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Introducing centralized system presents people challenges Diagnosing issues

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Every year, more than 15 million diagnostic tests are ordered from Manitoba's public sector -- and that's not including an additional eight to 10 million tests conducted in private facilities.

"Eighty-five per cent of all medical decisions are based on some kind of lab or medical imaging result," says Jim Slater, CEO of Diagnostic Services of Manitoba (DSM), the non-profit corporation responsible for delivering public laboratory and rural diagnostic imaging services supported by over 1,500 professionals at 79 sites.

"We know from the cancer work being done in this province that diagnostics touch every step of that journey. It's critical to get people diagnosed so they can then make decisions on the most appropriate type of treatment therapy."

Slater, who began his career as a medical laboratory technologist, says that with the phenomenal growth of diagnostics due to the advancement of technology and increased demand, it is important that Manitoba has a centralized leadership body to oversee the delivery of diagnostic services.

"Manitoba has a complex health-care system of players delivering services and we need a central entity that can co-ordinate the delivery of those services while bringing the efficiencies to ensure there are no redundancies," he says. "The intention of DSM is to be the organization that can pull it all together to ensure that the delivery of services is effective, efficient and sustainable."

Now in Stage 2 organizational growth, DSM has gone through a period of building its infrastructure. The challenge now, Slater says, is rallying the staff and all stakeholders to deliver on its intended purpose.

Q: You came on board at DSM last fall with fresh perspective; what has this allowed you to see as the organization's challenges?

A: DSM has not quite fulfilled the vision that was contemplated when it was first established in 2002. It's been a slow progression because the organization was pulled together from scratch in a health-care world that resists change and tends to be very territorial and protectionist. Today, it's not the infrastructure that needs to be worked out, it's the delivery of the benefits that come from centralization. We need to further prove the value of having a provincial role to our stakeholders including the regional health authorities, public labs, hospital labs, cancer care labs and clinics.

DSM can provide everything from technical and clinical support to human resources and we believe those things can be delivered better centrally versus taking 15 or more different approaches.

At the same time, managers around the province can work collegially to share issues and receive support. Previously, if they had an equipment malfunction, they would've been at the mercy of a busy equipment supplier. But now they have access to provincial support, either by requesting assistance from another site or asking DSM to mobilize help to their region. As a result of this collaborative culture, we are starting to see a renewal of optimism amongst stakeholders -- even those who have something they must let go of -- and a reaffirmation of the value we can bring.

Q: What are some of the residual challenges of centralization that you still need to address?

A: People have long memories. Certainly, they remain working in their particular health region, site or hospital so even though they are in the same community or workplace, they now have a different boss and sometimes they aren't sure where their loyalty lies. My position on that is they should remain loyal to wherever they are delivering their service. Another challenge is that through DSM's inevitable inheritance of a myriad of different facilities, we have seen that quite a wide range of investments have been made over the past decade. Some sites have invested in technology and staffing, others have not. Some physical spaces are no longer big enough or appropriate and we still need to address needs such as bringing in new equipment or supporting additional training and development.

Q: What do you view as your main "people" priorities?

A: I have two main priorities. The first is to hire only qualified technical and medical staff to deliver diagnostic services. I strongly believe that we should not hire below standard. When you're short staffed, it's not easy to stay the course and be patient in hiring the right people, but I would rather a position stayed vacant than provide sub-quality service. The second, but equally important, priority is to begin recognizing people within our existing staff who can move into leadership roles in order to lead and support our frontline people. That's been the desire, but up until the past couple of years, it hasn't necessarily been the outcome.

Q: What attributes are you looking for in future leaders?

A: I want people who understand the value that they bring, whether they're a manager or a technical director or a vice-president or an accounts payable person. I've spent a great deal of time talking to our leadership team about refocusing on our true purpose and value. We need to be planning provincially, delivering regionally and also serving the local need to deliver appropriate diagnostic services to the patient for whatever they need it for. In order to do this, I want leaders who can handle being challenged but are also willing to challenge me back. I absolutely want people who can challenge the in-box thinking that health care tends to be so stymied by. I want them to take the risk of coming up with more creative and innovative ways to do things and in return, we will give them the authority right down to the front line to make decisions that will enable them to take action.

Q: As a new organizational leader, what challenges have you set out for yourself?

A: As I came to Manitoba from Saskatchewan, the biggest challenge for me is learning all our stakeholders. I'm hoping to learn the geography of all 79 of our labs and rural diagnostic imaging service sites without looking at the map. My goal is to spend more time getting out there and personally visiting each site so I can get a sense of the community and of the relationships in it. Secondly, you can't talk about health care without mentioning the small "p" and big "P" of politics and that is something I've also had to get up to speed on. However, I've felt a tremendous amount of support as people seem to be going out of their way to help me learn that aspect of this job.

Q: Who or what has been your greatest leadership influence?

A: Interestingly, I think that poor examples of leadership have influenced me more into becoming the leader I want to be. Going back to my early lab tech days, I worked for one manager who didn't leave her office. When there was an issue with an employee, she couldn't confront the individual making a mistake or causing problems; instead she would address it in writing in a communiqué for the entire staff. As a result, everyone knew who it was meant for except the person it was actually directed to. That taught me the importance of getting out and talking to people face to face. Good leadership is not about pushing paper, it's about interacting with your people and building relationships.

Q: What type of leadership books do you prefer?

A: I would say I am more drawn to out-of-the-box thinking by authors who aren't afraid to break the rules and challenge the status quo. Some of my favourite books are written in parable style, including Who Moved My Cheese? by Spencer Johnson and My Iceberg is Melting by John Kotter. The book that best emphasizes my leadership style is probably Who Are "They" Anyway? by BJ Gallagher. It's a fable about achieving success through personal accountability when "they" say you can't do something. Of course, "they" are "us," and anyone who wants to get on my bus needs to know that each of us must take charge of addressing issues within the organization.

-- With reporting by Barbara Chabai

John McFerran, PhD, F.CHRP, is managing director of Boyden Global Executive Search. He can be contacted at jmcferran@boyden.com

Republished from the Winnipeg Free Press print edition January 21, 2012 H1

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