Indholdsfortegnelse for Winter 2016 i Rotman Management

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The CEO of one of Ontario’s 14 Local Health Integration Networks says it’s time to focus on system leadership. Ontario’s Local Health Integration Networks (LHINs) have been called the ‘air traffic controllers’ of the healthcare industry. Can you describe your mandate? In the Southeast LHIN, which I oversee, we have accountability agreements with 120 different organizations. While we don’t run these organizations, we are responsible for managing the entire system. Our specific mandate has six components to it: local health system planning; efforts to integrate the system by bringing organizations together to work cooperatively; funding the organizations (we allocate CAD$ 1.1 billion per year to our 120 members); accountability (we hold every organization accountable for the funding they receive through performance metrics that are publicly reported); and lastly, we’re responsible…

Not long ago, I decided to enlist the guidance of a nutritionist. I liked the results I was seeing in one of my regular tennis partners: I had observed him gradually getting faster and less-winded than he used to — and unfortunately for me, winning more of our matches than ever. When I asked him about his ‘program’, he informed me that he had been under the watchful eye of a nutrition expert, and happily shared a referral. The truth was, I should have had a lot more energy. I wasn’t eating much and I exercised like a maniac—playing tennis, mountain biking, and stand-up paddle boarding on a regular basis. Over the course of two short weeks, what I learned about nutrition was contradictory to nearly everything I thought I…

BETWEEN GENETICS, bad luck, and the occasional flu bug, getting sick is a natural part of life. Health problems cause the average employee to miss three to six days of work each year. But the ‘average’ employee doesn’t really exist: while some people never take a sick day, others will be away for more than five days — many more, if they suffer from a chronic illness. What about those who do show up for work every day? Are they really giving their all — or are they just struggling through despite an emotional or physical health issue? These could include anything from worrying about a sick child to chronic depression or back pain, and studies show that three out of ten working people admit that such issues lower their…

A few years ago, the New York State Department of Health asked my colleagues and I a burning question: how much would the government need to subsidize fruit in school lunchrooms, so that children would select and eat five per cent more of it? A quick visit to local schools showed that fruit was being sold in metal chafing dishes, in a dim corner of the serving line, under a sneeze shield. The 50¢ price tag wasn’t the issue: the young students didn’t even know the price of the fruit, as it would simply be deducted from their pre-paid debit account, set up by their parents or the USDA. We found that with two simple steps — arranging the fruit in attractive bowls and placing it in a well-lit part…

IT IS FAIR TO SAY THAT OUR WORLD MOVES AHEAD in fits and starts. Sometimes, cataclysmic events — oppressive regimes, wars and other catastrophes — move humanity backwards; but most of the time, our advances are of the ‘normal science’ variety, whereby someone figures out a way to make the current system work a bit better. A business will tweak its product or service to the benefit of users, or a government will tweak existing legislation to produce a benefit for society. Such incremental advances are helpful, and the governments, businesses and non-profit organizations that work to produce them deserve our encouragement and support. However, every once in a while — backed by revolutionary thinking — a society leaps forward to a fundamentally ‘new equilibrium’. The status quo is left…

Stryker has always done acquisitions, but it has been much more aggressive in the two years since you joined it. While acquisitions create growth, they can also be disruptive to a company’s culture. Tell us how you’ve dealt with this. I would start by saying that there are two different kinds of acquisitions: ‘scale acquisitions’ and ‘bolt-on acquisitions’. We tend to focus on the latter: we like to buy a technology and ‘plug it in’, because our sales force and distribution channel are second to none. The last six deals we’ve done — including a bed business in London, Ontario — were all about technologies or products that we wanted to own. In these cases, some of the management team stays with us, but we’re really taking on the product…

You believe that within 10 years, the ‘health business’ will look very much like other consumer-oriented, tech-enabled industries. Describe how you see this unfolding. My colleagues and I characterize this movement as the New Health Economy, and there are several aspects to it. The first is a mindset shift among providers, from a volume-based approach to one that is based on creating value for people. Patients will be treated more like customers, with more personalized, convenient and on-demand care. Our data shows that one third of people would change their healthcare provider based on the promise of a better experience — so there is a strong basis for this shift. A second aspect of this movement will be a shift from ‘episodic’ treatment to care that is more continuous. Obviously,…

How do you define the ‘Cleveland Clinic experience’? Our guiding principle is, Patients First, and achieving that takes more than world-class clinical care: it requires care that addresses every aspect of a patient’s encounter with the Clinic — from their physical comfort to their educational, emotional and spiritual needs. We were the first major academic medical centre to make patient experience a strategic goal, the first to appoint a Chief Experience Officer, and one of the first to establish an Office of Patient Experience — which I oversee. Our mission is to ensure consistent, relationship-centred care by partnering with caregivers throughout the Clinic to exceed patient (and family) expectations. Our team of professionals serves as an advisory resource across the Clinic; provides data analytics; identifies and supports sustainable best practices;…

A SOCIETAL SHIFT TOWARDS the instantaneous — with the explicit intention of saving time — is infused into modern life. But what are the implications for our happiness? Technological innovations that offer convenience and time efficiency have brought remarkable changes to the way we spend our time, inarguably making our lives more convenient and our time usage more efficient. Presumably, being enabled to work more efficiently and spend less time on chores should provide us with greater opportunities for discretionary leisure time, enhancing our subjective well-being: yet while we have indeed experienced an appreciable increase in leisure time over the course of the past half-century, there has been no related improvement in aggregate happiness. In our research, we have found that cultural symbols that tout ‘time efficiency’ influence how we…

Twenty years ago, as I helped a parade of sick adults and kids at my family practice and witnessed nursing homes full of bed-ridden patients, I had an epiphany. I was partly to blame for their medical misery. Why? Because doctors do little to prevent sickness. What if I spent more time teaching people how to stay healthy? After all, isn’t prevention the better medicine? It is, and the return on proactive wellness investment is great. Today we can leverage science to predict an individual’s disease risk with genetic profiling. There are many biomarkers to screen for early risk factors such as glycation, inflammation and oxidative stress which lead to the big killers: heart disease, diabetes and cancer. Much can also be done to evaluate and balance one’s hormonal levels…

You have said that healthcare is in the midst of a ‘Gutenberg moment’. Please explain. Back in the 15th century, books were extremely costly to produce, and as a result, less than eight per cent of the population of Europe was able to read. Only the church and the wealthiest citizens could access the collected works of humankind in written form. For everyone else, knowledge and stories were communicated orally. Then Johannes Gutenberg came along and invented the printing press — and overnight, knowledge and information were democratized. Perhaps nothing in human history has had such a momentous impact on society. I see many parallels to that era today, with the widespread embrace of the smartphone. This is an extraordinary time in healthcare: we are witnessing nothing less than the…

ONE OF THE ICONIC DEMOGRAPHIC DEVELOPMENTS of the 21st century is the growth of cities: while 10 per cent of the world’s population lived in cities in 1900, 53.6 per cent now resides in an urban area — and by 2050, this number is expected to exceed 75 per cent. Nations such as Canada are already through much of the transition. In the mid-1870s, Canada was 20 per cent urban and 80 per cent rural, whereas by 2005, this balance had reversed. Other relatively high-income countries have moved through similar transitions, including Brazil (now 86% urban), the United States (82%), Australia (89%), United Kingdom (90%) and Jordan (78%). Going forward, virtually all of the world’s urban population growth will occur in less-developed countries. Cities of the developing world will absorb…

When Google famously allowed its engineers to spend 20 per cent of their time pursuing a passion, you spent your time on a cause dear to your heart. Please describe it. Back in 2003, I was out taking a walk, letting my mind wander, when I had an epiphany. Suddenly, I knew what I wanted to do for the rest of my life: I wanted to work on creating the conditions for world peace in my lifetime. Only an hour later I was asking myself, ‘Who am I to take this on? Is it even possible?’ But the thought kept returning, and after a while I realized, ‘This is for real.’ I began to think about what it would take to create the conditions for world peace, and after ruminating…

MANY OF US WISH WE HAD MORE FREE TIME to do what we love — whether it be working out, reading or playing guitar. In theory, it is possible to use the money we earn to ‘buy’ more of this kind of time; but research suggests that even when we can afford to do so, we are not spending our time in more enjoyable ways on a regular basis. Researchers refer to the amount of time that people spend in an unpleasant mood — when feelings of tension, depression or irritation outweigh feelings of happiness — as the ‘U-index’. For instance, people are rarely in an unpleasant mood while exercising, reading or praying; but unpleasant moods are common while working, commuting and doing housework. Sadly, over the past 50 years,…

IT IS ESTIMATED THAT ONE IN FOUR ADULTS will suffer from a diagnosable mental disorder that impairs their social, interpersonal or occupational functioning, and as a result, mental illness has become a leading global health concern. It is further estimated that the percentage of the population with an undiagnosed mental disorder is almost equivalent to those with diagnosed disorders, and that many sufferers of mental illness also have substance abuse problems. Given that these issues are so prevalent in the working population, managing employees with ongoing or episodic mental health conditions is a job demand that most managers are likely to face. In this article we will examine what is required to equip managers — and ultimately, organizations — to deal with these complex situations. The Business Impact of Mental…

The role of business in society has evolved over time, from a philanthropic approach, to corporate-social responsibility, to a model that you pioneered: Creating Shared Value. Please define it for us. Creating Shared Value (CSV) is about the ability of a business to move beyond meeting customer needs to address fundamental societal needs through its business model. The traditional approach has been to run your business and think about its social impact as a separate set of considerations. As you indicate, this began with a focus on philanthropy, and it evolved to employee volunteering and other initiatives that fall under the label of corporate social responsibility. The idea was to be a good corporate citizen by avoiding harm, being transparent and operating sustainably. There is no question that all of…

IN RECENT YEARS, a number of high-profile cases involving the violation of online customer privacy have raised public alarm. For example, Home Depot made headlines last year when a massive theft of its consumer credit and debit card database affected more than 56 million customers. And in 2012, Target was in the spotlight for a newsworthy privacy violation: the company’s data-driven algorithm had correctly identified a customer’s pregnancy, and proceeded to send the teenage girl coupons for baby gear — before her father knew about the pregnancy. Many other online businesses — including Facebook, Google and Amazon — have also been featured in the media regarding privacy concerns. Why are we seeing such an increase in high-profile violations? We believe that two forces have fueled this trend. First of all,…

FEELINGS OF ANXIETY are a pervasive problem in today’s fast-paced work environment: in recent surveys, 41 per cent of workers reported ‘elevated levels’ of workplace tension, and studies show that as many as 80 per cent feel ‘stressed out’. The bad news for employers? Anxiety-related absences are, on average, four times longer than other illnesses or injuries. The scourge of anxiety has been estimated to cost the U.S. economy over $40 billion, annually. High levels of anxiety are not just expensive for organizations, they have also been found to have negative effects on ethical behaviour, organizational effectiveness, and economic success. Anxiety is also problematic for employees, as it contributes to job dissatisfaction and has detrimental consequences on job performance. How exactly does anxiety affect job performance? Research in this domain…

Many people feel that healthcare is a fractured system. How is one of the world’s leading healthcare organizations tackling this issue? To date, the system has been optimized to mitigate risk, not to create value — but that is beginning to change. The main issue is, as ironic as it sounds, healthcare has not been sufficiently patient-focused. The traditional model is more like a ‘conveyor-belt’, whereby a patient moves from one specialist to another, and he is the only constant: he might go from a cardiologist to a radiologist to an oncologist, and it’s up to him to preserve his ‘story’ throughout these encounters. Mayo Clinic is unique because of our integrated practice model. This essentially means that all the services a patient might need — doctor visits, testing, surgery,…

Peter Drucker referred to healthcare organizations as ‘the most complex form of human organization that we have ever attempted to manage’. Do you agree? I do, for a number of reasons. First, there are so many well-intentioned people working within the healthcare system, but they don’t entirely agree on what the system’s goals are. Some believe the goal is ‘to extend life’, full stop; others believe it’s ‘to extend life, given the resources available’. There are also genuine disagreements about how to achieve these goals. Whenever you have lots of well-intentioned people framing a challenge differently, you get complexity. Another reason is that healthcare organizations have lots of moving parts, but they’re not machines — they’re social systems. As a result, when you change one part of the system, you…

FOR MORE THAN 20 YEARS, leaders around the world have been fascinated by the Toyota Production System. The system — known as ‘lean’ — has made the automaker one of the most successful and admired companies in the world, and as a result, the benefits of applying lean manufacturing principles to any kind of organization are now well known greater profitability, higher quality, lower costs, and improved employee engagement — to name a few. Unfortunately, while many have tried, few organizations have actually achieved a lean transformation. The reasons for this are varied: some leaders can’t make the intellectual leap required to translate a system from auto manufacturing to, say, healthcare or banking; and in other cases, the Japanese jargon — heijunka, kanban, muda — is too high a hurdle…

LET’S FACE IT: business models are less durable than they used to be. The basic rules of the game for creating and capturing economic value were once fixed in place for years, even decades, as companies tried to execute the same business model better than their competitors did. Today, business models are subject to rapid displacement, disruption, and in extreme cases, outright destruction. Consider a few examples: • Uber sidesteps the license system that protects taxicab franchises in cities around the world. • Coursera and edX, among others, threaten business schools with massive open online courses (MOOCs). • Bitcoin bypasses traditional banks and clearinghouses with blockchain technology. • Tencent outcompetes in Internet services through microtransactions. The examples are numerous — and familiar. But what’s less familiar is how these new…

IMAGINE THAT YOU MEET AN OLD FRIEND for lunch at a local restaurant. It’s an hour later than you usually eat, and you are really hungry. As soon as you sit down, the waitress hands you a full-colour menu, and right there on the first page — in all its glory — is a glorious cheeseburger and a side of golden French fries. Are you more likely to order the burger, or the spinach salad with grilled chicken, pictured underneath it? Research shows that close proximity to stimuli that induce a visceral reaction in us — whether it be hunger, thirst, fear, arousal or pain — greatly taxes our ability to make thoughtful decisions; and as a result, you will be more likely to opt for the unhealthy choice. The…

FOR MOST OF HUMAN HISTORY, people over the age of 65 have not exceeded three or four per cent of any country’s population. In today’s developed world, they comprise roughly 15 per cent, and by 2050, this could reach 25 per cent. While aging is a global phenomenon, its effects have thus far been most dramatic in developed countries. The overall median age in these countries rose from 29 in 1950 to 39.6 in 2009, and is forecasted to rise to 45.5 by mid-century. Also by 2050, in fast-aging European countries such as Germany, Spain and Italy, the share of the elderly population will be over 35 per cent, while in Japan, Korea and Singapore, it will approach 40 per cent. If current demographic trends continue, by 2040, Mexico will…

STEP 1: OBTAIN ENDORSEMENT FROM ORGANIZATIONAL LEADERS Why it matters. Unless organizational leaders clearly support efforts to protect and enhance workplace psychological health and safety (PH&S), there is little chance of making any lasting positive change. Leaders who understand the importance of PH&S will send a clear message regarding the urgency of these interventions, allocate sufficient resources to them, demonstrate the organization’s commitment to change, and drive change when reluctance or resistance form barriers. How it is done. Organizational commitment depends upon persuading all leaders that: (i) improving PH&S is important in relation to overall organizational priorities—that is, there is a strong business case for taking action; (ii) improving PH&S is feasible, given available staff and financial resources. The business case rests on three pillars: Financial benefit: Psychological health problems…

It is widely believed that stress makes us sick. But as a result of your research, you’ve changed your mind about it. Please explain. The effects of stress are extremely diverse and complex. While they include increasing our risk of illness, they also include positive things, like better brain functioning and increased resilience. The time has come to change the notion that stress is uniformly negative, and that the appropriate response is to attempt to construct a stress-free life. These days, we use the word ‘stress’ to describe anything that is uncomfortable or difficult; but the fact is, these same circumstances can ultimately provide learning, pleasure and meaning. We have transferred the scientific findings about one aspect of stress — that it can increase our risk of illness — to…

In your first few months as CEO of the University Health Network (UHN), you encouraged employees to tell you what they liked — and didn’t like — about working there. What did they tell you? The thing that stood out was that so many of them talked about how much they loved their teams — the people they work with each and every day. Enthusiasm and respect for their team members came through uniformly — which is great, because if you think about how healthcare is practiced, we provide clinical care in teams, we do research in teams and we provide support services like human resources and finance in teams. What they told me they don’t like about their work is the high degree of complexity they face, and that…

Does the modern imperative of putting customers first extend to all players in the healthcare industry? Dr. Jean-Christophe Tellier believes so. He joined UCB in 2011 after holding senior positions at Macrogenics and Novartis. UCB, a Belgium-based multinational that focuses on drugs to treat neurological and immunological chronic diseases, has 8,500 employees in 40 countries and generated nearly $4 billion in revenue in 2014. Since taking the helm in January 2015, Tellier has sought to promote the concept of ‘patient value’ throughout the organization. I recently spoke with Dr. Tellier to learn about UCB’s efforts to embrace a ‘patient value mindset’ at all levels of the organization. What is the current state of patient-centricity in the pharmaceutical industry? Traditionally, the patient has been relatively far from the pharma industry’s consciousness. If you think about…

SINCE THE ECONOMIC DOWNTURN of 2009, my colleagues and I have been studying workplace trust and its impact on business performance. For the purposes of our work, we define trust as ‘the willingness to accept personal risk based on another person’s actions.’ We have compared the practices of organizations across industries, and found that they fall somewhere on a continuum between ‘Trust Leaders’ and ‘Trust Laggards’. Trust Leaders are the elite 10 per cent of companies whose workers uniformly agree with the statement, ‘Employees have high trust in leaders and the organization’. Trust Laggards are the 10 per cent whose employees say this statement ‘does not describe [their company] very well’ or ‘does not describe [it] at all’. The benefits of being a Trust Leader are many: these companies are…

January 11, 5:00-6:00pm, Toronto Speaker: Chris Bailey, Author Topic: The Productivity Project: Accomplishing More by Managing Your Time, Attention, and Energy Better (Crown Business, Jan. 6, 2016) January 12, 2:00-3:00pm, Toronto Speaker: Wendy Dobson, Professor of Business Economics, Rotman Topic: The Future of Canada’s Relationship with China January 12, 4:30-5:30pm, Toronto Speaker: Deepak Chopra, President and CEO, Canada Post Corporation Topic: Can Elephants Really Dance? – What Does It Take to Transform a 252-Years Young Institution Called Canada Post? January 21, 5:00-6:00pm, Toronto Speaker: Michael Lee-Chin, Founder and Chairman, Portland Holdings Inc. Topic: The Wealthy Invest Differently – Opportunities Typically Reserved for the Affluent and Institutional Investor February 2, 5:00-6:00pm, Toronto Speaker: Greg Ip, Chief Economics Commentator, The Wall Street Journal; Author Topic: Foolproof: Why Safety Can be Dangerous and How Danger Makes Us Safe…