International Master’s for Health Leadership Module Three: Tackling complex issues in healthcare systems

Health systems influence billions of people in different countries for better or worse. They can save lives, but also exclude access to care. They are extremely complex ecosystems in which multiple political, economic, cultural, and technical issues emerge in different ways every day.

The COVID-19 pandemic has shown us how health systems, depending on how they are structured and managed, can impact people very differently. Countries and health systems responded in different ways to this unprecedented crisis, trying to provide efficient solutions in a very short time frame. Creativity and innovation were mobilized, and different initiatives were put in place with different degrees of success to address multiple issues.

To try to address these complex issues, the International Masters in Health Leadership (IMHL) has designed an experiential learning exercise aimed at favouring an exchange of practices among actors regarding issues and solutions experimented by health systems around the world. Participants took on the role of an expert hired by the Health Ministry of a country to advise on the current issues and areas for improvement.

Using analytic tools such as the Impact Gaps Canvas Tool, PEST (political, economic, social and technological), and the House Model, groups presented their health system under study, mapped the issues faced by this system, highlighting blind spots or gaps, and presented solutions and recommendations to a panel of “health ministers,” Prof. Henry Mintzberg, Dr. Abraham Fuks, Prof. Jonathan Gosling and Erin Wiltse (IMHL ’21).

Earlier this year, we navigated the globe in one morning session, with international groups presenting virtually across cultures, health care systems and time zones. What resulted were 10 practical, pragmatic and highly implementable recommendations championed by experienced health care leaders.

Each of the 10 groups passionately presented their recommendations and confidently addressed the Ministers’ questions and challenges. Part of this exercise was to bring to light important issues and successfully communicate ideas in a compressed period.

As “Minister” Gosling explained, “there is strength in the presentations being short.” This focus on synthesis is a valuable exercise for the class, who will undoubtedly be asked to succinctly present their ideas throughout their respective careers.

Some groups saw the possibilities brought on by the pandemic, notably through improved communications and technological advances to recommend the implementation of electronic health records. Individuals were brought to the center and empowerment and communication were seen as tools to alleviate health care roadblocks and allow for integrated and personalized care. Virtual health care was seen as a viable, practical, and implementable alternative to primary care models, not only in the current pandemic reality, but moving forward.

In other groups, geographical challenges within larger land-mass systems were explored. We saw how policymaking often has rural and remote communities in blind spots, and we looked towards other health systems with similar urban/rural distributions for inspiration.

One group took a global problem such as vaccine hesitancy and looked towards historical events to better understand the population’s hesitancy to accept certain health policies and sanitary measures.

Storytelling was heavily used, not only to bring forth the experiences of health care users but practitioners as well. Essentially, deconstructing the processes behind their narratives to isolate the blind spots. And important questions were raised by one group; “Can a World-wide Pandemic help us to help each other?”

There was a discussion of environmental challenges faced in Ecuadorian regions in another group, which added a lens through which the health care system is reflected. Other groups used demographic projections to anticipate future gaps in providing health care and started looking at alternative levels of care that could be implemented now.

All groups did a remarkable job presenting ethnographical, lived experiences of individual patients. Storytelling was effectively used to spotlight concrete, grassroot examples which brought to light the importance of bottom-up change. They used the individual experiences, within the system, to highlight gaps and blind spots in the wider organization.

“Minister” Fuks highlighted the groups’ “notion of pushing social-cultural aspects that are often buried and leading with narratives.” Common themes of advocacy, engagement, active and pro-active participation, collaboration, communication, and empowerment were peppered throughout the presentations.

After the session, Minister Wiltse shared that “health care leadership requires a worldly mindset in order to address the present-day health systems challenges, as evident in every single one of the astounding presentations I had the privilege of hearing.”

Professor Luciano Barin Cruz, responsible for the pedagogical design of the module, congratulated participants at the end and reminded the importance of this type of assignment.

“It is important to understand problems, solutions, gaps and opportunities at the level of the system,” he said.” This is the way to go promote deeper and long-lasting change in healthcare systems.”

As “Minister” Mintzberg reflected after the session, “This is exactly what the Worldly Mindset should be.”

The IMHL team and participants would like to extend their gratitude to the four Ministers for their involvement. They brought their experience, knowledge, humanity, and humor to provide a real-life experience for the class.



McGill Intenational Masters in Health Leadership (IMHL) Program

Learn more about the McGill IMHL Program

McGill Graduate Certificate in Healthcare Management (GCHM) Program

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