Balancing change factors for healthy health care

Let’s divide the world into two influences – internal and external. Let’s add to the two influences one key assumption: both factors change forever at varying rates.

Internal factors originate at the core of us, the individuals. They include our interests and passions, our wants and needs, as well as our “age and stage” qualities such as caring responsibilities, health, and financial motivations. These elements change at rates that are specific to each person and that, although influenced by external factors, are about how we interact with our world. They make up the strengths and dynamic energy of health care human resources.

External factors include broad elements of change such as technology, politics, globalization, economics, demography, labour market and social trends. These elements change constantly and interact with each other to compound change. They inform our economy, our funding models, social structures and policy.

We are all obliged to respond to both internal and external influences in a very careful balancing act. We may all fall into habits of regarding one influence over another; as individuals we may become highly tuned into our internal influences at the expense of external, and as organizations we may become habituated to satisfying external demands at the expense of internal.

To make this careful balance function optimally for both the individual and the organization, we are obliged to do three important things simultaneously: understand ourselves very well, keep an eye on change in the world around us, and respond proactively. This juggling of these three distinct functions is difficult and critical to success. We must be fully in tune with our own changing motivations, passions and responsibilities with a clear sense of our own preferred future. At the same time we need to keep our finger on the pulse of trends influencing our work as well as workplace objectives and challenges. It is within the intersection of these internal and external influences that remarkable opportunity waits. Our proactive choices and actions need to be accurately and steadily informed by both sides of the balance so that we can capitalize on opportunity and become leaders in the delivery of quality health care.

The foundation for this balancing act is clear, regular, reciprocal communication. This means that as individuals we need to clearly communicate our passions and interests, changing motivators in our lives, and our desires for next steps at work. As organizations we must articulate trends influencing our work, emerging challenges and goals, as well as clearly voice our vision. It really means that we must listen intently for the harmonies between these two seemingly disparate voices in order to recognize and act upon emerging realities quickly, decisively and with a deep sense of genuine collaboration.


Challenges (and opportunities) offered up by a new generation of health care providers

My work is focused on learning and applying knowledge about the differences in the characteristics and values of generations of workers and learners. Although I find people of all characteristics and values in all generations, there are patterns and generalizations that are useful to organizations. A good example may be the Echo Generation (or Generation Y, or the Net Generation, or sometimes the Millennials), that has quite confounded many employers, allegedly because of their sense of “entitlement”.

For common ground, let’s establish this group as born roughly between 1980 and 1995[1], making them between the ages of 15 and 30. These are the children of Baby Boomers, have had fewer siblings than previous generations and tended to experience two-income households (in addition to a whole host of non-traditional configurations such as single-parent, blended families, etc.). They may have been somewhat held from harm by their well-intentioned parents and been individualized and celebrated as a matter of policy, rather than performance. They are relatively well travelled and can access a dizzying spectrum of information through the Internet. Their labour market has featured global scope, a chronic labour shortage, and the toppling of iconic firms (think GM, Martha Stewart, and the American financial industry).

It isn’t surprising that this group of young workers has high expectations for their own quality of life, expects to have an individualized relationship with their immediate supervisor and certainly with their employer in general, and knows how their employer performs relative to others. They have a labour shortage working in their favour (particularly in health care), they know and exercise their rights, and they don’t believe that any organizations are failsafe. They expect their wellness to be critical to employers.

The really interesting question is, WHY DOES THIS CONFOUND US?

This generation typically negotiates for self-care (albeit not always gracefully, however we must remember that they are relatively inexperienced) and values self over employer, individual over collective, family / leisure over wealth, and immediate over delayed gratification. It is easy to imagine how these workers challenge the culture of the health care sector.

As organizational leaders, it is critical to guard against accommodating one worker or group of workers at the expense of another. However appealing in the short term, it leaves organizations vulnerable to lobbying, infighting, bullying, turnover, and disengagement. None of these are helpful to productivity and the delivery of high quality health care.

In order to protect engagement, productivity and ultimately the delivery of high quality health care, organizations are being called upon to make proactive and bold choices to engage and retain ALL WORKERS by making their wellness an organizational priority. This does not mean abandoning all existing expectations and performance demands; rather it means really taking a hard look at our organizational values about employee wellness and asking ourselves if these values are manifest in our everyday work, unapologetically.



[1] David Foot, BOOM BUST AND ECHO

Wellness: Converting Knowledge into Wisdom


If a picture is worth a thousand words, then a graph has got to be worth millions.

The graph included here illustrates the change in the Canadian population between 1996 and 2006. The peak is, of course, the Baby Boomers. The wonderful thing about demography is its predictability; the frustrating thing may be its relentlessness. We are watching a wave of change come over us and we know it is going to further pressure an already overstressed health care system. As the Boomers age, key questions emerge:

  • How are patient characteristics and consumption patterns changing?
  • How are workforce characteristics changing?
  • What are the consequences to patient care?
  • What are the consequences to workforce wellness?

The Knowledge

We know per capita health care spending increases and will continue to increase from the patient age of 45 onwards [1]. We know health care has a comparatively high proportion of mature workers, with greater than 39% of health care workers over the age of 45 as of 2001 [2] leaving the sector vulnerable to a shortage of skilled, experienced workers at a time when demand is peaking. We can see that the number of workers entering the workforce is relatively smaller that the number of workers currently in the workforce.

Graph your own workplace age distribution and compare it to local and provincial information. The graph provided reflects the national profile; however significant variations exist between provinces. Alberta (one of Canada’s younger populations) is not dealing with the same pressures as Québec (one of Canada’s older populations). For this reason, the implementation of effective practices must be thoughtful. Project forward 5, 10 or even 15 years. How will your workplace age distribution change? What specific challenges will emerge for your practice and wellness?

The Wisdom

It isn’t going to get easier if we wait.

Health care is a large, complex sector with considerable political, economic and technological influences. As tempting as it may be to focus primarily on these influences, the workplace wellness issues currently facing health care are not going to improve on their own given these changing demographic realities. Mine the collective WISDOM of your team: What are the many ways that we can foster workplace wellness in the face of these changing circumstances?




  1. Meara, White and Cutler, “Trends in Health Care Spending by Age, 1963-1999”, March 2003.
  2. Francois Lamontagne, “Demographic Profile of the Natural Resources Sector”, Canadian Labour and Business Centre.