Jo-anne Marr and Mike Arnew: Transparency and Mutual Respect as Critical to the Board-CEO Relationship

Cover art of Ep 45 with Jo-anne Marr and Mike Arnew

Around the boardroom table at Oak Valley Health, Jo-anne Marr and Mike Arnew encourage directors to leverage their unique backgrounds, ask questions, and engage in a healthy debate.

Show Summary

At HIROC, we recognize the critical importance of good governance in healthcare, and its impact on safe, quality care. 

What makes for a positive relationship between a senior leadership team and their board? This year, we are digging deeper on Healthcare Change Makers and talking all about governing with impact. 

Today HIROC’s CEO, Catherine Gaulton, sits down with Jo-anne Marr, President and CEO, and Mike Arnew, Board Chair at Oak Valley Health. 

The two talk about the importance of healthy debate around the board table, where both leadership and the board need to approach decision making with a bit of humility. 

This is a great episode for emerging and seasoned leaders who are looking for a clear path forward. 

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 health care system.

Philip De Souza: Hey listeners, it's Philip De Souza here, Director of Communications and Marketing at HIROC. Firstly, thank you for taking time to listen to our podcast, Healthcare Change Makers. We see you, and we appreciate you. We're always on the lookout for new ideas and themes for our show. And we noticed you really loved our episode featuring Krista Jangaard and Catherine Woodman from the IWK Health. That episode, focusing on the unique dynamic between healthcare leaders and their boards. So we're bringing you another episode. In this episode, HIROC's CEO, Catherine Gaulton, once again takes over as host and this time, she chats with Oak Valley Health CEO, Jo-anne Marr and her board chair, Mike Arnew. I'm fortunate to know Jo-anne. And if someone were to ask me for one word that describes her, I'd say it's focus. Jo-anne is focused on driving change and transforming healthcare to positively impact the patient experience.

She's focused on making sure the entire team at Oak Valley Health is engaged, and she's also focused on making sure we collectively turn the corner on patient safety, serving as a board member for HIROC. Her board chair, Mike, is currently the chief operating officer of an engineering and manufacturing firm and has experience in multiple sectors, including private equity, consulting and automotive. Mike has served on the board for five years and participates in a variety of committees as well as equity, diversity and inclusion policy and strategic planning to name a few. So let's get to it. Catherine, over to you now.

Catherine Gaulton: Well, good morning both of you and it's absolutely fantastic to have you this lens of hearing from what boards want and what CEOs are responding to and what they need from their boards has been a phenomenally helpful and very interesting conversations we've been having. So Mike, I want to start with you and just this phenomenal experience that you bring from so many sectors. So automobile, healthcare, consulting, and we speak to leaders who come from these diverse backgrounds and I'm always amazed about what those different lenses contribute to how you work. And so what would you identify as a constant when it comes to good governance that you've gleaned from all of those different experiences?

Mike Arnew: That's a great question. Thanks. Yeah, and I wonder sometimes how I got here with a background, but I think the key constants I would say are balance and perspective. I think good governance ensures that management's empowered by the board with a very clear vision and based on balanced and broad perspective of both the organization and the market, in this case, our community. And I think that's true for any sector really, is really just trying to bring together different viewpoints to better inform your decision making.

Catherine Gaulton: I've been studying a lot about governance and so much of it speaks about this relationship between the board and the CEO with this heavy focus on it's not a friendship and yet, it's not a war either.

Mike Arnew: Exactly.

Catherine Gaulton: This is not a war. Right? And so this piece around how you exercise this great due diligence and as a governor at the same time as having really collegial relationships, I think seems to what you're thinking about. I wonder what your comments on that might be.

Mike Arnew: Yeah. I think that's very true. I think having that balance between enough challenge and enough collaboration, I mean, you want to push the issues to make sure that both sides are seeing all aspects of where you're at. And so I think you're right. I think it has to be collaborative, but it also has to have that element of challenge in it as well.

Catherine Gaulton: So with all of that and all of these experiences, what compelled you to be at the board member at Oak Valley Health?

Mike Arnew: Years ago, my wife had a business that was run through Markham, on the respiratory side. And so that was my first connection to the hospital. And then I think like most board members, the idea was to try and give back to the community and hopefully, a little bit of expertise and some perspective. And really, I think what attracted me specifically to the hospital, Oak Valley Health in that time was Markham Stouffville and Uxbridge, and really, I think it was the attitude that I saw within the leadership and the people that worked there, all of the staff that I had interacted with. And yeah, it was very collaborative, very congenial but very professional. And so it definitely attracted me to the hospital.

Catherine Gaulton: You speak about this a little bit, but I'll reiterate in my experience is this perspective that we would otherwise be missing without our boards and particularly with about the background that you bring, so thank you very much for doing that. And I'm sure Jo-anne will share that, and Jo-anne, we are, and our listeners are so fortunate to hear from the two sides from you today. And then as we've said, they're certainly not divisive sides but you have a unique experience as both the CEO at Oak Valley Health and you're also a board member, for example, sitting on HIROC's board. What are your thoughts on good governance and what does it mean to you as a CEO?

Jo-anne Marr: Thanks, Catherine. And yes, good governance. Absolutely. I think focusing on the principles of good governance is so important, and that means things like understanding the difference, of course, between governance versus the management role and staying in those lanes as much as possible, but also understanding that sometimes, those lines can blur. So the macro perspective that we think about as governors versus the micro detail and getting into the operations, the old adage nose in, fingers out, I think is absolutely true. Governors work in partnership with the CEO and the senior leadership team with respect to addressing key issues and decisions. So I think you really have to understand what the board role is and attending to those roles and rules and good practices, things like oversight of the process and monitoring of those processes for quality safety risk, leadership performance and succession, relations with stakeholders, legal compliance issues, and really key decisions and policies that advance the organizational goals.

Jo-anne Marr: And so what then does the board need to know about and understand? What discussions do they need to engage in? And really trying to work that dynamic, no matter which side you're sitting on, management or board, and this is something that Mike and I are always talking about. We're trying to find that balance that you referenced earlier by putting ourselves in each other's shoes. And I think it requires practice, it requires patience and understanding, but I think that that's really the secret sauce.

Catherine Gaulton: Thanks, Jo-anne. And you really touched on something that I think both you and Mike would bring a perspective to because, of course, in your respective organization, so you come to boards with experience in very senior leadership in your organizations. And I can imagine that when you take that away, your lens as board members actually contribute to then how you interact with your other boards. And certainly in my role, I always think about, well, if I was on this board, what would I want to be hearing? What level of conversation would I want to have? And I don't know, Mike, if that's your experience, too?

Mike Arnew: Absolutely. I think along the lines of really digging into seeing it from Jo-anne's standpoint and from the board level standpoint. So you look at an issue, for instance, in where the management has made a decision. And as a board member, you have to step back and say, it's less about the decision than the process of how the decision was made. And so you have to walk that line between getting into the nitty gritty, and as Jo-anne says, fingers out. But it's a great perspective to have been in those shoes at different points through your career where you've made those decisions and, excuse me, and then reflected on them and said "Was that a good decision? Did I look at all the different aspects? Did I survey and get enough information before making that decision?" And so those are the types of questions that Jo-anne and I talk about quite often, and as a board member, that's I think the key.

Catherine Gaulton: If you were to think about what is probably the most crucial element for board CEO relationships, Jo-anne, what would you say?

Jo-anne Marr: Well, transparency and candor and mutual respect, I think are absolutely critical. You need to be able to share what's going on, seek advice and wise counsel when needed. I think it's really important to keep the board, and certainly the chair updated with respect to actual risks, potential risks that are on the horizon because you never know, you may be able to predict, but you never really know what's going to escalate. And I think I have a great relationship with Mike. So I feel comfortable to share openly. We have great dialogue, in my opinion, and I think that that's a strong dynamic that gets felt by the rest of the senior team and then replicated with their relationships with their committee chairs.

Catherine Gaulton: That's great. And Mike, what would you say? If you were to have to choose one or two, what would be the most crucial elements from your perspective?

Mike Arnew: I would say respect is a very key element, really respecting, and as Jo-anne mentioned before about staying in your lanes and respecting her experience and her role, I mean, we're there to challenge but really to support and respect that she's got great experience and undoubtedly more knowledge about the specific situation than we could ever have. So I think that's the first one. And then I think the second one would be trust. You have to trust. And it's a little bit of that candor and transparency that Jo-anne mentioned because you have to trust that you can share the good, the bad and the ugly because if you don't, then you tend to get into a relationship where you're hiding things or telling the board what they want to hear, and you have to be able to share those detailed issues.

Catherine Gaulton: It's interesting. We talk about in relationships between leaders and those, those they work with, or this idea that you always make the assumption that the person's coming from the right place. It may not be translating as you'd like it in this moment, but that someone's coming from the right place. And I think your focus on trust really brings that to bear in our conversation.

Mike Arnew: Absolutely.

Catherine Gaulton: Mike, as a board member and chairing a board, what are boards looking for from their CEO and leadership teams?

Mike Arnew: I think there's a couple of what I would call would be must haves. I mean, good, probably great reporting. The level of detail needs to be there, but simplified and clarified because you recognize that the board has many different people from different backgrounds and they might not all have the same skillset in terms of whether it's finance or operations or quality or safety or whatever the issues are. So having great reporting is really key. I think open communication and really being thoughtful in what information is shared and how it's shared, how the reporting goes, being open to questions and queries and having, as Jo-anne mentioned, a little bit of patience because people come from different backgrounds.

And so having that extra element of patients is really important. Some of the questions, you might wonder if you've already answered them or provided lots of detail. And so Jo-anne and I have lots of conversations about those questions prior to, what could come up, what might arise, how do we tackle this if it comes up? And I think that's really what boards expect out of the CEO, is that strong preparation and good open communications with them.

Catherine Gaulton: Jo-anne, I've made myself a bit of a student in relation to how you work with boards. And you've given me some great advice and tips over time. What advice or tips can you share with our audience today in relation to working well with boards?

Jo-anne Marr: I think getting to know the board members by touching base with some degree of regularity is really helpful, in particular, the officers and the committee chairs. From my lens, it really helps me to be aware of perhaps an issue or concern that might be out there and to stay ahead of it before there's any unnecessary escalation. Those relationships are absolutely critical to identifying something that may be a concern or a suggestion for change. And obviously, if one person feels that probably there are others that do too, whether they're going to raise it or not, I always ask for wise counsel and perspective. I think it helps build trust. Trust is something that Mike mentioned. And then I think then, because of the comfort in the relationship, board members will feel comfortable to reach out any time to either to me, to my team, if they have questions or concerns. It's so much better than a last minute surprise.

I think we have to expect that board members, as Mike said, will ask lots of hard questions. We need to be really open to all of them. And maybe guiding a little bit when it's too operational, but having said that, sometimes, I think you have to dive into a bit of detail to step back and understand the context. And I would say that about some of quality issues, for example, and then putting yourself constantly in the director's shoes. They're not immersed in the day to day detail as management is and so things get forgotten. And so it's our job as managers to close that gap, give the context and really explain the so what, anticipate the questions that they might ask. And so we also have to understand that governance is a journey, boards have seasoned directors, they have newer directors also.

And then probably the last thing I would say is proactivity with respect to risk or other issues, and HIROC would definitely appreciate the risk issue. I often will say, "Well, if I were a board member, I might be thinking this or wanting to ask that" and then trying to address those questions before they even get asked. So it might be that when you're talking about a quality and safety issue, you're talking about the mitigation before it's even asked, and then that can sometimes stop people from digging into too much operational detail, but also realizing that inadvertently, if we don't present things in necessarily the right way or give the right amount of context and information, we might be actually taking unintentionally board members into that rabbit hole or into that detail. So I think, again, thinking ahead, being proactive, putting ourselves in and walking in each other's shoes is really helpful.

Catherine Gaulton: Thanks, Jo-anne. And particularly this identification of, well, the major governance issue for governors is there's this big knowledge gap and they're coming on infrequent basis to interact with topics. And so how you respectfully give enough details that people aren't asked to gloss things over, and then the respectful relationship back that that's not an invitation to be the CEO. And Mike, it takes me to this question around how it is that you have that healthy debate at the boardroom table, bringing, asking the questions you want to ask while still ensuring that you're showing the confidence that you and your CEO that, of course, needs to be present? And I don't know what thoughts you might have about how you do that well?

Mike Arnew: Again, it's a balance. You want to be able to dig in from down to three feet and back out to 30,000 feet. And just recognize that, again, you're asking about process and decision making rather than decisions because you really want to understand. And this goes to the data that gets presented as well. You really want to understand the thinking that went into that decision making or choice of action rather than the actual decision, I mean, obviously, it's important where you end up, but the key is to make sure that the team has evaluated all different aspects, that you're comfortable with their approach, and it's in alignment with the strategy and the direction and everything.

And so asking questions, and I think it's definitely a learned behavior to try and step back, especially, as you mentioned before, many of the directors have come from senior roles or are in senior roles. And so they're charged with their day job of making those types of decisions. And when you put on your director's hat, you have to step back and say, "Okay, how did I make that decision?" Or "How did this team make that decision? And did they evaluate all the different aspects?" And so if you keep your questions focused on those elements, I think it will allow you to challenge the decision making rather than putting people on the defensive on the other side.

Catherine Gaulton: Jo-anne, what are your thoughts on this, on how you keep that healthy debate while having a respectful relationship at the table?

Jo-anne Marr: I really believe in well prepared briefing notes that really set that context and present materials in the right way, again, thinking in the director's shoes. And then the debate can really be focused on the issue at hand. And another option is to deal with any major concerns or clarity, not to have the discussion outside of the board meeting, but one of the things that we've done, I think, and it's been effective is to take questions that involve clarity or specific details in advance and share them with all committee or board members. And again, it doesn't negate the generative dialogue that you want to have, but I think it focuses it more on the issue at hand. So we've found that particularly successful.

Mike Arnew: Mm-hmm. I think the other thing is I think when both sides approach it with a little bit of humility, it absolutely helps. When you go into answering a question, you go, "Well, I'm not really sure. This is the best information that I have. This is what I think, this is how we've approached it." And from the board's standpoint, if you go "That doesn't quite sit well with me. What I'm bothered about is this, or what worries me is this" how have you attacked that? And so I think that level of humility and the questioning and the approach also can help being a little bit vulnerable. We don't all have all the answers all the time.

Philip De Souza: You mentioned CEO and board chair should meet up, have some cadence, some regular conversation. And for emerging leaders out there, or leaders who may not flex this muscle, I guess for them, what advice would you give them to create an agenda for this weekly meetup? What should they be talking about?

Mike Arnew: We keep it very fluid. It's really issues of the day, and both Jo-anne and I bring questions or thoughts or concerns based on something that's happened during the week, something that's relevant, something that's brewing. And because, of course, there are so many other meetings and committee meetings, as well as issues that appear certainly in both of our worlds that yeah, we keep it pretty fluid, but I think we do make sure that we touch base pretty much every week, and sometimes, more than that. And so I think just really, the regular cadence is important because you've got to have enough time to let some of these issues digest a bit and consider them and mull over them before, as you bring them forward.

Jo-anne Marr: I would just add, although I think Mike covered it really well. We do use an agenda, as he indicated, it's quite loose but I think we do attend to debrief on education sessions, committee meetings, board meetings, both previous and upcoming so that we're really talking about governance practices, issues, what could we do better? What could we do differently? All the time, I think that's important. And then key issues of the day and strategic priorities, I think we do make it a point to talk about those things. Otherwise, I think if you're too loosey goosey, then you might miss out on some key things and practices that I think are really important to drive that conversation. So we do that, I think, pretty diligently.

Philip De Souza: No, that's good. And Catherine, any last points from you?

Catherine Gaulton: The thing that comes from both Mike and Jo-anne's conversations, though, I would say is that it's not about the CEO delivering information to the board chair, it's partly that, of course, it has to be, but it shouldn't be exclusively that because part of these things are how you actually build relationships for future meetings, for future things you need to do together. And so, for example, you might think you don't need to have that meeting in a week when you've had six board meetings. And in fact, it's probably a really crucial time to do it because when you are sharing impressions with each other on the general cadence, in your word, Philip, about how things need to go as opposed to it being an information dump session, certainly, there is sharing of information as there should be. And I think Jo-anne's voice advice about having an agenda, even with the acknowledgement that it should stay loose, is very good advice.

Your passion for leading and governing well is very clear and we're appreciative of it, but I want to turn to another passion of yours, which is of course, Oak Valley Health, and wanted to just give you an opportunity to give us some thoughts about what's happening there. And I'll just say, as a HIROC CEO in the early days, having the chance to be involved with some of the innovative approaches to quality that were coming out of Oak Valley and your colleagues was just phenomenal. So this is your chance to tell us a little bit about what's happening at Oak Valley. Joanne, we'll start with you.

Jo-anne Marr: Thanks, Catherine. So a lot happening at Oak Valley, for sure. Recently, we had approval to rebuild our Uxbridge Hospital site, which is critical for the future development and growth of the Markham Campus too, so very exciting. We just finished up, or just finishing up our master planning activities. We have major developments planned for both campuses and to support longer term clinical planning work. And we also did, through the pandemic, we've leveraged our Ontario Health team work to support our outreach efforts, to support long-term care and congregate settings as many hospitals did.

And we worked very closely with primary care. So this whole envelope of community care and home care, which is rapidly expanding, is very much a part of our future planning and growth. We've also got some really interesting community engagement work on the horizon that's a bit novel and different to respond to what we have, particularly surrounding the Markham catchment, a very diverse community. And also, we are gearing up in the next year to start work on our next strategic planning cycle. And of course, everybody else in healthcare, health human resources is as a key priority looking for innovative and different ways to attract and retain top talent.

Catherine Gaulton: Huge. No shortage. You're not twiddling your thumbs, as we say in Newfoundland, for sure.

Jo-anne Marr: We're not.

Catherine Gaulton: And Mike, your thoughts on this?

Mike Arnew: Yeah. No, I think Jo-anne's covered a lot of the different issues. I would say that we've been very fortunate, I think with Joanne and our leadership team to have moved just a ton of different initiatives forward despite being embroiled in the pandemic for the last two or three years. And so I think it's put us in a great position, but no doubt, there's many challenges. And I think the work, particularly with the frontline staff as well as all the professional staff and the doctors and administrators and support people as well, but really looking at the people that make up the different hospitals that we have, I think that's the key for success going forward. And so anything that we can do to continue supporting that is crucial and very important.

Catherine Gaulton: This is now the easy part of the interview, where we get to let the audience get to know you a bit better. And so consider this our lightning round. What book are you currently reading or just finished reading? And let's continue with you on that one, Mike.

Mike Arnew: Okay. So the one I just read was Love and Work by Marcus Buckingham. Quite interesting, little different perspective. I think as many people have felt, our relationship with work is definitely changing. And in many cases, very dramatically. So good read.

Catherine Gaulton: Excellent. What about you, Jo-anne? What are you reading?

Jo-anne Marr: Well, I'm usually reading a couple of things at once but one has quite an interesting title, Five Little Indians and the author is Michelle Good. It's a composite story of five survivors of residential schools in British Columbia. Very educational, enlightening, it's tragic. And I think it corrects a lot of misunderstanding, misinformation in accuracy and sheds a lot of light on a very timely issue, but in a very entertaining way.

Catherine Gaulton: Excellent. I'm in the midst of it as well, so we'll have to chat at some point. Jo-anne, your first job ever?

Jo-anne Marr: Well, aside from post basic education, I worked as a staff nurse but my first job ever, other than one or two day jobs as a poll clerk and those types of things, was as a lifeguard and a swimming instructor, which actually, I think had a lot of relevance to the work I did as a frontline nurse.

Catherine Gaulton: Perfect. And what about you, Mike? First job ever.

Mike Arnew: I was a server at the Dairy Queen, little local Dairy Queen up in North Bay. Yep.

Catherine Gaulton: Mike, what do you do to unwind outside of your work day?

Mike Arnew: I cycle quite a bit. I'm big bike rider and mostly on the road, but a little bit of off-road and some gravel stuff now and lots in the wintertime as well. And I play acoustic guitar. I took it up when I turned 50.

Catherine Gaulton: Fantastic.

Mike Arnew: Yeah, it's been great. Yeah. I think it keeps your mind active and learning and yeah, it's a good way to unwind, for sure.

Catherine Gaulton: Jo-anne, what do you do to unwind outside of a work day?

Jo-anne Marr: So love the cycling too, we always share that, but I like to be outside, go to the gym or work out in my basement and be on the water in any way, for sure. And you might get a chuckle out of this, but after probably 15 years of never, I mean, never watching TV, during the pandemic, I got addicted to Netflix.

Catherine Gaulton: I can't actually imagine you sitting still long enough to do that, so that is a good one.

Jo-anne Marr: It's a great distractor.

Catherine Gaulton: Yeah. Jo-anne, if you could have a lunch meet up with anyone, dead or alive, who would it be and why?

Jo-anne Marr:
Well, actually, it would be the queen. I've always been fascinated by the monarchy, certainly followed up a lot of that on Netflix. That was really what got me hooked, actually, but I'd really like to ask about lessons learned and what history has taught her about life and work and the world. I think history is a great teacher and lesson giver. So I'd love to talk about that.

Catherine Gaulton: That's fantastic. And what about you, Mike? Who would you meet up with?

Mike Arnew: That's a good question. I was going to say Einstein because I've always been fascinated with physics and that, and I look at his picture of the one with his tongue hanging out in the crazy air and think that he'd be a great lunch mate. Although today, since it's the anniversary of D Day, Winston Churchill probably would be a great lunch companion.

Catherine Gaulton: So in the spirit of passing our learnings on as we finish, Jo-anne, best piece of advice you've received from a mentor?

Jo-anne Marr: So probably two things, focusing on the prize or your end goals. I think it really helps put in perspective what you should focus on, what you should fight for, what to let go of, and where to really stand your ground. And then using what you have, which really means optimizing or leveraging talents and strengths. I think it's a great lens and it results in a lot less frustration when you think about it from that perspective.

Catherine Gaulton: Fantastic. And what about you, Mike? What would you say?

Mike Arnew: I think mine would be arguing over things that really matter quite often. And I mean, you see this time and time again is that people dwell in the past. And I mean, I beat myself up over past decisions as well as anybody, but it's so easy to get mired in that and not look forward. And so I think when you're going to take a stand or make an argument to make sure it's worthwhile, life's too short.

Catherine Gaulton: I agree. And thank you so much. I think those are great ways to end our conversation. Our sincere thank you. It's been fun, and really made me think about things in a different way. And I think it'll do the same thing for our audience. So I want to thank you both and have a great week.

Jo-anne Marr: Thank you.

Mike Arnew: Thank you.

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.