Lawrence Rosenberg

Lawrence Rosenberg is the president and CEO of the Integrated Health and Social Services University Network for West-Central Montreal (CIUSSS West-Central Montreal), which includes the Jewish General Hospital here in Montreal, Canada. He's also affiliated with McGill University as a professor in the departments of medicine and surgery.

Can you tell me where you grew up and what your childhood general experience was like? Were there any moments that, at a very young age, sparked your interest in health care and medicine?

I was born and raised here in Montreal, Canada, and spent most of my life in the city. I never had an interest in health care until I had to make a career decision in university. I was looking to go into astrophysics, but when it came down to making a career decision on how I would be able to support myself and a family, medicine rose to the top of the list.

What really started to crystallize my interest in medicine was some of the coursework I was taking in biology, molecular biology, organic chemistry and the idea that began to crystallize in my mind was how medicine brought these diverse academic interests together.

Can you just walk us through a couple pivotal moments in your career development?

My career path is somewhat unusual. I completed a pre-university college program, then applied to get into medical school. I decided early in medical school to go into a surgical career. After I completed medical school at McGill, I was accepted into a general surgical training program, also at McGill. Upon finishing my residency, I went off to University of Michigan in Ann Arbor to do a transplant surgery training fellowship, then returned to McGill to take up a position as an assistant professor in the faculty and to begin the multi-organ transplant program at the university. I became a pancreatic surgeon.

In 2004, after I had been in practice for about 15 years, I went back to complete a management degree, a Master of Engineering in the University of Waterloo School of Engineering.

About three years after that, I was asked to move to Jewish General Hospital, the large McGill University teaching hospital, to take on the position of chief of surgery, which I did and held for about six years until I was asked to apply for the job of executive director of the hospital. I did that in roughly 2013, and within about a year, a new health minister that came in the election of the new government decided he wanted to reform the health care system. I had to reapply for my job, which is the job I hold now.

Going back to your days as a clinician and a surgeon, is there a particular patient story that profoundly affected you and continues to influence you to this day?

There are a number of patient stories that continue to influence me. I had a very fulfilling and important clinical practice with respect to the transplants. When it came time to take on this job as president and CEO, and I had to give up my clinical practice, it wasn't without a lot of second guessing myself as to whether or not that was the right thing to do.

The first patient that I performed a combined kidney-pancreas transplant on when I came back to Montreal sticks in my mind. The youngish nurse with Type 1 diabetes developed kidney failure and had poorly managed diabetes, and the combined transplant changed her life. She ended up being the longest recipient of a combined kidney pancreas graft in Canada, which functioned for over 30 years.

As a CEO, how do you define success? What does success look like at the end of the day?

I look at my job as being the person responsible for delivering excellent care to the population who chooses to come here and creating an excellent working environment for those who choose to work here. If both of those two things are true, then I think I've been successful.

In your journey towards leadership, is there a particular lesson that you had to learn the hard way that still sticks out in your mind and influences the way you lead today?

I've learned a lot of things over the last 13 or 14 years in this position. One of which is never be the first person to speak up in a room. I've always been accused of never saying enough, but I've always found that to be the safe way to function: Sit there and listen. That's probably the most important thing I've learned is not just to listen, but to hear.

Secondly, I think it's important to trust the people that work with you and work around you. You can't do everything. You don't know everything. The reciprocal concept is if you're going to start delegating, you have to hold people accountable. And if people want responsibility, then they also have to accept accountability.

Probably the third most important thing I've learned is that good enough really isn't good enough. If you're going to spend the time, the energy, the money doing something, you absolutely have to do it to the best of your ability.

What values guide your leadership decisions and how do those values influence the culture you've created at Jewish General Hospital?

It comes back again to excellence and not shying away from doing the right thing, and one of the things we did years ago was take the paradigm that Simon Sinek published in his book, Start With Why. He talks about, 'What's your why?' In our organization, I've ingrained that our 'why' is to do the right thing. Nobody should get upset if you're doing the right thing. The way we operationalize is by adopting value-based health care. Delivering on patient outcomes and doing that at an acceptable cost has become extremely important to us. And the way we've operationalized that is by developing the concept of Care Everywhere.

Can you explain the philosophy behind Care Everywhere, and why it resonates so strongly with you?

The concept of Care Everywhere comes back to our 'why,' which is doing the right thing. We're more than a hospital. We're an integrated health care and social services network. We should be providing care everywhere, given the nature of the network, and that became abundantly clear to us during the pandemic when people didn't have easy access to the hospital, clinics or their family members in long-term care.

Our original Hospital@Home program is now our fastest-growing program, which transcends all our facilities, all our missions and has become a recruiting tool. For example, for each nursing position in the hospital, we may get three to four applicants. For each job that's posted for our virtual care program, we get 13 or 14 applicants. It has allowed us to move care out of the hospital, into people's living rooms and literally provide care everywhere.

What does it look like in practice, and how does it address inefficiencies in the current system?

The Care Everywhere concept involves different types of clinical programs. It involves getting people out of hospital sooner than they might otherwise because we can set up remote monitoring via our command center, and we can monitor patient vital signs 24/7 with wearables.

We have a rehab-at-home program. Getting people out of the hospital or rehab sooner has made a huge difference in terms of increasing our institutional capacity to bring more people in who need to be here. We've had more traditional home care programs with visiting nurses, which have now been put on steroids because of the introduction of technology and remote monitoring.

We're starting point-of-care testing to do laboratory testing in people's homes, as opposed to having them come to a test center or the hospital to have blood drawn.

Month by month—as the technology evolves, and we get permission from government agencies to move forward—we're expanding the panoply of programs we can provide outside of a clinical institution.

Does data support patients are more inclined to recover in a home-based environment as opposed to a hospital environment?

During the fifth wave of the pandemic, I got my senior managers together on a Friday afternoon and told them I'm no longer turning surgical beds over to COVID patients.

If most of the patients we're admitting with COVID need oxygen, figure out a way of setting up a hospital at home. Seventy people worked over the weekend and set up the program by Tuesday morning. The first patient enrolled in our Hospital@Home program with oxygen being received in their living room. We never looked back.

That's how the program began, but we've conducted surveys of care providers and family members who look after patients at home to get a sense of how well received this is. Virtually 100 percent of the patients say they'd much rather be at home than be in the hospital, but 85 percent of their caregivers at home are also very positive. Not a hundred percent, because a lot are anxious over having to have sick relatives at home, even though they're in contact 24/7 with our command center. The clinical providers are absolutely thrilled with the experience.

From a financial point of view, this is a huge cost saver for us. There are 50 percent fewer people involved managing these clinical problems than if the patients were in the hospital.

It's where the budget is going. It's where the technology's going. As we bring in the next generation of health care providers and leaders, this is what gets them excited.

How are you integrating AI and other emerging technologies into daily operations?

When we set up the command center to manage our hospital-at-home program, we began to build AI and predictive analytics into the data we were collecting so that we would be able to predict room volumes and admissions.

One interesting use of AI during the pandemic was to track neighborhood outbreaks of COVID on the island of Montreal and look at whether our employees lived in those areas. We would be able to predict when we might develop outbreaks in our institutions because the employees would bring it in. This enabled us to keep those who might live in those areas away from our long-term care facilities.

During the pandemic, our institutions had the lowest rates of in-house COVID outbreaks than any other institution in Montreal. I think that is directly attributable to the early introduction of AI in that setting.

Do you have any non-work-related that you do to counterbalance some of the stress and pressure of your professional life?

Having a well-balanced perspective is important. Although I do spend an inordinate number of hours either in the office or working at home, there are two things important to me. One is staying in shape. That's been extremely important to me to keep me not only healthy, but grounded.

The other thing I happened onto during the pandemic was watercolor painting and photography. I was fortunate to work with a world-renowned artist, who wanted to teach me watercolor. What's involved is taking black-and-white photographs and then colorizing them with watercolor paint.

Looking ahead, what do you see as the greatest opportunity or area for growth for the health care industry as a whole?

The greatest of opportunity for the health care industry as a whole is getting away from the use of the term 'health care' and using the word 'health.' Health care implies you're looking after sick people, and for us to move into an era of sustainable systems, we really need to talk about wellness and health to try to prevent disease from developing. This is where AI will become increasingly important.

That will be better educating both the population in terms of their responsibility for their own health, but also politicians with respect to how they need to start conceiving of the health system and how and where money is spent.

As you reflect on your career thus far, what long-term impact do you hope to leave?

I've had a very different health care career, going from being a surgeon, a scientist, an administrator. My contributions in each of those stages of my life have been important. Looking back over what's now almost 35 years, the legacy that I would like to think I've left is that of an example of how someone should give back to the broader community, not just the health care community.

I was mentoring a medical student for the last three years, who has graduated now. In one of the last emails she sent me to say goodbye and to thank me, she said, she hopes when she grows up, she can be just like me and that resonates with me in terms of leaving a legacy.