Living with Dignity:
"Our time is now" for Collaboration

Charlie Coffey
Executive Vice President
Government Affairs & Business Development
RBC Financial Group
Hospice Association of Ontario's Annual Conference
Alliston, Ontario

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…not 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 money words:

"The Ministry of Health and Long-Term Care…has 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 started…

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 members.

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 effort…

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…and 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 about issues.

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 of Ontario.

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 competencies…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 this one!

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 partners.

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:

1. Define your issue and consult on current issues.
   
2. Spell out your goals.
   
3. Determine the decision-makers, influencers and your public/private sector targets.
   
4. Prepare your "customized" case - one size doesn't fit all.
   
5. Know your case inside and out.
   
6. Get an audience and present your case.
   
7. Assess results and share your learning.
   
8. Ask the question, where do we go from here…and get there.
   
9. Celebrate successes and learn from the challenges.
   
10. 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!

Thank you…now let's hear from you.