Episode 33: Dr. Tim Rutledge, Unity Health Toronto

Episode 33, Dr Tim Rutledge, Unity Health Toronto

 (Access show transcriptOne of the things that attracted Dr. Tim Rutledge to the position of President and CEO of Unity Health Toronto was the hospital’s mission of equity and focusing on the needs of the most vulnerable.  Since then, he’s made delivering care to marginalized populations a central priority of his leadership.

Show Summary

Today we’re talking with Dr. Tim Rutledge, President and CEO of Unity Health Toronto. Tim was previously President and CEO of North York General Hospital.

Tim is a physician, trained in Emergency Medicine. He developed a strong interest in medical education early in his career and chaired the committee that developed the University of Toronto’s first undergraduate course in Emergency Medicine.

From the earliest days of the pandemic, Unity Health put a strong emphasis on caring for and vaccinating people experiencing homelessness and Indigenous populations. Tim’s own journey of leading the hospital during this turbulent time has led him to a new understanding of the lessons of anti-racism, equity and social accountability.

A big part of Tim’s life – and one of the important ways he unwinds – is through music. He discovered his love of playing at the piano as a young man and he now plays and records on several instruments. Healthcare and leadership are of course his central preoccupations but coming back to his music always gives Tim a feeling of joy and fulfillment.

Mentioned in this Episode


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 produced by HIROC. I'm Ellen Gardner with Philip De Souza and Michelle Holden. Today, we're talking with Dr. Tim Rutledge, President and CEO of Unity Health Toronto. Tim was previously President and CEO of North York General Hospital. 

Tim is a physician trained in emergency medicine. He developed a strong interest in medical education early in his career, and shared the committee that developed the University of Toronto's first undergraduate course in emergency medicine. From the earliest days of the pandemic, Unity Health put a strong emphasis on caring for and vaccinating people experiencing homelessness and indigenous populations.

Tim's own journey of leading the hospital during this turbulent time has led him to a new understanding of the lessons of anti-racism, equity and social accountability. A big part of Tim's life, and one of the important ways he unwinds is through music. He discovered his love of playing the piano as a young man, and he now plays and records on several instruments. Healthcare and leadership are of course his central preoccupations, but coming back to his music always gives Tim a feeling of joy and fulfillment.

Before getting into our interview with Tim, we want to remind listeners to register for HIROC's upcoming conference from October 18 to 20. We know subscribers are busy, so IMPACT. NOW. is all about short topical sessions on things like cyber, property, midwifery, and of course, it's all virtual. Go to our website hiroc.com to find out how we'll be making an impact. 

Hi Tim, welcome to Healthcare Change Makers.

Dr. Tim Rutledge: Well, thank you very much 

Ellen Gardner: You were CEO of North York General for eight years, from 2010 to 2018. And before assuming the CEO position, you held a number of leadership positions at the hospital, including medical director of the emergency services program and chair of the medical advisory committee. In 2003, we went through the SARS epidemic and you provided important leadership during that time. You're now CEO of a much larger healthcare organization, but how did that experience prepare you for dealing with COVID?

Dr. Tim Rutledge: I've always felt that leadership in organizations is so important. And this is particularly true during a crisis. And when I say that, I mean all aspects of effective leadership. With regards to my own leadership development, I've certainly benefited from having successive leadership positions over quite a number of years. And that's provided me with a lot of valuable leadership experiences. So, experiences in formulating strategy. Change leadership was just so important. A real appreciation through experience of the critical importance of culture, and certainly as it pertains to SARS and other things crisis management. All of these things I think have been important through this marathon of the pandemic.

One of the most important attributes in my experience of an effective leader is the ability to listen. And I mean, capital L listen. I mean, listen to truly understand the issues. This has been critically important to our success through COVID. Communication itself is really important. And certainly in my experience through SARS, communication came out as being a majorly important aspect of managing through SARS. 

And when I say communication, I'm talking about actually both ways of communication. So, communicating out to the organization to keep everyone up to speed with what's going on, as well as interpreting what all this means to us as an organization. But then there's the other aspect of communication. And certainly this was incredibly true through SARS, and that is the ability to hear what the frontline people are saying, hear what they're anxious about, address those anxieties. So communication was critical and it certainly has been the case in COVID.

Another real important leadership attribute in my mind is for leaders to be able to learn. Constantly learn. And that was also extremely true through SARS and through COVID. Almost every month, there was many things to learn. One of the skills within learning is having the humility to challenge and evolve one's thinking on important issues. And so I found that to be a critically important leadership attribute for all of my team throughout this pandemic.

Ellen Gardner: In 2018 when you arrived at Unity Health, the three hospitals, Providence, St Joseph's and St. Mike's had merged a year before. How challenging were those early days and what steps did you take to bring those three distinct cultures together?

Dr. Tim Rutledge: Any bringing of large organizations together is always fraught with a number of challenges on many dimensions. And I would say that it does take a lot of effort. Before I got here to this organization, which is made up of Providence Healthcare in the east, St Joseph's Health Centre in the west and St. Michael's downtown, I had done some due diligence, if you will. And one of the things I learned is in fact, the cultures were more aligned than different. So we kind of had a bit of a head start, but in the very earliest days, it was really critically important to build that sense of network. Had to have a lot of presence at all three sites. Built a leadership team of people that were really committed to building Unity Health as a single entity. Paid a lot of attention to culture.

One of the first things we did is harmonize the values across the organizations. And that was actually fairly straightforward. Of the five value words that we have at Unity Health, four of them were shared by all three legacy organizations. And then we developed a strategic plan that we're all quite excited about, and that was a deeply engaged process. Through that engagement we really did start to develop a sense of a new organization. 

The other thing of course is tone at the top is critically important. And we were fortunate to have a board of directors that was terrific, and really saw themselves as a single board of this one new entity. So all of those things helped. And I would say at this point, really four years into it now, this integration is going as well as any that I've witnessed in my career.

Ellen Gardner: Maybe having a name like Unity Health really helps? 

Dr. Tim Rutledge: You know how much I've come to love that name. It's really great for a bunch of reasons. And it's very integrated with our Vision Statement as well, which is, the best care experience is created together. That together has a bunch of dimensions. It's together as three organizations. It's together with our system partners, with our government partners, but it's also of course, together with those that we serve. So patient and family-centred care is a real central philosophy here at Unity Health.

Ellen Gardner: At the beginning of the pandemic, Unity Health put a strong emphasis on caring for and vaccinating vulnerable and marginalized populations. And these would be people experiencing homelessness and Indigenous populations. Was that something that was a high priority for you?

Dr. Tim Rutledge: It certainly was. Thank you for asking the question. It's been important to me personally, and it's one of the things that attracted me to Unity Health. All three of these organizations have at the heart of their mission and values going the extra mile for those in our society who experience disadvantage. Our value words are community, excellence, compassion, human dignity and inclusion. And I think if you reflect on those words, you'll find that each one is related to that mission of equity and focusing on the needs of the most vulnerable. 

As you know, we're a large Catholic healthcare organization as well. And the essence of that is about compassionate, holistic healthcare to all, underlying ALL, in need. Sort of the Good Samaritan nature of our work. Now COVID has really put into stark relief the fact that there was a disproportionate impact on the vulnerable and racialized populations. So it really has highlighted that equity is a key dimension of quality in healthcare. And it is a major focus here at Unity and for me personally.

Ellen Gardner: You're absolutely correct that, yes, COVID highlighted the inequities in our healthcare treatment of marginalized populations. And I think in some ways it's also sparked a reckoning of our treatment of indigenous people. That and the discovery of the unmarked graves near residential schools. So we have a long way to go in all areas, but if we just focus on healthcare, do you think we're seeing a shift in our treatment of Indigenous people?

Dr. Tim Rutledge: An incredibly important question, actually for all of us as Canadians, and certainly in healthcare. And I would say that we need to see a shift. A gigantic shift in our treatment of Indigenous people. I see this as an imperative. So I certainly hope the answer to your question is yes, but again, part of your comment was that we have so much to do, and we do. We need to recognize that we all have blindspots as individuals and within our organizations. And so this is something that we're going to have to put a lot of work into. And given that the Catholic Church had significant involvement in a number of the residential schools, this is one that we particularly need to understand as a Catholic healthcare organization. Need to do our own pursuit of truth and reconciliation. Rebuild trust.

Dr. Tim Rutledge: We're doing a ton of education at Unity Health, not only of leaders, but right to the frontline staff. We're consulting with Indigenous leaders. And we have a wonderful First Nations, Inuit and Métis community advisory panel that is providing us good advice. Excellent advice. We're looking at recruiting a number of Indigenous persons at all levels of the organization and making plans to work hard on creating culturally safe environments.

Ellen Gardner: One of the things that was really important during COVID, and I'm sure you talked about it and put it into action, was having your leadership team really engage with their staff in meaningful ways. And yet leadership was under the same kinds of pressures as well. So what did you do? One or two things that you might have done to help your leadership team, support them? And I'm sure it's ongoing. One or two things that you've done that have really helped your team?

Dr. Tim Rutledge: Leaders across healthcare have all been working ridiculous hours. And you're right, it's been difficult to recruit new leaders in many areas. So I think resilience is something that we've had to focus on necessarily. And so I've really been encouraging people to have things to do for respite, to keep in good physical shape, to make sure they're having some downtime. And so within our team, we're trying to cover each other off to make sure that people get downtime. We've been so busy that it hasn't really been a time where we've been able to do a lot of professional development, but we certainly have done some internal work on that and plan for opportunities like that in the future. I think the most important thing we've been focusing on the last year or so has been making sure that people have some time to unplug. And we've been trying to be disciplined about that as well.

Ellen Gardner: I think I can pinpoint one of the areas where you unplug Tim, and that's your music. You play and you record and it's not just one instrument. You play the sax, keyboards, clarinet, and the flute. When did you discover this love of music?

Dr. Tim Rutledge: Well, since I can remember. This is going to tell you my vintage, but it began with me being kind of pulled towards the piano and started learning the first Beatles hits. So I'd listen to the very first Beatles hits and oh, this is what Paul McCartney's doing with my left hand. And so I was pretty much self-taught on piano at an early age, and then I got more and more interested. But I've been passionate, the whole family's passionate about music. But I've been passionate about it all my life.

Ellen Gardner: Was it ever going to be a career choice for you?

Dr. Tim Rutledge: Yeah. In fact, all through high school I was going to be a musician and I started out as a musician. I was on the road for a couple of years before I decided to come back and pursue a career in medicine. And I still play a fair amount, not out as much as I'd like to, but still play and record with a number of musicians in Toronto. My main instrument is saxophone, but as you've pointed out, I do have my doubles going. I do play clarinet and flute as well. And spend a fair amount of time on piano as well.

Ellen Gardner: Of your musical idols, are the Beatles still number one, or do you have other musical idols that you follow?

Dr. Tim Rutledge: Yeah, I have a lot of musical mentors, I guess, if you will. So, really the folks that I focus on more these days are, in fact, through most of my life, have been jazz players. So, John Coltrane, Charlie Parker, Miles Davis, Stanley Turrentine, Cannonball Adderley, those people. But I love the Beatles. I love the Stones. I love a band called Tower of Power. There's lots of beautiful music out there. And I love classical music as well.

Ellen Gardner: One piece in particular really stood out for us. On this piece, you're playing the sax and the electric piano. We're going to hear part of it, but can you tell us a little bit about how this recording came together?

Dr. Tim Rutledge: Sure. I mean, I love that piece as well, interestingly. That that's one of the first recordings I did in my studio, in my home. I just love the piece. So I wrote an arrangement for it and I play piano and a few saxophone tracks. I play a bit of a piano soul and a saxophone solo on it. And I just love that piece. It's mellow, it's rich. And I find it a very musical piece so, glad you like it, because I certainly enjoyed performing it.

Ellen Gardner: Well, I think one of the beautiful things about it is that there's a real variation in it. It starts off a certain way and then it moves in many different directions. So it's got a lot of variety. So, we are going to play part of that piece for you right now.

Ellen Gardner: I'm sure music is a welcome distraction from the stresses of the job and you're fortunate that you have that as an outlet. How do you carry the power of music into your life as a leader?

Dr. Tim Rutledge: I love the way you put that. I do find there is energy in music for me personally. I think we all have our own forms of driving energy, recharging ourselves. And for me, that is really music. There are other things, of course. I find, of course, music is incredibly creative. So it's an opportunity to express oneself. It's been described as a universal language. I also feel that music affects everyone on a deep level. And I think as you develop as a musician, you get in touch with that. I think music's one of those things like other forms of art that enhances one's appreciation of the importance of the connection people have on an emotional level. I'm not sure there's evidence for this, but perhaps the sensibilities musicians develop contribute to their emotional intelligence. Sort of feels that way to me.

And then my go-to music really is jazz. And so throughout my life, that's involved improvisation and communication with a small group of people. So really develops the sense of team. And as you say, it's an incredible distraction. Certainly, I've highlighted the importance of everyone's personal resilience. For me, it's clearly a form of respite. When I play, I'm very in the moment. And I think it's really important that everybody has things like that that allow them to switch off work at regular intervals and be in the moment in something other than work. And there's lots of ways to do that of course. For me, it's music.

Ellen Gardner: I read a wonderful story about the creation of a musical event at Providence where one particular resident who had been a regular at Grossman's Tavern, which was an amazing place in its time. And it sounded like it was just yes, like you say, a very unifying event.

Dr. Tim Rutledge: Oh my goodness. It certainly was. I attended that actually. It was a Dixie band and it was a palliative care patient. And one of the things he wanted to do was hear that band again. And so we were able to work things out. It was at a time in SARS where we could get together with masks on outdoors and the weather was amenable. And what a wonderful event. Everybody that was there, this man's family was there, just were glowing. It was just wonderful. And so it goes to that thing about music connecting with us on a deep level.

Ellen Gardner: A recent global study placed Canada's healthcare 10th out of 11 in high income developed countries. We're still ahead of the US, but we are behind everyone else. We have a single payer system that's struggling because the single payer can barely afford current costs and isn't well positioned to deal with even greater expensive new technologies and drugs. And of course, there's our rapidly aging population. The stresses were evident before COVID, but they certainly became screamingly obvious during the pandemic. You occupy a unique position in the healthcare system. You've held different positions and you've seen it from many sides. And I just wonder, do you think our system is in serious need of a revamp?

Dr. Tim Rutledge: Well, that's a very tough question and I think the simple answer is yes. I am personally a real supporter of a publicly funded system such as we have, but there are clearly opportunities for us to develop our system in positive ways. And so there have been movements towards a better integrated system, which I think is critically important, but it is going to be hard for us to achieve high levels of efficiency with just how constrained we are right now. We in Ontario, we have fewer acute care beds per population than any other province, and fewer beds than any other country in the world. We're tied at the bottom with Mexico at 1.4 beds per thousand. So, we have some basic capacity issues and that's just hospitals.

Dr. Tim Rutledge: We have to be looking at a very accessible and high functioning primary care system. We need to address long term care. We're also incredibly short on long term care capacity. Home care is critically important. So we have to address capacity issues, I think first and foremost, and then we have to stitch the system better together. And efforts have been made in that way, but I am quite concerned. And as you point out, the economy is going to be a real challenge going forward. We’re going to have some tough questions to answer around how we're going to sustain this system. But you're right, it is going to require some significant work on redesign.

Philip De Souza: It's a great interview so far, thank you for everything. And I really like the fact that you talked about the culture and learning, but I wonder, the complexities of the healthcare system, they're not changing anytime soon. With everything that's happening around us from the pandemic to just everything. So taking all that in consideration, the complexity of the healthcare system that we're all facing right now, what do you think leaders can do today to prepare for the emerging trends on the horizon?

Dr. Tim Rutledge: We really need as leaders in the healthcare system to put our heads together, to start to strategize around an evolved future. But within the house, we are trying to continue to optimize efficiency and we are trying to optimize the potential of capacity. The other thing is that, and this is not new, but the power of the perspectives that we get from our patients is not to be underestimated. Our patients are continually giving us great advice on how we can improve the care experience. And I think that is another thing that must be addressed in our healthcare system. So those are kind of the big categories. 

I guess I'm at this point kind of focused on the immediate needs. And they're more basic than that. Like getting staff, recruiting staff, retaining staff, training staff, extending staff's scope of practice. Those are the kind of immediate needs, but very soon we are going to face a situation where our system is extremely difficult to sustain with current resources. So we are going to have to get creative and innovative.

Philip De Souza: Fantastic. Thank you for that.

Ellen Gardner: I wondered thinking about how, and I know that you are very interested in education and medical education Tim. And you talked a little bit about the difficulties of recruiting healthcare leaders. So what should we be doing to attract new healthcare leaders and prepare them for what they're having to deal with?

Dr. Tim Rutledge: There's lots of dimensions to that question. So on the sort of most urgent front, I'm going to say, and I touched on this earlier, I think we need to make all of our training programs of healthcare professionals, be it nurses or therapists, or physicians, as efficient as possible to get them into the workforce ready to go. That's a basic need. But there's a lot more to the question. 

We are getting to the point where machines are going to be able to do a lot of the stuff that we have relied on clinicians to do in the past. Many of our clinicians have been selected for medical school, for example, on the basis of their ability to problem-solve and memorize. I think the memorization piece is going to be less important. The problem-solving will always be important, but we will have advanced analytics that will help with that as well. What we really need to focus on in the future healthcare provider is the human aspect. The clinician-patient relationship, and connecting with patients in a way that optimizes their care and optimizes their experience. Plan for the many, deliver to the one and make it a far better holistic healthcare experience.

Ellen Gardner: I think we're going to move into the Lightning Round. So this is where I just ask you a series of quick questions, Tim. And yes, just tell me the first thing that comes into your mind. So what are you reading or watching right now?

Dr. Tim Rutledge: I'm just finishing a wonderful book called Five Little Indians. It's written by Michelle Good and it is around five people who grew up in their residential school system, Indian residential school system, and it tells the story of their life and how they cope. And it's extremely well-written, and it really provides insight that I think we can all benefit from.

Ellen Gardner: Name your go-to resource for when you're stuck, or you need a creative boost?

Dr. Tim Rutledge: Well, to get stuck, to get a creative boost, I often read. And really this evolves over time. So I've read people who I've really found visionary over the years. Clay Christensen, Don Berwick, Eric Topol. So reading has been always a kind of a go-to for me. And as I say, the authors to read that are really kind of seeing where the puck is going in healthcare, evolve over time. Then another thing that one does when they're stuck is they need to have an opportunity for reflection. And for me, it's things like hiking and gardening and music and spending time with family.

Ellen Gardner: What's one thing you've learned, or one skill that you've honed in 2021?

Dr. Tim Rutledge: There's been so many skills that we've been called upon to have. And so I think constant evolution of leadership skills, listening, learning, communicating well, understanding the importance of culture. But I guess if I was going to be really specific about something that I've dug in on in this past year, it's really been enhancing my appreciation and understanding of anti-racism, equity, social accountability.

Ellen Gardner: Finish this sentence, a little known fact about Scarborough, where you grew up is?

Dr. Tim Rutledge: Scarborough's a great place to grow up, and it continues to be a great place. I'm very proud of my roots in Scarborough. And when you look at it, there's been a lot of successful people who grew up in Scarborough. So athletics, Andre De Grasse. Comedian, Mike Myers. And then a whole bunch of musicians: Carole Pope, The Barenaked Ladies, Kardinal Offishall, Maestro Fresh Wes, The Weeknd. Told you.

Ellen Gardner: I might be able to predict the answer to this sentence, but if I wasn't in healthcare, I'd be a?

Dr. Tim Rutledge: A musician. I am a musician, but I'd be more of a musician. That said, I have a great deal of appreciation of my healthcare career. I think it's a wonderful career. It's a very meaningful career. So I certainly encourage it for youngsters.

Ellen Gardner: Well, you've had a very interesting career, Tim, and you've go on in many different directions, but have kept your love of music strong throughout. So just a pleasure talking to you, and we really wish you all the best in the next little while.

Dr. Tim Rutledge: Well, many thanks to you and many thanks to all the healthcare professionals out there who've been working so hard for many months.

Ellen Gardner: You have just been listening to our interview with Dr. Tim Rutledge, CEO of Unity Health Toronto. For more information about HIROC and our upcoming conference impact now, go to hiroc.com. Thank you for listening.

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