I cannot believe we are already more than halfway through December. Whereas last year seemed to drag on because of multiple waves of COVID-19, 2022 appears to have flown by. It’s as if we had been spat out somewhat unceremoniously—like Jonah from the body of the great fish—back into “the real world.”
Needless to say, I am delighted to be back, face to face, among colleagues and friends, care providers, and users—masks not withstanding!
It’s been a long two-plus years, but I think it’s safe to say the pandemic is behind us—at least, the very worst of it. As an organization, we have clearly shown what we’re made of. Look no further than our outpouring of dedication and compassion for the most fragile and vulnerable among us, our resilience, and our innovative, entrepreneurial, pioneering spirit whose great strides are evident in the continued development of digital health across our sites.
We continue to rely on all of the traits I just mentioned, since we are rallying our forces at a time of change and challenge that is perhaps unprecedented in modern health care.
The prevailing “inquietude” is captured in a poem by Portia Nelson, entitled “Autobiography in Five Short Chapters”:
Chapter 1: I walk down the street. There is a deep hole in the sidewalk. I fall in. I am lost… I am helpless. It isn’t my fault. It takes forever to find a way out.
Chapter 2: I walk down the same street. There is a deep hole in the sidewalk. I pretend I don’t see it. I fall in again. I can’t believe I am in this same place. But it isn’t my fault. It still takes a long time to get out.
Chapter 3: I walk down the same street. There is a deep hole in the sidewalk. I see it is there. I still fall in… It’s a habit… But, my eyes are open. I know where I am. It is my fault. I get out immediately.
Chapter 4: I walk down the same street. There is a deep hole in the sidewalk. I walk around it.
Chapter 5: I walk down another street.
This is probably what life is like for many of us; it certainly was for me, these past few years. We set off, confident that we knew where we were going, only to find that the journey is rarely that simple. “Life,” said John Lennon, “is what happens to you while you’re busy making other plans.” Or as we are wont to say, “Man plans and G-d laughs!”
CIUSSS West-Central Montreal is a very special place, made all the more exceptional by those who work here—people from all religions, ethnicities and walks of life. Every day, they endeavour to embody the dream of our constituent communities, as they breathe life into a healthcare organization that is embedded with the values of those communities. Their goal is to provide care for all—and so it has been for nearly a century, whether in a stand-alone hospital, in long-term care facilities, in CLCSs, in CSSSs, and now in our CIUSSS.
Those who came before us made sure that our facilities rode the first nascent waves of modern health care. I’m certain that the generation that is our present workforce has no wish to founder in the backwash of the unfolding age of the next healthcare revolution—that of virtual care, AI, augmented reality and personalized medicine. Not only do we mean to be a part of it, we mean to lead it! The eyes of the world now look to digital health in its broadest conception as a way out of the current healthcare morass.
In short, our blossoming leadership in digital health—our foundational work of putting in place a continuum of value-based care, with enhanced access that includes virtual care—is, in fact, the realization of obligations to ourselves, as well as to those we serve. We strive to become a world-leading, next-generation healthcare institution: We are no less than the Future of Health.
As a CIUSSS, we chose to pursue digital health now, not because it is easy, but because it is right and because that goal will serve to organize and measure the best of our energies and skills. It’s a goal we cannot postpone, and one at which we intend to excel and to lead. There has been no better validation for our accomplishments than the three peer-reviewed awards that we have been honoured with over the past few months.
The challenge here is not the technology, but the people!
The trouble with most discussions about change is that, very often, you discover that you’re talking to people who, metaphorically speaking, are “living in the basement of a tall building.” When you try to tell them there’s more to the building than the basement—that there are also upper floors rising a hundred stories or more, that these floors are available to be lived in, and that a beautiful, sweeping expanse of a great world can be seen from the top floors—they will deny the other floors exist.
Invariably, they will invent all kinds of excuses for not seeking out the truth. “We’ve never been there, so how can we be sure?” Or, “We’re afraid of heights; we’re afraid to climb; it’s dangerous; we may fall.” Even if a few courageous individuals begin to talk about climbing to the upper floors, they are discouraged from doing so by their habit-frozen friends.
The inevitable result is that many of us remain in the basement of life, thinking there’s nothing more to it. We continue to live on the lowest floor, unaware of the view and sunlight that is on the top floors. Occasionally, we may catch a glimpse of a higher floor or may see a picture of the life “up there.” Or we may hear a description of what it’s like from someone who is excited about “the upper floors.” But we can’t bring ourselves to break old habits, to make a special effort, to find the courage to explore the upper floors.
This is not a criticism, but an observation—something we’ll be paying special attention to in the new year, as we introduce our approach to adaptive change management. I look forward to working closely with all of those who are interested in learning more.
All of which brings me to an insightful parable:
A father and son were traveling on the road, the father riding a donkey and the son walking beside him. They met a person who told the father, "You’re cruel. You ride the donkey and make your son walk! What kind of father are you?" So the father got off the donkey and put his son in his place. A little farther, they came across someone who criticized them: "What kind of son are you raising? On such a hot day, how can you let your child ride as if he’s a prince, while he makes you walk?" So the father took his son off the donkey and they both walked. They met a third person who was also upset with them: "What a bunch of fools! Why isn't at least one of you riding the donkey?" So they both rode the donkey rode until a fourth man saw them and cried, "How cruel you are, both of you riding this little donkey! Don't you have any concern for the welfare of animals?" So they dismounted and both of them carried the donkey. Finally, they met a fifth person who sneered at them: "You fools! Who in his right mind carries a donkey?"
The point of this story? Whatever you do, some people will inevitably be unhappy. If you try to make everybody happy, you’ll wind up like a couple of people carrying a donkey!
There’s been some banter over the past year or so about whether, in fact, we’ve been on the wrong track. My reply is to point to how one builds an organization that can endure. The formula? Lasting organizations reinvent themselves! This is the significance of our Care Everywhere rebranding.
Tension always exists between the old and the new, between continuity and innovation, between the unbroken continuum of the past and the bold determination to forge new paths into the future. Nevertheless, these sorts of conflicts and tensions give rise to the beginnings of creativity.
Creativity also includes the notion of transforming or improving on the past. Each generation builds on the achievements of the prior one, because each sees itself as part of a covenant with its original founders.
Permit me to conclude with a brief story from the Jewish tradition:
Rabbi Yehoshua ben Hanania asked a young man who was sitting at a crossroad, “Which is the way to the town?” The man pointed to one of the paths and said, “This way is short, but long. The other way is long, but short.” The Rabbi set out on the first path and quickly arrived near the town, but found his way blocked by gardens and orchards. So he returned to the young man and said, “Didn’t you tell me this path was short?” “Yes,” said the man, “but I also warned you it was long.” What we learn is that it’s better to take the long road that eventually and reliably gets you to your destination, than it is to take the short one that fails to do so, even though it looks as if it will.
There are no fast tracks. The long way can be short; the short way can be long. Better, by far, to know at the outset that the road is long, the work hard, and the setbacks and false turns numerous as we move forward.
As we embark on the next phase of our CIUSSS’s future, we will need grit, resilience, stamina and persistence. But the journey is exhilarating, and there is no other way. The harder it may get, the stronger we will become.
I want to take this opportunity to thank each and every one of you for your herculean effort in easing the burden of our users of health care and social services, as well as our colleagues. I wish you all a happy and healthy 2023 and I look forward to work by your side to overcome the inevitable challenges of the coming years.
Lawrence Rosenberg, M.D., Ph.D.
President and CEO