going to take some heavy lifting. There will be some twists and turns in the road that we didn't expect, but we're committed to getting there together.
Philip De Souza: Absolutely. And I love the fact that everything we're saying kind of also revolved around access. And for those listening today, who are listening right now, we're recording this conversation on Wednesday, March 3rd. And today actually is the official launch of Healthcare Excellence, Canada.
So I guess I'm not sure if anyone asked this today, Jennifer, but I guess I'll ask you: how are you feeling today with this amazing announcement and all this, like you said, there's lots of work going into today getting to where you are today. So how are you feeling?
Jennifer Zelmer: I mean, it's so exciting to be launching and naming our new baby and being out there publicly. It has been and will be a journey, right? This is not something where you click your fingers and you're done. So lots of work has been done, as you said, lots of work still to do, but the great part about the public launch means that so much easier for us to do that work together with our partners and really to listen deeply as we develop our new strategy for the new organization, so much easier to do now that we're out there and really looking forward to the path ahead.
Ellen Gardner: I did have just a quick question about, because earlier on you talked about innovation and I wondered if you've ever drawn inspiration from looking outside the healthcare lens, looking at different industries, if that's something that you ever do?
Jennifer Zelmer: Absolutely. If we think about the work that we do in terms of spread and scale, for instance, learned from work way back when in the agriculture sector where some of the agricultural extension-type programs were developed, learned from lots of different folks now who are thinking about implementation science in different ways. If we think about an area that's become super important during the pandemic, was before, but certainly its importance was elevated during the pandemic in terms of safe, virtual care. So much to learn there from other industries as well. So plenty of opportunities to take the best, recognize that you always need to adapt to local context. And in this case, local, maybe the health system context, but so many things to learn.
Ellen Gardner: You've probably heard our lightening round before. I think you might know how it works, but I just throw a couple of quick questions at you and just tell me what comes into your mind. So the first thing is, what are you reading right now?
Jennifer Zelmer: I'm actually just about to have the option to speak with André Picard about his new book on long-term care. And it just came out, so I'm speed reading right now!
Ellen Gardner: Well, he's a good writer, so it should go quickly.
Jennifer Zelmer: It totally is. It's a great book.
Ellen Gardner: When travel opens up again, where do you plan to go first?
Jennifer Zelmer: Probably first will be anywhere in motorized transport. I've literally been in something with an engine twice since March, so that may not be that far. It may be just further than my bike can take me. But seriously, as to your bigger question, I think, my parents live in Australia, so that'll be my first big trip.
Ellen Gardner: Name your go-to resource when you're stuck or you need an energy or creative boost.
Jennifer Zelmer: Absolutely chocolate.
Ellen Gardner: (laughs) That's great. I can relate to that. What's your best habit, Jennifer?
Jennifer Zelmer: I've gotten into habit over the last few years of starting every day with a yoga practice and it makes a big difference in my life.
Ellen Gardner: What's one thing you've learned or a skill that you've honed in 2020?
Jennifer Zelmer: Well, I'm not sure I've learned the skill of remembering to keep myself off mute, but becoming my own tech support has certainly forced me to learn a whole bunch of technical things that I never expected to know.
Ellen Gardner: Can you finish this sentence: if I wasn't in healthcare, I'd be working as a...
Jennifer Zelmer: I would be working as a seafarer in the Merchant Marine, which was my alternate career choice way back when.
Ellen Gardner: How did you come to that?
Jennifer Zelmer: Australia had a program. They'd been given a gift of a tall ship by Britain for their bicentennial, and so the Australian Navy ran the program, it was sail training for young people, and I took the program, and I got hooked. So I spent a fair bit of time at sea, actually, going back and forth between health policy and the Merchant Marine, which was not maybe the most obvious combination and clearly health policy won.
For a very brief period out of my life, actually, partly when I was sailing, and there was a high school on board. I was a guidance counselor, and at that time, people would always ask me, so, what do you want to be afterwards? How are you helping students to figure out what they want to be? I don't think it's a one-sentence answer for most of us. It's a how do we want to evolve our career over the course of that career over a lifetime? And how does that fit with other aspects of our life.
Philip De Souza: Excellent. I love the fact that you love water, Jennifer, and I also love the fact that you love chocolate. It's funny, Catherine's hosting a ‘Chocolate with Catherine’ next Friday. We were trying to commemorate our one year of sadly being a virtual organization. And we were like, it's not like something we should be celebrating, but if there's any way to...if there's anything to commemorate and to bring us all together, it's definitely chocolate. So every staff member is getting a chocolate kit. We're going to have a chocolate tasting with a chocolate connoisseur next Friday. So all the staff is eagerly looking forward to that.
Jennifer Zelmer: Oh my goodness, I totally need to steal that idea! That sounds amazing!
Ellen Gardner: It's been such a pleasure talking to Jennifer, especially today, an exciting day in your life, an exciting day in the new organization. And we really just want to wish you all the best. We're going to be watching, and we want to really actively participate with you in it.
Jennifer Zelmer: Fantastic! I hope you'll join us and I hope many, many people will, too.
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