Our guest this episode was Jennifer Zelmer, President & CEO of Healthcare Excellence Canada. Jennifer joined Reuben Hall to discuss the integration and scaling of digital health innovations within the Canadian healthcare system.
“It’s rarely the technology on its own that is able to deliver the real value. So it’s that combination of technology in a really smart way of implementing to ensure that you get the value from it.” Jennifer Zelmer on maximizing technology’s potential through thoughtful use.
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Read Transcript:
Reuben (00:01)
Welcome to the MindSea podcast series, Moving Digital Health. Our guest today is Jennifer Zelmer, President and CEO of Healthcare Excellence Canada. Thanks for joining us today, Jennifer.
Jennifer Zelmer (00:13)
Thanks for having me, so nice to be with you.
Reuben (00:16)
Maybe you could start by telling us a bit about your background.
Jennifer Zelmer (00:20)
Sure, so I grew up mostly in Edmonton. But from relevance for this podcast, moved to Victoria for university to take a health information science program and have been involved with digital health since then, both working in Canada and overseas. And about five years ago, landed in Ottawa to start working then with the Canadian Foundation for Healthcare Improvement that then amalgamated with the Canadian Patient Safety Institute and to Healthcare Excellence Canada. So that’s the whistle stop tour of how I ended up here today.
Reuben (00:56)
Okay, interesting. I actually grew up in Victoria and ended up going to University of Alberta and moving to Edmonton. So we’ve may have crossed paths and been in similar cities over the years.
Jennifer Zelmer (01:13)
Nice, we swapped locations.
Reuben (01:15)
Yeah, so did you go to University of Victoria or…
Jennifer Zelmer (01:18)
Yeah, I did.
Reuben (01:19)
Excellent. So maybe you could tell us a little bit more about Healthcare Excellence Canada and your role there.
Jennifer Zelmer (01:27)
Sure, so Healthcare Excellence Canada is a national charity working with folks across the country to shape a future where everyone in Canada has safe and high quality health care.
We’re pretty new organization, so formed from that amalgamation that I mentioned in the middle of the pandemic, and really focused on doing that work in four ways. So identifying people who are working on wicked problems and the innovations that they’re finding along the way. And once those innovations are proven, looking to spread and scale them to more people.
Recognizing though that if we work innovation by innovation, we’re going to be at this for a very long time. So also building capacity for change within the health system, things like leadership development, engagement capable environments. And last but not least, recognizing that local teams can do amazing work. But if they’re trying to do that work in a policy or a structural context that makes things hard, they’re pushing water uphill. So we also work to catalyze policy and structural change that makes the things that deliver value easier to do.
Reuben (02:35)
Excellent. And maybe you could dive into some of those big pillars a little bit, specifically around innovation. What are some of the initiatives that you’ve been part of or are trying to spearhead?
Jennifer Zelmer (02:54)
You bet. So that first pillar, identify innovators and innovations. We just finished a health workforce innovation challenge, recognizing that recruitment is obviously important, lots of people working on that side of things, but if we’re not supporting and retaining people who work in healthcare, then we’re not doing what we need to do.
So the Workforce Innovation Challenge invited folks from across the country who were interested in that support and retention challenge to come together to work with their innovations in their context, but then share knowledge about what was working, build capacity together to make those changes happen. And we saw a whole array range of innovations across. So everything from scheduling changes, in some cases supported by digital tools that enabled that to happen, to changes in roles, supporting folks in different ways with creating psychological safety in the workplace. creating the ability to feel that you can make changes in your workplace as well that we know is associated with retention and better quality of work life. So we had hundreds of folks across the country focused on that challenge sharing with each other. So that’s an example of that sort of first pillar identifying those innovations. If think about the second pillar, that’s spreading and scaling individual innovations.
So if I take a couple examples in the digital space that we worked on a few years ago was around e-consults. So recognizing that if we can connect primary care providers with specialists in a more dynamic way, that we can shorten the time for the consults and also in about half of the cases, there’s actually not a need for a consult at the end of the day. If there’s able to be a need for a formal referral, if there’s able to be a quick e-consult between the primary care provider and the specialist. And so we worked there with two different models, one from Ontario, one from BC as sort of the initial innovations, and then worked with folks across the country to spread and scale those particular approaches. And we did see that in the end about half of the time a formal referral was able to be avoided and the average time to get a response was one to two days. So you were able to get a much more much quicker access to specialist care through that process in a way that supported primary care providers to be able to deliver care directly to their patients.
Reuben (05:29)
Okay, and so what form did that tool take? Was it more of a digital tool or interface or was it more of like a process procedure change?
Jennifer Zelmer (05:40)
We actually had both as part of the process. I don’t know what your experience has been, my experience has been, it’s rarely the technology on its own that is able to deliver the real value. So it’s that combination of technology in a really smart way of implementing to ensure that you get the value from it. And different teams in that challenge use different specific technologies. So what we were looking to identify as we do in all of our work is what are the core elements of that innovation that you need fidelity to, to get the results that you’re looking for and where do you need to adapt to local circumstances to realize the outcomes that you seek. And it’s that balance between the two that allows us to move something from a pilot project to spreading across other settings and being able to understand those differences. Where do you need that consistency? Where do you need the variation that adapts locally that you’re really able to move to scale successfully at the end of the day?
Reuben (06:42)
Yeah, I was going to ask about that local adaptation and variations from province to province or health authority. How are you meeting some of those challenges? Or are you seeing that it is in that specific circumstance? Were things very different from location to location? Or did the same solution generally work in the different contexts?
Jennifer Zelmer (07:11)
On the tech side, the solutions were quite different. But the end outcomes were the same, so the goals were the same. And so it was about how do you really deeply understand the needs of the patients you’re serving, the needs of the providers you’re working with? What’s the nature of how that technology solution is going to embed within their workflow, is going to embed within their needs? So the needs of, for instance, a primary care practitioner who may be primarily serving patients in very rural and remote areas will be different than the needs of someone who’s in downtown Toronto, downtown Vancouver, and has easy access to specialists right around the corner. So recognizing that those circumstances differ, and therefore the needs of not just the specific technology solution, but also how you implement it are going to differ as well.
Reuben (08:06)
And who are some of the partners involved there? Like, is this a collaboration between private sector and public, or is it more kind of innovation from within?
Jennifer Zelmer (08:17)
Yeah, so we tended to work directly with care providers, whether they were in regional health authorities or primary care or specialist services. And then they were the ones who chose the tech solutions that were best in their circumstance. So we didn’t do a collective procurement of a tech solution. They decided what was going to be right for them within the context and concept and with support from coaches, with support from tools and resources that we had available to them, to help make that easier to do, to be able to benefit from also their shared learnings peer to peer.
So we often hear from folks who join our programs that initially when they join, they may be attracted by the seed funding opportunities, some of those kinds of things, but often where they actually find the most value is by working with coaches and by working with other people like them and being able to share those experiences and learn together as they move forward. Because chances are the particular thing they may be tripping over, somebody else has already dealt with it and has an ability to connect and be able to learn together. And we definitely found that we’ve more recently been doing a lot of work around appropriate use of virtual care in primary care. And we’re seeing that in spades, that there’s practices, there’s approaches, there’s shared learnings that apply and can be beneficial across multiple settings and can just save you that time in angst somebody has already been down this path before. Great. Let’s learn from their experience.
Reuben (09:48)
Yeah. And what are some of those learnings? I’m not sure if you can talk about anything specific around virtual care that you’re seeing or just improving the whole experience for everyone.
Jennifer Zelmer (10:01)
I mean, I think virtual care at the beginning of the pandemic got slammed in fast and hard in lots of places because it had to be. And thinking as it was, right, that was what we had available to us. So, you know, super grateful to everybody who took the plunge at that point. It didn’t necessarily get introduced out of necessity in the most thoughtful way or in the ways that we now know are most effective. So there’s an opportunity now to look at what do we want to do going forward? What does the use of virtual care look like going forward? Where does it really deliver value? And where are the areas where frankly we need to adapt and adjust? So we’ve seen, for example, the real importance of connecting with patients and providers, really deeply engaging around how do we design this virtual care service that’s really going to be effective in that particular context, particular care path for patients.
So if you think about something like remote patient monitoring, there’s different ways of introducing remote patient monitoring. There’s different ways of approaching what types of tech you have in the home. Do you need to train in person before you go home or can you do that training remotely? So it’s all those kinds of experiences that we can learn from and improve everything from the mechanics of the user interface on the tech itself through to something as simple as how do you the tech when you’re done with it. How do you make that easier for patients as well?
Reuben (11:35)
Yes, all the logistics around actually having these devices in your home and then the aptitude to be able to maybe even troubleshoot something if it doesn’t work perfectly, right? Like who has the skills to be able to do that? How do you support the patients in their home? So what does some of that look like? people going into homes and kind of more hands-on supporting people who might not be very technically proficient in teaching them.
Jennifer Zelmer (12:19)
it actually starts even way before that. So engaging patients right upfront to understand the context in which the technology will be used, to do some testing with patient partners so that you actually decrease some of those things that are going to be tripped over. So, you know, if for instance, when you have a couple of patients test things, you find, gee, you know, a key problem is that this particular step is being missed. It’s not obvious. Well, Is there something you can even do upfront to eliminate that step that pre does it so that people don’t trip up over it? Or that really highlights that step in a process to make sure it doesn’t get missed? So what are the things that we can make the thing that you need to do easier to do? So it’s that design phase upfront where it starts. And then absolutely, once you’re in process, how do you then make it easier to troubleshoot along the way? So what are some of the most common things that come up?
In some cases, we actually had peer-to-peer support, so patient partners helping other patient partners to be able to learn from each other about how to effectively use the tech. In other cases, it required some different types of approaches and thinking about who was really in the best position to be able to provide that support so that things would go smoothly.
Reuben (13:39)
Yeah, it’s just like the human-centered design process that we’re using on an everyday basis when we’re designing mobile applications or web applications for patients. Really thinking through that user journey step by step and involving the patient in the process. Asking them questions, showing them prototypes. How would you do this? observing and getting their feedback at every step of the process and designing the system around them instead of forcing them to adapt.
Jennifer Zelmer (14:20)
Absolutely. mean, in a way, none of it’s rocket science, right? Like we know these core principles, but it is about doing them consistently and doing them well and doing them with a range of different patients and circumstances. So you’re not just working with partners in the design phase who may already be tech savvy, for instance, but making sure we’re bringing in the full range of patients who are going to be actually using whatever the solution is.
Reuben (14:38)
Yeah, sometimes the main barrier can be convincing the stakeholders that this is the right way to go about to do things because it takes time and it takes resources and sometimes not everyone’s on board. Have you found that you have to really kind of sell it up the chain or to everyone involved or is it pretty? people kind of see the value and are willing to invest in it.
Jennifer Zelmer (15:20)
I think most of the time people see the sort of value in principle. Sometimes haven’t had experience doing that kind of work in practice. So there is a process of, how do you do this work? And there’s always that tension isn’t there between, as you said, you know, it takes time, it takes resources up front. So that tension between making sure that we’ve allocated the time, we’ve allocated the resource to do that step as part of the planning versus, you know, quickly diving in. which is so tempting to do, but then you end up spending the time one way or the other, right? You can either spend it upfront or you can spend it later. Just depends on whether you want to suffer the pain in the meantime of not having done it.
Reuben (16:03)
You mentioned scheduling as well, and I’ve heard this is a big one from many others, that every hospital system is using different ways of scheduling. A lot of it’s just like spreadsheets, and there’s so many last minute changes and swapping and rotations. It can become very complex and chaotic. Was it a very similar situation as to what you described with virtual health, or is there different challenges to solve?
Jennifer Zelmer (16:42)
I mean to some of the core principles like user-centered design, absolutely the same. you know, there’s definitely some of those common threads. I think where there can be some differences is some of the structural issues that you need to think about in scheduling are different than the ones you need to think about in terms of virtual care.
So for instance, what’s the relationship between scheduling shifts and existing collective agreements? How do you provide the flexibility that people are looking for while staying true to the commitments that have been made through those agreements? Or do you need to have conversations around the next round of adapting those agreements going forward to meet everybody’s needs more effectively? So there’s some of those kinds of broader considerations that would be different than with virtual care. Care where you may be more thinking about how does virtual care fit within a clinician’s workflow, how is virtual care compensated. All those kinds of issues are a bit different, but some of the same core issues on the sort of tech adoption side ring true still.
Reuben (17:51)
And how about rolling out a solution because, you know, it’s the kind of thing it’s tough to just do little pieces and improvements and iterative scheduling improvements without just kind of, you know, a complete new system. How did you tackle that?
Jennifer Zelmer (18:11)
So different teams who we’ve worked with have tackled it differently. There’s definitely not one size fits all. For some folks it has been more of a process leading up to a full implementation of a new scheduling solution. Others have decided to start with maybe one unit or one group of home care nurses or one particular area so that they have a chance to walk before they run and work in more of that iterative approach and incremental change. So we have seen both approaches being used. you can use some similar, there’s user-centered design applies to both, so it’s not like that’s necessity one way or the other. But it does mean that sometimes you don’t have a choice, right? Like the agreement may require you go all one way or all another and so you may have some particular structural considerations that you need to have in
Reuben (19:11)
So I love hearing about the success stories obviously like that it sounds like a lot of progress is being made here you know virtual health scheduling through other any other kind of examples or innovations you’d love to talk about.
Jennifer Zelmer (19:29)
Yeah, I we get, I feel so lucky in my job because frankly, I get to work with people across the country who are just fired up to fix healthcare. So, you know, nobody has to work with us really. So when you come to us, it means that, you know, the thousand teams across the country we worked with last year, all of them had that commitment many of them had a tech component because now we’re looking at healthcare in a digital world, right? And that’s the lens we tend to take. It’s not digital health first. It’s about what are the healthcare goals or the health goals that you’re aiming for? And then how do you best use all of the means at your disposal to get there? So some of the kinds of things that we’ve been done have been much more around models of care,
for instance paramedics providing palliative care in the home. Most people want to be at home in that situation. Most don’t want to be in hospital. But often home palliative programs aren’t available 24-7 and you can bet your boots that the crisis happens 2 a.m. on a Saturday, right? It doesn’t conveniently happen at 2 p.m. on a Monday. So what often used to happen is that paramedics who visited the home, because that’s who the call goes to, it goes to 911, all they could do was just transport the patient to hospital. And then they ended up in a merge, which is not the place where they wanted to be.
So by introducing new models of care that supported different scopes of practice for paramedics, also often had a back-end clinical solution, digital solution, that would allow them to connect in with the patient’s care plan from the palliative team, that would allow them to connect in with support that they might need to deliver the best possible care they were then able to provide care in the home. So about half of the time, actually, paramedics who’ve been trained in this approach and supported to deliver it no longer have to transport the patient to hospital, but they’re actually able to support them in their own home. And not only is that way better for the individuals and their families, paramedics find it really rewarding work because they’re able to provide that care and address the issue that folks call 911 and also we found that on average it saves half an hour on a paramedic call. Because many of our emergency departments paramedics have to wait for the patient to be admitted. So by being able to care for the patient in the home, they’re actually also saving time and then able to help more patients too.
Reuben (22:10)
Yeah, less waving around. Excellent. So it sounds like your team is very busy. Maybe tell me about the team at Healthcare Excellence and some of the people that are helping to move forward these innovations.
Jennifer Zelmer (22:14)
Exactly. Yet we do have an absolutely amazing group of just over 100 folks who work at Health Care Excellence Canada. And we’ve now got folks who work in every province across the country. Not yet in the territories, but I’m sure that’s coming soon. And so we as an organization work very virtually as well, although we do still have a physical office in Ottawa and the folks who work with us have a combination of backgrounds. Some of them have clinical backgrounds, some of have backgrounds in improvement, some of them have IT type backgrounds. So we’ve got the whole mix of folks who work together and that’s sort of our core on staff, but the team is actually broader than that. So we have coaches as well across the country who don’t typically work for us, but are partnered with us.
faculty for the different programs, and then patient partners also who work with us and provide advice both to HEC but also to those we work with. And then of course as I mentioned peer-to-peer support is an important part of our programs. So the teams we work with are also part of that team because they can provide support to the team next door or the team very far away. We find for instance we have a Northern and Remote Network that we host which is basically the Health Systems North of 60. And you can imagine that somebody in northern Saskatchewan probably has more in common with someone in Labrador than they do with someone in Regina in terms of the care setting and the context. creating those broader connections is an important part of what we do as well
Reuben (24:00)
Yes. And you talked about the coach role and that’s really interesting and can be really effective. So who are the coaches? Are they physicians themselves or is it just varied backgrounds again like the rest of the team?
Jennifer Zelmer (24:24)
Yeah, it is very background. So some of them do have clinical backgrounds and then provide coaching on those aspects. But we also need people with other backgrounds. So we need people, for instance, with an evaluation background who can support teams to understand how are the changes that they’re making changing the outcomes that they’re looking for or not, and how do you adjust? We have folks who have expertise in improvement science and in implementation science. So bringing that knowledge and set of skills in as well. So you have a whole range of with different backgrounds so that we can draw on them as we need to along the way.
And a really important part of our coaching team are expert patient partners and folks who have other types of lived experience because they can provide a very different perspective on things like how do you engage effectively? How do you ensure that you are being responsive to your community, that you’re really listening well? So we need that full range of skills in our coaching team just as we do in our core staff.
Reuben (25:31)
Excellent. Switching gears a little bit, I did notice that you recently graduated from Royal Roads University. Could you tell us a bit about the program there?
Jennifer Zelmer (25:46)
Yeah, so I took an executive coaching certificate actually. So to up my own skill level on coaching and get a different set of tools in my leadership toolbox was really the goal. And it was very much a learning by doing program, which is a way that I learn effectively. So it was the opportunity to really get skills and experience in how do you coach well. And how do you do that in a context where you may have technical expertise in a subject matter or you may not? And how do you support people to be their best selves and to achieve the things that they’re aiming for?
Reuben (26:29)
And was that a lot of in-person work or was it mostly remote and virtual?
Jennifer Zelmer (26:37)
it was no in-person work. It was all remote. So I met, I think, with one of my fellow cohort, there was quite a lot of us, once for coffee in person, because she happens to be in Ottawa, but otherwise it was all remote. But it was just such a fascinating mix of people across the country. in the team that I was working, for instance, with most directly, we had one person who was had a sales background on the commercial side, one person who was a master trades person, so brought that set of experience, a former Olympian who brought a sports background, someone who came from a real estate world and brought that perspective. So we had a whole range of different backgrounds, which meant that we were really able to focus on coaching competencies, because we did not have subject matter in common.
Reuben (27:12)
Okay, nice. Well, it sounds like a great group. And is that something you’ve you always been kind of kind of continuously learning and in addition to your career?
Jennifer Zelmer (27:48)
I love to learn how many of us, you know, don’t want to do that and try new things along the way. I think for anyone in digital health though, it’s kind of a requirement, isn’t it? You even if I think about where something like generative AI is today compared to where it was even a couple of years ago, you fundamental change. So I think early on, maybe it was some of the tech changes that sort of pushed me into that continuous learning. And now I just love to learn whatever the subject has to be.
Reuben (28:19)
Yeah, I think in my day job in technology, know, things are changing so fast. Every day is continuous learning for me. And I love it as well. I’m just always impressed when people can, you know, take courses on top of their regular duties and to kind of improve their knowledge and other subject matters. So good for you.
Jennifer Zelmer (28:44)
I was really fortunate I had two colleagues who forged the path a year ahead of me and showed me that it was possible. I was able to take the plunge based on those peer-to-peer learnings.
Reuben (28:55)
So when it comes to Health Care Excellence Canada, are there any new initiatives or events or exciting things coming up that you’d to share?
Jennifer Zelmer (29:10)
So we actually just launched a new initiative in long-term care focused on how do we improve person-centered care so that we reduce inappropriate use of antipsychotic medication. So antipsychotics are amazing if you have psychoses, but if you do not have that diagnosis, then they are not the right medication for you typically. but they are often prescribed to folks in long-term care. And so what we know is that reducing the use of those medications means that we need to look to what are the non-pharmacological approaches that are supportive of people where they’re at and the needs that they have.
So just to give you a concrete example, I remember this story that one of the teams that we worked with in an earlier program told me that one of the residents anytime there was a team meeting at the nursing station would come and would bang on the window. And it was quite disruptive to the meetings and it was one of the behaviors that meant that he was put on antipsychotic medication. And when they huddled with the family and they really looked at what the background, what his background was, he had been an executive for his career. And so he was used to being the person in the meetings making the decision, not the person excluded from the meetings. So they brought in an extra chair, they brought in a clipboard, they welcomed him into the meeting, and he was there. And the meeting proceeded as it would normally have, and he felt included in that process. There was no more banging on the window, obviously. so sometimes it’s those kind of concrete specific changes that allow you to get to a different place.
So that’s a program that we’ve just launched and then we’ve got more stuff coming up in the spring looking at how do we support high quality primary and community care that reduces the need for emergency department visits. Because about four in ten Canadians said they went to the emergency department for something that they didn’t need to if other care had been available in their community. So that’s a big effort that we’re going to be tackling in the spring.
Reuben (31:27)
Mm-hmm. And all very important places for improvement. And I love that story too. It’s a great way to kind of wrap things up. And I really appreciate you joining me on the podcast today, Jennifer.
Jennifer Zelmer (31:46)
Likewise, lovely to chat with you.