Capital District Health Authority uses ‘inconvenient truths’ to transform healthcare

by admin admin | Nov 01, 2009
Prior to 2006, the Board of Directors of Nova Scotia’s Capital District Health Authority was doing what it thought a board should be doing: controlling and managing financial risk for the organization it governed. However, it was also aware that the organization’s financial outlay was rapidly becoming unsustainable.

Key Messages

Nova Scotia’s Capital District Health Authority has embarked on a process to transform all aspects of its healthcare delivery, with the goal of improving population health outcomes and focusing on prevention.

Citizen engagement and public accountability are critical elements of the organization’s transformation. The process has involved structured dialogues with thousands of residents, patients, businesspeople, community representatives, and healthcare workers ranging from cafeteria servers to surgeons.

As a result, there are fundamental changes in thinking, both at the board level and throughout the organization. The culture is gradually shifting to one where people not in formal leadership roles take personal accountability and bring forward ideas for change, becoming excited about their role in improving healthcare.

Prior to 2006, the Board of Directors of Nova Scotia’s Capital District Health Authority was doing what it thought a board should be doing: controlling and managing financial risk for the organization it governed.

However, the Board was aware that the organization’s financial outlay was rapidly becoming unsustainable due to the demographic trends of an aging population. It also knew that Capital Health was spending money – nearly $2 million a day – to treat illnesses, but in spite of the financial outlay, there was no tangible improvement in overall population health outcomes.

When Chris Power took on the job of President and CEO in 2006, it was on the condition that the Board supported her vision to transform fundamentally the way the organization delivered its care and services. Power set about to create a truly patient-centred healthcare system, a task that involved changing the beliefs, attitudes and actions of her 11,000 employees and the 400,000 people Capital Health serves in the Halifax Regional Municipality and West Hants county. “We have set our sights on creating a world-leading haven for people-centred health, healing and learning,” Power told the Halifax Chamber of Commerce after taking the job.

Fundamental transformation is a tall order and can take years to achieve. To get to where it needed to be, Power knew that the organization needed to start with a clear understanding of its current situation.

Engaging, listening, learning

Armed with evidence showing that decisions based on public input are of higher quality and more sustainable, Capital Health initiated what it called a “reality check” of the organization and the local healthcare system. Beginning in the spring of 2007, for two months, Capital Health hosted community meetings in church basements, soup kitchens, town halls, and during night shifts, to involve thousands of people the organization didn’t normally hear from. About 50 Capital Health employees, chosen for their capacity to be open to new ideas, asked people what it would take to transform the organization. Then they listened to the answers.

They're not just walking the talk; they are working very hard to live up to this new way of working and listening.

That initial process of engagement “created what we came to not-so-lovingly call our ‘inconvenient truths,’” says Lea Bryden, vice-president of citizen engagement and accountability. Capital Health learned it was not seen as holistic, but rather as treating body parts and not people. Feedback showed that Capital Health was perceived by its community as an organization that didn’t share information and decisions, was isolated from the community, and was often caught up in politics.

The opinions revealed through citizen engagement emphasized that Capital Health needed to shift from being providers who exclusively treat illness and injury, to being committed learners dedicated to creating the conditions to change the behaviours that would lead to optimal health. In response to citizens’ suggestions, the organization published its commitment in the form of a new charter, A Declaration of Health, which begins with a promise to treat the whole person, articulates its new relationship with its employees, and embraces broader community co-operation. The organization then implemented five strategic imperatives – including citizen engagement and accountability.

Capital Health is already changing the way it does business, beginning by embracing openness. For example, it now shares, on its website, all the engineering studies and building assessments it receives concerning the need for capital improvements to its hospitals and other infrastructure.

Changes are being seen at the community level as well, as demonstrated by the creation of a Wellness Centre in the Spryfield area of Halifax that will be the base for a community health team. Marjorie Willison, a community developer with the Chebucto Communities Development Association, says that instead of dictating what services will be available through the Centre, Capital Health is waiting for the results of citizen consultation. “They’re not just walking the talk; they are working very hard to live up to this new way of working and listening,” Willison says.

A shift in thinking

At a board level, there are also fundamental differences in thinking, says Jim McAllister, a former banker and an eight-year board veteran. “In the early days, this transformation was a little unsettling, and we verbalized that,” he says. Power helped make them comfortable enough to leave the day-to-day management on her doorstep and those of the people she hired to help.

An ongoing challenge for the board, and for the organization as a whole, is to find ways to measure whether Capital Health is meeting its goal of becoming a world leader in putting patients at the centre of care and in helping citizens take responsibility for their own health and health system. To help determine outcomes, Capital Health’s new chief financial officer has developed a three-year rolling business plan, rather than the standard yearly budget. In addition, more than 100 people, from doctors to food service workers, have accepted the CFO’s invitation to join the financial planning team.

In embracing the concept of citizen engagement and celebrating its successes, Capital Health is acknowledging its “inconvenient truths” and moving forward with a renewed, positive outlook. “People are genuinely concerned and are taking ownership of not only the financial piece, but also of the business and the patient and the implications for the patient and the organization,” McAllister says. “I call that a spirit of accountability, and it’s wonderful to watch.”


Pass it on! is a publication of the Canadian Health Services Research Foundation (CHSRF). Funded through an agreement with the Government of Canada, CHSRF is an independent, not-for-profit corporation with a mandate to promote the use of evidence to strengthen the delivery of services that improve the health of Canadians. The views expressed herein do not necessarily represent the views of the Government of Canada. © CHSRF 2009