Leading like a jazz conductor, not a classical maestro | Mark Walton

Mark Walton, guest · [03:02]But looking back at my work that I have done over my almost 40 years in healthcare now, it started really when I was 17. My mother was a nurse at the then Mississauga hospital, and she gave me an indication that there was a ward clerk position in the emergency department there. Ward clerk is effectively a unit secretary, somebody who helps to coordinate all of the comings and goings, and this was at the emergency department, and it was my first exposure to healthcare in a major way, and I was enamored, I was captured by it almost immediately. I was watching people respond to code blues, cardiac arrests, I was looking people rallying around patients and situations, and I knew I needed to be a part of that. And I was fortunate enough in that role, somebody kindly introduced me down the hallway to the administrative wing because they knew I didn't want to be a clinician. I was not into the blood and guts and bodily fluids that some people can tolerate, not me. So they took me down to the admin wing and I learned that there was a, a career path to this, through a master's program and, and other things and went home that night and I said to my parents, I know what I want to be. I want to be a hospital CEO. This was at about 19 years old. Wow, that's incredible. Yeah. It was, yeah, it really was. I, you know, had a very clear sense of what I wanted to be and what I wanted to do. but it wasn't until 2023 that I actually, well, 2022, I got the call from Guelph General Hospital after I'd gone through the interview process. I happened to be doing some Christmas shopping right around this time of year. And I got the call and I heard that I got the job as the CEO at Guelph General Hospital and I stopped and I actually cried. I was standing in the middle of a Canadian tire because it was a full circle moment for me. Wow. Where, that 17 year old kid, 19 year old kid got to sort of realize that trajectory that he'd been on. And it's been a long trajectory and I would say looking back, it's been a continuous journey. I think Kierkegaard was right, like to really understand how I got here, you got to look backwards and I would say that entire journey I've just been building muscles to hold complexity, to translate between worlds and frankly to keep patients at the center of a system where it sometimes feels impossible to do that.

Mark Walton, guest · [06:06]Well, I would say that the public sector right now, and I would include a variety of different organizations in, in this description beyond healthcare and hospitals. You've got universities, you've got Ontario health teams, family practices, governments, crown agencies, you know, these are all, organizations that are funded by the Ontario or the Canadian taxpayer. And they're all in a really challenging situation right now. And I would say population growth being what it is, services continue to go up, but the rate at which we are able to raise taxes and to pay for those services is not going up commensurate to that. And I would say, you know, often when you hear this discussion, it starts off very much with a comparison of public versus private organizations. And in some ways, I think there's almost a natural jump to Publicly held organizations are broken corporations, like not as good as private sector. And I would say, they're not broken corporations, universities, hospitals, government agencies. They're just a different species of organization. They're mission-driven, and while we do have our bottom lines, and that's really where we're feeling a bit of the pinch right now is financially, we've got to balance quality, patient experience, staff well-being, community trust, donors, regulators. It is a very messy system that we work in with a lot of competing interests, and I would say the greatest competing interest is actually the growth rate and the disease rate that is going to be coming upon us, because it's going to demand more, not less of those organizations, and frankly, we're sitting right in the middle of it, trying to figure out how we pay for all of this, how we deliver it well, and continue to meet the growth in our

Daniel Atlin, host · [08:00]No question about that. I think we see a tsunami now of people actually who are, who are my age and a little bit older perhaps, who are, who are needing, you know, services, but also, you know, illness is getting more complex as well. And, and, while we've done a great job, I think, of keeping people healthy for longer, you know, there's more complexity to, to those illnesses. And of course, you factor in the, the mental health issues on top of that and, and the relationship between those two things, it becomes even more messy.

Mark Walton, guest · [08:27]Well, and, and we know as dollars get tighter, inflation goes up, people are in more precarious housing, under housing situations, all of those determinants of health get pressure. they start to crack, and that's when people start to get sick. And so, you know, I will always argue, obviously, for my hospital to get as much funding as it possibly can to serve our population. But I also recognize every one of those other agencies that I've mentioned are also struggling to keep their heads above water, and they play a vital role in our society. And, you know, when we don't have education, when we don't have food security, when we don't have housing, people get sick, and then guess what? They end up in my emergency department. So getting ahead of some of the stuff is tricky too. And hospitals never stop.

Mark Walton, guest · [13:44]A couple of things that I learned, and I would say maybe putting a bit of the leadership role on it, I had responsibility for coordinating the response of Ontario Health, which was about 22 different health agencies. Including oversight of the incident management system for, for Ontario. And every day was different, but, you know, we look at it now in 2025, and if I go back to 2020 and think about what could have we done, what should have we done, how might have we done things differently, I do so now with perfect knowledge. I do so now with a view that we know what the vaccines are capable of, we have vaccines, we have face masks, all that sort of thing. But if we go back to March of 2020, we were dominated by fear and very little fact. We didn't know how it was transmitted, we didn't know its virology, we didn't know how deadly it would be. We could only look across the seas to Italy or some other nation to find out that it was decimating generations of older adults. And so we prepared accordingly. And one of the lessons I learned at that point in time was when people were frightened and scared, it was very important for you to say, here's what we know. But it may be wrong in the next four hours, right? To say I don't know is an incredibly authenticating experience for people when a leader says that. And I would say, I saw a lot of leaders who tried to have all the answers, and in fact, it hurt their credibility. Saying I don't know sometimes is a really important admission. People can at least then accept, we'll do our best, and we'll keep you updated. But that was a really key piece. The other thing that I learned was, you know, at the beginning, everybody was bashing pots and pans and, you know, cheering on our healthcare workers, and that sort of died a unceremonious death, so to speak, later on in the pandemic. People got a little angrier, perhaps a little bit more jaded about some of the mandates that were out there. But we talked about our healthcare folks as heroes, and I do believe that they were heroes. But that term, while it offered pride, it also made it harder for them to admit exhaustion and to ask for help. And I still see the weariness in people's eyes and the way that they engage and the way that they step up. It's different than it was prior to the pandemic because I think we, we hurt some of our people. and, and I say that in the sense that we asked a lot of them and being the great people that they were, they didn't ask much of us. And so I see it now. And I think sometimes, we need to acknowledge that healthcare, healthcare personnel are heroes. There's no question, but in that there's also a degree of responsibility and invulnerability that they like to portray that I just don't think is true. they need to help as much as anybody else. And I think some people are still wearing that. And of course, we're trying to support them as best we can, but I, I, something I learned is I think you've got to find space for those heroes to collapse once in a while.

Mark Walton, guest · [27:46]The, the story was during the pandemic, actually. And we were in a, in a position where in southwestern Ontario, we had a number of agricultural workers who were part of the foreign agricultural worker program. these are, these are people who come in on a seasonal basis, seasonal farm workers, work the farm, send money back to their families back in their home countries, and then eventually make their way back as well, only to return again to, to work in these greenhouses, et cetera. A real backbone for the agricultural industry down in southwestern Ontario. But because they are temporary foreign workers, did not have all the same, rights, and I'll say access to health services that most Canadians would have had during the pandemic. This actually resulted in the death of two individuals down in southwestern Ontario during the early parts of the pandemic. And As someone who was leading the IMS, I was asked to step in and try and solve this. And what was really interesting about this particular population, and sad, was they were managed by about 10 different ministries at the federal, provincial, municipal level, multiple levels of government, and because of that, nobody really had accountability for these individuals. And so as we were working through the solutions, I went to my boss and I said, here's what we need in order to take care of these people so this doesn't happen again. We just couldn't get all of those different stakeholders aligned to say, yes, do it. And then my boss called me on one evening after I'd asked for these things, and he said, Mark, no help is coming. Right, now that's a really dire statement for your boss to deliver to you. And I said, well, what do I do? And he said, and this is Matt Anderson at Ontario Health, so I have no problem telling this story because I think it was a really defining moment for me in terms of what leadership looks like. And he said to me, Mark, I will never fault somebody for an active commission if it's done in the right spirit and for the right reason. And he said, so go do what you need to do to take care of these people, right? And so he empowered me. He effectively said, and he didn't give me a blank check. I wasn't going to be irresponsible about this, but he empowered me to make solutions where there were none, to take authority where I had to and to act. And we did, and we created isolation spaces. We created a sort of food program for these folks. We had primary care coming in and doing the checking and all that sort of stuff. And I would say, from a moment of complete and abject failure where I could not rally the support that was required in order to get help to these people, despite all the reasoning and, you know, there was a failure there that I was not able to convey to folks that this needed to be done. But through an act of leadership, I believe, and an empowerment of the people that work for him, this particular boss created the conditions for success. And we did, and no other temporary foreign workers died after that, from our interventions. They got connected to primary care, they got what they needed, they got access to vaccines. Or the lesson for me was leadership matters, right? Being empowered, having somebody who will have your back in that moment was a really, really key thing, and I, and I learned a lot from it.

Mark Walton, guest · [33:58]The other one that I would say is I don't think that you will see AI in the next five years doing the job of a doctor. That's not what I believe is responsible or appropriate because while you can say something to a terminal or to an algorithm and give it facts, there's so much more to medicine than just what the patient says. It's how they say it, it's what they look like, the color, the, you know, the color of their eyes, the way they're breathing, the way they're sitting. There's a bunch of subtle nonverbal pieces that come through as well. And so what I would say is I think that AI in the meantime will be good at flagging things for physicians to think about. A great example of this is down at Unity Health in Toronto, was they felt that they were missing things like intracranial bleeds. People were presenting migraines, blurred vision, a variety of other things, and their sense was they were missing things called intracranial bleeds, small vascular anomalies that are happening and, and can turn out to be quite serious. And as they talked about this, they talked about the fact that the human doctor can really only process seven, eight, maybe nine variables at once. And as such, there's a limitation in terms of all the things that they could be running through in terms of that differential diagnosis they're trying to create. But AI is capable of looking at hundreds of variables at once, not to make a decision, but to say, hey, doctor, maybe you should take a look over here because this one has enough of the necessary conditions that this might be worth an investigation. Now, I believe that's where we get smart, because if we get that flag, it tees us in to say, perhaps that's something we should be looking at. And in fact, they found that they reduced the number of missed intracranial bleeds by 80% in doing that. So wasn't diagnosing it, but it was saying, hey, this is somebody that's worth looking at just to make sure that sober second thought. And I, I would say to you, that's where I see the opportunity in the immediate term, Daniel, is not to replace the clinician, but to give them an additional tool that says, here's a number of things that are presenting, and in typical, consistent way, this is the type of patient that you might want to consider, or a differential diagnosis that might be worth investigating. And then they can do what they're best at, which is the art of medicine and digging into the other subtler things.

Mark Walton, guest · [38:18]The goal of a leader is much like the goal of, as I said before, the conductor, right? Here's what we want to achieve, right? We're going to play a little blues tune here. It's going to, you know, go to this timing and, you know, be about this long, and it should kind of have this general vibe, and here's the chord structure. But within that, go do your thing. Go be brilliant. You're a brilliant musician, you're a brilliant clinician, you're a brilliant whatever. You know, hire smarter people. And this was one of the true lessons, I think, that I learned throughout my things. You don't have to be the smartest person in the room, but you need to know how to identify those who are, and get them rallied and sitting around that table. And I will say, I have stood on the shoulders of giants when it comes to their intellect. I am seldom the smartest person in the room. But I can get them around the table and I can describe a problem and a reason why it's going to make a difference, and that's my strength. But the intellectual horsepower comes from other people, people who know this business. I say, so hire smart people. Don't worry if they're smarter than you, they probably should be, to be honest with you. And I would say that's one piece. I would say the other one is that, and I mentioned this before as well, just like good music, you got to put some silence into that music. There's got to be some rests, right? You cannot have an entire symphony where people are just going hard. There are moments of crescendo, there are moments where you're Pianissimo, right? There's times where you are silent. And as leaders, we have to be silent once in a while, not only in our language, but I would say also in we need to take down time. We need to rest. And there's a time where you just sit back and you need to rest. I don't think we do that well enough. And that's why you are seeing so much burnout, I'd say, in society in general. People don't know how to rest. And I guess the other thing, if we go back to this notion of complex adaptive systems, you can't script every moment, right? Like you, you cannot possibly Come up with the algorithm or the sheet music that would suggest that this is exactly how it's going to go. People are imperfect. Systems are imperfect. The human animal that walks through my door at the hospital wounded is not the same person who normally sits at their kitchen table when feeling well and happy and content. They are anxious and they are in pain. That's an unpredictable person. And I would say for us, the best we can do as leaders is kind of just set the tone, lead with values, talk about what an active commission really means at the end of the day. Like, what is it that we're trying to achieve here? What are the values we're going to use to do that? And honestly, get out of the way, because most people know exactly what they need to do in those moments. And I would say maybe that's the biggest lesson I've taken from almost all of my career. Is let the smart people do their jobs, because they know exactly what they're there to do, and if they're led with the right mission and the right values, you're probably going to end up in the right space.