Canadian Medical Association: Health Care Transformation – From Words to Action

Good afternoon members of the CMA.

I am delighted that such a venerable and influential body as the CMA would invite a former hack journalist, current parliamentarian and very much a generalist to speak to you on how to move your plan for health-care transformation into the mainstream. I am humbled.

I have always said that generally I know a lot of things but specifically, I know little.  However I believe I understand this communications business.  Working for Jean Chretien gave me a new understanding of when to under emphasize, when to overreach and when not to say anything. I never thought I would be the Director of Communications for the Prime Minister of Canada but when I crossed that line into what we reporters would sarcastically call the “dark side”, I received a great deal of enlightenment. If only I knew how government really worked after 32 years of journalism, I wouldn’t have had to ask so many useless questions.

Today I have a few ideas and because I don’t know the inner workings of the CMA, I will have a few questions.  Some of what I suggest is strategic, some has to do with smaller details, such as “talking in examples”.

In delivering a new idea, a new proposal, a new agenda, it’s what you say, how you say it and when you say it. It’s how you engage.

The few ideas I want to share this afternoon will hopefully dovetail with the information and wisdom Nick Nanos has already covered. Together, we hope we can feed a rich discussion and exchange on your own role as advocates in this huge CMA undertaking.

As some of you may know, I bring to this table an understanding of the workings in the media landscape in Canada and internationally.  As I mentioned, I also have some experience in creating and carrying out communications strategies through my role as Director of Communications for the former Prime Minister, Jean Chretien.

As a Senator and in my current role as Opposition Whip in the Senate, I have developed a better appreciation of how government works, how ideas become policy and how these policies move into action. It is from this perspective that I can share some very general views on moving from words to action.

My assumption is that Nick and I have before us the “true believers” and the front-line advocates of Health Care Transformation’s powerful VISION.

The enormity of the CMA’s plan for health-care change is astounding: the vision is that virtually all Canadians – from health-care providers, associations and NGOs, to the countless patients you counsel and treat – will ultimately think about their health and health care in a different way. A better way. This is as mind boggling as it is courageous.

But how do you move that IDEA out? How do you create a multi-stakeholder paradigm shift? How do you influence key actors, a network of people and groups… and then the public? How do you shape the debate to engage decision-makers and the public?

You know what you want to do.  You want to share your vision with target groups.  You want to spark people’s interest so they can recognize and act on their stake in patient-centred care.

To start, then:
• you simplify your message and you use “real life examples”
• you craft the message to engage specific groups.
• you design your outreach for specific target groups.
• you invest in the development of your messengers.
• you develop a strategy to reach out to advocates with your vision and then build alliances
• you use the best of new technology tools and services, such as social marketing networks.
• You sweep the country, you criss-cross the country with your message, and you meet editorial boards, big and small.

Never underestimate your local media.

As complex as this will be, the CMA has its “communications professionals” who are no doubt anxious to work with you to further develop and refine a master communications strategy.  I understand that CMA’s communications group is, in fact, already at work on a strategy for engaging stakeholders within the health and medical community, different levels of government and the political sphere.

The CMA Annual meeting is key to grabbing all the media attention you can target and to get the communications strategy rolling out. Within 10 days or so, we enter a new media season. Media organisations are getting ready for the Parliamentary busy fall season and are ready to pay attention to key national issues. People’s minds are open. Stakeholders will react to the Healthcare Transformation Initiative and you need to engage the conversation with them. For example, use the Canadian Nurses Association’s strong reaction to engage, to develop interest, feed the conversation and generate informed debate in the public mind about the steps needed to transform health care. Ahead are countless opportunities to be seized.

Earlier this month, I read two headlines. One said “Health care rights should be enshrined in patient charter says CMA.”  The other read, “Canadians are not getting value for money in Health Care system and it needs to be massively transformed’’

I am not sure which headline you like but the headline I would have preferred is “Doctors prescribe massive changes in caring for Canadians”

I understand that you wanted to get the debate going in preparation for this annual meeting, but I still have nagging questions about your timing.  Announcements in early August are rarely heard, hardly understood and having been one of those media hacks, I would rather be on the golf course in August playing golf with my family doctor.

But now is a new opportunity! It’s never too late!

Messaging is about opportunity and I believe that opportunity is this fall when politicians and the Canadian public is paying attention.

This is also the time for you to start working closely with the communications professionals at CMA and within the communities where you work and live.  I want to be a bit more specific about what I mean and why I’m saying this.

To achieve success in any communications and outreach endeavour, you need to be guided by three practical ideas. These are:
• Professional communications people need to be “in the room”.
• Collaboration and teams are critical.
• Champions, advocates and third-party stakeholders need to be aligned and equipped with the right strategies, language and technologies.

In the Room
I call the first practical idea my “in the room” advice. Your communications professionals are the ones who will help you design strategies and messages. They are experienced and they need to be an integral part of your team. They need to accompany you every step of the way.

Just as health care involves a team approach – with doctors, nurses, caregivers, patients and their families functioning in a coordinated way – so too is effective communications. It needs teamwork.

My experience has taught me that you can’t expect your communications people to be brought in as an afterthought and to be equipped to craft messages for media and the public. Your communicators are critical team members who should be “at the table” and “in the room” as strategists. A surgeon never operates in the room alone, why should a communicator be outside the room. They are the ones who will help you prepare for the unintended consequences. They bring invaluable insight. They are critical to the blueprint. They develop the language and bring about the fluency that you as champions and advocates will need to demonstrate.

I can give you a very powerful example of this. A few days ago, former Prime Minister Paul Martin was interviewed on Evan Solomon’s Power & Politics. He was speaking with great sadness of the passing of Mario Lague, the Liberal Party’s Director of Communications who lost his life in an accident in Ottawa on August 12.  He said this of Mario:

“You can’t communicate something which you don’t believe in.  And you can’t communicate something that, in fact, you haven’t been part of. And Mario was very much part of the messages that he crafted.  And his ability, basically to communicate that really I think spun from that deep conviction that he had and what he was saying.” Mario was involved in policy discussions. Mario was in the room.

….it is those qualities that made him so effective as a communications advisor and strategist.

Collaboration & Teams
The second practical idea has to do with the power of teams and with the spirit of collaboration. As you roll out the communications strategy nationally, provincially and at the local level, bringing together teams of engaged players will be critical. How you explore the creativity, the talents and the different strengths of each member of those teams will be key. The climate of collaboration you create, how you select team members, the qualities you will look for in them are all critical factors to transformation from the local level to the national one.

In that respect, I was struck by an article in our own Ottawa Citizen recently about one of your colleagues, Dr. Robert Cushman, who has announced his retirement as Eastern Ontario’s first regional chief executive of the Champlain Local Health Integration Network. The article described how Dr. Cushman had been able to steer clear of controversies and to get stakeholders and partners to cooperate and collaborate on issues never before considered.  He was able to focus people to say “what is good for the whole [system]? What’s in the best interest of the whole [system]?” He was able to demonstrate leadership and  reated a climate where consensus-building was key to success.…I hate to be Ottawa-centric, but I am confident that your incoming president, Dr. Jeffrey Turnbull will be demonstrating the same leadership. He has already done so in Ottawa.

Champions & Advocates
My third piece of advice has to do with finding the champions, whether they are champions on the Hill, the champions in your province and territory or the champions in your community. My life on the Hill is rich with examples of how champions work. Let me talk to you about Dr. Wilfred Keon, how his work could eventually be made into legislation and how bi-partisanship approaches can play out.

As chair of the Senate Subcommittee on Population Health, Dr. Keon guided studies and reports with convincing recommendations for applying the tenets of a population health approach and strengthening Canada’s health-care system.

For the 2007 Senate report, Maternal Health and Early Childhood Development in Cuba, Dr. Keon, along with myself and other members of the subcommittee, looked at some remarkable, successful examples of a population-wide program that takes a preventive approach to fostering health, education and the early development of children. We recognized useful and potentially revolutionary concepts applied within Cuba and, through our report and communications efforts, shared them with key Canadian health organizations, advocacy groups and the media.

In 2009, Dr. Keon again demonstrated his ability to champion ideas and engage Canadians in a subsequent report, A Healthy, Productive Canada, challenging governments, political decision-makers – all of us – to acknowledge and assume a population health approach.

You as Champions
As I prepared for today, it quickly became clear that fundamentally, engaging this nation in a vision for transforming health care is about you, the “physician as believer”. This is about your central role as physicians in believing that this transformation is the right thing going in the right direction. At the community level, you are key to the success of this transformation. You are key in spreading the idea, the word.  You are the champions, the advocates who will introduce this vision into the medical networks, into the media and in the public’s mind. You are the champions and the advocates who will find other champions and advocates to work with.

Find your champions on the Hill…and on the provincial “Hills”.

I can tell you too that on the Hill in Ottawa today, there are other senators and Members of Parliament who are researching, and thinking and debating about health care.

When you do come to the hill, I have a few ideas on how you can go about your business. And I mean business. MPs and Senators have small allowances to hold events in one of the function rooms. There is nothing wrong with having a wine and cheese gathering but out of experience I  find with MPs and Senators coming out of an intense debate or that gong show called question period, most politicians have the attention span of  a humming bird in heat. Drink the wine, eat the cheese, grab the brochure and what was that message again.

To be more effective, I believe the Canadian Medical Association in small groups of 5 or 6 must visit individual caucuses and ask to deliver a 30 minute presentation. Whether it is the Ontario Liberal Caucus, a Conservative Regional Caucus or the NDP, it would be an effective way to deliver your message and bring allies into your room.

The CMA’s team of communication specialists will design the right public awareness, media, advocacy and education campaigns…. but the personal question for you is this: “What is my role in this? What can I do in my community? What actions are mine to take with the players in my community, in my medical network, in my province?”

You the physicians are a perfect example of that Marshall McLuhan truism “The medium is the message”… You are the message.  But I would like to take the message one step further, the message must be repeated and repeated and repeated.  Put yourself in the place of a politician. Politicians hate doing it but to be successful they keep repeating the message. I have covered most of them and watched Pierre Trudeau and Brian Mulroney repeat policy after policy in every corner of this country. Never assume, the patient or the public has heard it before. It may be painful but in the long run, the prescriptions you are offering will pay healthy dividends.

I will leave you with this:

The very first recommendation in your association’s health-care transformation plan is “gain government and public support for the CMA’s Charter for Patient-Centred Care.” Communications is central.  Full commitment to the CMA’s plan requires commitment to a national, long-term communications strategy and investment in adequate, reliable financial and human resources to support it.

Look on these requirements as an investment.  Also, be open to making some adjustments within your organization.  One challenge I see for you will be maintaining the necessary ongoing leadership for your plan when the president of your association only holds a one-year term. In light of your objectives, a two or three-year term for this leadership position would make more sense.  If this cannot be changed, your communications strategy will have to accommodate this challenge right from the start.

In summary, there are three points I have made:
• Invest in your communications professionals and involve them from the outset; bring them in the room.
• Infuse the project of transformation with a spirit of collaboration, teamwork and consensus-building;
• Find champions and build alliances with them.

And in the end, your successful strategy will rest on how you engage each and every stakeholder. It is about a solid communications strategy and a solid engagement strategy.  For most of you, this may not be new and I know that the CMA, its board and particularly the professionals on Jacques Lefebvre’s team will lead you into a most successful communications strategy.

Success will be when patient-centered care is imprinted in the Canadian psyche as yet another great Canadian value.

And when this has been accomplished, you can bring in Nick Nanos to take the pulse of it, the measure of it!

Thank you.