Transcript
Transcript: 2024 Manion Lecture: A Discussion on the Canadian Health Care Polycrisis, with Dr. Alika Lafontaine
CSPS Descriptive 2024 Manion Lecture
[00:00:00 Title page: Dr. Alika Lafontaine in medical scrubs; Text on screen: 2024 Manion Lecture; A Discussion on the Canadian Health Care Polycrisis, with Dr. Alika Lafontaine; Welcome.]
[00:00:06 Split screen: Title page; Vanessa Vermette and Nathalie Laviades Jodouin stand at a lectern on a darkened stage.]
Vanessa Vermette: Hello, and welcome everyone, to the 2024 Manion Lecture,
[00:00:12 Vanessa Vermette and Nathalie Laviades Jodouin appear full screen. Text on screen: Vanessa Vermette, Vice-President, Innovation and Skills Development, Canada School of Public Service; Nathalie Laviades Jodouin, Vice-President, Public Sector Operations and Inclusion Branch, Canada School of Public Service.]
Vanessa Vermette: a discussion on the Canadian Health Care Polycrisis with Dr. Alika Lafontaine. My name is Vanessa Vermette, I am the Vice-President at the Canada School of Public Service and I'm joined by my colleague, Nathalie Laviades Jodouin, also Vice-President at the Canada School. Together we will be your hosts.
We have a great event planned and we want all of you to have the best possible experience, so please take a quick moment to silence your mobile devices. Today's event is in English with French interpretation, and headsets are available at the entrance if you need one.
Nathalie Laviades Jodouin: So, without further ado, I'd like to welcome Elder Verna McGregor of the Algonquin community of Kitigan Zibi Anishinabeg, who will welcome us to her traditional territory and open the 2024 Manion Lecture.
[00:00:57 Vanessa Vermette and Nathalie Laviades Jodouin leave the stage. A slide with their names and photos reads Masters of Ceremonies.
[00:01:01 Elder Verna McGregor takes the stage; slide changes to show Elder Verna McGregor's name and photo and reads Traditional Opening.]
Elder Verna McGregor: Okay now. Bonjour tout le monde. Hello everybody.
[00:01:06 Elder Verna McGregor appears full screen. Text on screen: Verna McGregor, Elder, Algonquin Community of Kitigan Zibi Anishinabeg.]
Elder Verna McGregor: I'd like to welcome you to our traditional unceded lands. What unceded means is that, amazingly, we never signed a treaty connected to the land here. The significance of Ottawa for us, we're known as the <Indigenous Language>, which means the Nomads. And we had big territories because of our understanding that if you stay in one area, you over-harvest the resources. And, interestingly enough, we survived on the land. And that with the understanding, also with the medicines, which were land based. And here we are today, with technology and the poly health crisis as we're talking about today. I'm very honoured to be here today. I was thinking about the venue here. A couple of years ago, the CEO of the National Gallery met with Elders, and they came up with the theme of < Indigenous Language >, meaning everything is connected.
[00:02:14 Elder Verna McGregor holds up an Indigenous Medicine Wheel.]
Elder Verna McGregor: And that's similar to, for us, an example is the medicine wheel.
And the significance of Ottawa is that it's at the confluence of the four rivers coming together from the four directions. At the centre represents balance. This also represents the four seasons, the four directions, but it also represents the need for emotional, physical, spiritual, and mental health well-being. Because sometimes as well, that translates into physical health.
So, at the centre is balance. And I always find it interesting that Parliament Hill and all the national headquarters are situated here today at this confluence. And I think that's why Dr. Lafontaine's talk here is so important.
[00:03:09 Elder Verna McGregor holds up an Indigenous Dream Catcher.]
Elder Verna McGregor: Then going back to < Indigenous Language >, meaning everything's connected, is similar to – this is a dream catcher, but it also represents the spider teachings. The spider weaves the web of life, and everything is connected and interconnected, including the healthcare system. And one of the biggest teachings is that what we do to the Earth, we do to ourselves. And we always strive for balance. And right now, I think our healthcare system is out of balance. So, I think this is such an important gathering.
[00:03:09 Elder Verna McGregor holds up her eagle feathers and a small pouch of tobacco.]
Elder Verna McGregor: I'm just going to get my eagle feathers and I'm just going to say a little opening prayer for you to wish you well and a good gathering today. I was offered tobacco too, beforehand. And this is part of our protocol because part of our creation story is this is one of the first gifts given to us. So, anytime you harvest anything, or someone shares knowledge with you, there's the offering of tobacco. And, of course, with contact and colonization, this turned into a commercial good. And like any medicine, over consumption can cause harm.
So, on that note, I'm going to say, Miigwech, <Indigenous prayer>.
I just go around the medicine wheel thanking the Earth and the all-knowing for us being here. But also, the four elements: the earth; the water; the fire; and the air, because without them, we wouldn't be here. And I asked for everybody, well wishes for our gathering. And < Indigenous Language > is well being. And that's your learning word for today. So, I wish you well. And we're going to quiz Dr. Alika afterwards, too. Thank you, Miigwech.
[00:06:11 Elder Verna McGregor leaves the stage. Vanessa Vermette and Nathalie Laviades Jodouin re-enter and take the stage.]
Nathalie Laviades Jodouin: Thank you, Elder Verna, for your words of welcome and for opening our event by reminding us that at the end of the day, we are all connected.
Now it is with great pleasure that I welcome you all once again to the 2024 Manion Lecture. I would like to offer a very special welcome today to Dr. Douglas Manion,
[00:06:43 Slide showing Dr. Douglas Manion, Chief Executive Officer, Flare Therapeutics.]
Nathalie Laviades Jodouin: who is here with us. I believe you are – there you are. Thank you. He is here with us on behalf of the Manion family.
[00:06:49 Vanessa Vermette and Nathalie Laviades Jodouin appear full screen.]
Nathalie Laviades Jodouin: Thank you so much for joining us today. I would also like to take a moment to mention the recent passing of an important member of the Manion family.
[00:06:59 Slide in memory of Sylvia Manion, The "Matriarch", 1933 – 2023.]
Nathalie Laviades Jodouin: Last November, at the age of 90, Sylvia, or the Matriarch as the family called her, passed away peacefully, surrounded by loved ones. She was, among other things, a devoted mother, grandmother, and great grandmother.
[00:07:14 Vanessa Vermette and Nathalie Laviades Jodouin appear full screen.]
Nathalie Laviades Jodouin: An outstanding community organizer and social planner, and a volunteer who knew how to bring comfort to sick children in local hospitals. Dr. Manion, our thoughts are with your family.
So, the Manion family can take pride in the legacy of John Lawrence Manion, the inaugural Director of the Canadian Centre for Management Development, whose name is honoured in this event. For over 30 years, the Manion Lecture has been one of the School's most important annual events and it gives us the opportunity to engage in dialogue with eminent speakers from different backgrounds, professions and points of view. It gives federal public service leaders the opportunity to be challenged by other professionals who question the status quo, wonder about the future, and help us expand our horizons with their insights. Our keynote speaker this afternoon fits perfectly into the Manion conference tradition.
Vanessa Vermette: So, in a moment, we will introduce our lecturer, Dr. Alika Lafontaine. Following his lecture, he's going to be joined on stage by a panel of distinguished guests to continue the discussion.
[00:08:32 Slide on screen: Program, as described.]
Vanessa Vermette: After the panel, we will be ending the formal program with a traditional closing provided by Elder Verna McGregor. And then finally, we invite you all to join us in the foyer for a networking reception once the event program is complete.
So, we would now like to formally introduce this year's lecturer, and this is going to take a while, so this is your trigger warning if you've ever had imposter syndrome or anything like that because this is a highly accomplished person [that] we have the privilege of having with us today.
[00:08:53 Slide on screen: Photo of Dr. Alika Lafontaine, Past President and Nominations Committee Chair, Canadian Medical Association.]
Vanessa Vermette: Dr. Alika Lafontaine uses his political capital and influence to create spaces where Indigenous communities can collaborate with physicians, politicians, and policy makers to improve Indigenous healthcare. He is an award-winning physician and the first Indigenous doctor listed in Medical Post's 50 most powerful doctors.
[00:09:12 Vanessa Vermette and Nathalie Laviades Jodouin appear full screen.]
Vanessa Vermette: From 2013 to 2017, Dr. Alika Lafontaine co-led the Indigenous Health Alliance Project, one of the most ambitious health transformation initiatives in Canadian history. It involved Indigenous leadership from more than 150 First Nations across three provinces. For the last two decades, he served in a variety of medical leadership positions with the Alberta Medical Association, the Canadian Medical Association, and the Royal College of Physicians and Surgeons of Canada. He also served as Vice President and President of the Indigenous Physicians Association of Canada.
After being labelled with learning difficulties as a child, his parents made the decision to homeschool him. At the age of 16, he became one of the youngest recipients of a prestigious NSERC fellowship through the University of Regina. After graduating with a BSc in chemistry, he completed his MD at the University of Saskatchewan, followed by a five-year internship in anesthesiology.
During his internship, Dr. Alika Lafontaine won CBC's Canada's next great Prime Minister competition for his platform on the importance of treaty implementation in strengthening relations between Indigenous peoples and Canadians. Yeah, let's clap for that. Absolutely. In addition to many other awards and distinctions, he remains the youngest recipient of the Inspire Award, which is the highest distinction awarded by and for Indigenous peoples. In 2015, he also received the Young Leaders Award from the Canadian Medical Association.
Dr. Alika Lafontaine continues to practice as an anesthesiologist in Grande Prairie, where he and his family have lived for the last ten years. He was born and raised in Treaty Four Territory in southern Saskatchewan and has Anishinaabe, Cree, Métis, and Pacific Islander ancestry. It's an incredible journey, and we're deeply grateful that he's able to be here today with us. Please enjoy a short video and then join us in welcoming Dr. Alika Lafontaine to the stage to begin this year's lecture.
[00:11:13 Video opens with text on screen: Welcome to Manion 2024. A series of images: smokestacks emitting fumes; glaciers collapsing into the sea; forests ravaged by fire; a bleak apartment building; a graph showing housing availability falling; people marching in a street with a banner "Housing for All"; a person working in a food bank; a person checking prices in a store; a copy of a grocery receipt; people with their arms raised in protest; a "tarp ghetto"; a shrine created for missing Indigenous youth.]
Vanessa Vermette: Climate change, the housing crisis, food insecurity, widening socio-economic disparities. This intersection of multiple crises is called polycrisis.
[00:11:28 Text on screen: Polycrisis; Quote from the Cascade Institute, as described.]
Vanessa Vermette: "A polycrisis stems from the activation of a particular kind of risk – systemic risk – by which a small problem quickly spreads throughout a system and often into other systems."
[00:11:40 Image of an open laptop. Text on laptop screen: World Economic Forum, The Global Risks Report 2023, 18th Edition Insight Report; aerial view of Parliament Hill.]
Vanessa Vermette: Global reports say that the polycrisis is here to stay. Is the public service ready?
[00:11:47 Video of Dr. Alasdair Roberts appears full screen. Text on screen: Dr. Alasdair Roberts, 2022-23 CSPS Visiting Scholar.]
Dr. Alasdair Roberts: An adaptable system is one that is capable of transforming itself to meet new challenges. Adaptability is an essential if governments want to retain authority and legitimacy in a turbulent and often dangerous world.
[00:12:00 A series of images: the Canadian flag flying in front of a government office tower; people lining a highway and overpass waving flags and signs; a crowd of people march across a bridge.]
Vanessa Vermette: How can the public service adapt to the challenges of the polycrisis, which are already placing a tremendous strain on Canadians? What strategies can we take to move forward?
[00:12:10 Video of John Hannaford appears full screen. Text on screen: John Hannaford, Clerk of the Privy Council.]
John Hannaford: Figuring out how we do things in a new way. Figuring out how we manage the risks that are in front of us. Acknowledging that this is hard, being innovative and collaborative, I think that gives us the best shot we have.
[00:12:23 Images of Dr. Alika Lafontaine.]
Vanessa Vermette: In this year's Manion Lecture, special guest speaker Dr. Alika Lafontaine, an award-winning physician and past president of the Canadian Medical Association, will examine the changes taking place in the Canadian healthcare system and their impact on our social cohesion. Drawing on his personal and professional experiences, Dr. Alika Lafontaine will discuss the human experience of systemic change, and how changes to public health policies are enabling citizens to better manage their own interests. Welcome to Manion 2024.
[00:13:03 Dr. Alika Lafontaine walks out on stage, now set up with chairs. Text on screen: Dr. Alika Lafontaine, Past President, Canadian Medical Association.]
Dr. Alika Lafontaine: It's an absolute pleasure to be here tonight. You know, out of all the different types of lectures that I've been a part of, I've really come to enjoy interacting with the public service. There's a lot of thoughts out there that the way that systems change is through marches or protests or breaking systems, or in some cases, lighting them on fire.
But the reality is, change is a grind. And for those who've been in the public service for enough of your career, you realize that with the peaks and valleys, you still remain. And so, I'm really hoping with the topic today that I'll help to share a bit of my own experience and ground you in a way of understanding the very real and very big and complex entrenched problems that we deal with nowadays.
This lecture is also really special because my dad is in the audience today. Like most dads, you give him a call and say, hey, I achieved this thing. And he kind of shrugs his shoulders and says, oh, that's nice. And I think having the person who first taught me how to think through complex, challenging problems really brings a lot of my career full circle.
[00:14:30 Slide on screen: Silhouette image of a person reading a book. Text on screen: In the end, the essence of any crisis is a story. Polycrisis is no different.]
Dr. Alika Lafontaine: And my dad was one of the first people to have me think about my life as a story.
[00:14:36 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: And I think when you look at polycrisis, just like anything, it ends up being a story that we tell ourselves.
[00:14:44 Text on screen, as described.]
Dr. Alika Lafontaine: And the stories that we tell ourselves, they really set the way that we interact with the world.
[00:14:50 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: And stories shape how we see ourselves. When you go into work, there's a story that you tell yourself about the change that you're going to be able to make that day. About whether or not it's going to be a hard or an easy day. The meetings that you have with people are projections on how stories shape how we see each other. And stories really ground us in either feelings of hope, or feelings of despair and isolation.
[00:15:20 Images on screen: a forest fire titled "Climate Change"; $100 bills going down a hole titled "Unaffordability"; A person in distress titled "Mental Health and Social Isolation; A row of houses titled "Housing".]
Dr. Alika Lafontaine: And I think especially with polycrisis, it's incredibly important to have those stories ground us in a place that helps us move from where we are right now,
[00:15:25 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: to where we need to go. All these polycrises are probably no surprise to the public service. Each of you are probably on teams where at least one time during the week you hear or think about these problems.
Climate change has affected where I live. In particular, in Grande Prairie, Alberta, which is 4 hours north of Edmonton, we had a fire that was burning 30 km away from us for a few days and it was out of control for most of it. Luckily, the winds were blowing away from the city and rain came for the past couple of weeks.
But I found it interesting that when we first had forest fires, we were all quite terrified about what happened. Now we have a bit of a protocol. We went and grabbed our air purifiers and we set them up in the house. We turned off our ventilation to make sure that we had a bit of a sealed system. We packed our five days of clothes, filled up the van, and went to work.
And I think with any type of crisis that you're dealing with, eventually you start to get very used to the reactions that you have.
[00:16:25 Image of an hospital Emergency entrance. Text on screen: Six million Canadians without access to primary care; Rolling or permanent closures of emergency departments; Long waitlists for medical procedures and surgical interventions; Shortages of nearly every type of health provider; Crumbling infrastructure; Exponential ride in patient frustration, provider burnout; Dangerous impacts on patient safety and care quality.]
Dr. Alika Lafontaine: Now, in healthcare, crisis that I've been a part of quite deeply over the past three years, we know that we truly are in a critical moment right now for our healthcare system. 6 million Canadians are without access to primary care. That's one in five, depending on which studies you look at.
[00:16:45 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: There are rolling or permanent closures of a lot of healthcare services. In the pandemic, we really saw a pullback of services, rightly so, because of dealing with an unknown pathogen that was spreading across the system fairly rapidly and causing widespread injury and morbidity. But we're also seeing kind of a tail end of that, where now emergency rooms are closing, surgical services are closing. That's lengthening the access to a person actually seeing someone who can deal with their problem. Whether that's access to a certain type of testing, or some type of medical procedure. And we're also starting to see crumbling infrastructure, not just among the people who fill and ensure that people can get pushed through the system as they get the care that they need, but also our hospitals and other types of infrastructure are starting to wear away and, at times, actually crumble.
[00:17:37 Images of various newspaper articles featuring Dr. Lafontaine.]
Dr. Alika Lafontaine: Now, I've had the opportunity, with the Canadian Medical Association presidency, to really tell stories at scale. And for twelve months, I was Canada's top doc. I was on tv probably every night for a period of that time. And with the different crises that were emerging,
[00:17:55 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: the biggest challenge that we actually had was how do we weave together all of these things that seem disconnected, but at the end of the day, probably aren't.
[00:18:05 Images of the forest fire, the money, the distressed person, the hospital Emergency sign, and the housing are arranged in a circle around the word Polycrises and are all interconnected by harsh black arrows.]
Dr. Alika Lafontaine: And I think when you look at polycrisis, that's one of the most important parts of understanding the story.
[00:18:12 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: Climate change led to the evacuation of patients from Northwest Territories to my hospital and other hospitals in Northern Alberta and Northern BC. The lack of housing impacts the opioid crisis, as well as your ability to have people go to somewhere safe where they can continue to be on their path towards better health. The lack of affordability leads to patients realizing just how desperate of a state they're in when they truly are sick. Mental isolation and our mental health crisis all feed into all these other things. And polycrisis spins round and round until the small problems that used to be solvable, stories that used to be easier to understand, suddenly become incredibly complex.
[00:18:57 Text on screen: Polycrisis and the Physics of Storytelling. Images of: people holding onto each other dangling on a cliff-face, titled "Weight of the Past"; a person leaping over a crevasse, titled "Push of the Present"; a person reaching for the sky, titled "Pull of the Future".]
Dr. Alika Lafontaine: So, this talk is going to be split into three parts.
[00:19:02 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: I'm going to focus mostly on the first two, and it's going to talk about the physics of storytelling using a model where we look at the weight of the past, the push of the present, and the pull of the future.
[00:19:14 Slide, as described. *Future Triangle was developed by Sohail Inayatullah.]
Dr. Alika Lafontaine: This comes from something called the Futures Triangle.
[00:19:18 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: It was developed and has been used for the past 20 years. But it's a really great way to really help to understand where you, as the public service, can make an impact and help to frame why change ends up being so hard, especially in the midst of polycrisis.
[00:19:35 Slide, as described.]
Dr. Alika Lafontaine: So, starting off with the weight of the past. So, the weight of the past is something that we end up inheriting. It's not something that we create. When any of you have moved from department to department, you know the feeling as you walk into your office,
[00:19:51 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: or open your portfolio, and for the first time see everything that came before you got there. Those are the histories, the culture, the good and bad decisions, relationships that people have with each other, the ways that physical and digital infrastructure is organized. In healthcare, there is a heavy weight on the past because our system was really designed around things that weren't necessarily structured in a way that matches the world that we live in now.
[00:20:22 Text on screen: Count the F's.]
Dr. Alika Lafontaine: So, I'm going to do a quick exercise with all of you. I'm going to ask you just to count some Fs in a paragraph.
[00:20:26 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: We'll throw this up in just a second. I'm going to give you 3 seconds. I'm going to ask you how many Fs you've counted. So, maybe just wait until I ask you, but we'll put that up right here.
[00:20:38 Text on screen: Finished files are the result of years of scientific study combined with the experience of years.]
Dr. Alika Lafontaine: So, here's 3 seconds. One, two, and three.
[00:20:42 Text on screen: How many F's were there?]
Dr. Alika Lafontaine: And I'm going to ask how many people in the audience saw three Fs?
[00:20:47 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: Can you just raise your hands up high? Okay. It's a fair number. How many people saw four? It's always interesting, the people who saw three get very concerned once they see. And then how many people saw more than four?
[00:21:05 Text on screen has all the F's underlined: Finished files are the result of years of scientific study combined with the experience of years.]
Dr. Alika Lafontaine: All right, so there's actually six. All right, I'll just read them out here:
[00:21:10 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: Finished files with the result of – that's three. Years of scientific – that takes us to five. Study combined with the experience of years.
[00:21:19 Slide, as described.]
Dr. Alika Lafontaine: Now, I presented this many times over the last few years. And the larger your audience,
[00:21:24 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: the more you tend to migrate towards a common set of responses, a normalized distribution. So, about half the folks in the audience, which I say was pretty similar to the people that raised their hand, see three Fs. About a quarter see four. And then a quarter see more than four.
[00:21:41 Slide, as described.]
Dr. Alika Lafontaine: Now, I'm going to suggest that if you have a similar reaction to other people and, time wise and location wise, that response is independent. There's probably a way of thinking about things that we should.
[00:22:01 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: So, when we talk about these ways of approaching problems or thinking about problems that are similar, we can give them a label, and I'm going to give the label of mental models. So, with the exercise that I just presented, there's a set of common things that people tend to say for why they read the paragraph the way that they did.
The first is, is that you read for content. So, although I gave you the task of counting the Fs, most of you were probably wondering what the paragraph is actually about. The second is that when you're limited as far as time, you tend to skim. So, large words mean content, small words mean filler. The last is that you tend to read aloud. So, the sound of scientific in your head sounded very different than the sound of "of".
Now, with any way of thinking, there's always people who do not think that way. So, for whatever reason, if you never graduated high school, or past grade four, these folks tend to not get tricked by this exercise. I'm not sure what you learned between grade four and grade five, but there's something out there that kind of centres on that.
The second is that if English is not your first language, meaning that when you read something, you translate in your head to your language of origin and then translate back, for whatever reason, this doesn't work either.
[00:23:13 Text on screen: Read the Triangles.]
Dr. Alika Lafontaine: So, I'm going to give you one more exercise here. I'm just going to have you read these triangles. I'm going to throw this up. I'll give you 3 seconds again.
[00:23:17 Three triangles with text in them: Paris in the the spring; Bird in the the hand; Once in a a lifetime.]
Dr. Alika Lafontaine: So, I'm going to count to three here. One, two, and three.
[00:23:22 Text on screen: Read them again.]
Dr. Alika Lafontaine: I'm going to have you read them one more time.
[00:23:25 Three triangles with text in them, with the repeated words underlined.]
Dr. Alika Lafontaine: How many people saw the trick? And how many people did not see the trick?
[00:23:30 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: Raise your hands if you did not see the trick. This is actually the exact same mental model. There is no difference between what I literally just explained to you and what you've experienced right now.
[00:23:44 Slide, as described.]
Dr. Alika Lafontaine: And this is a really important concept when you're thinking about the weight of the past. Is the weight of the past really a collection of mental models that have normalized what you experience day to day in the things that you're trying to change? They're often shared beliefs. These are often rooted in childhood experiences,
[00:24:05 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: traumatic experiences that you might have had with relation to what you're thinking about. They signal how to act in a socially acceptable sort of way, which means that they don't have to be true, they don't have to be logical. And most importantly, they don't have to be adaptive. Which means that you can believe something that has you act in a certain way, that doesn't help you get to where you need to go. For example, with the paragraphs, the way that you read the Fs, I gave you the task of counting, but instead you wanted to know what the paragraph meant. It was a maladaptive way of thinking about things.
The interesting thing about mental models is that if you change a mental model, you almost always change behaviour. And I say almost because I'm a scientist, but I would say that I've actually never seen someone not change their actions as a result of changing their mental models.
[00:24:56 Slide, as described.]
Dr. Alika Lafontaine: Now, mental models can be abstract, or they can be concrete. So, I'm sure many in the public service have gotten familiar with certain files where you pick it up and you read through it, and you're just like, I just don't get this. Or you hear an announcement or become a part of a program,
[00:25:16 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: and you say to yourself, I just don't know what this is about, I don't know why this matters. Why are we using resources in this area? When you can't explain a problem, that problem is abstract.
Now, as you get less abstract about a problem, you start to understand that the problem is actually out there, but the problem is not where you are, it's everywhere else. So, if you ever come into an environment where the majority of people are talking about a problem that needs to get solved, but folks are talking about that problem in the sense that this is a problem everywhere except for here, you're getting less abstract than being unknowable, but not concrete enough to actually start to solve them.
Now, once you start to see that the problems out there are the problems in here, you start to get on the concrete side of this continuum. Now, even though you know that these problems are here, the issue is you still don't know how to solve them.
Now, the ultimately concrete problems are when you know that things are knowable. When you sit back, and you see a problem and you can break it down into three parts.
[00:26:23 Slide, as described.]
Dr. Alika Lafontaine: You can explain it, and with that explanation, you can predict where it's present and where it's not. And with that prediction model, you can then dial up or down different elements in order to make the problem worse or make the problem better.
[00:26:40 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: Now, in healthcare, we have a lot of abstract discussions about problems that we know are quite concrete. With the health human resource crisis, for example, there's often the discussion that we don't really know how to solve the problem; this is a brand-new issue, et cetera, et cetera. For anyone who's ever been recruited into an area, it's very concrete to them why they came.
We came to Grande Prairie because I wanted to get away from academia for a little bit. I stayed because it was an amazing place to work, with people that I knew would show up if I called them. And we started there for two years and ended up there for twelve.
[00:27:22 Slide, as described.]
Dr. Alika Lafontaine: So, I'm going to explain to you some mental models in healthcare design. I'm going to try and do it in less than ten minutes.
[00:27:28 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: I would just warn you that this is a very simplified way of thinking about this. Those of you with deep knowledge in healthcare will be able to add a little bit more to the story. But just for brevity, I'll be simplifying it.
[00:27:40 Slide, as described.]
Dr. Alika Lafontaine: So, with any thriving society, you really need a couple of components. You need to have a way for people to exchange value – we call these economic systems – and you need social cohesion.
[00:27:53 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: A way for people to be sticky enough with each other so they solve problems with each other.
[00:28:00 Slide, as described.]
Dr. Alika Lafontaine: Now, if you think of society as soil that's fertilized with these elements, if it's fertile enough, you can grow certain things.
[00:28:07 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: And so, this is where our shared social systems come from. This is where our health system, education system, justice, and housing systems come [from]. But with those elements, there's booms and busts that occur.
[00:28:19 Slide, as described.]
Dr. Alika Lafontaine: And the soil that these systems grow in eventually become arid and dry and just not great to grow things in. Now, if you leave these for too long, the systems start to wither, and in some cases, they actually start on fire. Now, I argue that much of the systems that we have nowadays,
[00:28:38 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: in the federal, provincial, and territorial governments, are in the area of actually being on fire.
[00:28:43 Slide, as described.]
Dr. Alika Lafontaine: Now, if you look at the brief history of Canadian Healthcare, you can start to understand how we got here from knowing where we started. So, before 1947, when Saskatchewan first came out with its first attempts at publicly funded healthcare, the healthcare system was really a mix of non-profit, for profit, and charitable approaches to healthcare.
[00:29:07 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: There was just a very, very small sliver that existed as publicly funded and publicly administrated. Now, because of an economic issue that Saskatchewan had, I'd argue, the Saskatchewan government decided that it was going to fund public health care.
So, in the 40s, farmers and other folks who were participating in the Canadian economy were getting sick. They were going to hospitals. They couldn't afford care. So, as a result, they were going to the charitable and non-profit section of care. That was under peopled; it was under resourced; and people weren't just getting healthy enough to go back and work again. And so, as a result, the Saskatchewan government saw that if they didn't do something about it, the system would continue to spiral around, and the economy would probably crater and crash. Now, I think in retrospect, we often try and rewrite history as far as the reasons why people went about doing these systems. But if you look at the original debates around healthcare, a lot of the discussion was grounded in this economic viability. If they did not solve this problem, then Saskatchewan society would fall apart.
So, Canadian healthcare then was initiated. And from the 50s to the 90s, there was a period of growth. Now, with this growth, the approach was simply to mirror locations. So, if you had a small community hospital that had a doctor, a couple nurses, and a few support staff, you would simply duplicate that number of people and bring them closer and closer to where people actually lived. People weren't very mobile at the time. If you weren't able to drive around, which was expensive and out of the reach for the average person, for the most part, you just didn't receive care and you ended up passing away.
So, from the 50s to the 90s, you had a spread across different systems. Saskatchewan's a really great example of this, where the healthcare system went into more than 50 small towns in the periphery of the major centres, which were Regina and Saskatoon.
Now, once you hit the 90s, there was a resource limitation that occurred. So, people realized that we could duplicate the number of places where people can access care. But the challenge is there's not enough people to actually duplicate. It's really expensive to build a new location, and it was restrictive financially to actually buy new CT or MRI machines or other types of specializations equipment.
So, from the 90s to the early 2010s, the system started to regionalize. And this has happened at different rates across the country. Ontario is probably one of the last places to adopt regionalization. But in Saskatchewan, what ended up happening is instead of being able to access anything at any hospital, no matter where you went, you started to have one trauma hospital. Instead of having a psychiatric ward in every hospital, you ended up having to go to a single one.
And so, with this regionalization, people also became much more mobile. And so, although you had more limited options in where you could go, people were able to get up and travel from place to place. And so, you started having people move from jurisdiction to jurisdiction within provinces and territories in order to access care.
Under Minister McKinnon, who was the finance minister in Saskatchewan at the time of this happening, there was a big push with regionalization to shut down access locations. And in the late 90s, early 2000s, there was the closure of more than 50 hospitals, or many hospitals, within Saskatchewan towns, to the point that people had to go to Saskatoon or Regina for care.
Moving into the 2010s and 2020s, really becomes the age of austerity. So, the major message from governments was that we have to bend the cost curve. Sustainability is a huge issue. To be fair, [the] GDP was, as far as the health proportion that was being used, moving into the 30% and 40% of overall budgets. You end up having the pandemic, which has now pushed the efficiency balance, that really happened between the 2010s and 2020s, into the critical situation that we're in right now.
[00:33:21 Slide, as described.]
Dr. Alika Lafontaine: Now, if you look back across that history, I'll argue, after having lived with these problems for quite a long time,
[00:33:28 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: that there really was just three things that we were trying to solve. The first was access. The second was complexity. And the last was to have high value.
[00:33:40 Slide, as described.]
Dr. Alika Lafontaine: So, if you look at the sticky problem of poor access, the mental model that we've used over the last 60 years is really just build new access. If you can't get access to care, what do you do?
[00:33:51 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: You build a new hospital; you build a new access location. Even now, this has just been rewritten in different ways. In Ontario, for example, if you can't get access to surgical care, what do you do? You go to a non-hospital surgical facility. If you can't get access to primary care, we've now expanded the number of people that we label as primary care providers, which is really just increasing and creating a new access point.
With rising complexity, you move towards new specialization and more training. When I sat on the council of the Royal College of Physicians and Surgeons, which deals with specialty training across the country, every month there would be a new application for a different type of surgical or medical specialty in order to deal with the changes in how people practice.
When you have low value, it was really new metrics and new technology. You create new ways of counting things, new types of ratios. You would have people adopt new types of technologies in order to have people communicate faster and be able to track more easily.
[00:34:53 Slide, as described.]
Dr. Alika Lafontaine: Now, past problems and past solutions have become our new challenges, in my opinion. So, with poor access and building new access, our current challenge right now is actually fragmentation. So, when you look at the numbers for family physicians across the country, for example,
[00:35:13 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: there are three different sets that we used at the CMA in order to count them. The people on the lists weren't necessarily practicing longitudinal family care. In one of the sets, a Canadian family physician, who was an astronaut in space at the time that it was counted, realized he was actually on the list. I guess he could have provided virtual care. But we don't know what people do, we don't know where they're at, and we can't agree on how many people are actually present. If you look at rising complexity and new specialization and more training, there's really been a loss of general skills. And to a great degree, over-regulation of a lot of the ways that people train.
When I was in Grande Prairie, when I first moved there, we saw that there was an issue with people getting access to sleep medicine services. Another colleague and I went away for three months of training. We provided the service for a couple of years. They brought in a new rule saying that we weren't allowed to do that unless we took a three-year residency. Neither of us were willing to do that after being in active practice. Now we have people with one- or two-years training in kinesiology, or some other specialty, providing sleep medicine services while myself, as someone who actually manages airways for their living, can't provide this type of service.
When you look at low value, with new metrics and new technology, manipulative metrics and uneven adoption are very, very common across the healthcare system. It's always very surreal for me to sit at the front desk as I'm responding on my secured, managed electronic device in Alberta's pan-provincial electronic medical record system, sending a message back and forth to make sure that patient information is protected, and I can hear the fax machine moving in the background.
[00:37:10 Slide, as described.]
Dr. Alika Lafontaine: So, as you go through cycles of having the same solutions and polycrisis, these problems start to mix together. So, with building new access, poor access and fragmentation have become very similar in the discussions and with the ways that we frame these problems.
[00:37:31 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: And, as these problems start to stack, complexity starts to get harder, things get more entrenched as far as problems that you're trying to solve. And as a result, you move towards what I call critical failures.
So, because of these stack problems, broken patient flow is probably the biggest critical failure for folks trying to navigate the healthcare system right now. You ask the average Canadian, do you get access to a family doc? Even if you're attached to a family physician, you still have to go through multiple doors to figure out whether or not you can get the care that you need. When people migrate to emergency rooms in order to try and get care for a problem that they have, the reason why they go there is because they think that that's going to be the person that they need to talk to. And so, broken patient flow is the end result of these stack problems of building new access.
For new specialization and more training, we have inaccurate predictions, as well as broken HHR strategies. I will say that the predictions that we've made in every area of healthcare, whether it's for spending, or for the numbers that we need to train for physicians, or the ratios that we have for nurses who are working in the healthcare system, they've been wildly inaccurate. I think that most of the reports have been so inaccurate that following the reports themselves has actually become one of the big problems.
With the mental model of new metrics and new technologies, the critical failure has been exponential costs; redundant care, meaning that you go and see someone, they charge for care, but they don't actually fix any of your problems; and then worker burnout, which is a rising and escalating issue that I heard lots about during my time as CMA president.
[00:39:11 Slides, as described.]
Dr. Alika Lafontaine: Now, these mental models and stack problems go round and round in cycles as these critical failures get worse and worse. And for those of you in the public service, I can imagine that it's incredibly frustrating to sit there and try and deal with these problems and feel like no matter what you do, nothing ever gets better. So, how do we break this cycle?
So, like I said at the very beginning of the talk, everything is a story.
[00:39:41 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: And the essence of any crisis is a story. And it's understanding the right types of stories that lead you to different types of solutions.
[00:39:47 Slide, as described.]
Dr. Alika Lafontaine: This brings us to the push of the present. So, the push of the present is what pushes you in a direction of telling a different story or reconsidering that the story that you've been following isn't really grounded in something that's practical, pragmatic, or getting you closer to where you need to go.
[00:40:05 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: So, the push of the present can be split into social drivers; technological drivers; economic drivers; environmental drivers; or political. And I'm sure all of you have felt these at some time during your career.
[00:40:18 Slide, as described.]
Dr. Alika Lafontaine: So, if you look at the push to the present and you apply it to the way that folks experience change in the healthcare system, you can use something called the Kübler-Ross Change Curve, which I think most folks have come across at some point during their training, which is really a way to understand the stages of grief as people go through system change.
You start off with a status quo that leads into a crisis because your status quo doesn't work during that time.
[00:40:47 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: That leads to people to reconsider whether or not things are working the way that they want. That pushes you into this denial phase, where people push back at the change that's suggested. That drags you into resistance, and then moves you into exploration, commitment, and a new status quo.
[00:41:02 Slide, as described.]
Dr. Alika Lafontaine: Now, understanding where people think change happens is really important in understanding why it doesn't. So, most people focus, when they're trying to explain the human experience of change, on exploration, commitment, and a new status quo.
[00:41:17 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: How many of you have written calls to action? How many of you have had strategies to try and socialize those calls to action? To really push people to consider adopting your ten-step method of changing the world?
[00:41:35 Slide, as described.]
Dr. Alika Lafontaine: Now, change actually happens at the front side of this model, with your status quo, your crisis, denial, and resistance. Crisis is the result of maladaptive status quo, as I mentioned.
[00:41:51 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: Denial is the intuitive pushback that people have when they feel like their mental models are not consistent with the actions that have been suggested. Resistance is when we try and reallocate resources between one place versus another. And the reason why there's such a huge dip in support for change and a peak in the opposition to change, is because when you reach into someone's pocket to take out a resource, or you fire someone from a team, or you tell someone that they'll have a new boss, they will die on that hill. Why? With denial, they'll push until it's not worth it anymore.
[00:42:25 Slide, as described.]
Dr. Alika Lafontaine: So, change doesn't happen because we stay trapped in this circular failure for change because we never get past denial, and we never get past resistance.
Our weight of the past is really our status quo, our denial and resistance, the only push of the future is the crises that we're trapped in.
[00:42:53 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: So, many of you may feel, when you hear about crisis, the urge to de-escalate and minimize the crisis that is present. That is actually helping things stay the same. Crisis is the only fuel that leads to a reconsideration of entrenched status quo.
[00:43:11 Slide, as described.]
Dr. Alika Lafontaine: So, just in summary, all mental models that I've talked about likely worked at some point. I'm sure you can appreciate that when healthcare was first being organized,
[00:43:25 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: the approaches that we had to access – complexity and value – actually made a tonne of sense. But when they became maladaptive, when the world changed, they started to generate crisis instead of generating solutions. Every mental model that you come across is maladaptive in some context.
[00:43:44 Slide, as described.]
Dr. Alika Lafontaine: Crisis is the fuel for transformative change. Embrace crisis as an opportunity for you to change things.
[00:43:53 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: Crisis is what pushes us together, what causes people who otherwise would be on too far sides of a discussion, to actually sit down and decide to work together.
[00:44:05 Slides, as described.]
Dr. Alika Lafontaine: With the weight of the past, the push of the present, and the pull of the future, cycles of entrenched crisis make it increasingly difficult to make changes as you move round and round. Change means changing our shared beliefs enough to meaningfully shift who gets resources and who doesn't.
[00:44:27 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: But those beliefs have to match the world as it is, versus the world as we think it is.
[00:44:33 Image of a group of people holding hands on a hilltop, silhouetted by a beautiful sunrise.]
Dr. Alika Lafontaine: The public service is probably one of the most important groups that really needs to figure this out.
[00:44:40 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: You are the glue that helps us grind through these long-term problems. You're what survives political cycles. You're what survives schisms between political groups and demographics. You're who's left to pick up the pieces when provinces and territories fight with the federal government, or with each other.
There is a bright future, I think, for dealing with polycrisis, but it really comes down to the stories we tell ourselves. And importantly, most importantly I think, the stories that you tell in your day-to-day work. Thank you very much.
[00:45:29 The audience applauds while Dr. Alika Lafontaine leaves the stage. Nathalie Laviades Jodouin steps to the lectern.]
Nathalie Laviades Jodouin: Thank you, Dr. Lafontaine.
[00:45:39 Nathalie Laviades Jodouin appears full screen. Text on screen: Nathalie Laviades Jodouin, Vice-President, Public Sector Operations and Inclusion Branch, Canada School of Public Service.]
Nathalie Laviades Jodouin: I've had the pleasure of watching many of his events. I've had a greater pleasure in moderating one event directly with Dr. Lafontaine. And every time I'm left both speechless and in awe, and always with an important takeaway. And today, the frame that you presented through which we look at polycrisis around the weight of the past, the push of the present, and the pull of the future, I think has tremendous relevance for us in the public service. Thank you very much.
So, with that, it's time for our panel discussion. So, I'd like to first welcome our moderator,
[00:46:21 Image of Taki Sarantakis, President, Canada School of Public Service.]
Nathalie Laviades Jodouin: Taki Sarantakis, also President of the Canada School of Public Service. Thank you.
[00:46:24 Nathalie Laviades Jodouin appears full screen.]
Nathalie Laviades Jodouin: Yes, you can clap.
And joining Taki, our very esteemed guests.
[00:46:36 Image of Dr. Douglas Manion, Chief Executive Officer, Flare Therapeutics. Dr. Manion walks on stage.]
Nathalie Laviades Jodouin: So, starting with Dr. Douglas Manion, who's the CEO of Flare Therapeutics.
[00:46:45 Image of Dr. Onye Nnorom, Co-Founder of the Black Health Education Collaborative, Assistant Professor, University of Toronto. Dr. Nnorom walks on stage.]
Nathalie Laviades Jodouin: Dr. Onye Nnorom, co-founder of the Black Health Education Collaborative, assistant professor at the University of Toronto, and host of the Race, Health and Happiness podcast.
[00:47:02 Image of Dr. Cameron Love, President and Chief Executive Officer, Ottawa Hospital. Cameron Love walks on stage.]
Nathalie Laviades Jodouin: I'd like to welcome, as well, Cameron Love, who's the President and CEO of the Ottawa Hospital.
[00:47:11 Image of Dr. Zayna Khayat, Adjunct Faculty, Health Sector Strategy, Rotman School of Management, University of Toronto. Dr. Zayna Khayat walks on stage.]
Nathalie Laviades Jodouin: Dr. Zayna Khayat, health futurist from Deloitte Canada.
[00:47:22 Nathalie Laviades Jodouin appears full screen. Dr. Alika Lafontaine joins the rest of the panel on stage.]
Nathalie Laviades Jodouin: And rejoining us, of course, our Manion lecturer, Dr. Alika Lafontaine.
[00:47:32 The panel take their seats on stage. Taki Sarantakis and Dr. Alika Lafontaine appear full screen.]
Taki Sarantakis: All right, I wonder if that's me? I always have problems with these microphones. Dr. Lafontaine, just remarkable. Remarkable. And it's really an honour to have the opportunity to explore some of the themes that you talked about in the next half hour or so.
[00:47:32 Text on screen: Taki Sarantakis, President, Canada School of Public Service.]
Taki Sarantakis: So, every good panel starts with a confession, so we're going to start with a confession.
[00:47:56 The panelists are seated together on stage.]
Taki Sarantakis: I am the token dummy on the panel. As you may have noticed in the introductions, everybody here is a doctor except me, so please forgive me because I know not what I do.
[00:48:12 Taki Sarantakis and Dr. Alika Lafontaine appear full screen.]
Taki Sarantakis: So, we're going to start to go around the table in order. So, Zayna, I'm going to pick on you first. We've also decided, since I'm not a doctor, that we're going to use first names instead of doctor.
[00:48:24 The panelists are seated together on stage.]
Taki Sarantakis: So, Zayna, I've known you for a few years. You had come to the School relatively early in my tenure at the School because you were like one of these very cool, techie people.
[00:48:39 Taki Sarantakis and Dr. Alika Lafontaine appear full screen.]
Taki Sarantakis: And I remember you talking a lot about AI and healthcare. And it seems so long ago, it seemed like healthcare was in a better place back then.
[00:48:56 The panelists are seated together on stage.]
Taki Sarantakis: And I don't know if it's a story that we tell ourselves, that healthcare is getting worse or healthcare is getting better, but maybe if you could kick us off a little bit with healthcare and technology, vis a vis how you see things.
Dr. Zayna Khayat: So, I've evolved my story as well, so here's the story that I'm sticking to. At this point, healthcare is a labour-intensive sector. It's 75% labour.
[00:49:23 Dr. Zayna Khayat appears full screen. Text on screen: Dr. Zayna Khayat, Adjunct Faculty, Health Sector Strategy, Rotman School of Management, University of Toronto.]
Dr. Zayna Khayat: That's 75% – 12% of our GDP. It's the most labour-intensive core sector in the world. More than agriculture, mining, anything else. Yet it's an information intensive thing. And I honestly think we don't need the labour, the humans, to keep doing these things.
[00:49:36 The panelists are seated together on stage.]
Dr. Zayna Khayat: So, technology replaces labour wage. That's all technology does. That's all it's ever done. And I think that's why we've been trying to get the promise of freeing up these precious, incredibly trained humans to do what only humans can do,
[00:49:51 Dr. Zayna Khayat appears full screen.]
Dr. Zayna Khayat: and do it well, and then let the technology do all the riff raff. And I think we're now finally at a precipice with this word AI, where we're actually going to start to see some of those returns. And those stories are being shared right now at the National e-Health Conference, including one I think my firm is doing with Ottawa Hospital, where we're using AI to give leverage to humans.
So, I think we're through the mucky muck of digitizing. And we're going to start to see the value from technology finally in healthcare, but not fancy tech, just software.
[00:50:20 The panelists are seated together on stage.]
Taki Sarantakis: Now, Cameron, I want to bring you into this in a weird way. So, you are the President of the Ottawa Hospital, which means you're running a hospital, but you're also building a hospital. So, I want to talk to you about both of those things.
First, running a hospital. I can't imagine a more difficult job in 2024, as we see crisis after crisis after crisis in our emergency rooms, waiting lists, etcetera. It seems to me that we, as a society, are now putting a lot on two different groups of people. One of them seemed to me to be healthcare workers in general,
[00:51:08 Dr. Cameron Love appears full screen. Text on screen: Dr. Cameron Love, President and Chief Executive Officer, Ottawa Hospital.]
Taki Sarantakis: but emergency personnel, in particular. And then the second are police officers.
[00:51:18 The panelists are seated together on stage.]
Taki Sarantakis: They both, to me, seem to have become almost de facto social workers. Talk to us a little bit about your experience in the emergency room running a big organization, which is the Ottawa health network.
[00:51:32 Dr. Cameron Love appears full screen.]
Dr. Cameron Love: So, you chose the easy question. Thank you for that.
Taki Sarantakis: Yes, exactly.
Dr. Cameron Love: So, maybe I can go back a little bit. If you go back pre-pandemic, go back ten years, this has been a problem that's been building for literally a couple decades.
[00:51:48 The panelists are seated together on stage.]
Dr. Cameron Love: And I think what we're starting to see more and more is the emergency departments have become the de facto for where people get care
[00:51:58 Dr. Cameron Love appears full screen.]
Dr. Cameron Love: because we haven't created the capacity outside the hospital in some integrated way to support people before they need hospital and definitely after they leave hospital. So, in the absence of that, what you get is everybody coming into the Emerg department.
[00:52:09 The panelists are seated together on stage.]
Dr. Cameron Love: And I think it's a growing problem. I think you also have, if you take Ottawa, a growing population. It's an aging population. So, by default, with the lack of primary care that's evolved, primary care does not necessarily need to be a physician. It needs to be organized primary care to support people, whether it's in their home or whatever care they require.
[00:52:26 Dr. Cameron Love appears full screen.]
Dr. Cameron Love: We don't have the proper bed capacity that we need for people. We have more than enough acute care bed capacity. We don't have capacity in the community to support people when they leave the hospital.
[00:52:36 The panelists are seated together on stage.]
Dr. Cameron Love: And so, what ends up happening as the growth in the system builds – and we've seen a lot of that impact coming post-pandemic – physicians, nurses, orderlies, they are incredible people that are 100% dedicated to making sure. That's why Emergs function, for the most part.
[00:52:50 Dr. Cameron Love appears full screen.]
Dr. Cameron Love: I thought Alika's summary is bang on. You're starting to see rolling closures of Emerg departments across the country, across this region. Because the smaller ones that don't have the same infrastructure,
[00:53:01 The panelists are seated together on stage.]
Dr. Cameron Love: all it takes is one or two people to be off, and you just can't run the service. And so, I think what we have to start to continue to evolve on is building capacity in the community. It's not about the hospital. It's about building capacity as a healthcare system in the community. Which, ironically, if you get that right, and you start to build that way,
[00:53:16 Dr. Cameron Love appears full screen.]
Dr. Cameron Love: and you integrate it, you start to decant the Emerg department. But in the absence of that, we just continue to see more and more growth within Emerg departments with volumes, because we haven't built the capacity before and after.
[00:53:28 The panelists are seated together on stage.]
Taki Sarantakis: And, Onye, in addition to the other hats you wear at the University of Toronto, as a professor, as a podcast host, you're also a family physician. Talk to us [about] what it's like to be a family physician in 2024. I know a lot of us in this room might run to you after and say, could you be my family physician? Could you sign me up?
[00:54:02 Dr. Onye Nnorom appears full screen. Text on screen: Dr. Onye Nnorom Co-Founder of the Black Health Education Collaborative; Assistant Professor, University of Toronto; Host, Race Health and Happiness Podcast.]
Dr. Onye Nnorom: Yes. Yes. So, that's interesting, because I do get that question a lot.
So, for me, I actually fit under where Alika said, which is that I am qualified. So, I'm double certified as a family physician, and as a specialist in public health. So, my primary care work doesn't involve having a regular practice.
[00:54:18 The panelists are seated together on stage.]
Dr. Onye Nnorom: But I do see patients, aside from also looking at things from a population health lens, particularly an anti-racism lens.
So, what I can say that you spoke to the question before, have things gotten worse or better? I can say from the primary care end,
[00:54:36 Dr. Onye Nnorom appears full screen.]
Dr. Onye Nnorom: as somebody who, probably for over a decade, I've done house calls. So, that wasn't in my bio, but I do house calls in community, almost like the reverse of a walk-in clinic. So, for people who are seniors, for people who have low mobility, I do that with Medvisit.
[00:54:54 The panelists are seated together on stage.]
Dr. Onye Nnorom: And, having done that since 2010, 2011, what I noticed, post-pandemic, is that when I would go see seniors and be like, okay, we can change this medication for you. We can do that, but you're going to have to go back to your family doctor.
[00:55:10 Dr. Onye Nnorom appears full screen.]
Dr. Onye Nnorom: Sometimes I would hear people say, oh, my family doctor retired. And then we'll talk about how I can provide you that kind of care. But what I have heard, particularly in the region where I do most of my house calls, which is Scarborough, a high needs area in Toronto, is people saying the clinic is gone.
[00:55:28 The panelists are seated together on stage.]
Dr. Onye Nnorom: That's very different than the doctor retired, which is what I would hear from time to time. I've heard lots of people saying, the whole clinic has disappeared.
[00:55:36 Dr. Onye Nnorom appears full screen.]
Dr. Onye Nnorom: And so, from a primary care standpoint, that's devastating. And it became really difficult to help people navigate that, especially people who are in their homes. And after a pandemic, where we learned how to help people more virtually, it was particularly devastating and difficult to be able to navigate. So, I think there are certainly areas where we are objectively in a worse place.
[00:56:02 The panelists are seated together on stage.]
Dr. Onye Nnorom: And I think, in the context of crisis, the other thing that we need to think about is that we found very innovative ways to do things that, in healthcare, we had previously said were impossible.
[00:56:13 Dr. Onye Nnorom appears full screen.]
Dr. Onye Nnorom: During the pandemic, I worked with Black communities and Indigenous communities, and we found very amazing ways to provide humanistic care that wasn't just about the vaccine, but about real connection. And I think we need to tap into that and hold onto those pieces that we applied at the height of the crisis. That, as people want to scurry back to status quo, we need to have a resistance for that. And we already have some promising practices that can help people who are in home and cannot leave, but also with other marginalized groups, as well.
[00:56:52 The panelists are seated together on stage.]
Taki Sarantakis: That's wonderful, and we'll get back to that, because that's a key theme of your closing, where you talked about how crisis is really the impetus for change.
Douglas, you're in a unique situation. You're a Canadian, born and bred, but then you moved. How long have you been outside of Canada?
[00:57:09 Dr. Douglas Manion appears full screen. Text on screen: Dr. Douglas Manion, Chief Executive Officer, Flare Therapeutics.
Dr. Douglas Manion: So, I moved to Boston for a one-year post-doctoral fellowship in Harvard. I never made it home.
Taki Sarantakis: How many years ago was that?
Dr. Douglas Manion: 1992 until now.
[00:57:18 The panelists are seated together on stage.]
Taki Sarantakis: So, over 30 years. So, Alika started with the importance of stories. And, as humans, stories define us because stories are how we take in information, how we see the world. And they're also how we look at solving problems.
One of the stories that we used to tell ourselves, when you were still north of the 49th parallel, is that we have this incredible healthcare system – the envy of the world. In fact, the story was so deeply ingrained in us, that I think it's not even unfair to say that it was part of the Canadian identity – that healthcare is part and parcel of what it means to be a Canadian.
Does it surprise you as somebody who's gone away – not too far, but gone away – that now we're having a national angst about the quality of healthcare in Canada?
[00:58:24 Dr. Douglas Manion appears full screen.]
Dr. Douglas Manion: Well, we are Canadians, after all. So, I did not move to the States for their healthcare system, their healthcare system is abominable. So, we look at the stats in Canada: one in five don't have access to primary care. In the states, it's one in three. That means 110 million Americans don't have access to primary care. 110 million. Three times the population of this country has no access to primary care. So, it's staggering. The scale is just staggering.
[00:58:47 The panelists are seated together on stage.]
Dr. Douglas Manion: So, I still believe that Canada could and should have the best healthcare system in the world, because you have the right balance between the public, the private sectors, and civil society.
[00:59:00 Dr. Douglas Manion appears full screen.]
Dr. Douglas Manion: And in America, the public sector has advocated the role in providing health. They don't see health as a right, whereas I do, and I believe most Canadians do. And that means we have extra levers that we can pull. My contribution to the system is through the private sector. I help develop drugs that will keep people out of hospital and will reduce costs, which is a very, very good thing.
[00:59:28 The panelists are seated together on stage.]
Dr. Douglas Manion: But the only other way I can have influence in America is by being an elected official, so I'm an elected official in my little hometown. It's in very rural Pennsylvania. They are not pro-healthcare, to say the least. And we do not have an emergency care facility in our entire county of 54,000 people.
[00:59:36 Dr. Douglas Manion appears full screen.]
Dr. Douglas Manion: And the only way to make that happen is for me to basically work with the private sector to somehow convince them it is worth their profit motive to move to our little place, and it is almost certainly not going to work.
[00:59:51 The panelists are seated together on stage.]
Dr. Douglas Manion: So, more to be done. But I tell you, you have all the levers here. It's just a function, as was said so eloquently by our speaker, to just make sure that people are firing on all pistons.
Taki Sarantakis: Now, we have to talk about the M word, and the M word is money. Now, as the President of the Canadian Medical Association,
[01:00:10 Taki Sarantakis and Dr. Alika Lafontaine appear full screen.]
Taki Sarantakis: I'm sure you must have advocated for more money. Is that the solution to our problems? More money?
Dr. Alika Lafontaine: I think when we look backwards at change that's happened,
[01:00:22 The panelists are seated together on stage.]
Dr. Alika Lafontaine: we sometimes retcon the past and imagine something different than what existed at the time. For example, when the CHA – the Canada Health Act – first came out,
[01:00:33 Dr. Alika Lafontaine appears full screen. Text on screen: Dr. Alika Lafontaine, Past President, Canadian Medical Association.]
Dr. Alika Lafontaine: it wasn't the five pillars that had everyone snapped to attention and suddenly everyone was working together, it was a vision that we could do better.
And so, the CHA hasn't been very effective at all in getting anyone to work together. There's only been two parts of it that's actually gone to court to be interrogated. There's very, very different approaches to how you get compliance, and what is compliance, or interpretation of compliance.
[01:01:02 The panelists are seated together on stage.]
Dr. Alika Lafontaine: But it was that vision of people coming together and that, for the first time, they actually could have a national health care system. I think we're at the beginning of a new cycle. A couple of years ago now, or the budget before this last one,
[01:01:19 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: the federal government did invest the highest amount in healthcare ever since the Health Accords first started in the early 2000s. And so, we have that spark that I think could lead to people adopting a common vision.
[01:01:31 The panelists are seated together on stage.]
Dr. Alika Lafontaine: Money, in and of itself, is just a tool. And so, if that tool is used in the right sort of way, or is put in the right sort of hands,
[01:01:40 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: absolutely, I think we could solve our big problems. But the question is whether or not there'll be a vision to go along with the tools. And I think that is what a lot of us are still sitting here waiting to see.
[01:01:51 The panelists are seated together on stage.]
Taki Sarantakis: I'm going to ask you each to answer in one word, yes or no. Alika said the system is on fire. Yes, or no?
Dr. Zayna Khayat: Yes.
Dr. Cameron Love: Yes.
Dr. Onye Nnorom: Yes.
Dr. Douglas Manion: Yes.
[01:02:06 Taki Sarantakis and Dr. Alika Lafontaine appear full screen.]
Taki Sarantakis: So, when something's on fire, our natural inclination is to run. Should we run or should we – and I mean run in a different way here – run is, I think, in this sense, it's like, should we go to the United States to get our medical service? Should we sign up for private clinics? Should we bake cookies and other things for anybody who we know who's a family doctor
[01:02:36 The panelists are seated together on stage.]
Taki Sarantakis: to try and get them to accept us? I'll kind of go this way. You said yes. A moment ago, you said that we're still far better than the United States,
[01:02:50 Taki Sarantakis and Dr. Alika Lafontaine appear full screen.]
Taki Sarantakis: if I heard you correctly. But if we're on fire, oh my God, what is it outside of Canada, then?
[01:02:59 The panelists are seated together on stage.]
Dr. Douglas Manion: Well, here I'm going to hearken back to my dad. So, he taught me that good things happen because of leadership and bad things happen because of leadership.
[01:03:06 Dr. Douglas Manion appears full screen.]
Dr. Douglas Manion: And not everyone's going to run into the burning building, but leaders do. And they save the people and/or put out the fire so more people survive.
So, I think the clarion call to this audience, and [there's] a lot of young people here, is amass as many personal tools as you can to have as much influence as possible and run into that burning building and fix it. And if you look, for instance, the CMA put out a great paper in 2022, which gave a roadmap of how it is that we could fix our problem here in Canada is just a function of having the leadership and the intestinal fortitude to execute.
[01:03:40 The panelists are seated together on stage.]
Taki Sarantakis: That's a big word, leadership. And we'll come back to that one. Why are we on fire?
[01:03:48 Dr. Onye Nnorom appears full screen.]
Dr. Onye Nnorom: Why are we on fire? I think, again, Alika spoke to it. It's just we had a healthcare system – lot of people say that it's broken – but it's performing in the way that it was meant to perform, it's just not relevant for our needs today. So, I think that's a huge part of why it's on fire, that we're noticing that it's on fire. I think it's been on fire for a while.
But I think part of the solutions that we need to think about –
[01:04:11 The panelists are seated together on stage.]
Dr. Onye Nnorom: you talk about young people running into the building – is also thinking about – I'm coming back to marginalized groups –
[01:04:16 Dr. Onye Nnorom appears full screen.]
Dr. Onye Nnorom: we come from communities that have been on fire. We know how to thrive in conditions of fire. And I think the question is, and even from public service or for leaders, is, when you're at the table, first of all, are we there? Those of us who know how to navigate in difficult circumstances? But on top of that, when we say there are five Fs, and you think there are three, are you willing to listen to the fact that there are five Fs and move towards those innovative solutions? That's tough in leadership.
[01:04:48 The panelists are seated together on stage. Audience applauds.]
[01:04:58 Taki Sarantakis and Dr. Alika Lafontaine appear full screen.]
Taki Sarantakis: That's really tough because we're in a world now where leaders, because Douglas brought up the term, leaders are having challenges. Leaders have a credibility gap almost by definition.
[01:05:10 The panelists are seated together on stage.]
Taki Sarantakis: I think it's fair to say when we were younger, if you were a doctor, you were automatically unquestioned. Like, the doctor says this, you have this.
[01:05:22 Taki Sarantakis appears full screen.]
Taki Sarantakis: Now it's, well I might have this. I might not have this. I looked on Google, I talked to my aunt. I was in a chat room yesterday, and I posted what I've got, and they told me, your doctor is insane.
[01:05:37 The panelists are seated together on stage.]
Taki Sarantakis: How do you be a leader in 2024 in this field, given everything's on fire?
Dr. Cameron Love: Yes. So, on fire is an interesting analogy, I think. I want to go back to the pandemic, and I want to go back to something Alika said,
[01:05:50 Dr. Cameron Love appears full screen.]
Dr. Cameron Love: because I think there's an element here where we had a major crisis in the middle of the pandemic. And what I saw personally was we've never had a problem, based on the last comment, we've never had a problem in this country with tremendous leadership and innovation and research and really trying to drive change. I think the perspective everyone's saying, going back to the pandemic, going back to the pandemic was not a great place to start. What we saw in the pandemic is all the bureaucracy, all the traditional silos, all public policy, it kind of went out the window, and there was a focus on managing one population, which was Covid.
[01:06:26 The panelists are seated together on stage.]
Dr. Cameron Love: And the amount of innovation that happened was incredible because it was in the middle of the crisis. The crisis ends, everything goes back to the way it was. We really didn't implement anything we learned through the pandemic.
[01:06:35 Dr. Cameron Love appears full screen.]
Dr. Cameron Love: And so, I think part of – to your question around it from a leadership perspective – what we have to do is we have to realize that we do have significant challenges.
There [are] pockets of things that are on fire, that are crises; there are pockets of things that are working well. But what it requires is a lot of leadership to drive change that is not going to be tremendously popular. But if we're focused on truly the most important body in this entire thing, is the patient and the family.
[01:07:02 The panelists are seated together on stage.]
Dr. Cameron Love: It's not the hundreds of associations and all the providers. If we're going to focus on what's right from a patient perspective, that means we have to systemically change. Which means, at best, 80% agree. But if we try and find consensus and leave it the way it's been traditionally,
[01:07:15 Dr. Cameron Love appears full screen.]
Dr. Cameron Love: I think to Alika's point, we will continue to see pockets of fires and greater challenges. Personally, I think within this region and within this country, we actually have a very good system. We just have to play a lot greater leadership roles, at all levels,
[01:07:30 The panelists are seated together on stage.]
Dr. Cameron Love: on driving a change that's going to create better sustainability. And sure, you need more money, but I'll tell you, the amount of inefficiency within this system is enormous. And so, there are ways to drive that out.
[01:07:41 Taki Sarantakis and Dr. Alika Lafontaine appear full screen.]
Taki Sarantakis: Now, Zayna, all five of you, including you, said that the system is on fire. Talk to us a little bit about it, maybe?
[01:07:46 The panelists are seated together on stage.]
Dr. Zayna Khayat: I thought I'd make a joke. So, when things are on fire, as normal, rational humans, we would run or whatever. In Canadian healthcare, what do we do? We commission a study. A study, again, for the same conclusion. Anyway, that's what we do.
[01:08:03 Dr. Zayna Khayat appears full screen.]
Dr. Zayna Khayat: So, I think we absolutely do not need another penny in Canadian healthcare. We can't find it anyway because we're already 75% publicly funded and we can't get taxed anymore, so there is no more money. So, I think there's two things. The only thing every study, everybody universally agrees to, is kind of what we've heard.
[01:08:21 The panelists are seated together on stage.]
Dr. Zayna Khayat: You, as Canadian citizens, the financers of the system, the people who are the users and the beneficiaries, if you don't pull us to the future, I think all the leadership in the world is never going to get us there.
[01:08:33 Dr. Zayna Khayat appears full screen.]
Dr. Zayna Khayat: And I don't think Canadians are angry enough yet. They're not demanding more, and they're not pulling us to the future. So, I think we're close, but I think that's going to be the lock in the key. In parallel, this whole conversation about leadership, to me, the lever on money is, set the conditions under which the public sector will pay. And make people accountable to deliver care that we all agree we want, under those conditions.
Right now, we pay for procedures. We don't pay for the results. And I think until we start having way more accountability,
[01:09:05 The panelists are seated together on stage.]
Dr. Zayna Khayat: like under the Canada Health Act, I think we're just going to have free flowing money, and who's going to always suffer is going to be our patients.
[01:09:14 Audience applauds.]
Taki Sarantakis: Alika, you said that in a crisis, we create change, which I think is true.
[01:09:27 Taki Sarantakis and Dr. Alika Lafontaine appear full screen.]
Taki Sarantakis: You also said that we come together on a singularity of focus. And I think a few of you have brought up your concurrence with that. But there were some things that we saw that were the opposite of that during a crisis.
[01:09:44 The panelists are seated together on stage.]
Taki Sarantakis: I always kind of imagined if things ever got really, really bad, Tribe A and Tribe B, and everybody would put their differences aside. And we would all pitch in when the Martians landed. The Americans and Canadians and Russians and Chinese, we would all kind of [say], it's a worldwide crisis. It didn't really work out like that.
[01:10:10 Taki Sarantakis and Dr. Alika Lafontaine appear full screen.]
Taki Sarantakis: Did it feel like that from inside of a hospital to you guys? From outside of the hospital, it felt like the pandemic, probably the greatest public crisis of our lives, it felt like it accelerated and differentiated difference, rather than bring us together.
[01:10:35 The panelists are seated together on stage.]
Taki Sarantakis: And I'm curious what it was, the hopeful thing, that made you say that this brought us together, and we will continue moving forward.
[01:10:45 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: Yes, I think the flow of crisis is not evenly distributed first. When Katharine Smart, my predecessor at the CMA, said on Power and Politics, our healthcare system is collapsed. And we'll start off with Firestorm, where pretty much everyone said, this is not true. You're overreacting. I inherited that. And over time, people realized, no, she was actually right. And the reason why is because collapse is not evenly distributed. Just like the calculus of suffering is never evenly distributed across a society.
I think one of the things to remember about crisis is that it both breaks and build systems.
[01:11:17 The panelists are seated together on stage.]
Dr. Alika Lafontaine: And so, crisis can break relationships. It can break trust, especially when you're gaslit, which I think was a lot of what happened during the pandemic. Originally, it was a command-and-control structure,
[01:11:34 Taki Sarantakis and Dr. Alika Lafontaine appear full screen.]
Dr. Alika Lafontaine: because we really did have this unknown pathogen, we didn't know how it was spreading. I mean, I slept in the garage for a little bit after the pandemic was officially called because I didn't want to get my family sick. And there were lots of us who were living at the hospital
[01:11:48 The panelists are seated together on stage.]
Dr. Alika Lafontaine: because we were thinking to ourselves, well, I'll just be around in case somebody needs help.
Now, with subsequent cycles of meetings and other things where we gave our lived experience,
[01:11:58 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: and offered our expertise to fix things, a lot of us realized by wave three, four, and five, no one was actually interested in changing anything. And so, at that point, we stepped back and said, well, if the house is on fire, and there's nothing I can do to help with it, I'm just going to make sure I don't get burned.
And I think that that was what happened in the course of the pandemic that really took things south. When the instruction was given to the public not to wear masks because masks didn't work,
[01:12:26 The panelists are seated together on stage.]
Dr. Alika Lafontaine: that had nothing to do with science, that had everything to do with managing inventory. But instead of being honest with people and saying they don't have enough to go around, they instead said something else that wasn't true when you actually interrogated the information. I think we took too long to come out of lockdowns. We know that now.
[01:12:45 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: And instead of just being honest with people, instead of giving them these complex solutions and helping them come along with the story and be brought together, we told people that – once they interrogated a little bit more closely, they all realized this doesn't feel right.
And the truth is, crisis is complex. It's messy. We don't actually know what's going on. I see smoke coming out from a plume that's 30 km away from me and Grande Prairie.
[01:13:15 The panelists are seated together on stage.]
Dr. Alika Lafontaine: I don't know which direction that fire is going. I have to go turn to someone. I have to trust them. I have to trust their assessment. And I think forest fires are an interesting experience in understanding how to manage crisis, because in Grande Prairie, lots of people have their own heavy machinery.
[01:13:32 Taki Sarantakis and Dr. Alika Lafontaine appear full screen.]
Dr. Alika Lafontaine: And people were going out, trying to build these barricades. But they were creating more problems than they were fixing because they didn't know how to do it properly. And so, even though you have the willingness and the thought that you know what you're doing, you still need leaders, you still need people to buy into shared truth and shared approaches.
[01:13:49 The panelists are seated together on stage.]
Dr. Alika Lafontaine: And I think that that's really where crisis goes off track, is you lack these shared types of understandings, the cohesion that it takes to have us work together.
[01:13:57 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: And then you have this arbitrage of the crisis, where special interests come in, they take all the momentum that you built, and they walk away with what they need, while the rest of us are left with little, if nothing.
[01:14:11 The panelists are seated together on stage.]
Taki Sarantakis: I love that notion, Alika. That crisis both builds and breaks. It reminds me of William Gibson, who said that
[01:14:19 Taki Sarantakis and Dr. Alika Lafontaine appear full screen.]
Taki Sarantakis: "The future is already here; it's just unequally distributed."
It just depends on where you look, and you'll see the future.
[01:14:26 The panelists are seated together on stage.]
Taki Sarantakis: Onye, I want to ask you, in the myriad of issues, good and bad, that we see in the healthcare system, and Alika, I'm going to ask you again for your community. You have a particular expertise and focus on healthcare vis a vis racialized peoples, and even more specifically, vis a vis Black Canadians. Can you talk to us a little bit about,
[01:14:48 Taki Sarantakis and Dr. Alika Lafontaine appear full screen.]
Taki Sarantakis: with all the challenges that we see in the healthcare system, are some populations even more disadvantaged interacting with the healthcare system?
[01:15:00 The panelists are seated together on stage.]
Taki Sarantakis: Do they carry even a greater burden than the rest of us?
Dr. Onye Nnorom: Yes.
Dr. Zayna Khayat: Next question.
Taki Sarantakis: Absolutely. But how so?
[01:15:15 Dr. Onye Nnorom appears full screen.]
Dr. Onye Nnorom: So, yes, I think what a lot of people might not realize is that in the formation of western medicine as we know it, and the way that it is taught, so much of it focused – let me say the gold standard patient is the white, 70-kilogram male, and all that comes with that. And you can see, even for, let's say, white women, either misunderstanding; biases; and all types of things. We've seen the studies that if a woman has a surgery with a male surgeon – so this is not even about race –
[01:15:50 The panelists are seated together on stage.]
Dr. Onye Nnorom: she's 30% more likely to experience death from that surgery compared to if it's a woman surgeon. And we don't know all the reasons why.
So, now take that, that's just gender.
[01:16:01 Dr. Onye Nnorom appears full screen.]
Dr. Onye Nnorom: And then on top of that, if you add race and the biases and stereotypes against, I'll focus on Black people, that actually stem from our history of slavery in Canada – yes, we had slavery here, not just in the United States – but the things about us, that we're less intelligent, or not to be trusted.
[01:16:19 The panelists are seated together on stage.]
Dr. Onye Nnorom: So, when, for instance, a Black woman is pregnant and presents, and says, I'm in pain, or something's happening, she's less likely to be believed. She's less likely for that physician to understand the complexity of her situation. Not that she's biologically different.
[01:16:34 Dr. Onye Nnorom appears full screen.]
Dr. Onye Nnorom: We've mapped the human genome where there's no biological race. But her lived experience, the stressors that she's under, her context, that's a complexity that a lot of physicians are not taught about, or actually provided misinformation about different groups. And so, that leads to worse outcomes in healthcare.
Racism kills people, and in healthcare, it's no different. Health care providers have biases. And if you think about the Indigenous example, or if we're thinking about Joyce Echaquan, that was a key case that people reflected on.
[01:17:13 The panelists are seated together on stage.]
Dr. Onye Nnorom: So, time and time again, Black folks, Indigenous folks, racialized folks, experience really poor outcomes in healthcare.
[01:17:23 Dr. Onye Nnorom appears full screen.]
Dr. Onye Nnorom: Not always, but either due to intentional or unintentional biases from healthcare providers who are just part of a regular society where there are those biases.
[01:17:34 The panelists are seated together on stage.]
Taki Sarantakis: Alika, you're kind of on both sides of this. You're an Indigenous person and you've seen, out west in particular,
[01:17:42 Taki Sarantakis and Dr. Alika Lafontaine appear full screen.]
Taki Sarantakis: how Indigenous communities are treated vis a vis the healthcare system, but you're also a healthcare provider. Is there something that you've seen on either side of those two sides of the coin that has particularly struck you?
Dr. Alika Lafontaine: You know, my dad used to teach me when I was younger through parables. So, he'd say, you have a researcher, you have an advocate, and you have a community organizer all walking down the street together.
[01:18:10 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: And they see someone who is homeless. And the researcher counts, the advocate yells for someone else to help, and the community organizer sits down and sees whether they need medical care or provides them food.
[01:18:24 The panelists are seated together on stage.]
Dr. Alika Lafontaine: And I think one of the biggest challenges that talks about what Onye was referring to is, we're all waiting for someone to tell us, oh, this is a big enough problem for us to deal with things, instead of just recognizing we can see it. Each of you in the audience probably has a personal experience, or has one relationship,
[01:18:43 Taki Sarantakis and Dr. Alika Lafontaine appear full screen.]
Dr. Alika Lafontaine: a way of knowing someone who did not get access to care, even though they needed healthcare. And I think that the challenge with being a provider is knowing when your story ends and your patient's story begins, and kind of getting out of the way of people being hurt.
[01:19:00 The panelists are seated together on stage.]
Dr. Alika Lafontaine: It's also knowing when you can't do anything to help.
You know, anesthesiologists are the medical ninjas of the healthcare system: We're highly specialized; we're dark and mysterious; and we're the last thing you remember before you lose consciousness.
Taki Sarantakis: You keep slipping that in every time.
Dr. Alika Lafontaine: But there's certain things that we just can't do. I can't function as a family physician.
[01:19:23 Dr. Alika Lafontaine appears full screen.]
Dr. Alika Lafontaine: There are surgical things that need to get done but I know that when ORs get turned over, I can mop the floor. I can go grab the patient because the nurse is busy and doesn't have time to check in the patient. That can save me a whole case or two. That stops someone from having to be in a holding pattern of having to need care again.
[01:19:41 The panelists are seated together on stage.]
Dr. Alika Lafontaine: And so, I would really love to see in the future of healthcare – once again, we need a vision. We need a leader or set of leaders who are committed to working together, because the provincial, territorial system of these isolated approaches, it will fail.
[01:19:55 Taki Sarantakis and Dr. Alika Lafontaine appear full screen.]
Dr. Alika Lafontaine: We know it fails. That's what every part of history tells us with these big problems – to bring us together and then just start doing things. We need this age of action where we all just go out and start doing what we do well.
And I really do think the public service is going to be a really big part of that. Because the stories that you believe, become the stories that we believe.
[01:20:19 The panelists are seated together on stage.]
Dr. Alika Lafontaine: Because you're the ones who create that narrative for new political leaders. You're the folks who listen to lived experience. You see from a broad 40,000-foot vantage point what's working and what's not.
[01:20:33 Taki Sarantakis and Dr. Alika Lafontaine appear full screen.]
Dr. Alika Lafontaine: And we desperately need that in healthcare right now.
Taki Sarantakis: So, we've come to the end of our time almost. So, I'm going to ask each of you, and I'm going to start with you, Douglas, to give us final thoughts. Give us either a prescription, or a little bit of hope. Be a Pollyanna, be a Cassandra. Close any way you'd like to close,
[01:20:55 The panelists are seated together on stage.]
Taki Sarantakis: in terms of talking not just to the people in this room, but also to the people who will be watching this on our website over the years to come.
Dr. Douglas Manion: Well, if I could, I just want to say, you honour my father and I really appreciate it, as does my entire family.
[01:21:11 Audience applauds.]
[01:21:17 Dr. Douglas Manion appears full screen.]
Dr. Douglas Manion: And I've told my dad yet again, if you don't have dreams, you have nightmares, and you might as well just make up your own dreams.
[01:21:23 The panelists are seated together on stage.]
Taki Sarantakis: I like that a lot. Onye?
[01:21:31 Dr. Onye Nnorom appears full screen.]
Dr. Onye Nnorom: Yes, I'm thinking about, again, in Alika's slide, the piece around hope. And I think that's where we need to anchor ourselves. And in that understanding, as was discussed earlier, that we're all connected.
And so, for me, I think that the piece again that we used when we were working in community and the vaccine clinics and working in collaboration, but also bringing our different cultures into the mix, a lot of us used the South African principle of Ubuntu. "I am, because we are."
And it was necessary, not just for our patients, but it was necessary to do that with our providers, to recognize their humanity, so they were better positioned to be able to serve others. And I think that applies to the public service. And anywhere that we are working, and connected together, we have to see the humanity in ourselves and the humanity in others.
[01:22:23 The panelists are seated together on stage.]
Dr. Onye Nnorom: So, for me, this work, the hope for me, is anchored very much in Ubuntu.
Taki Sarantakis: Thank you. Cameron.
[01:22:30 Dr. Cameron Love appears full screen.]
Dr. Cameron Love: So, I do think there's a hopeful future here. I've been doing this for close to 30 years now. We've been through dozens and dozens of crises. And while we often reflect on what we need to improve, what you need to do from a leadership perspective, we often forget of how many things we've done well and the strengths we've built in a healthcare system. So, I do think we're starting from a foundation that has a lot of strength and history.
I do think, though, that regardless of what happens with governments within communities, communities need strong leadership to continue to build healthcare, regardless of what happens with government. And I think when you look at the leadership that exists within healthcare, it doesn't matter whether it's in a hospital, whether it's in the community, whether it's with physician leadership, it's how do you rally that engagement? Because what's interesting is when you talk to whether it's patients, physicians, nurses, everybody completely agrees there's a way to make it better. What we need to do is rally people to make it better.
And you can't wait. The worst thing to do is to wait for someone to fix the problem.
[01:23:26 The panelists are seated together on stage.]
Dr. Cameron Love: What we need to do is stand up and fix the problem within each community.
Taki Sarantakis: Zayna.
Dr. Zayna Khayat: My message: I think that policymakers or influencers is, obsess about creating the future.
[01:23:37 Dr. Zayna Khayat appears full screen.]
Dr. Zayna Khayat: The new story that Alika talked about, that pull to the future instead of protecting the past. And we just heard the weight of the past, the inertia, it is in the DNA.
So, when you catch yourself doing stuff that's going to propagate the very thing that we just said no longer serves,
[01:23:52 The panelists are seated together on stage.]
Dr. Zayna Khayat: I think that threatens the survival of our healthcare system. So, create the future and don't protect the past.
Taki Sarantakis: Mister Ninja, you get our last substantive word.
[01:24:06 Taki Sarantakis and Dr. Alika Lafontaine appear full screen.]
Dr. Alika Lafontaine: I truly believe that what we need for leadership has shifted. And I remember what my parents tried to instill in me when I was young, which was regulating inside myself and not worrying about the world and everything that was going on outside.
I grew up feeling like I was broken. I was labelled with a learning disability. We experienced racism growing up. I didn't really feel like I fit in anywhere. And it was that grounding in understanding who I could change,
[01:24:39 The panelists are seated together on stage.]
Dr. Alika Lafontaine: and the emotions I was going through, that really helped to ground me. But that's also led into a leadership skill where I can help other people ground each other.
[01:24:52 Taki Sarantakis and Dr. Alika Lafontaine appear full screen.]
Dr. Alika Lafontaine: You know, anesthesiologists, they're peacemakers in the OR. When surgeons fight over what case to do at 03:00 a.m. and they can't agree with each other, someone who does anesthesia well walks in, disappoints everyone, but everyone feels better. That usually involves pizza,
[01:25:10 The panelists are seated together on stage.]
Dr. Alika Lafontaine: but I think that that's what we need from our leaders. We need people who themselves know how to self-regulate their own emotions, and then people that can manage conflict.
And so, if you see leaders like that, I really hope that you lift those folks up. Those people will be who will lead us out of this crisis.
Taki Sarantakis: Now, I can't let you go yet, because somebody's going to give formal thank yous, but I want to, on behalf of the audience, give you all a round of applause. But sit still, don't move, okay?
[01:25:42 Audience applauds. Vanessa Vermette and Nathalie Laviades Jodouin re-join the panel on stage and stand at the lectern.]
[01:25:50 Taki Sarantakis and Dr. Alika Lafontaine appear full screen.]
Taki Sarantakis: The was the 2024, the 27th annual Manion Lecture. The 2025, the 28th annual Manion Lecture, will be given by somebody in the audience. If she's here, she can stand up. It will be Madame Jocelyne Bourgon, former Clerk of Canada's Privy Council.
[01:26:10 The panelists are seated together on stage. The audience applauds.]
[01:26:18 Vanessa Vermette and Nathalie Laviades Jodouin appear full screen. Text on screen: Nathalie Laviades Jodouin, Vice-President, Public Sector Operations and Inclusion Branch, Canada School of Public Service.]
Nathalie Laviades Jodouin: So, before I turn it over officially to Vanessa to close and conclude, I just want to take a moment again to thank our esteemed panel.
[01:26:26 The participants are together on stage.]
Nathalie Laviades Jodouin: Leadership matters. You are incredible leaders. And just a few things that I noted, if I may,
[01:26:35 Vanessa Vermette and Nathalie Laviades Jodouin appear full screen.]
Nathalie Laviades Jodouin: which were really your takeaways. If you don't have dreams, you have nightmares. I am, because we are. Leadership matters, so stand up and fix it. Create the future, don't hold on to the past.
[01:26:56 The participants are together on stage.]
Nathalie Laviades Jodouin: And finally, the importance of lifting one another up and the importance of connection.
[01:27:00 Vanessa Vermette and Nathalie Laviades Jodouin appear full screen. Text on screen: Vanessa Vermette, Vice-President, Innovation and Skills Development, Canada School of Public Service.]
Nathalie Laviades Jodouin: So, thank you. Over to Vanessa.
Vanessa Vermette: Thanks, Nat. And thank you to our panelists. Thank you to our guest lecturer, Dr. Lafontaine. Thank you, Taki. Thank you to the team who work behind the scenes to make today's event happen. And thank you all for being here with us today in person.
I also want to share a few of my takeaways if I may take a few seconds.
[01:27:23 The participants are together on stage.]
Vanessa Vermette: Douglas, running into the fire. Run towards the danger. I'm going to take that away. Run towards the danger with the right team, to Onye's point. And then once you have the right team and the right people, listen to them. Have the courage to actually listen to them and take on what they're saying. Have the courage to listen to the crisis itself and the wisdom that is in that crisis and what it's trying to impart to you in that situation.
[01:27:47 Vanessa Vermette and Nathalie Laviades Jodouin appear full screen.]
Vanessa Vermette: Get angry. Get angrier, to Zayna's point. There's a lot of wisdom in anger, and it can be channeled as fuel, so that we have the courage, as Cameron said, to keep the main thing the main thing.
[01:28:00 The participants are together on stage.]
Vanessa Vermette: Focus on the patients, focus on our families, our communities, and the prosperity and health and wellness of Canadians.
So, with that, I hope that the polycrisis talk has been inspiring,
[01:28:13 Vanessa Vermette and Nathalie Laviades Jodouin appear full screen.]
Vanessa Vermette: and we are creating a story that pulls us towards the future which contains, hopefully, poly opportunities for us.
[01:28:22 The participants are together on stage.]
Vanessa Vermette: And to officially close the Manion Lecture this year, we would like to welcome back Elder Verna McGregor to send us off in a good way.
[01:28:36 Elder Verna McGregor joins the participants on stage.]
Elder Verna McGregor: Again, I have to send you off in a good way.
[01:28:38 Elder Verna McGregor appears full screen. Text on screen: Verna McGregor, Elder, Algonquin Community of Kitigan Zibi Anishinabeg.]
Elder Verna McGregor: Usually, if I was in a lodge, we'd send you off with a little honour song. But I'm going to ask you to maybe join in because you have to earn your juice outside.
[01:28:59 The participants are together on stage.]
Elder Verna McGregor: I'm going to sing a warrior song because I think all of you are warriors and need to be honoured. And I'm going to sing the first part, but the second part is we'll just have a pre-practice. So, the second part goes like,
[01:29:18 Elder Verna McGregor appears full screen.]
Elder Verna McGregor: Ya, hey-ya, hey-ya, hey-ya, hey. You think you could do that? Let's try.
Elder Verna McGregor and audience: Ya, hey-ya, hey-ya, hey-ya, hey-ya, hey.
Elder Verna McGregor: See, we're going to get on YouTube after this. You sound wonderful. So, follow on. So, I'm just really quickly to close, and it's to honour all of you for the work that you do, because I know you usually go above and beyond.
So, here we go. That goes like this. This is my rattle. And we call that < Indigenous Language >. And we use that too, in healing ceremonies before. And it also represents the rattlesnake. And if you look at the Canadian Medical Association, you see the two snakes intertwined. It represents, for us though, is snake medicine is one of the highest forms. And I'm very honoured to be amongst one of the highest forms here in the medical profession.
So, here we go. You ready? Hey-ya, hey-ya, hey-ya, hey. Hey-ya, hey-ya, hey, hey-ya, hey. Hey-ya, hey. Hey-ya, hey-ya, hey. Hey-ya, hey-ya, hey. Hey-ya, hey-ya, hey.
Now here you go. Here comes the crisis. Are you ready?
Elder Verna McGregor and audience: Ya, hey-ya, hey-ya, hey-ya, hey. One more time. Ya, hey-ya, hey-ya, hey-ya, hey. Hey-ya, hey-ya, hey.
Elder Verna McGregor: Hey-ya, hey-ya, hey. Hey-ya, hey-ya, hey-ya, hey. Hey-ya, hey-ya, hey. You all sound wonderful. Miigwech.
Elder Verna McGregor: Really, what I sang is a warrior song, and a warrior is not somebody who picks up the sword in battle. A warrior is a person who looks after the community. And when you sang "Ya", it's alerting the community that there's danger and something needs to change. And that's what we've all went through also, with Covid. So, have a good evening and drink lots of juice.
[01:32:20 The audience applauds. Title page re-appears: Image of Dr. Alika Lafontaine in medical scrubs; Text on screen: 2024 Manion Lecture; A Discussion on the Canadian Health Care Polycrisis, with Dr. Alika Lafontaine; Welcome.]
[01:32:24 The CSPS animated logo appears onscreen.]
[01:32:31 The Government of Canada wordmark appears, and fades to black.]
