Living with Dignity:
"Our time is now" for Collaboration
Executive Vice President
Government Affairs & Business Development
RBC Financial Group
Hospice Association of Ontario's Annual Conference
Friday, September 16, 2005
Janet, thank you for the marvelous introduction.
As many of you know, Janet delivered a speech entitled "The
Role of Hospices within Ontario's Transformed Health Care
System" to the Bayview Community Hospice last November.
It was striking to me for a whole host of reasons
the least of which is Janet's innate understanding of the
issues and the opportunities - not to mention, her innate
understanding that when it comes to living with dignity, the
time is now for collaboration. In Janet's right on the
"The Ministry of Health and Long-Term Care
declared end-of-life care a transformational project within
a much larger initiative to transform and enlarge home care
services. The thrust is especially important for hospices,
because while 90 percent of Canadians say they want to die
at home if possible, 75 percent of Canadians die in hospitals
or other institutional settings. And while 86 percent of people
say they want to spend their final days in a familiar setting,
only 6 percent of family members say they would be able to
take care of a loved one at home without outside support being
given by organizations such as hospices."
In the next few minutes, I want to focus on collaboration,
as it relates to influencing public policy and building relationships
- and then we'll open up this session to a Q/A, as I really
want to hear from you. The "time is now" to get
There's a distinct need for hospices to collaborate/work
with the Hospice Association of Ontario in order to develop
common messages and consistent actions not only in the newly
formed Local Health Integration Networks (LHINs), but also
on a province-wide basis. A decentralized health care setting
requires cooperation, collaboration and focus. And without
cooperation, collaboration and focus in this environment,
the voices of hospices could be lost on a local level - and
HAO and hospices across the province could lose some ground
in terms of all the advances made in the last year or two.
And I'm not just talking about losing ground with government;
I'm talking about losing ground with various partners, including
those in the private sector. It's a hard reality.
Approaching advocacy to build a stronger case and momentum
for quality end-of-life care, while engaging people, plans
and promotion with collaboration as the centerpiece to success,
is the ultimate goal. It's essential to focus on strategies
and action plans - proven advocacy steps - that will help
HAO members cultivate more caring alliances with governments,
corporate Canada and other organizations.
We're all aware that Ontario is in the formative stages of
moving from a centralized to a decentralized health care system.
As Minister of Health and Long-Term Care, George Smitherman
said on April 7th, as part of World Health Day: "LHINs
are based on the simple principle that local people, close
to the action, are best able to determine the urgency of local
priorities. They represent an understanding that community-based
care, reflecting the needs of that community, is best planned,
coordinated and funded in an integrated manner within that
community." By virtue of its name, the success of LHINs
is about collaboration.
And Ontario's May 11th Budget included the following commitment,
as part of its transformation agenda: "The government
intends to improve access to doctors, nurses and other health
professionals by...supporting end-of- life care services,
including those in residential hospices, for 4,300 adults
and children in their communities by investing an additional
$39 million this year." This announcement is a result
of collaboration in action and quite significant to HAO and
In Ottawa, as part of National Hospice Palliative Care Week
2005 last May, The Honourable Tony Ianno, Minister of State
(Families and Caregivers) welcomed the launch of 'A Caregiver's
Guide - A Handbook About End-Of-Life Care'. Another collaborative
On June 2, Senator Sharon Carstairs, "called upon the
federal government to renew its commitment to a national strategy
on palliative and end-of-life care in her report, Still Not
There: Quality End-of-Life Care: A Progress Report. The Senator's
report makes 10 new recommendations for improving end-of-life
care for Canadians. Along with a recommendation for a renewed
national strategy, the report also recommends improvements
to the compassionate care leave benefit under Employment Insurance,
increased education and training for health professionals
and informal caregivers on end-of-life and the creation of
a public information program on services available, legal
rights, and care for the dying."
"In the past five years we have instituted a compassionate
care leave benefit, increased research dollars, increased
physician education and created a virtual hospice. However,
there are still only about 15% of Canadians who have access
to quality palliative and end-of-life care. With an aging
population, by 2020 we are expecting there will be 40% more
deaths each year. We need an integrated, well-funded, cross-departmental
and cross-jurisdictional national strategy on palliative and
end-of-life care now to ensure we can cope with the needs
of Canadians," said Senator Carstairs. Again, these recommendations
revolve around collaboration.
Public policy advocacy is about getting information to the
right people at the right time and in the right way - marketing
and managing what you have to say to influence your targets
ultimately getting results. And when you get it right, you're
paving the way for strong alliances or partnerships that have
immense power to push the envelope on public policy. It's
always about collaboration.
One of the key challenges in education - understanding the
dynamics - almost always has to do with timing. Messages tend
to resonate when something significant happens in the public
domain - something that directly interests/affects governments
and their constituents (elections, budgets etc.). Given the
increasing influence and activity of grassroots leadership
(from backbenchers to special interest groups, business and
everyday citizens) in terms of shaping public policy, it's
very important for growth groups to be well informed and consulted
A fundamental principle of good relationship building is
to establish a foundation of Trust, Integrity
and Credibility, as TIC is a must when higher levels
of engagement on more serious issues, is required. When possible,
framing your agenda from the perspective of the government's
agenda or the corporation's agenda (and their need to satisfy
multiple stakeholders) is helpful for building trust and leveraging.
Many people still ask the question, does business have something
to bring to the table on quality end-of-life care? I believe
it does. In the broadest sense, business interests are not
special interests - they are the national interest. At a policy
level, business interests are about jobs, investment, growth,
trade, prosperity and the standard of living. We're interested
in almost all of the policies that affect the economic well
being of our customers, shareholders and employees. It's essential
for HAO to continue seeking out internal collaborative opportunities,
with public sector/community and business partners.
I can only echo the words of Sharon Carstairs: "It's
important to recognize that the key to the success of the
Canadian strategy will be collaboration among governments,
health professionals, voluntary organizations and communities.
This is a message that I will be taking to business community
members and other community leaders across the country to
increase public awareness of palliative care
it has implications
that extend far beyond the health sector. End-of-life issues
directly affect the lives of not only patients and their immediate
families; they also have a direct bearing on their employers,
friends and communities."
RBC Financial Group's association with the HAO is a good example
of collaboration at work. We continue to support hospices
across Canada, mainly through the RBC Foundation. We're also
proud of the volunteer work employees do in supporting hospices
right here in Ontario and from coast to coast. And we're especially
proud of our 15 year relationship with the Hospice Association
From supporting HAO's Life Line services program and enhancing
family members' understanding of issues relating to the financial
implications of terminal illness, to advancing regional and
province-wide educational opportunities, RBC can share our
skills and expertise with hospice staff, members and volunteers.
And we can help increase their skill sets in areas such as
human resources, marketing, planned giving and financial accountability.
In addition, we're establishing a working group of RBC and
HAO representatives to ensure these collaborative initiatives
are delivering on commitments. It's all about supporting HAO
and its members in terms of building capacity, sustainability
and it revolves around collaboration.
The bottom line is that we all want to live with dignity -
end-of-life is everybody's business. No one misses out on
There are strong business reasons for RBC to be involved with
HAO, which are important for you to know in terms of advocacy.
Canadians providing care for aging parents, either alone or
while raising children - the so-called "sandwich generation"
- are facing huge challenges and often with sacrifice to careers,
social lives and overall health. There are thousands of Canadians
caring for an elder and children in Canada - a number that's
growing each year. Many RBC employees are faced with this
challenge each day and the hospice movement is working to
create policy and awareness on some of these key issues.
As well, RBC can help various HAO care providers and clients
navigate financial decisions that arise with terminal and
long-term illness, including decisions about investment and
estate planning. This is also part of building relationships.
I've been pleased to advise HAO in the area of public policy
from time to time and I'm delighted that Yvette Holt, RBC's
Regional Vice-President, Ontario Central South Region is now
a member of the board of directors (and in the audience this
afternoon). And then there's RBC's Renae Addis, Manager Community
Investments Ontario, who above and beyond her business relationship
with HAO, has a personal involvement too. Why have I mentioned
all this? Just look at the results to see how collaboration
has worked in the RBC/HAO relationship. Use the tools at your
disposal and continue to repeat this success story with other
Janet Napper sums it up so well: "Ontario's hospices
have a very large opportunity to play an important role in
the development of local end-of-life service delivery models,
regional networks, the provincial end-of-life committee as
well as LIHNS. Once all of these systems begin to work, what
will be crucial for all health care providers, including hospices,
will be to develop partnerships and collaborations.
These alliances will be central to hospices' ability to provide
integrated care. Hospices will need to be strategic in their
collaborations, will need to clearly define their objectives
and what "excellence" and "integration"
mean to them, and then develop the partnerships that will
best position them in the future." As I said two years
ago at your conference - Janet gets it big time!
And we all know that incremental progress would not be possible
without the tireless work of staff, members and volunteers
in the HAO and throughout the province. I applaud each and
every one of you at this conference
you're all champions
in my mind. I applaud your unwavering support of hospice palliative
care - you bring new meaning to vision, voice and action -
new meaning to "living with dignity: our time is now."
Before we open the floor for questions and discussion, here's
my top 10 advocacy check list for you to think about:
- Define your issue and consult on current issues.
- Spell out your goals.
- Determine the decision-makers, influencers and your public/private
- Prepare your "customized" case - one size doesn't
- Know your case inside and out.
- Get an audience and present your case.
- Assess results and share your learning.
- Ask the question, where do we go from here
- Celebrate successes and learn from the challenges.
- And collaborate, collaborate, collaborate!
In closing, enlightened public advocacy leads to enlightened
public policy. The Hospice Association of Ontario - and its
members - has the vision and voice to make a difference. Try
new approaches for aligning interests and support - in cultivating
alliances with governments, communities and businesses. Do
so at this conference and the Palliative Care Association
National Conference in Edmonton on September 25-28th. The
time is now for collaboration!
now let's hear from you.