When a young Brendan Carr was put on a wait-list for medical school, he thought it was the end of the world. Instead, it was the beginning of the long road that has led to him becoming head of the Vancouver Island Health Authority.
Carr would eventually get into Dalhousie University in Halifax and earn a degree in medicine, later specializing in emergency and family medicine at the University of Ottawa. But first — while waiting — he earned his master’s degree in business administration.
For someone who had been focused solely on science, it was a game-changer. “It was fortuitous. I’d like to say I planned it, but it didn’t happen that way,” Carr said.
“At the time, I thought I was going to die because I didn’t get into medical school but, in retrospect, it … has served me better than anything I’ve done because it gave me — more than any of the technical skills — it gave me a different perspective.”
Last week, the health authority — which serves about 760,000 citizens, employs 18,000 staff, operates 153 health facilities and manages an operating budget of $1.9 billion — announced it had found its new chief executive officer in Carr, who had been acting CEO since Howard Waldner’s retirement in April.
Carr joined VIHA last year as executive vice-president and chief medical officer. Before that, he was vice-president of medicine with the Capital District Health Authority in Halifax and an assistant professor at Dalhousie University.
The new man at the top promises to change the health authority’s reputation of being a top-down organization by engaging and involving the public in a way that can be seen in new programs, services and construction. “The engagement is not to say we met with 1,000 people,” Carr said. “It’s not so that we can say we have 1,000 people who agree with us on our plan… It’s so that we can say those 1,000 people have been a part of and actually influenced this … [and] shaped it somehow.”
VIHA is respected across Canada for its advancements on primary health care, said Carr — an achievement for which he praises his predecessor. But different styles of leadership are appropriate for organizations at different points in their evolution, he said.
The unintended consequence of an era of in which large health authority structures were created in B.C. and across Canada has been a loss of connection with communities, physicians and other care providers and staff, Carr said.
VIHA’s at a natural inflection point in its evolution, he said, and the focus now must be on relationships so that the health authority becomes a trusted collaborator and partner.
“If we want to be respectful and aspire to do something better with our resources, we have to engage differently with our staff,” Carr said.
Carr, who was born in Ontario and raised in Nova Scotia, is married to Caroline, a physiotherapist specializing in cardiac rehabilitation, and has four children ranging in age from 13 to 21.
His initial interest in hospitals likely came from visiting his mother at the Halifax hospital where she worked as an executive assistant — and typed up his high school and university papers. (During those years he was a naval reservist and even spent time at the naval officer training centre at CFB Esquimalt).
But Carr’s interest in being a doctor was likely more influenced by his Roman Catholic upbringing. Though more spiritual than religious, he toyed with the idea of delivering care and compassion as a priest, but soon turned his attention to science.
“I wanted to give,” Carr said. “We were a family that went to church growing up. In my generation, doing health care medicine was seen as a giving kind of care and I felt something deep inside me drawing me to that.”
Carr tries to remain clinically active to keep up his skills and give him “street credibility.”
One might think as a health authority CEO, experience as a doctor would serve him well. Carr admits he has a keen insight into the workings of hospitals and the use of resources, but said it’s the values he learned at the hospital bedside that most guide his leadership.
“I have literally thousands of memories of individuals and lives I’ve touched who have touched me and changed me as a person,” Carr said. “Those kinds of things shape you as a person and if you’re smart, you let those important things shape you as a leader over time.”
Early challenges
Carr was officially named CEO of the Vancouver Island Health Authority last week, but he has led the health authority in an acting role since April. Under his watch there have been challenges:
• VIHA elected to launch a provincewide colorectal cancer screening program yet quickly amassed a backlog of patients requiring a colonoscopy.
“We’ve learned through the process we weren’t as prepared as we needed to be,” Carr said. B.C. Cancer Agency estimates on the impact the program would have on the demand for subsequent colonoscopies were off: “The actual number that came forward has between 30 to 40 per cent higher than what was projected to come forward,” he said.
As well, patients who had positive tests were referred to gastroenterologists rather than put in a queue and guided by a nurse navigator for a colonoscopy, and the lines for urgent and screening colonoscopies were blurred, he explained.
VIHA had to figure out quickly how many scopes it could do in a day, extend days and hours of operation, separate the various groups requiring colonoscopies and weed out those not in need of the test, and add an additional 400 procedures.
“It won’t meet the entire backlog but it will certainly move us forward and I think if we continue on that pace we will be able to [end] the backlog pretty quickly,” Carr said.
• The Vancouver Island Health Authority is investigating allegations by staff that a Victoria urologist photographed an unconscious male patient and sent the picture to an unrelated person.
Carr said the health authority has a lot of work to do in building better policies around new technologies such as smartphones.
“As we start to use these technologies, I think we need to catch up as a profession and as a broader discipline in terms of how do we incorporate these tools in our day-to-day practice in a way that will be respectful and caring and that can advance care,” Carr said.
“I am just concerned we have an instance where it appears that we have not done that and that’s a flag for me,” he said, adding he has no details of the case and is not making judgments.
“The very fact the question has been raised suggests to me that we have work to do to clarify and educate our professional staff and others on what’s appropriate and not appropriate and how best to use these tools in care.”
• Norovirus swept through Selkirk Place during the last three weeks of July, infecting about 100 patients and 50 staff with gastrointestinal illness. Nine residents died during the period of the outbreak July 11 to Aug. 7. VIHA would not directly link the deaths to norovirus, saying many of the facility’s residents are in frail health.
However, a week later, VIHA reported that deaths were three times higher in July than the average month. The Times Colonist reported the subsequent death of an 87-year-old resident of Selkirk Place on Aug. 3; according to the death certificate, it was directly linked to “norovirus infection.”
“We are saddened by the loss of life at Selkirk place and our condolences go out to the families and staff who care deeply for these elders. This outbreak occurred at an unusual time of the year and it appeared to be quite virulent,” Carr said in an email.
“The staff, with the assistance of the public health team worked hard to get the outbreak under control. Generally speaking, an illness like norovirus is not life threatening; however, in frail elderly or people with weakened immune systems, these infections can be a contributing factor to more serious illness — like heart failure, pneumonia or heart attacks. In this sense, they may be a contributing factor to death.”
