If It Ain’t Broke, Break It: The Courage to Disrupt the Status Quo with Dan Florizone and Marlene Smadu

In this episode, I sit down with two of Saskatchewan’s most experienced health care leaders, Dan Florizone and Marlene Smadu, to explore a fundamental crisis in leadership: why we continue to treat an infinite system like a “finite game."

 Drawing on their decades of experience—from pioneering "Magnet" hospital environments in the late 90s to their current work teaching excellence in health leadership—Dan and Marlene discuss the urgent need to shift away from "command and control" culture brought in by the militaristic and religious structures of the 20th century. They reflect on how the modern health care system is often trapped by finite thinking, where leaders are pressured by four-year election cycles to "win" short-term battles like surgical wait-time targets, often at the expense of the long-term sustainability of the workforce and the system itself.

We also discuss the power of the public and the direct care workforce as the greatest untapped resources for change. Marlene emphasizes that we have a well-educated public and 44,000 staff members who are "bursting to participate" if only they are given an invitation and a "North Star" to follow. While the administrative and logistical challenges are significant, both guests leave us with a message of deep hope, noting that the clinical breakthroughs and the "Patient First" shift in the last decade have been significant. 

This episode is a call to action for leaders at every level to embrace humility, curiosity, and transparency to build a health care system that is not just fit for the next election, but fit for the next century.

Resources:

The Infinite Game – Simon Sinek

Excellence in Healthcare Leadership Program

Kouzes & Posner Leadership Model

Berkana Two Loops Model

Raise Her Community

Industrial Disease

Transcript

SPEAKER_03 0:05

Welcome to Shift.

SPEAKER_02 0:06

In this episode, I explore leadership in healthcare and how it can move from 18th and 19th century models rooted in militaristic and religious hierarchies to approaches better suited to the challenges of today. While preparing this episode, I came across a compelling talk by Simon Sinek, where he introduces the concept of finite and infinite games. If you have time, I highly recommend watching this 30-minute video, linked in the show notes, before returning to this episode. Sinek explains that a finite game, like baseball, has known players, fixed rules, and a clear objective to win. By contrast, an infinite game, which better describes healthcare, has changing rules and an aim not to win but to perpetuate the game, ensuring the system endures for decades. Much of today's tension stems from pitting short-term finite-minded actors focused on election cycles or annual targets against a complex long-term healthcare system. When the system prioritizes siloed targets over long-term survival, we risk winning the battles but losing the war. Joining me to navigate this topic are two individuals who have held some of the highest leadership positions in Saskatchewan's healthcare system, Dan Florizone and Marlene Smaidu. I would consider both of these individuals my mentors who provided me with the inspiration I needed early in my career to truly believe we could change the healthcare system and make it better for everyone. Marlene Smaidu was a registered nurse for over 45 years and served in every nursing leadership role you can think of, including Assistant Deputy Minister of Health and Principal Nursing Advisor. She's an absolute legend in nursing circles. And Dan Floresone. He's currently the executive in residence at the Johnson Choyama Graduate School of Public Policy and a former Deputy Minister of Health and Education. Dan is unique as a leader. I have never seen anyone better at creating an inspirational and compelling vision for the healthcare system as Dan. Together, they co-lead the Excellence in Health Leadership Program, helping current leaders learn and reflect on leadership strategies for the future. In this episode, we'll discuss why it takes time to challenge the process and how we can use controlled burns to agitate the status quo without destroying the whole system, and how to shift from being in charge to taking care of those in our charge. It is a conversation about the enduring hope that can be found in the formal and informal leaders across the system who are bursting to make change. We just need to build the structures and processes to make it happen. Here's my conversation with Dana Marlene. My deepest appreciation to Dana Marlene for taking time to do this podcast. It's clear that navigating healthcare system change as leaders requires an understanding of both understanding of what kind of games we are playing and not losing the perspectives of the value of both. Dan shared an insight regarding the use of driver diagrams. These diagrams act as a vital bridge, allowing us to fit finite, measurable targets within the much larger, infinite game of improved healthcare outcomes. However, to truly move a system of 50,000 people, we must take that logistical step, that logistical tool one step further. We need a driver diagram to build a compelling narrative, a shared story that provides the insight and motivation for everyone to row in the same direction. Without a North Star to follow, a diagram is just a map with no reason to travel. Then, once we identify those drivers for change, we must provide all of our team with the tools to actually move the dials. You cannot play a game of baseball without balls, bats, and helmets, and we cannot expect our healthcare system workforce to succeed in a new system if we don't give them what they need to win the target or meet the goal. As Marlene noticed, if we just gave people in our system some more time, money, space, and opportunities to connect, share, and learn, we would get better results faster and have a more engaged empower workforce as well. To truly lead for the future, we should look at the five practices in the infinite games as outlined by Simon Sinek, a just cause. We need a purpose so visionary that people are willing to sacrifice to advance it. This must be bigger than hitting a metric. It must be an inspiring vision that people feel is worth their time and energy. Building trusting teams. We must shift from taking charge to taking care of those in our charge. This means creating an environment where people feel safe to admit mistakes or ask for help without the fear of the lie, hide in fake culture of the past. Seeking out the competition. While healthcare in Canada lacks traditional competitors, we must seek out worthy rivals, other systems or positive deviants who are doing things better than us. We should use their success as a motivation and proof that there is a better way. Existential flexibility. This is the capacity to make profound strategic shifts when you realize the current path has limited lifespan. Like Dan's metaphor of the controlled burns, we must be willing to burn down our old ways of doing things that aren't working to allow for the infinite game to continue. And the courage to lead. We must find the courage to stand up to the finite pressures that tell us to just play the game. We need to challenge the process. What are your thoughts about leadership in the healthcare system? Reach out to me at shiftpodcastcanada at gmail.com or shiftpodcast Canada on Facebook and LinkedIn. You can also find all my links to my podcasts on www.kdaconsulting.ca slash podcast. And remember, systems don't change unless we do. This is Shift. See you next time. Welcome to Shift. In this episode, I explore leadership in healthcare and how it can move from 18th and 19th century models rooted in militaristic and religious hierarchies to approaches better suited to the challenges of today. While preparing this episode, I came across a compelling talk by Simon Sinek, where he introduces the concept of finite and infinite games. If you have time, I highly recommend watching this 30-minute video, linked in the show notes, before returning to this episode. Sinek explains that a finite game, like baseball, has known players, fixed rules, and a clear objective to win. By contrast, an infinite game, which better describes healthcare, has changing rules and an aim not to win but to perpetuate the game, ensuring the system endures for decades. Much of today's tension stems from pitting short-term finite-minded actors focused on election cycles or annual targets against a complex long-term healthcare system. When the system prioritizes siloed targets over long-term survival, we risk winning the battles but losing the war. Joining me to navigate this topic are two individuals who have held some of the highest leadership positions in Saskatchewan's healthcare system, Dan Florizone and Marlene Smaidu. I would consider both of these individuals my mentors who provided me with the inspiration I needed early in my career to truly believe we could change the healthcare system and make it better for everyone. Marlene Smaidu was a registered nurse for over 45 years and served in every nursing leadership role you can think of, including Assistant Deputy Minister of Health and Principal Nursing Advisor. She's an absolute legend in nursing circles. And Dan Florizone. He's currently the executive in residence at the Johnson Shoyama Graduate School of Public Policy and a former Deputy Minister of Health and Education. Dan is unique as a leader. I have never seen anyone better at creating an inspirational and compelling vision for the healthcare system as Dan. Together, they co-lead the Excellence in Health Leadership Program, helping current leaders learn and reflect on leadership strategies for the future. In this episode, we'll discuss why it takes time to challenge the process and how we can use controlled burns to agitate the status quo and how to shift from being in charge to taking care of those in our charge. It is a conversation about the enduring hope that can be found in the formal and informal leaders across the system who are bursting to make change. We just need to build the structures and processes to make it happen. Here's my conversation with Dan and Marlene. So I thought it might be good if you guys introduced yourselves and gave me your piss like honestly. Both of you have such extensive careers that I just thought it might be good for you to summarize them in the way you want them to be summarized. So, Marlene, go ahead.

SPEAKER_01 8:12

Oh, great. I'm Marlene Smeidu. I am a retired registered nurse. I was licensed for probably 45 years. Um I'm no longer licensed as a registered nurse, but I teach part-time at the Johnson Sherman Graduate School of Public Policy at U of R with Dan. I teach um the Excellence in Healthcare Leadership course, which is offered online. It is a fantastic experience. I wasn't looking for any work. I told Dan this all the time, but but when I saw the curriculum, which he was very instrumental in constructing, I said, I can't resist. It's exactly what I think healthcare leaders need. And uh I think that we the response from our participants is the same. It's what they need. Um, I've practiced nursing in all domains. So we we talk about clinical administration, education research, and policy. Did work four years with the provincial government. Um, and I've worked in three countries Canada mostly. I worked in Papua New Guinea very early in my career and in uh Qatar in um as part of an administrative leave I was having. I worked there in developing a new nursing education program for six months. So that's a thumbnail sketch.

SPEAKER_02 9:14

Yeah, and you were in the ministry for a while too, right? Were you deputy minister, assisting deputy minister?

SPEAKER_01 9:18

I was an assistant deputy minister and and principal nursing advisor for four years.

SPEAKER_02 9:22

Yes. Yeah. So Dan, I don't know if you know this story. I've told Marlene this a few times, but when I was a nursing student, I was doing a practicum at the Kinsman Children's Center. Oh, and the director had a meeting in Regina, and she was like, You should come with me and go do a meeting at the Ministry of Health. And I was like, Okay, like honestly, like I was whatever, 20 years old, um, like no money, no experience, like nothing. So we flew to Regina and we got in a limo to go from the airport because they said, Well, there's five of us or something, so it's cheaper to get a limo to take us all. I'm like, okay. So we got into this limo and then we went there, we had this meeting, and Marlene, I don't know if she's in the meeting or I met her somewhere else or whatever. But a couple weeks later, I get a note in the mail of Marlene saying, It was nice to meet you. Good luck with your nurse and career. I know you'll do good things, like whatever, whatever. And I still have that note in my little like memory keepsake box. Ah, cute. Yeah. So I mean, when you're talking about nursing leaders, she is gold standard.

SPEAKER_00 10:24

Oh, absolutely.

SPEAKER_02 10:26

Okay, Dan, now your turn. See if you can beat that.

SPEAKER_00 10:29

I I can beat it because I get I get to work with Marlene every week.

SPEAKER_03 10:34

Thank God.

SPEAKER_00 10:35

So, as a fellow uh executive in residence, uh, we we get to uh co-teach, co-instruct, co-lead uh the Excellence and Health Leadership Program. Um, that is an online program that uh uh it it just feels like uh almost therapy, uh recovery from a healthcare system, but also uh a bit of a sense of continuous contribution. We still, I think, have something to share. And uh I'm learning every day from Marlene. So uh, you know, we we start out uh you have these stories, and I have lots of stories in in my early career of bumping into people who are shining lights and uh uh who are mentors. Marlene's my mentor. Hard to believe a bald-haired, uh you know, a washed up uh deputy minister, but Marlene was my inspiration. Yeah. 99, do you remember going uh to Ottawa?

SPEAKER_01 11:34

Yeah, yeah, yeah.

SPEAKER_00 11:35

Presenting.

SPEAKER_01 11:36

We were presenting for the Canadian Medical Association and both thinking, are we gonna get like daggers thrown at us?

SPEAKER_00 11:42

Yeah, I was great.

SPEAKER_01 11:44

We were well accepted.

SPEAKER_00 11:46

Absolutely.

SPEAKER_02 11:47

So in 1999, you guys presented together?

SPEAKER_00 11:49

We did.

SPEAKER_02 11:50

What were you presenting on in 1999?

SPEAKER_00 11:52

Magnet environment, magnet hospitals. Oh, so yeah.

SPEAKER_01 11:56

Dan was the only uh well, he was the first, but the only CEO in 1998-99 who agreed to participate. We had some money at the Ministry of Health to implement high-quality healthcare workplaces, okay, with um uh some of the SRNA staff were supporting it. Karen Eisler was actually kind of leading it, but we allocated it. It was like $150,000. It was really nothing. But we said we wanted to try some things that were related to magnet environments and creating high-quality healthcare workplaces. None of the other CEOs came forward and dad said, I'll try. I said, Do you know what you're getting into? I'll try it.

SPEAKER_03 12:33

Awesome.

SPEAKER_01 12:34

It was an amazing, amazing uh opportunity. And it it then it became a huge program after that.

SPEAKER_02 12:39

But he was the only one that came forward, but tomorrow I'm releasing just a short little podcast about what I've learned over the last three months. So every quarter I'm gonna do a little reflection and learning on all the interviews. And the first learning or the biggest learning that came out of the last three months is the power of yes and just saying yes and trying something and taking risks because every podcast episode had something around um like the energy it creates, the motivation, the connections, like the let's try it, like really can mobilize people as opposed to a culture of no, we can't do this. So it's good, like it's already coming up again in this one. Yeah, yeah, yeah. No, it's great. Okay, so I wanted to speak to you both because of your extensive leadership experience and because you're teaching leadership. So you are really deep into this topic and probably reflecting on your own careers and the leadership you've seen, the leadership you've been a part of. And I really feel like there's a bit of a crossroads in the healthcare system right now, in terms of maybe a recognition that the old ways of doing or the old ways of being or the way we set up the healthcare system 75 years ago is like not maybe working so well. And then there's this pressure to like reimagine and redesign and figure out what that future looks like. And that's going to take a lot of leadership. And I don't envy leaders at all for the position that they're in. It must be the hardest job in the world when you're leading in a space that has so many real-world consequences, like life and death decisions, and you know, and I know everybody's doing the best that they can with what they know and what they have. And so I just thought we'd just have like a conversation about what do you think the leadership skills are of the future? How are we going to usher in this new era? What is that going to look like from not only formal leaders but informal leaders at every level? And just have a kind of a wide-ranging conversation wherever you guys want to take it. So when you think back to leadership in the 80s or 90s, what are your memories of that time?

SPEAKER_01 14:53

Well, I I came up, my my first nursing education program was at the Regina Green Ons Hospital School of Nursing. So if you want to talk about the origins of the Canadian healthcare system in sort of military, church-related, hierarchical, you know, that was all there. Um but but there was a huge relational piece to everything that went on in that hospital, both when I was a student and when I was practicing there. The values that they espoused were, you know, really very clearly enacted, but very much top-down management and lots of management. I always say to the nursing students that I was working on a very large unit with one ABC, it was, you know, psychiatry, female orthopedics, iron nose and through. Like it was just this hodgepodge. It was like a rural hospital. Lots of patients. We had a big medical unit there. And but I had a head nurse, an assistant head nurse, and a team leader who made me successful. Like they made sure that I wasn't going to make a mistake. I'm not suggesting that that's the right model, but it worked because of the values and the kind expectations and and relationships that occurred in that. Um, I I think that early on in um in healthcare management, I would say it's still happening to some extent, but the the idea is if if we can maintain the status quo, if we can keep things running, we are doing a good job. And I I I'm not sure that even in the 80s that was appropriate. I mean, some things were kept running, but um it's absolutely not appropriate now. So I um it's interesting when you talked about redesigning the healthcare system because uh with Dan's help, I'm um leading the Masters of Health Administration spring seminar in June. And I got to pick the theme. That was actually why I agreed to do it. I said, if I can do this, I'll do it. And it was challenge the process, redesigning the Canadian healthcare system. And the challenge the process is coming from the Cusis and Posner attributes of exemplary leadership. I've used that model for myself for years. Um sometimes I focused on other aspects of that model. Uh, you know, I know for a while in my career I was really focusing on that, you know, celebrate successes because I thought we'd really missed out on that in many aspects, especially when I was in the Ministry of Health. But I'll I'd say in the last 10 years, and I'm not even having been fully employed in the last 10 years, but I'm as a member of the public, I've really focused on challenge the process. I don't think you can be a leader in the Canadian healthcare system now to be effective if you are not prepared to challenge the process. You need to look at the patriarchy, the colonial structures, the misogyny. It's just so many pieces of our society that are reflected in the Canadian healthcare system. And if we're not willing to challenge that, we're not meeting the needs of our patients, families, residents, and clients. We're also not meeting the needs of our workforce. And that's where I think when you think about what do the leaders have to do, it's it's different. It's actually the phrase I use, if it's not broke, break it. Like if you're doing, if you're still doing something that you were doing 25 years ago in the health system, you need to break it and start over because it's not going to work. And it's not, maybe it's working for you, but it's not working for the system.

SPEAKER_00 18:08

So there was a huge insight we got. Actually, Marlene and I were together. We went on a best of Brittany where we looked at high-performing organizations. And it's kind of the this opportunity with an outside set of eyes to look at a system that's you know historically highly bureaucratic and uh has its elements. But so we were we were talking uh to some of the quality gurus, Helen Bevan and Kurt. And uh one said, We, you know, they were talking about what failed. And that this is a uh something that didn't exist in the 80s but started to emerge in the 2000s is humility. Like the humility to say, boy, that didn't work, but this spirit of fail forward fast, which you know, you pick yourself up, you dust yourself off, and per in a persistent way, we said yes, we'd do it, and it didn't work. But we're gonna try something else. So they said what wasn't working for us is we failed to address for the team members what's in it for them. And this is a hard question. I don't know if it's hard culturally because we're Canadian or what what the deal is, but if someone were to ask you, Kyla, what it what's in it for you, you'd come up blank potentially. And they said we had to reframe the question. And we reframed it by asking what does a great day look like? So, inspired by this, years later, I was in Saskatoon. I thought we keep on telling the physicians, and in this case it was family physicians, that we've got this great thing for you. It's called primary care, it's team-based care. Here it is, here's the design, here's the graphs and the pictures. And the physicians would have a blank look on their face, and we keep on asking them, what do you want? And they'd say, nothing. So we stopped and asked them, What does a great day look like? And I can recall this like it was yesterday. There were probably 10 or so family physicians around a table, and the first few that responded responded by answering the question with, I don't know, with a whoa. So we keep on coming here to try and rescue, to think that, you know, as administrators or as leaders, we've got the greatest of ideas, but we haven't even addressed the fact that we have a couple positions, at least around this room, that can't describe what a great day looks like. Now, as we get into it, what started to emerge as an answer to that question were all of those barriers, those niggling, maybe they were pebbles in the shoe, yeah, but those niggling things that were in their way from today being a great day. Turns out 95% of what they're raised wasn't about them. It was about the patients that they were really struggling, sir, to treat. It was about the fact that episodic care was being outstripped by chronic disease, that mental health and addictions and chronic illness and uh uh complex care was really tough to deliver in the current context of fee for service and time was the enemy. Anyway, I could go into it, but the key is how we frame it. And uh that taught me that in the 80s Marlene said stability. A lot of it was designed uh around command and control, and there's still remnants of that. It was a militaristic structure, it was a religious uh structure. Uh, we came from our history to be, you know, kind of as in who's in command, who's in control. And what we found is that it, you know, you enter into this and you watch the people in charge. For decades before, and they were dealing with a very static system that you could get away with that.

SPEAKER_03 22:08

Yeah.

SPEAKER_00 22:09

They were very much command and control. They were bulletproof in terms of uh anyone thinking they didn't know what they were doing. And we found that that was a failed approach. What it took was humility, curiosity, and all of those preconditions for learning.

SPEAKER_02 22:32

Yeah, the two-loops model, I the Burcana two-loops model I use a lot about systems that are no longer fit for purpose and new systems that are emerging. And there's a really strong role in the dominant system of stabilizing it and holding on to it and keeping it static. Um, even as the system is becoming less and less fit for purpose, they're just holding on to it because it's what they know, it's what they're comfortable with. Um, and so the the idea now is how do you yes, stabilize what needs to be stabilized, but then also sort of generate the energy and the change that you need to create the new system that's more fit for purpose.

SPEAKER_00 23:12

The metaphor that we've been using is a controlled burn. Okay, you you can wait, and there is a finite kind of uh uh trajectory for any organization. You take it long enough, and this organization is going to fail if you allow it to just sustain and build up, but it's almost like old growth in a forest.

SPEAKER_03 23:34

Yeah.

SPEAKER_00 23:35

Um, it's gonna go through that natural progression and life cycle. Um what we do is we can't risk in a 24-7 system that's continually providing care and service, we can't risk destroying or blowing the whole thing up.

SPEAKER_03 23:54

Yeah.

SPEAKER_00 23:55

What we do in Marlene's words, if it if it ain't broke, break it, is we do the breaking like a control burn. We mitigate our risk by picking an area and going in there hard. And then we pick another area. And eventually we disrupt everything, but we can't just lay to the proverbial and let the whole thing go ablaze. So if we're not agitating, if we're not doing a control burn, then we're not really being as thoughtful as we need to be about uh uh the future. So it's small tests of change, continual experimentation.

SPEAKER_02 24:31

So, Marlene, what are the skills that you're you're trying to build in leaders to challenge the process?

SPEAKER_01 24:37

And and I'll just start my comments by talking about what both you and Dan have talked about is that you know, we tend to talk about leaders who are in formal positions. And in a system as large as the health system, you know, I don't know if we're 40 or 50,000 people now, like we actually need to support the leadership at all of those levels. That's one of the key messages that we give within our program. You know, we we have people who are in formal positions, but it's it's the licensed practical nurse who's working on a surgical unit at the Regina General Hospital who has a leadership opportunity and needs to be supported in that leadership. So the controlled burns, and I love that metaphor, can happen at a variety of levels. We saw that with all of our QI work, right? It was like figure, you know, get people data that has meaning to them at their level, and then let them figure out how they would do things differently in order to make sure that that is um uh effective or whatever the process is is good for the patients, families, residents, clients, and themselves. So I think that the leadership attributes, and and the reason I've picked on challenge the process is that's often the scariest part is is to say, you know, I came into this system as I don't know, like a 22-year-old, but my most people don't come in as a CEO, but anyway. Um, and uh and and they've always done it this way. And and you know, therefore, like even though I think it might be better if we did it another way, like, do I have the support? Do I have the backing? Can I fail? And people will still have my back, that kind of thing. So cush and poison are talk about seeking out opportunities and looking for opportunities for innovation without blowing up the whole system. And it's whatever level that you're at, you know, be able to have an environment that's comfortable enough and that and you need to be supported by others to be able to try those things. And and when I start, when I I teach this to nursing students as well, like when you start to say to them, you know, the the nurse that's worked on a neurosurgery unit for 12 years, and you know, the care is she's an expert, and the care is, you know, pretty easy to unfold each day, and you know, she manages all of her responsibilities. And say to her, like, why don't you volunteer to be on a committee that's perhaps looking at uh I don't know, the integration of AI into patient teaching tools or something like that. Like those opportunities get people thinking bigger than what their particular role is. If we could energize 40,000 people at whatever level they're at, to be able to think about how things could be. I mean, QI, we talk about how can you improve the system every day, but how things could be different. You know, we would come up with that it's it's kind of incremental, but it actually becomes, it's like uh an Ameeba joining was another one. Like it pretty soon it becomes this big mass of uh thinking differently and and being more open to change. I think our leaders, uh I would say one of the biggest frustrations, Dan, you can check me on this, but the people that are in our program is when they are stopped from implementing something that they know they have to do. And you can say, well, why are they stopped? It's often some kind of an edict that comes from someplace well above them and they have no idea where it's coming from, uh, or it's it's a removal of resources. So you know, we we were moving along on this particular piece, and then now there's no budget for it. So you know gotta figure out how to do it on the side of their desk. So we we have lots of challenges with a huge organization like the healthcare system. And traditionally we've acted as if you reorganize, you change the organizational structure, that you're actually gonna help make things better, and it's exactly the opposite. Yeah, it's that's not where we need to invest time. It wouldn't matter. I mean, it does matter what the structure is. I I I know there are some there's great research on that, but but please don't change the structure one more time, thinking that now you're gonna get these amazing results out of cancer care or whatever it is. That's not where it happens, it happens here and it needs to be supported and it needs to be led. And I think, and we just talked about this yesterday in class, so Dan, you can add to it, but you know, uh many people in our system, uh, including the leaders, have no idea what the system looks like.

unknown 29:03

Yeah, right.

SPEAKER_01 29:03

They don't even see it as a system. Yeah. And if you're going to try to lead through just looking at isolated pieces, you are you are failing everybody. You're certainly feeling the patient who's going through the system, you're failing the people who work in it.

SPEAKER_00 29:16

It's interesting, Marlene, because one of the things that we've noticed throughout the years, and you and I have talked about this, is historically it took a leader to become ill themselves or to have a family member close to them who have to experience the system. They come back with religion. Like it's like insight. Oh my God, I had no idea. Like I can talk about the silos, but boy, the journey. That's a different matter. This thing is strung together or not, right? To deliver an experience, a journey uh that is uh fundamentally broken. And that's that's some of the challenge here. A lot of where we start with quality improvement is on point improvement, but we've got to move on to higher levels, right? So I get, I guess what it comes down to in leadership is that ability to zoom in right to the youth level and zoom out to be able to see the myriad of players that are necessary to team together to be able to tackle wicked problems. Um, so you know that it we started out by talking about finite and infinite. There's no doubt the game is infinite, but the structures are finite, the approaches are finite.

SPEAKER_03 30:30

Yeah, yeah.

SPEAKER_00 30:31

In fact, we want to disrupt those. So I want to take you back because this is an important kind of point in time, and that it involves Marlene and I. This is where Dan had a huge aha moment, and Marlene was there. It was her initiative around magnet hospitals. Do you remember? And and you can say you can describe this so well, Marlene, the surprise and and kind of the nervousness that we had around creating a just a small fund for the stata to innovate.

SPEAKER_01 31:02

Yeah, and that was part of this funding from the Ministry of Health. But people thought that when if we gave this small amount of money to the nurses around their workplace, that they would buy things for themselves, you know, that they would fix up the coffee room or get a new coffee machine or, you know, to make their work environment better. And every one of the suggestions that came back had to do with providing better patient care.

SPEAKER_02 31:25

Yeah, of course.

SPEAKER_01 31:26

You know, uh getting a broto chair, getting IV poles and commodes that would actually fit in the bathrooms. And Dan, your your explanation was those were things that never hit your radar because they didn't ever hit the capital budget, right? Yeah, they were too small. They were they were so small, and they were instrumental in making the work life of those nurses and the care of those patients better. Um, and so they did. They bought IV poles that had four legs instead of three, and they got so they didn't tip, yeah. They tip commodo chairs and this broda chair, brakes on beds, breaks on beds.

SPEAKER_00 31:59

Um I never knew.

SPEAKER_01 32:02

Yeah, yeah.

SPEAKER_00 32:03

I'm in the nosebleed section, even though it's one hospital or one health region, right? But they knew they knew that these were barriers to a great day. Yeah, these were pebbles in their shoes, yeah, but they added up, you know, the big things.

SPEAKER_02 32:19

I had a friend who was in palliative care on the medicine unit I used to work at, and I was a deep into quality improvement at that time. And I said to him, I'm like, okay, you've been spending lots of time in the hospital. What what's one thing you would change? And like he was literally within a week of passing away, and he said, I would like someone to get some WD 40 and go and put it on all the wheels of every bed and every wheelchair in this hospital because all I hear all day long is squeaking wheels again. Like, would you ever think of that? You know, like it's like it's just the small things. And I had my 25th um nursing reunion this fall, and so many of my friends are still frontline direct care providers. I talked to lots of them separately, and the general theme was I don't know if I can do this much longer because there was this sense across a lot of people that we used to be able to make change, we used to be able to decide things, we used to be able to make decisions that were in the best interest of our patients. Um, and now we have no choice, and things are being done to us and for us. There was a real sense of defeat. They're like, I've been working for 25 years and it's worse than ever.

SPEAKER_00 33:36

So, Kyla, that worse than ever. I just want to uh flag that. Um, there has been a deterioration and COVID played a very good role.

SPEAKER_02 33:46

Yes.

SPEAKER_00 33:46

Well, what happened is we went to emergency management type approaches, which are by by their definition command and control. And you can do that for a week or two. You could possibly do it for a month, but don't do it for four or five years.

SPEAKER_03 34:01

Yeah.

SPEAKER_00 34:01

Because what you do is you're changing the culture. We revert it back to old approaches. We also learn some very bad lessons around the episodic needs of the population. Yeah, we needed to be better prepared. Yes, we needed to respond in that way, but it all shifted back to we need more beds, we need more acute care, we need more institutions, and and we we really need to break free of this thinking where we can really look at home-based, community-based alternatives, look upstream, look at complexity, look at chronic disease. Um, ultimately, this system um it seems to take on a life of its own, but it also creates some of the problems that we're encountering. So if you take someone frail and elderly, and the only crisis response we have for them is the emergency department, within hours they start, we start to see that decline. And uh, if they didn't need long-term care coming in, they'll need it going out. Now, for the staff that are working in these various units, from where they sit, they see ALC patients, they see um people in beds and stretchers. Their immediate thought is we need more beds. We need urgent care centers, we need beds, we need. Well, if we don't get upstream of this, we're never going to come up with a system that avoids the crisis in the first place.

SPEAKER_02 35:39

I sent you guys a video, I'll put it in the show notes too, that Simon Sinek video where he talks about finite and infinite games, and that a finite game is like a game of baseball. Like everybody knows what they're playing, everybody knows what they're doing, everybody knows the rules, that the objective is to win, the objective is to finish the game, as opposed to an infinite game, which is about keeping the play going, about sustainability as the players change, as the conditions change, you're playing the long game for sustainability. And if everybody's playing a finite game, there's balance and stability. If everybody's playing the infinite game, there's balance and stability. It's when you put finite players or thinkers into an infinite game, and there's this pressure to succeed, to win, to um, and this comes with election cycles as well. Like, what can we get before we put out the next campaign brochure? How do we win this aspect of wait times or you know, but you have this system that's actually playing this long game of relational care and sustainability of the system? And I feel like there is a tension there that is not being talked about. And people are getting really unmotivated by the finite games that are being played with the healthcare system instead of the long-term thinking that's required. Marlene, do you have any thoughts on that?

SPEAKER_01 37:06

Absolutely agree with you. We actually use the finite infinite games in some of our other work with the Razor community that I am part of with my daughter, and because it is about when you're going to collaborate over things like gender equity or domestic violence or whatever, those are some of the things that we're interested in. You you are in it for the relational piece and you look at other organizations that bring, you know, kind of different strengths and different pieces so that you are collectively going to be able to start to make some progress. Dan and I teach wicked problems in the programming. It's an example of a wicked problem. Like it's it's morphing and changing, and different people have different perspectives. But you, if you stay together and you stick with it, then you can actually make some progress and and you're you you all understand that. I think the the we we have a lot of lifers in the system. We have people who have seen, you know, as their own professional capacity has grown and their competence and and they've seen the system, they they actually, if they're sticking with it, they have a sense that this is something that they're committed to and that they believe is worthwhile sort of kind of fighting for. But but to get back to your earlier point about, you know, like giving people some resources where they're at, I know Stephen Lewis talked about this in his video about time being a critical resource.

SPEAKER_03 38:25

Yeah.

SPEAKER_01 38:26

You know, we don't give people time, we don't give them even small pockets of money, we don't give them any kind of resources that would allow them to try some things, to innovate, to do some small tests of change. Uh and if when you have that uh mentality that there is, well, first of all, somebody else is controlling the budget. Uh and and that it's that it's uh um not an abundance mentality. It's not that we we have all these resources, what would be the best way to use them? It's I don't have enough and I'm gonna keep mine and you know yeah, can't share. Yeah, can't share. That we actually we we are not, again, going back to the 40,000 people, we're not creating an opportunity for these leaders to emerge wherever they are and to be supported and to actually create the change. You know, it's not gonna be, I don't know, the 10 VPs or however many VPs there are now that are gonna lead this, the the kind of change that people want. I think another resource we don't use well when we're thinking about change in the system is our public. And when in 2012, when we were doing uh, we did a national expert commission on the sustainability of the Canadian healthcare system and the health of Canadians, we we had um Nick Nanos do polling for us with the public uh right across Canada. Blew me away the willingness of people, and these are not people accessing the healthcare system necessarily, it was you know just the public, uh, their willingness to support the sustainability of the system. They were happy to pay their tax dollars for a system that didn't have waste and that was well functioning, and their willingness to donate their own time uh to be part of that restructuring. We we have a huge public. We've got the baby boomers like me, but we've got uh another really well-educated public that that could be part of it. But instead, we somehow believe that there's going to be this small group of people at the top of some system uh who are who are going to be able to figure out all the changes that need to be made. And if they don't, if they're not on the gemba, if they're not listening to people, if they're not providing time and resources for people who do have some good ideas, uh, and that would be able to make some changes that could be, you know, spread more widely, then we we are losing so much potential, so much creativity, so much, you know, we've got wonderful thinkers, why aren't and doers actually, and why aren't we using them? It's not just the health system. Dan, you could speak to education system, but somehow the health system has kept this structure that is that so oppressive. It's so oppressive, yeah. And it's and it's built on well, it's built on its origins of the colonialism that created it in the first place. And anyway, we we have a lot of work to do on that, but we have a lot of resources if we would mobilize them and if we would get people the kinds of things that they need. I mean, time, I think Stephen says, like, we we think if people are not working 120%, if nurses aren't going flat out on their unit, then we're we don't need as many of them. I I witnessed this, I I um chair the independent assessment committees, I and I witnessed that sort of thinking all of the time. If you gave that staff on that unit 10% of their time for actually learning and development and making changes, they would do it. Yeah, you wouldn't have to think about what you have to do, they could figure it out because they know the practice. Yeah.

SPEAKER_00 41:46

That's great. I, you know, I uh summed it up yesterday. I I was kind of on a bit of a rant in a class. Oh Dan on a rant? Yeah, it happens, but I said, you know what the problem is, and I just blurted it out. I thought it was going to break out in some it's industrial disease. Yeah, yeah. Yeah, like we've got this old model. Um, the military have abandoned it because it doesn't work, but we still embrace it, right? This old structure, and then we build bigger because you know, obviously bigger is better, right? It's a recognition that when someone comes to us to work, to contribute, to lead, to uh be able to practice, they don't work for this big monolith, they work for their unit, they work with the team, they you know it's it's local. Well, we could talk about public health and uh broader community-based services, which are really important. Care itself is delivered locally. It's you know, you can't if you can't touch or virtually touch, you you got a problem. Um, so here's attention. Here's my first reaction when I heard uh this notion of gaming, uh gaming theory with finite and infinite. It's not either or it's both. We're gonna have to live with the reality. Yeah, and and I think this is uh I'm Marlene, I don't know if you'll agree, but I think the use of driver diagrams gives us an opportunity to fit in the finite within the infinite game. No, often what I've said to leaders is uh you'll you'll hear it's all about the outcomes. Yeah, and the problem with that is process is at least as important as the outcomes.

SPEAKER_03 43:29

Yeah.

SPEAKER_00 43:30

Because if I get outcomes and I've just burnt out all the staff, wrung out all the assets, left the place in a shambles, yeah, we we survived a pandemic or uh we achieved uh surgical wait list nirvana. Um but the bottom line is what's the capacity that we built within the organization to take on the next series? That's right. Because it never ends, it's continuous, right? The next series. So driver digraphs, I think, are key.

unknown 43:58

Okay.

SPEAKER_00 43:59

So an education. This was a major aha for me as the privilege of serving as deputy minister of education. Teachers said, based on the evidence, grade three literacy is the best determinant of graduation. So we were able to keep our eye on the ball in terms of educational attainment. And it was evolving and growing, what that meant. Not just marks, not just a pass, but bringing out the full potential in people. At the same time, we were able to throw together a very important, finite set of targets that got us in some way a control burn to be able to see the change, to celebrate the change, to be able to have the politicians witness during their political term an improvement. Right. We don't have enough time to do that. But I think the winning formula is somewhere in there. So when we talk about population health targets, these are by definition decades, right? How do you get a political cycle of four years to line up with a 20-year initiative? And the answer is a driver diagram, leading and lagging measures, being able to show the picture and make sure that we continue to show the picture so we don't lose sight that it's not about this individual target or this individual initiative. It's about greater mission.

SPEAKER_01 45:30

And you know, it's not just politicians who need that. That's brilliant the way that you've described that, because we all, I mean, that's one of the Kusas and Plausners' attributes of good leadership is to celebrate, to plan and celebrate small wins. That's what keeps people going. Sure. And what made my heart burst with pride was when I was with RQHR and I would go to the nursing units where they had through their visibility wall identified things that they were going to work on. And when they would come to their huddle, and then they would be so proud about, you know, they had no falls on their on their false cross. And the things that they had done to accomplish that, that that is what keeps you going. But that was because they had the data that they needed at their level and they were able to implement. And they actually, even the time for a huddle, I mean, I don't know, three minutes or whatever it was, it valued them gathering. It was that you didn't have to be out with patients every minute of your day or doing charting. You actually gathered and talked about how are we going to make this unit and this patient care better.

SPEAKER_00 46:29

So you said something yesterday, Marlene, about transparency.

SPEAKER_01 46:32

Yes.

SPEAKER_00 46:33

I think the other element is those walls, that data was all there for the public and for the staff. Yeah, that was that was another important element.

SPEAKER_02 46:42

Like now we're recognizing yes, we have to be this and we have to be this, and we have to see the system and we have to focus on local. I would think that that would feel very overwhelming to leaders who are trying to lead in this increasing complexity and there's more education than ever, and there's more thinking than ever, and there's no more books than ever about all these different approaches and things. What if you guys could like boil it down? What do you think are the key things that leaders need at every level that will help us shift out of this command and control, or at least have a little bit of balance between, you know, the things we do have to command and control and the things that we maybe can let go of and trust? Um, like Steven has an article where he says, trust the talent, like such an educated workforce, you know, so many ideas, and yet we control it probably more than any other workforce out there.

SPEAKER_00 47:40

Yeah. So respect, curiosity, humility, being present. Like it, I don't care how big you are, go out there and see, right? Go to where the problems are, speak to people, placing yourself out there and risking that somebody might ask you a question you don't have an answer to. Well, command control, maybe that matters, but in this new era, it doesn't matter if you don't have the answers, it's about the questions, right? About the learning. So these are easier said than done. And you know, we we now have this other uh big elephant in the room, and that is government intervention directly into the health system. You see, as we're struggling, we're being held more and more to account. And accountability in government is wholly different than accountability for learning that we're talking about.

SPEAKER_02 48:37

Right. Yes, yeah.

SPEAKER_00 48:39

So we've got to become a bit of a buffer. We've got to be able to feed the need for information and data. We've got to build trust. I I would say respect for people is probably number one on our list. Engagement of those in the know.

SPEAKER_01 48:57

Yeah.

SPEAKER_00 48:58

Number one, number two on our list. Sorry, Marlene.

SPEAKER_01 49:02

No, I agree with all of those things. And I I I guess I was thinking about what do I say to people who are in leadership roles or who are developing leadership? And there's a couple of key messages I give. One is you are never there as a leader. If you think that you've learned everything you need to be about being a leader, you're wrong because leadership, like anything else, has to continually be developed and you have to respond to the context and the environment that you're in. So I always say create a leadership development plan for yourself. Like you actually need to be that concrete. Use a framework, whatever framework you like, whatever theory, but every day you need to reflect on how have I advanced my competence and my attributes in this area. And that, like I said, that for me is how I started to really think about I have a responsibility to challenge the process. This isn't about somebody else doing it. I have, and how can I do that in a way that is respectful and garners trust and that kind of thing? I think the other thing is ongoing learning. And, you know, Kylie, you're well read and you spend a lot of time in the literature, but there are so many helpful resources. And if if we can encourage our leaders to access the kinds of resources that they need, which might be literature and you know, formal education, but sometimes it's peers and peer support. Or, you know, uh some of the units do things like have journal clubs or something like that, where you you actually get together and learn. I mean, I I'm a teacher, so it's like if I'm a hammer, everything looks like a nail. But I and I actually think that there's so much to be said about supporting people in their leadership development by actually continuing to learn. And Dan, you've said that many times. I I actually think leadership is a very lonely job.

SPEAKER_03 50:40

Yeah.

SPEAKER_01 50:40

It doesn't matter what your position is. So for sure you need mentors and for sure you need um uh a peer support group. I don't care if it's, you know, if you're the director and you need other directors, but they need to to seek that out and develop it themselves. But we actually again need to create time and space for that to occur. So instead of rushing in and rushing out of meetings where the agenda is 10 times longer than what you can actually accomplish, and that you actually create other fora for people to to come together and to do that. Dan said it. But they have a chance to exchange some ideas and to reflect on what some, oh, you're doing this, and you know, how about this? Like one hour a week, uh, and they show up. And they're busy people, but they show up because it's important to be able to talk to other people. We we can structure some things to support leadership, ongoing leadership development in our system in a way that demonstrates that it's valued. Um, I don't I don't think we've done a good job of that.

SPEAKER_00 51:46

It's interesting, uh, because when you talk about the one hour a week, that's uh and and they're multidisciplinary and they're across all kinds of sectors, even other provinces, they never get that opportunity. So we talk a good talk about working across silos, but they never actually get to meet to just talk, just chat. I think if I were ever to become a CEO again, which probably isn't gonna happen, um, I I would start those types of forums. You know, you talk about free time, we're gonna spend an hour. Anyone who wants to come forward and we're just gonna chat. We're gonna innovate, we're going to think through and ask questions.

SPEAKER_01 52:25

Yeah.

SPEAKER_02 52:26

Somebody asked me if I was interested in doing some coaching with doctors. And they asked if I had any experience in working with doctors, and I was like, Yeah, I've had experience working, because he's like, they're real, they're real difficult. Like it's uh it's really hard to coach and work with them. And I said, Oh, that's okay. I'm like, I've realized now after a few years of consulting that I just need a budget for beer and nachos. Uh but honestly, that's a lot of what it is, is just talking and networking and building relationships and earning trust. And like it's not as hard as I think people think it is.

SPEAKER_00 53:04

It's interesting that uh as a as a relatively new grandfather, as a child.

SPEAKER_03 53:09

Oh, more good, yeah.

SPEAKER_00 53:10

Right, yeah. Um, my kids, my daughter asked me the other day, who who are you? Because she doesn't recognize me, right? Um, I have a feeling that if I ever ended up back in some role, people would look at me and say, I don't even recognize you. Like, how are you? And this is back to Marlene's continuous learning. I mean, fundamentally at the core, we're the same people, but this is a journey. I mean, this the learnings, yeah, 10 years I've been out, the learnings have been so steep.

SPEAKER_03 53:45

Yeah.

SPEAKER_00 53:45

And uh we look, we look at it and we say, wow, if only knew then what I know now. I'm in awe. Like as we listen to people and as we take the time to really hear their perspective. I we mentioned yesterday's session because it was top of mind, but I'm in awe of what I heard yesterday. Thinking, you know, from from those willing to kind of put it out there, yeah. I think we have the nuggets. So I I want to kind of leave a message of hope. There's huge hope. Yeah, we've got uh people bursting to want to participate. All they need is an invitation, yeah. Um give them a North Star and they will innovate around that North Star.

SPEAKER_01 54:29

And along that line, I I I also want to give a message of hope and commendation because um, as many times as we talk about, you know, the maybe the structural problems and people don't see it as a system and all that, the care at the clinical level is exceptional. And I have lots of opportunity. I've I've just journeyed with my sister through palliative care. I've uh you know, my husband accesses the healthcare system, my kids and grandkids. Like I am blown away by how I how much I think it's improved. Um, you know, patient and family centers, no question. Like, you know, you come on in, you're part of the like the how can we work together with you? That wasn't the case, probably even 20 years ago or 10 years ago. So I think the the there's been so much progress made in terms of what I would call the quality of care. I would give a lot of credit to the focus on quality improvement and that ability for people to kind of have permission to keep improving and making things better at whatever level they're at. Um, and so it's it's definitely not all negative. And I I just actually talked to two neighbors recently because they know I'm a retired nurse and they said to me, I don't know what all the complaining is about, you know, I got the best care ever. I couldn't have asked for anything more. And I say, kudos to you and to the system and to the people in the system that do it. So there's lots of room for hope and and positivity and optimism. But if in thinking of always wanting to make the system better, we we have to keep challenging it. We have to keep asking questions about it and making sure that we're gonna be responsive, not just for the people of today, but for the people of tomorrow and 10 and 15 years from today. So um anyway, that that would be my I think you're right, Dan, to say we have to leave with hope because we do have that benefit of interacting with people who are in the system and who are doing brilliant things.

SPEAKER_00 56:17

So it's interesting that two things can be true at the same time.

SPEAKER_01 56:21

Yeah, right.

SPEAKER_00 56:22

Lots of improvement on the administrative side, on the logistical side, on um, you know, in terms of dealing with quality and safety, there's still a long journey ahead of us. But we have the ability to do things that are just second to none. Really impressive.

SPEAKER_02 56:37

Even this morning, um, my mom went to the doctor a few days ago and she needs a follow-up. And we said, Well, do you have that follow-up booked? And she's with a primary care team in Swift Current, and she said, No, because I know I can get a same-day appointment because they've restructured to team-based care. And I was like, Wow, that's a change, that's an improvement, right?

SPEAKER_00 56:56

Like it is Helen, do you remember the work on positive deviance? Yes, you know, in spite of any problem that we're dealing with, someone somewhere has succeeded. And Marlene, your work internationally, I mean, this was the heart of it. You go and you look with the the community, given all the same constraints, there's always someone who's thriving.

unknown 57:15

Yep.

SPEAKER_00 57:16

And you ask, well, what is it about then? Yeah, maybe that's the work we need to start shifting into. Like shine a spotlight on what's going really great, and then understand, okay, so why can't we have this everywhere? It's that kind of elusive scale and spread that the Canadian system has really uh struggled at. We got really good at that, right?

SPEAKER_02 57:38

Yeah, that's right. And that's the conversations I'm trying to have on this podcast. Like, where are people pushing through? Where are they making changes and then highlighting it so that other people can say, oh, maybe we could do that here? Or well, I don't know why they're doing it and the town over is not doing it. Like, what's the what's the holdup? So that's my goal is to find all the the individuals, the teams, the organizations, the communities that are just taking a risk and doing things differently and it's working. And then come tell me about it, come share it with other people, and then that'll maybe inspire other people to learn from them and then do the same thing because we did not share enough in this system.

SPEAKER_00 58:19

Yeah, you recall this releasing time to care. Um, the real innovation was in the collaborative, right? In bringing people together and oh my god, they're sharing. And here's what worked, here's what didn't work. I mean, that's what we need to do is to get to get that cascade of learning. Yes, where we can say, this is possible.

SPEAKER_02 58:40

Yeah, yeah. Releasing time to care was probably the most, you know, affecting program that I ever did in terms of seeing the potential of what happens when you give people space, time, a little bit of resources and permission to just do things. And they were in a lot of cases small things that made a huge difference, like you were saying, Dan. Like it, I would like to get some of that energy back to the front line. Yeah. So what don't we? Yeah.

SPEAKER_01 59:08

Well, the good news, Kylie, is when I was in Yorkton uh in this in the fall, I can't remember where it was. I was at the it was part of an IAC um site visit, and um the nurses on the unit actually talked about releasing time to care. Yeah, that's it still comes up when 20 years ago. And they were they talked about the things that some of them had been there that long and they talked about the things they implemented. So I think the mindset that comes along with that, those sorts of programs will stick with people. Again, if we just get things out of the barriers out of the way so that they can actually do what they know they need to do, um, we'll release tons of potential.

SPEAKER_00 59:43

So so building on that, I would say let's get back to the unit. And again, run running the risk that there's going to be a lot of point improvement, but that's okay. Yeah, that's okay. We need to really build on it, build on what makes for a great day, right? Build up the next level is the design of a new RTC, that series of modules that look at the patient journey across sectors. And and then the next level is to look across in an intersectoral way at how we can collaborate to influence the social determinants of health. So we've got a capability here of doing something that's breakthrough. And uh it's not everything, but it's a huge way of flipping a culture by changing our behaviors and actions. Um, you mentioned it was difficult in the RTC days to get a leader to visit a unit.

SPEAKER_03 1:00:36

Yeah.

SPEAKER_00 1:00:36

That's gotta be something that's every day.

SPEAKER_03 1:00:38

Yeah, yeah.

SPEAKER_00 1:00:39

And I it doesn't matter how big. Go somewhere, go anywhere, yeah, but go there with intent. Go there, not just management by walking around, but curiosity around what they're doing and celebration in terms of shining a spotlight on the great things that are going on.

SPEAKER_02 1:00:59

Well, I know you guys have meetings coming up, so I'll let you go. Thank you so much for taking the time. I I know that this conversation, again, will inspire people, will make people think, maybe, you know, and maybe even take your program, which would be amazing. Yeah, yeah, awesome. My deepest appreciation to Dan and Marlene for taking time to do this podcast. It's clear that navigating healthcare's change as leaders requires an understanding of what kind of games we are playing and not losing the perspectives of the value of both. Dan shared an insight regarding the use of driver diagrams. These diagrams act as a vital bridge, allowing us to fit finite, measurable targets within the much larger, infinite game of improved healthcare outcomes. However, to truly move a system of 50,000 people, we must take that logistical tool one step further. We need a driver diagram to build a compelling narrative, a shared story that provides the insight and motivation for everyone to row in the same direction. Without a North Star to follow, a diagram is just a map with no reason to travel. Then, once we identify those drivers for change, we must provide all of our team with the tools to actually move the dials. You cannot play a game of baseball without balls, bats, and helmets, and we cannot expect our healthcare system workforce to succeed in a new system if we don't give them what they need to win the target or meet the goal. As Marlene noticed, if we just gave people in our system some more time, money, space, and opportunities to connect, share, and learn, we would get better results faster and have a more engaged empowered workforce as well. What are your thoughts about leadership in the healthcare system? Reach out to me at shiftpodcastcanada at gmail.com or shiftpodcast canada on Facebook and LinkedIn. You can also find all my links to my podcasts on www.kdaconsulting.ca slash podcast. And remember, systems don't change unless we do. This is Shift. See you next time.