Personal Reflections - RO at the Victorian Order of Nurses

Speaker A When I joined Von I found an organization that had around 60 standalone entities that were in a process of trying to merge under one corporate structure. But it was really a federation with a national office where every standalone organization had its onboard fiduciary responsibilities with different financial system, different hiring system. The same thing was called many different ways, oftentimes in the same site. And it was in the spiraling downstate following to six months after I arrived in our January 205 board meeting, I basically laid out my observations to the board and had a very serious conversation of what are some of the choices that the board can make? And in 2000 the board has realized that it needed to come together as one corporation but in the good Canadian spirit and the good charitable and not for profit spirit it was all voluntary. So when I arrived there were 20 of the 60 entities were part of the corporate structure and the other 40 were continuing to be independent and it was a formula for disaster. Then the board made some difficult decisions and basically gave the standalone branches 18 months to come together. So that started the path in building truly an incorporated organization but that was more the motion and the process to do it. The challenge that I faced and senior management faced is how you build it's. Like we acquired 51 different entities over a period of twelve months and try to make it work on the same mission, on the same deliverables, on the same metrics and so on. And I was looking for a system that will help us to do that. One of our managers, a level three manager went help us to do that meeting. I think it was over two years ago there was a regional meeting and she came back and basically shared with myself and the vice president for human resources basically now he's vice president of people and organizations. Her learnings in the meeting that she went to on our own and at that time Richard, who is the vice president went to I think to your meeting two years ago and came back and he thought that it has a major potential to help to deal with some of the challenges that we were facing. And we asked Ken if he will spend some time with us and we basically spent over a day or they asked Ken if he of us have had Ken talk about the system, the processes, the issues, the benefits. We pushed him with various questions. Richard and I come from collective of 40 years of senior management experiences. He headed up HR in Canada, post Cnrel and others and I came from healthcare primarily and I think with the conclusion of the discussions with Ken and after a lot of reading it seemed like it was going to offer some solution to us and it was going to offer some solutions in many ways. First of all in the ability to have the levels, because as we went into various organizations and when people ask where I live, my answer is usually Air Canada, because I make a point of crisscrossing the country and visiting branches and visiting staff. I couldn't connect the dots between the various branches and what they were doing. So our looked like it has the promise of cleaning up some of the structures, some of the systems, some of the labels, some of the span of control, some of the interactions between professionals and management, some of the interactions between what we call functional elements, which is Our, some of the finance and so on. Each branch in each region had its own fisdom of financial people and so on, and try to build standards and system. It's basically impossible. So we started the journey, as I said, with Ken two years ago. We have done a lot of assessments of building spines and looking at the processes. And at this point, we are year and a half into implementation, and we made some progress, as John and I were talking. John is the vice president in the eastern region. We have not went as far as we would like to go. It's a three to five year process, at least, if not longer. And many of us who come from the healthcare system are used to the fact that the CEO goes away on a fishing trip and Monday morning comes back with a new organizational chart. Well, Ro doesn't support that. And the process was much more difficult and time consuming. And while I was pushing from the top that we needed to move with it, ken and Richard and others were working through a lot of the processes in understanding what makes sense. And it was clear that we needed to get it right. We couldn't afford any failure because we had two major challenges within Von. One is to stabilize, and the second to grow. And challenges within VR. The reality was that I would have loved to do one after the other, would have loved to spend five to seven years to clean, love to do the perfect organization. But we were losing market share and we were sliding, and we couldn't afford to wait five to seven years to start to grow, sliding and with the system that allowed the growth while we were cleaning up and building a standardized system. But we had the clear vision, and we heard some conversation this morning about the vision, had a very strong board commitment, and we went through some of the stories that we heard this morning. When I arrived, I think we had a very operational level, three type boards. Most of the board members came from local boards in Von branches, whether it's in cities or small towns. And they wanted to talk about various operational issues. And in many ways, they got used to it because they had seven CEOs in a span of five years. And when you have that, inevitably the board becomes the managing entity. We were fortunate over the last couple of years to bring in a lot of level four, level five, level six individuals, whether it's previous deputy ministers of health. We brought in Catherine Hannah, who is from the west, but Hannah Gartner from CBC and other individuals who came in at a very different level and a very different visionary direction. So now we have a very strategic board that's able to manage with the complexity and the direction that we're pursuing. Interestingly enough, our new treasurer is an individual who implemented Ro in some of the banking system. So the process is an ongoing process. And I guess the piece that I have not mentioned is that because we are a national organization, we have a presence in every province and we deal with around 15,000 paid and unpaid staff. So the part of the challenge was how you build a system with thousands of volunteers, thousands of professionals, thousands of support staff. And I like the description of the army of third are really the front line and the two third is supporting the front line. And oftentimes particularly in the hospital sector, in the academic sectors, not so much in government. And those are the settings I've worked at. There is a lot of tension and often disrespect in healthcare between the frontline professionals, nurses, doctors and the support staff. And in an organization like a Von, you can't afford that kind of attention. So in many ways and one other comment I will talk about in the spirit of the benefits where Ro was useful for us, is that it helped us to deal with professionals. The biggest issue in my management career is that in healthcare there is a continuous detrimental tension between the professionals, the self regulated professionals and management. And I think Ro, with the attention to individual contributors allowed found place to individuals in level three and level four who are not necessarily managing hundreds of people or managing millions of dollars, but because of their contribution and because of their level of abstract thinking and their horizon of time frames, we're able to be positioned in a very different situation. One of the situations that we're having problems we are the largest employers of nurse practitioners in community settings in Ontario, nurse practitioners who are usually graduate level preparation, independent practitioners were reporting to level three managers that were more level two behavior and capable. And those individuals were choking the nurse practitioners who needed the independent practice and so on. By putting on Ro, we basically removed the nurse practitioners from that reporting structure and put them into a reporting structure that is more aligned with their skill set and scope and relevance to their abilities. The other thing that helped us, which will be familiar to all of you who implemented Ro, we've been able to clean up compression. So oftentimes you wonder why there is conflict between Mary and Jane and so on. And when you start to figure out the spine and you figure out their scope and reporting structure, you realize that they are tripping over each other. And once we were able to remove that and identify Clear accountabilities, it helped us in managing the services in a different way. The other thing that been very important to me and I learned it when I was with the federal government, just before I went to Von. When you look at acute care settings in healthcare, in Canada in particular, the investment in human capital is very limited, by and large, we assume. I have a Master's, I have a PhD, I am a physician, I am a self regulated professional. I will figure it out. Well, it's not that simple. And we see the consequences in acute care and the hospital sector, understanding the importance of investing and building the human capital and diagnosing them based on the strata they are in and how we're going to support them. To go from a junior four to a senior five, how you move along the continuum was extremely helpful in this process. Execution. I think we heard a fair amount of conversation around execution. Von is a beautiful organization, and when I arrived, I found some of the most incredible documents and discussions and so on. But the execution was really problematic. And in trying to figure out how to implement execution across the country from coast to coast, ro has provided a very powerful tool for us in working on it. Did we get it right already? No. Do we have a long way to go? Yes. And what we do is that Richard, who is the Vice President, keeps going back to the well to ken and building capacity internally and keep using the principles and the reading and the learning in order to advance it. My final comment would be, as a CEO, is that you need the CEO commitment to stay the course because it's time consuming, it's energy consuming, but you need internal experts. I am not considering myself to be the expert in Ro principles. My Vice President for people and Operation is the one that works with the other VPs and the other level tree managers continuously to make sure that we keep the principle and the values moving forward.