Innovating Innovations in Healthcare

Yesterday, I had the pleasure of visiting the Centre for Innovation in Complex Care. It is an interprofessional, trans-institutional organization, housed at the University Health Network in downtown Toronto that is

dedicated to studying how to improve the entire process of care for patients with multiple problems. Its purpose is to engage our patients and clinicians to identify problems with current healthcare practices and develop solutions for addressing them. Innovative research and evaluation in a real clinical environment will allow our clinicians to utilize the latest technology to improve patient care.

It is also, much to my delight, a UCaPP organization, and it is its UCaPP nature that is its key to success in achieving true innovation throughout every aspect of the healthcare system.

The Centre has active projects that range from improving clinical communications via new Blackberry applications, to methods that are focused on improving the in-patient experience, to completely rethinking and redesigning the systems and processes associated with treating atrial fibrillation, currently the most frequently encountered arrhythmia for which patients are admitted to hospital (not to mention being “challenging, costly, and resource intensive”).

So what makes the CICC innovative in its approach and organizational design – that is, what makes it UCaPP – and how does this influence its success? Fundamental to all UCaPP organizations is the idea that change happens where it happens, and the impetus for change can come from literally anywhere in an organization, or in this case, anywhere throughout the healthcare system. CICC members include physicians and nurses, pharmacists and nutritionists, engineers and designers, researchers and patients. It includes members from all the teaching hospitals in Toronto, and institutions elsewhere in Ontario. To become a member, one “only” needs to initiate a project (more on that in a moment), and find collaborators, which precisely echoes the process I’ve observed in other UCaPP organizations. Their “rounds” – medical jargon for socializing knowledge – are generally open to any interested party, and those who are interested in innovations in healthcare that address systemic or global issues are welcome to initiate a project conversation that is consistent with the Centre’s vision and values. As its Medical Director, Dr. Dante Morra, said to me, “if you’re interested in addressing a handwashing issue on 13E, we’re not so interested. If you’re interested in addressing a handwashing issue throughout the entire system, come talk to us.” Project participation is largely through self-nomination, which means that there is an emergent and organic vetting and review process that occurs throughout its life. There are lots of opportunities to share information, through weekly operational rounds, monthly deep-dive reviews of active projects in which all members from among multiple areas of expertise have an opportunity to contribute, and innovation rounds that look at new opportunities coming into the Centre.

The Centre strikes me as non-hierarchical, with any individual being able to take relative leadership roles, depending on the nature of what type of leadership needed at any particular time for any given project. Most important, however, is that the collaborative leadership creates a tremendous sense of camaraderie, with individual autonomy among the members, collective responsibility for the success of each project, and mutual accountability for the Centre’s overall success. It’s through innovations like this one that healthcare will become sustainable, especially in the face of increasing challenges and demands.

A Letter Sent to OISE Dean Julia O'Sullivan Regarding the Peto Thesis Controversy

Dear Dean O’Sullivan

I am writing to express my concern over the recent controversy surrounding the master’s thesis of a recently graduated student from the Sociology and Equity Studies in Education department, Jennifer Peto. Aside from Ms. Peto’s particular political views – with which I will admit I do not agree – my concern centres specifically on the questionability of the scholarship represented by the thesis, and hence on the reflected questionability of the scholarship produced at OISE in general. As a recent graduate of OISE myself, having earned both master’s and doctoral degrees in Adult Education and Counselling Psychology, I am dismayed by the prospect of the value of my degree being diminished, and my own scholarly contributions being called into question. After all, the worth of one’s academic credentials are only as valuable as the reputation of the institution from which they were obtained.

The common discourse in the popular press – The National Post and Macleans Magazine, to name but two examples – and on the floor of the Ontario Legislature directly calls into question OISE’s academic standards, including the rigour with which its graduate students are supervised, and the quality of work that is accepted as a graduate thesis. Indeed, an academic examination of eighteen thesis abstracts (including two for which the theses were reviewed in toto), prepared for University of Toronto’s President, David Naylor, and reported on in today’s press can be summarized with a sad indictment: having accepted what appears to be a sub-standard polemical essay as scholarship worthy of a master’s degree has “hurt the scholarly reputation of one of the world’s great universities … [and] are related to a larger systemic problem at OISE.”

Knowing the politics-in-use among the various graduate departments, I can appreciate the differences between the critical discourse and focus on transformative praxis in Adult Education, for example, and the discourse of radical activism-at-all-costs that pervades Sociology and Equity Studies. Others, who are not as familiar with the specific political agendas of various faculty members, like Prof. Sheryl Nestel, cannot so easily contextualize and distinguish the supposedly scholarly production of one department from another. To outsiders, all masters and doctoral graduates from OISE can potentially be tarred with the same brush of questionable scholarship, dubious supervision, and laissez-faire awarding of graduate degrees. It is not only the reputation of the Institute that is being called into question; it is the individual reputations and qualifications of each and every graduate that are equally being doubted.

I, for one, am proud of the “contributions to knowledge” represented by both my doctoral and (empirically based) master’s theses. I am thankful for the outstanding mentorship and guidance I received from my professors in the Adult Education program. I cannot passively stand on the sidelines while the reputations of so many hard-working scholars are being summarily cast onto an academic midden heap because of what appears to be the politics of relatively few individuals.

The Provost’s initial response to this controversy, that the thesis is merely “a student paper,” is alarming. There is a substantial difference between a thesis entered into the university’s compendium of knowledge production on Tspace and a course paper that, in many cases, often reflects the professor’s espoused worldview, replayed through lenses of the professor’s preferred political hue. As a first response in an attempt to diffuse the controversy, it was an unfortunate statement. On reflection, it seems to cast aspersions on, and uniformly diminish, the value of all scholarship produced throughout the university—clearly not the intent of the Provost.

As has been done in other post-hoc cases of questionable academic standards, I am calling for an independent academic review of the master’s thesis in question to determine whether it truly meets the standards for an acceptable thesis at the University of Toronto. To be clear: it is not the specific subject matter of the thesis that I am questioning, but rather the degree to which the subject matter has been adequately examined and vetted in accordance with the standards of academic rigour worthy of a master’s thesis at a top-tier university in Canada. In my opinion, at this point only an independent review will be able to establish the scholarly merit of Ms. Peto’s thesis, and therefore, the validity of the degree to which she was recently admitted at convocation. Only such a review will help to clear the air and to begin to rehabilitate the seemingly tarnished reputation of OISE, a reputation that deserves to be held in high esteem.

Sincerely yours,

Mark L. Federman, Ph.D.