Anne McGuire (’92) and Chris Power (’89) are not ones to engage in doom and gloom when discussing the future of healthcare in Nova Scotia.

“I’m very optimistic,” says McGuire, president and CEO of the IWK Health Centre. “I see our field working together in ways that we haven’t before. We still have silos and we still have a long way to go in terms of sharing services and getting rid of duplication, but I am confident there will be a public system based on the Canada Health Act.”

Even so, it won’t be the same system we have today, according to Power, president and CEO of Capital Health. “If we are the exact same in ten years’ time as we are today, then shame on us. We’ve failed.”

There are few topics of conversation that make people anxious quite like changes to healthcare. After all, for millions of Canadians, access to a publicly funded system is not just a fundamental right; it is a source of national pride. McGuire and Power understand this, but they also recognize that, without action, the future of healthcare in Nova Scotia is in jeopardy. They have committed to leading and embracing change, and involving everyone in the process – practitioners, patients and the public.

It was similar paths that led McGuire and Power to their leadership positions in the effort to set a future vision for healthcare. Each credits family for inspiring them to make a difference. The Nova Scotia-born Power says her parents told her she was put on earth to get involved and give back; Winnipeg native McGuire recalls her father, a policeman, telling her that Canada had not done right by its aboriginal people. They entered the healthcare system as nurses and gained first-hand insight into the impact that healthcare has on the well-being of families and communities across the province. And they both earned their Master of Health Services Administration degrees at Dalhousie.

With that kind of shared background, it’s no surprise to learn that McGuire and Power have similar visions for healthcare grounded in creating and supporting healthy communities. That starts in part with shifting public perceptions about the healthcare system.

“We are always going to be a repair shop, but we’ve got to get away from thinking that’s all that healthcare is,” says Power. “We’ve been engaging the community on the issue, and how the choices we make in food and exercise have a huge impact. It’s about switching thinking from a health system in crisis to let’s all think about our own accountability and how we can work together.”

Adds McGuire: “We have a huge problem with childhood obesity and inactivity in Nova Scotia. If we don’t intervene now, it will be a tsunami of impossibility. So the vision is to have a system that balances the population’s need for services against the need to create healthier individuals, communities and families.”

The future of healthcare

Although pinning down what healthcare will look like in Nova Scotia is difficult, Power and McGuire agree it will not be all things to all people. “If you look back to when Medicare was first introduced, it was not about covering everything,” says Power. “It was put in place so people would not lose their homes. And yet, there is an insatiable demand for service that we just can’t keep up with. Every report will tell you we’re failing as a system because the demands are so great we can’t keep pace.”

This suggests services could be delisted, but McGuire says the evidence base isn’t there to make such decisions right now. “People come into the system, are treated for all kinds of issues and we don’t measure to see if what we did for them made a difference. Until we know how best to do that, and do that consistently, we can’t be arbitrary and stop offering a service or vaccine without knowing the outcomes.”

Power agrees: “We do a lot in healthcare because we’ve always done it. We need to look at three things: evidence, ethics and economics. This is increasingly the path we’re going down in our business planning and everything we do. I believe it’s an answer to our sustainability issue in healthcare.”

It could take years to gather the necessary data to decide which services are cut or enhanced. Despite that, Power sees that recent efforts to create healthier communities are having an impact, whether it is a decline in the number of Nova Scotians who smoke or a growing interest in eating healthy.

“All of the district health authorities are working together around healthy food policy. We’ve partnered with school boards, the military and with different businesses on that. Do we have the healthy outcomes to prove that we’ve made a difference? Not yet, but in terms of public engagement, we’re seeing uptake.”

The particulars may not be worked out, but the big picture is clear: Nova Scotians will take more ownership over their health. Primary care givers – family doctors, nurse practitioners – will take the lead in serving the public. Private service providers will be in the mix, just as they have been for years. And the IWK and Capital Health will be there to provide support, promote good health and focus on high-end technical interventions.

A ‘big picture’ education

As for Power and McGuire, they are both drawing on their Dalhousie experiences to achieve that vision and ensure the continued vitality of our healthcare system.

“Dalhousie helped shape my thinking about what needs to happen for a sustainable and high-performing health system to exist,” says Power. “Through my interactions with professors, faculty and fellow students at an undergraduate (nursing) and graduate level, I further honed my skills in  how to use evidence for decision-making, be provocative and bold in my thinking, take risks and lead.”

Adds McGuire: “the University’s MHSA program provided a ‘big picture’ education, incorporating evidence-based learnings from around the world. I was also encouraged to develop my leadership skills by the faculty, which I have been able to apply in my working roles. And the program gave me the confidence to step up to new challenges such as this.”

Eventually, it will fall to someone else to address this challenge. McGuire says succession planning is underway for the IWK’s next president and CEO, and Power hints she may step down after 10 years at the helm. Still, both anticipate continued involvement in the evolution of healthcare, to some degree, and both are confident we are on the path to a healthcare system we can all be proud of.

“I would hope in 10 years’ time we have a system where people are getting the right care at the right time from the right provider,” says Power. “I hope we’re only doing things for people that benefit them and that we’ve stopped doing things that add little to no value. I hope we’re all accountable for our own health and that the system is there as a partner, not a default. That’s what I’d like to see.”