Kathryn Nichol: Leading from a Place of Compassion

Covert art for episode with headshot of Kathryn Nichol, Episode 42

(Access show transcript) She’s only been in the CEO position at VHA Home HealthCare for a year and even as COVID continues to be a presence, Kathryn Nichol is advocating for the essential role of homecare in our healthcare system and a much biggest investment in homecare.

Show Summary

Today we’re talking with Kathryn Nichol, who is President and CEO of VHA Home HealthCare. She stepped into the role in early 2021 after several years at VHA working as Vice President Quality, Best Practice, Research and Education.

Our aging population, movement towards a community-based model of care, and the pandemic have put the spotlight on homecare like never before. For Kathryn, this has reinforced homecare’s crucial role in facilitating the flow of people out of hospital so they can return to their homes where they want to be.

Her initial desire was to go to medical school but when that proved too expensive, she happily went to nursing school and worked as a frontline nurse for several years before discovering her passionate interest in research. 

Having a clinical background in a leadership position Kathryn says is valuable – not just for her but for all healthcare leaders – because it enables them to lead from a place of compassion. 

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 health care system.

Ellen Gardner: Welcome to Healthcare Change Makers, a podcast produced by HIROC. I'm Ellen Gardner with Michelle Holden and Philip De Souza. Today, we're talking with Kathryn Nichol, president and CEO of VHA Home HealthCare. She stepped into the role in early 2021, after several years at VHA working as vice president of quality, best practice, research and education. Our aging population movement towards a community-based model of care and the pandemic have put the spotlight on home care like never before.

For Kathryn, this has reinforced home care's crucial role in facilitating the flow of people out of hospital so they can return to their homes where they want to be. Her initial desire was to go to medical school, but when that proved too expensive, she happily went to nursing school and worked as a frontline nurse for several years before discovering her passionate interest in research.

Having a clinical background in a leadership position, Kathryn says is valuable, not just for her, but for all healthcare leaders, because it enables them to lead from a place of compassion. Welcome to Healthcare Change Makers, Kathryn. It's great to have you.

Kathryn Nichol: Thank you, Ellen. It's great to be here.

Ellen Gardner: You've been in the CEO role for a year now and I was looking at your most recent blog. I really liked your analogy to hiking that you're very concentrated on watching the ground and watching for rocks and sticks, but you also want to keep your eye on the sky and the treeline. So how does it feel to be a year in?

Kathryn Nichol: So it feels good for sure to have a year under my belt, but it's also a little surprising at how fast the year went. It feels like yesterday, honestly, that I got the news that I was the successful candidate and starting in the role with the team. So it's gone by really quick, but it's also been really exciting, starting a new role like this. There is a bit of time to get your legs underneath you, but honestly, not that much time.

So jumping right into understanding what's happening? What are the implications for home care? Where are the opportunities to contribute? And what tables do we need to be at to make sure that home care is the best it can be? Going forward was my top priority probably right from the get go. So it's been busy, surprisingly short, yet exciting.

Ellen Gardner: The pandemic, it continues to ebb and flow and it's almost become such a normal part of our lives at this point. I want to ask you how people in home care are feeling and is there a sense that the worst has passed?

Kathryn Nichol: We're now pretty used to the new processes and what we need to do to protect ourselves. And I think that there certainly is hope that this new normal, if I can steal a word that's used to way too much, this new normal we can work in this new normal, we can do it safely, we can continue to provide great home care. It certainly gives people hope. 

And then also there's a ton of pride. I have to say, there is a ton of pride because home care never stopped for a moment, not for a second. Talking about essential workers, there was no question that home care workers were essential workers and that they needed to be out in the community right from the get-go, right from the moment that we knew that COVID had traveled overseas, had hit the US first and then had hit Canada. And then of course we had a period of time before we then went into lockdown in mid-March and pretty much everything changed.

The team never stopped. Many aspects of the health and community sector didn't stop, but certainly home care didn't.

Ellen Gardner: Would you say that things have changed in any kind of permanent way for VHA home care workers?

Kathryn Nichol: Well, I think one of the most remarkable changes, if you think about day-to-day life as somebody providing home care in Ontario is the personal protective equipment and the attention to infection prevention and control practices is part of home care like it never was before. So certainly our home care workers wore gloves regularly. That was a part of regular practice, of course, dealing with looking after folks and providing personal services like bathing and toileting and feeding, et cetera. And hand hygiene of course, was part of our practice.

But using facial protective equipment, so using surgical masks and N95 respirators, face shields were definitely not part of the practice. And I think that has been a significant change because it's not only about wearing it and wearing it properly, it's also about supplying it to a mobile workforce and carrying it around with you in a safe way so that when you put it on, it's in good shape and it's going to work for you.

So there were so many different pieces to figure out for the team. I think that's something that's really, really remarkable. Sort of an on the ground significant change. There's a couple of other really important changes though that I think are worth flagging. And one is the view of how safe is home care? How safe is it to receive home care in a pandemic? And in the very beginning, there was a lot of concern that home care workers were infectious. I hate this word, but they were vectors of disease. It was terrible.

We had some pretty disheartening incidents when our home care workers arrived at people's homes. But what happened over time with the lack of transmission, the lack of burden of illness to clients and families from workers in our sector, as that became well known, what happened was there was this realization that actually home care is a very, very safe way to provide care in a pandemic.

It's much safer than providing care within an institution where there's many, many more people involved and you have to be closer together. So that I think was a remarkable change for our sector. 

And then I think the last thing is really just the value of home care to a healthy, publicly funded healthcare system. The role that our team has to play in making sure that hallway medicine and alternate level of care, burden, and emergency department crowding and really just flow out of hospital.

Our role is to facilitate flow out of hospital, and so people can return to their homes where they want to be and where they can provide sort of the rest of their healthcare if needed, really became emphasized over the pandemic. And I think that's helped us. That's absolutely helped us in our quest for some of the investments that we know we need in the sector.

Ellen Gardner: One of the things we really admire, Kathryn, that you did early on in your CEO journey was talking openly with staff and asking them what they want you to know. One person told you that they felt that leadership sometimes was missing the focus on the workers. And the implication was that you're not listening enough. Was that a shock to you? What did you think when you heard that?

Kathryn Nichol: Was it a shock? Well, you never want to hear that there's a problem, but honestly it was a gift because there's of course problems. There's always going to be areas to improve. And I think that the candor in which this PSW shared her experience was actually reassuring that she felt safe enough to be able to say that to the new CEO. What does that tell you about the culture of an organization?

I had worked at VHA previously, so I had some insight into the culture of the organization which is sort of why I was keen to throw my hat in the ring for this position, but that was a true Testament to the culture of the organization. And she's right. The interesting thing about home care is that there are really two very important functions.

One is coordination and scheduling. So putting the visit in people's calendars and getting it organized. And then the other is actually going out and providing the care. And the two really important frontline functions are done by two very different types of people. One is done by coordinators and people with administrative know how. And the other is done by clinical folks, PSWs, nurses, rehab therapists.

This PSW used the language that sometimes the head of the organization is not connected to the body. She's meaning that the head, the scheduling and the coordination is not connected to the actual service and care delivery. So what are we going to do about it? The obligation is we've heard this. What are we going to do about it?

VHA is 100 old. So we've changed our model and our structure many, many times over in the past. Now we actually are working to change it again. And what we're trying to do is create a triad at the point of care. And the triad consists of the supervisor, the point of care supervisor who's one of the most important roles in the organization who oversees now both the coordinator and the PSW.

So it's kind of like a triad team that's working together to make sure that the care is scheduled in a way that makes sense and that the PSW is supported then to go out and provide the service.

Ellen Gardner: Another person, a family caregiver talked about inequity in the salaries of nurses and PSWs and home care compared to other healthcare workers. I know that VHA has probably worked hard to address that inequity. Can you tell us, if anything has changed around that recently?

Kathryn Nichol: So there have been some positive advances, which I can speak to, but nothing has really changed. So we really need to continue to raise awareness of this issue and the impact that it has on a healthy publicly funded healthcare system. As I mentioned earlier, the sort of the emphasis on the importance of home care to a well-functioning system that's come out as a result of the pandemic is really helpful in this regard because if we don't have people who want to work in our sector and who are compensated at an equal level, they're going to leave.

You can do as much as you possibly can to keep people. But the bottom line is that we all have bills to pay, people to look after, and life is more and more expensive every day that we live, especially over the last few months. And wages matter. Wages really, really matter. For the first time in the long time, hospitals are now really strained for staff as well.

There's a lot of open postings and open positions at hospitals. So we're seeing even more of our team leave to take higher paying jobs in long-term care and higher paying jobs in hospitals. So the capacity issue is more acute really than it ever has been before. I think what my goal would be is for those who love working in the community who love the autonomy and the independent practice and the flexibility, which are some of the benefits of working in the community, those are the people we want.

We want the people who love it. We want them to want to stay. And then we want them to have equal pay for equal work. Then it's our job as an employer to make sure that we do all the things we can to support them, education, professional development, etc. etc.

Ellen Gardner: Healthcare is really moving away from the big hospital and adding more beds and moving into other models, specifically home care. So you've even called it the safety net of our publicly funded systems. So I'm going to ask you to put your superpower hat on, Kathryn. And now that you've been a CEO for a certain period of time, if you could reimagine home care in an ideal world, and maybe you've probably thought about this already, what would it look like?

Kathryn Nichol: I have thought about this. So in a perfect world, if I had super powers and I could make this happen, home would be the default place to provide care in all cases. And if it absolutely couldn't be provided in the home, then it could be provided in another setting, but it would be the default place for those who wanted it to be in all cases.

I think that home care would be recognized as a clinical specialty and our workers would be recognized as home care or clinical specialists, because it takes a very unique set of skills to be able to operate in the kind of environment that they have to operate and be able to provide high quality and sometimes highly technical care in an uncontrolled space. I think their contribution would be considered to be of equal importance to their peers and other sectors. And this would be reflected in compensation. So if I had superpowers, I'd fix that today.

And this would mean we could attract people who love home care. They loved working in home care and we would have a workforce that loved where they worked and felt recognized. 

And then finally, I would love to see the investment in home care as a percentage of overall healthcare spending in line with the aging population's desire to be at home. So much bigger investment in home care as opposed to other parts of the system to support that to happen. We know that that's going on in other countries and it's very, very successful.

Ellen Gardner: Our podcast taps into the expertise of leaders across the healthcare system. And we know that in healthcare leadership can take many forms. It's certainly not limited to the C-suite. So in your experience, Kathryn, where have you seen courageous leadership in home care?

Kathryn Nichol: So many places especially over the last two years where people went way above and beyond what they understood their job description to be to keep the organization running, to keep people supported in the field and to keep the information flowing so that we all knew what was happening. If I were to give you one really remarkable example, I would share that in June of 2020 when things were fairly new and long-term care was starting to crumble, it was a little bit in the media. There was some early stories, devastating, early stories of institutions that were basically sinking because of the burden of staff with illness and the inability to bring people in to look after residents. Before our health system could truly get organized to assist, there was this on the ground call for help.

Always, we are trying to find ways to help. So we put the call out across our organization for volunteers. We didn't want to tell anybody. We didn't want to deploy anybody without their consent. But we wanted to see if anyone would be willing. We had about 30 of our RPNs and PSWs who put their hands up to go into those homes to look after those clients while the structures and processes were put in place for the military to come in and hold the ground until we could sort things out.

They were deployed, self-deployed for a month. Those people that stepped up to do that, that is probably the most remarkable example of courageous leadership that I can think of to share with you.

Ellen Gardner: From the earliest days of your career when you were UHN as director of academic affairs, research and education, and then when you joined VHA, your primary focus has been on education and research. It sounds like it was always your first love. And I think you still chair the research advisory council for the institute for education research at The Michener Institute at UHN.

One of the things you've done has made research a key differentiator for VHA. So I really want to ask you two questions around that, is that, why do you think investing in research is critical for your sector? And are there any research projects that you're still involved in?

Kathryn Nichol: Yes. Research is a passionate part of my life now. It certainly wasn't way back when I was frontline nursing and I don't think I ever saw myself in a future where I was a researcher and an academic. But it certainly has become part of my life. To your first question, investing in research as a differentiator, home care is significantly understudied, yet it's an incredibly important part of our health system. Our mantra in the province is evidence-based medicine, evidence-based healthcare.

So, the generation of evidence to inform the best and the leading practices to deliver great care is really the way you have to go. So here we are, a fairly large organization sitting on a mountain of clinical and administrative data that can be mined to inform great decision-making. I really feel like it's our obligation to make sure that happens so that the evidence is generated, so that changes can be evidence based and successful.

I also think that it's incredibly important for an organization like VHA to elevate. Sort of elevated status within the health system. We see hospitals affiliated with universities. We see medical practitioners and physicians having a key part of their role being, teaching and research. And that level of credibility needs to extend across the system because we are all providing care and we all need to make sure our care is based on great evidence and great data.

So this was an opportunity for VHA to truly step into that space. And over the last, I think it's sort of been a 16 or 17 year journey now, it's really, really exploded. And I'm really, really proud of what we've accomplished and sort of the differences that we've been able to make. So your question about what am I doing? Am I doing anything?

Ellen Gardner: Yes.

Kathryn Nichol: I was doing a lot before I had this job. No, but yes, absolutely. You never not have your finger in the research pie, to be honest with you. So some of the studies that I'm involved in right now, I may not be leading them anymore, but certainly involved in them. We're looking closely at the impact of the pandemic on the mental health of our frontline staff with a focus on our PSWs. We're looking at the new use of facial protective equipment by frontline home care workers. What is the experience of that and what are the opportunities to increase the use?

What are the drivers of increased use? We need to understand that. We understand that clearly in hospitals. We have no idea about that in home care. 

And then finally, probably one of the most exciting pieces that we're involved in right now is an economic analysis where we are trying to outline how the home care PSW shortage could be mitigated through investments to equalize pay between home care and long-term care, and how these investments would result in substantial government cost savings anyway.

Even with the investment to achieve wage parody between the two sectors, the analysis is showing that there would still be significant government savings as a result because we'd be moving people. We'd be retaining staff and moving people out of hospital quickly. So even just doing that analysis in a rigorous and credible way and getting it published in a professional journal that's widely read by the health community is, I think, a really important thing to do and an obligation of ours.

Michelle Holden: Hi, Kathryn. It's Michelle here. Thank you so much for all of that. I love how you keep a focus on people, but also on future and business innovation. I just wanted to step back for a minute and ask you, you have a background in nursing, kind of why you got into healthcare in first place?

Kathryn Nichol: Yeah. I wanted to go to medical school, to be honest with you. When you work in the health system, it's really, really good work. And at the end of the day, you could be exhausted and frustrated. But underneath all that, you feel really, really good about your contribution. And I think that's the draw for me to the clinical world. I didn't go to medical school because it was too expensive. So I happily went to nursing school and landed there. I know you didn't ask this, but I do think that leaders, health system leaders with some kind of clinical background are more important now than ever before, because leading through the pandemic, having a clinical background is so helpful leading through the pandemic, but also leading from a position of compassion, because your profession is people based.

Ellen Gardner: We are ready to move into the lightning round. First question is, who's a leader you really look up to?

Kathryn Nichol: Dr. Samir Sinha is a leader I really look up to, I'm sure you're familiar with who he is, I think.

Ellen Gardner: Oh, yes, yes.

Kathryn Nichol: He speaks from the heart. He is courageous, knowledgeable, people-centred. And of course it really helps that he's a home care advocate.
Ellen Gardner: What's one piece of career advice that has stuck with you?

Kathryn Nichol: My mother said something to me. Can you believe I'm bringing my mother into this? That's crazy. But anyway, I said to my mom, when I was 39, I said, "Mom, my colleague wants me to do a PhD and she's willing to be my supervisor, and I think the opportunity to do my PhD is on the table." I said, "But, I'm, I'm going to be 44 when I'm done. That's insane. It's way too old to be going to school." And my mom's advice was, "Well, would you rather be..." She said, "Well, you're going to be 44 anyway. Would you rather be 44 with a PhD or without a PhD?" So my advice is always go for it.

Ellen Gardner: Now, that travel is opening up again. When you visit a new city, what's the most important thing for you to experience?

Kathryn Nichol: The subway. The transit system. I just had the pleasure of being in New York, yay, for a weekend getaway. We spent so much time on the subway. And honestly, if you're going to get the feel of a city, you got to go into the public transit system and check it out. I would probably also go to a small patio restaurant that serves craft beer and see what was going on there.

Ellen Gardner: What are you reading now?

Kathryn Nichol: One of the books that I reread recently, actually I read it before, but I reread it recently was by Whitney Johnson and it's called Disrupt Yourself. I don't know if you guys have read it, but she talks about the S-curve of life and how when you move from being in a very comfortable place to something new, where there's learning involved and there's challenge involved, you're basically jumping from the top of the S curve to the bottom.

And if you think about an S like the shape of the S. What happens is you jump onto the bottom of the curve and you have no idea what you don't know. So you're kind of at a plateau. And then all of a sudden you realize, "There’s so much that I don't know." And then you start up that incredibly tall part of the curve and you're in an intense phase of learning.

But then of course, you get to the top and you plateau. You plateau and the learning goes down. And so her comment is when you find yourself at the top of the S, that's when you think, it's time to disrupt yourself. You got to jump to your next curve.

Ellen Gardner: When you need a creative or energy boost, what do you do?

Kathryn Nichol: I play tons of ice hockey. I feel like ice hockey is the only time in my life when I'm living fully in the moment and not thinking about the future, because in a sport like that, if you're not thinking about right now, you're going to fall and hurt yourself. Or look like an idiot. If I can get out of the swirl of always having to think about what do we need to do next at work? What do I need to do next at home? Who haven't I called back? When was the last time I talked to my adult children and all those things. If I can get myself into a position where I'm fully in the moment, when I'm done, I am in a completely different head space. That's probably when I'm most creative is afterwards.

Ellen Gardner: What are you looking forward to in the year ahead?

Kathryn Nichol: The summer, the sun, the summer. So I think that the year ahead... So I'm really, really looking forward to landing our business growth strategy and having it be part of our annual planning cycle for 2023. We'll be looking at 2023 to 2025 and I think that collectively setting our priorities... When I say collectively, I mean, with members of the senior team and with our board, collectively setting where are we going to focus and then getting down to work and making those things happen, that is exciting. 

I'm also a great outdoors enthusiast and I love this time of year because it means that summer is all in front of us here in Canada, and the opportunities abound to get outside, play sports, go for walks, sit on patios, take my dog out. I love all that stuff and I'm really excited to have that happen.

Ellen Gardner: We really want to thank you, Kathryn, for just a wonderful conversation and we wish you all the best. And yes, hopefully you will get to enjoy the summer really soon.

Kathryn Nichol: Oh, thank you. Thank you, Ellen. It's been a fun interview. Thank you.

Ellen Gardner: You have just been listening to our interview with Kathryn Nichol, president and CEO of VHA Home HealthCare. For more information about HIROC and to listen to past episodes of Healthcare Change Makers, go to our website, hiroc.com. Thank you for listening.

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.