Dave Veale interviews Dr. Marc Pelletier, Head of Cardiac Surgery at the New Brunswick Heart Centre in Saint John. In both business and healthcare there are similar leadership challenges. In this clip, we discuss the importance of asking the right questions in order to improve diagnosis & outcomes.
Here’s Dave's Leadership Unleashed column, published in the Telegraph-Journal on 09/13/2012, page B01
HOME IS WHERE THE HEART IS FOR CARDIAC DOCTOR
Dr. Marc Pelletier is shown in his office in the heart centre at the Saint John Regional Hospital. PHOTO: PETER WALSH/TELEGRAPH-JOURNAL
Dr. Marc Pelletier’s story is a compelling one – especially if you are a resident of New Brunswick. From the time he was 11 or 12, Marc knew he wanted to be a doctor; he knew he wanted to help people. He grew up in a small New Brunswick town and was the first in his family to attend university. He credits his parents with encouraging him and making him believe that he could do whatever he wanted to do.
After graduating from high school at age 16, Marc headed to Mount Allison University and was accepted to medical school at the tender age of 18. After spending four years at Dalhousie, he went on to McGill in Montreal. From there he accepted a one-year Cardiothoracic Transplant Fellowship at the prestigious Stanford University. He became an Associate Professor in the Department of Cardiovascular Surgery at the University of Toronto for three years before heading back to California to Stanford’s Department of Cardiothoracic Surgery.
In 2007, Marc returned to New Brunswick to become the department head of cardiac surgery at the New Brunswick Heart Centre in Saint John. Both Marc and his wife felt “the pull” to return home to New Brunswick.
Because Marc worked in health care in both Canada and the United States, I was curious about his perspective regarding the differences between the two systems.
A: The positives in the American system: You have access to new technology, resources for operating rooms and for treating patients. It’s all provided to you, and it’s the whole basis for how hospitals function financially.
In Canada, anybody coming into a hospital is a cost to that hospital. So they start with a fixed budget. In the States, anybody who comes into the hospital is a source of income for the hospital. It’s more like an independent business.
For example, if you are bringing in surgeries or patients who need surgery, the hospital will be very happy to help you with the resources you need in order for that to happen. Cardiac surgery, cardiology, is a fairly big financial driver for a lot of American hospitals. You had to run your practice more like a business.
Q: When you became the department head of cardiac surgery, what were some of the challenges you identified at the New Brunswick Heart Centre?
A: In essence, when I arrived, our two main challenges were to repatriate our patients and then to offer new developments and new techniques.
The mandate in ’92 when this program started was to provide good, safe, cardiac surgery care for the population in New Brunswick. The program, designed by the government – Jim Parrott and others over a few years – grew to a volume of about 600 patients a year. There were very good results statistically of doing excellent standard operations: valve replacements, repairs, coronary bypasses.
When I arrived in 2007, I analyzed the procedures that were being done, the volume, and the financial aspect. From this we determined what we were doing well, where we needed to improve and what we weren’t doing at all. I was very fortunate to have worked in the Canadian system at U of T before going to Stanford. I saw a bit of both systems, and I thought we could incorporate some of the things that other centres were doing across the country and across the States that we weren’t doing here.
Q: What did you conclude as a result of your analysis?
A: Over 200 patients a year were still being sent out of New Brunswick which meant, as a province, we were exporting $3 million per year to other provinces. There were reasons for that.
The second thing was looking at the service we provided.
We asked ourselves, ”What are we not doing that we could be doing that might help our patients?” It’s a challenge in this environment to get new equipment. Getting money for health care from the Department of Health is hard. It’s even harder now than it was even four years ago.
Q: I imagine that one of the services you would have personally liked to offer was heart transplants.
A: At Stanford, I was doing a lot of heart transplants, so it was a natural that I was asked a lot about whether we would start doing transplants. That was a normal question.
But, when you look at the population in New Brunswick, we have five to 10 people who need a transplant every year. You can’t be a world leader or even a Canadian leader doing such a low volume. Is it really worth our while to do transplants and use all the resources that need to go into it? I felt very strongly that, even though I’d be comfortable doing transplants, it wasn’t in the best interest of our division.
Q: What accomplishments are you most proud of to date?
A: Between 2004-06, we had an average of 228 patients a year leaving the province for cardiac care at a cost of about $3 million per year. We knew we needed to keep those patients from going to Quebec. We needed to improve the care that we were giving here by offering that care in both French and English. So the hospital began making it a priority to hire bilingual nurses. Now over 50 per cent of our nurses are certified bilingual. We began identifying every single patient who came into the heart centre and actually put a sticker on their chart of which language they preferred. It’s all about quality care.
Q: I am sure creating this priority would have required a strong business case.
A: The Department of Health needed to justify it. When we approached them, we said,” This is what we’d like to do and this is what it’s going to cost us. However, that’s now $3 million that you’re retaining within the province that you’re not going to have to export out of our province. We have the resources. We have the people. We have the expertise.” They came through and they need to be commended on that.
Q: A big part of your future is raising funds to support some of your current initiatives. Can you tell me about this?
A: THE GIVE 2012 campaign (www. thegive.ca) this year will fund a complete revamp of our heart-lung machines which, on its own, is a $500,000- to $600,000-ticket item.
Being in a leadership position means making sure that every facet of what allows your team to work is taken care of. THE GIVE 2012 will allow our operating room to be technically as good as any in North America. This campaign resonates with everybody in New Brunswick because almost everyone has a family member or a friend who has heart disease.
Q: How does it feel to be back working and living in New Brunswick?
A: From a quality-of-life perspective, I’m fortunate to be back in New Brunswick.
I grew up here, I was educated here and I was 17 years away from New Brunswick. To come back at this point in my life, where I can contribute and give something back is tremendously satisfying. It’s also a good challenge.