Centre Stage:

Marla Fryers, Vice President Programs & Chief Nursing Officer, Toronto East General Hospital & QHN Board Co-Chair

As part of our membership benefit package and our ongoing commitment to collaboration, we give impassioned improvers within the Network centre stage. We would like to get to know the faces of your organization. If you have a member that should get centre stage, let us know.

“...my leadership style comes from a core belief around distributed leadership. I believe that people who have their hands on the processes are actually the ones who should really be defining how the process works.”

Marla Fryers is a veteran on the healthcare scene. She has supported the sector for over 25-years. Marla joined the Toronto East General Hospital in 2000 and will have been with the organization nine years this September. Other things that you should know about Marla...She is an avid golfer who claims to have broke 100 twice this season already - a first for this senior health executive. A compulsive reader, Marla is reading Paulo Coelho's The Zahir. But on her night stand Barack Obama’s, The Audacity of Hope anxiously awaits her.

We hope that you enjoy reading or watching this interview with Marla. In the spirit of networking, please feel free to contact her in the future. Marla can be reached at mfrye@tegh.on.ca.

--------------------

QHN: What is the community that you serve?

Marla Fryers: We serve a catchment area of approximately 500,000 people. It’s a very diverse community, so we have lots of residents that live here who have English as a second language, not as their first language, probably a lower socio economic status then many other communities in and around Toronto. It’s a community that feels very proud of Toronto East General. Toronto East General is now, this year actually, is 80 years old. It’s a hospital that’s really been built and supported by the community members for many, many years.

QHN: How would you describe your role here at that hospital?

Marla: I have responsibility for all the clinical programs – so all of the care that’s received from the clinical programs reports up to me as vice president. And in addition to that I’m the Chief Nursing Officer. So I have all of the allied or various inter-professional groups reporting to me. As well as organizational learning and change.

QHN: What would you describe as the major influences that you’ve had along the way?

Marla: As a professional, my significant influences have been the people that I’ve reported to and mentors that I’ve worked with in various organizations. Having the opportunity to go back to school, kind of sprinkled into my career, has been really, I think, a luxury that many people don’t have an opportunity to take on. And so having professors that have supported me in my learning and that I’ve stayed connected with, getting involved in research projects, in mentoring new students myself, all of those things have really helped to shape my career.

QHN: What are you passionate about?

Marla: I’m passionate about patient care and providing good quality and safe patient care in an environment that is very respectful of patients and their families. Really when patients and their families come into hospital, it’s typically a very short episode in the total scheme of their life. So we need to just be cognizant of that and respect that and really value what their contribution is in terms of their care and what they really need and want from the hospital as an organization.

QHN: In 2008 you received the Canadian Society for Training and Development award for Leadership. For those that want to excel and want to be the kind of leader that you are, can you describe your leadership style?

Marla: I guess my leadership style comes from a core belief around distributed leadership. I believe that people who have their hands on the processes are actually the ones who should really be defining how the process works. [My leadership style involves] really removing barriers, removing roadblocks, enabling people through learning to give them the capacity to actually make change happen. Rather than having processes where there are a lot of redoes, reworks, working-arounds - having processes that really make sense to people and providing an environment where our staff can really question why we are doing things and the way we are doing them. And actually make suggestions and put in place new ways of doing things that probably function better and more effectively for our patients.

QHN: Can you describe any examples of how you were able to remove barriers, identify and alter work-arounds within your organization?

Marla: We just finished a project, well, we are working through the implementation phase of a project related to the time that a patient is deemed to be admitted into the hospital in emergency till the time that they actually get in their bed on an inpatient unit. The process we used with that was an ED Lean process. We gathered together a group of six staff members, all from various areas of the hospital and worked with them to map out what that process looked like. Where do we need to improve different process steps? We collected metrics on those processes, implemented rapid cycle change, and remeasured and then implemented the new process. So now we are in a place where we are putting controls in and trying to understand the process, specifically to one unit that we have identified. Once we get that process stabilized we will roll it out to the other units in the hospital. I think a part of that is providing the staff who are delivering a particular piece of the care, with the knowledge and the understanding of what Lean and Six Sigma are and ensure that we apply it appropriately to the problems that we have at hand.

That’s the kind of model that we have here. We actually have a program called Foundations of Leadership, where anyone in the organization can enter into a six week education program – its one morning a week for six weeks, and the components of that program that we teach are change management, how to live in an environment that is very uncertain. We teach emotional intelligence. Any staff member can become involved in that. It allows them, I think, to build their capacity to actually take on changes within the organization, work as teams to implement changes and really provides a perspective to all the staff in the hospital what needs to change, how we need to change things and how to get people involved and really caring about whether things are changing or not.

We’ve put over 400 people through that program. When we started the program three years ago, all the executives went through the program and all the directors went through the program. In combination with frontline staff, bed allocation staff, frontline nurses - it’s a real cross section. We’ve also done a session for physicians, so some of our physicians have gone through the program. I think what we’ve done is really created a common language for people within the organization. So that when we say, 'that really triggered me,', people understand and get what we are talking about.

QHN: Is there any particular reason why the Quality Healthcare Network has been something that you have committed yourself to?

Marla: The Quality Healthcare Network has been around for about ten years. [Before this it was called CQI Network (Continuous Quality Improvement Network) and was established in 1994]. I believe that it is an organization that has really focused on, how do we improve the quality of services that we deliver in healthcare? It brings together a group of people, organizations, partners who are very committed to the mandate of quality and really committed to understanding tools and methodologies and ways that we can improve the care that we deliver to our clients, whether they are in the hospital or community sector. It brings like-minded people together to really try and accelerate changes that are required in our industry.

QHN: How would you describe your organization's involvement in the Quality Healthcare Network in terms of the impacts on your processes and procedures and adoption of tools?

Marla: We’ve been members of the Network as an organization for a very long time. Membership has provided us with the opportunity to go to Forums so that our staff can actually learn what other organizations are doing. It’s a wonderful networking opportunity. They can also learn about the most advanced or recent tools and methodologies that people are using and looking at in quality. It also gives us an oppprutnity for our staff to share what we are doing here at this organization and develop relationships that are ongoing. So that through email and through the webiste we can stay connected to the work that is going on in the other organizations. It’s been a great membership for us for a variety of different reasons. I really wanted to participate on the board so that I understood more clearly what it was that Quality Healthcare Network was really trying to accomplish through its strategic directions so that I could have an influence on helping to shape the Quality Healthcare Network for Ontario.

QHN: Someone recently said to me that QHN is the closest thing to an association for those people working in quality improvement. How much would you agree with this statement?

Marla: I think that when you go to these Symposiums or when you join Author in the Room, or any of the initiatives that are sponsored by QHN, one of the things that you see right away is that people are very passionate about improvement. So when you get together with a lot of people that are passionate about improvement, I think you do feel very comfortable. The ideas may come from different perspectives, but I think where you can link together is looking for creative new ideas on how to improve your processes.

QHN: It’s sometimes difficult to pitch the value of the network - the value of networking in and of itself. Can you describe the importance of networking?

Marla: As leaders we all strive to bring innovation and creativity to our organizations. We know that there probably are lots of processes that don’t work perfectly and we’re often looking for new ideas. Especially for staff, you will hear, ‘oh we tried that before and it didn’t work.’ I think if you can get staff excited about new ways of looking at problems, perhaps innovations that they hadn’t thought of before, if they come home with either an interaction with a colleague or peer or they come home from a Symposium with a new idea that they want to try out, then I think the organization is able to better support people in making changes and getting the barriers out of the way. I think networking is a great value at all levels of the organization, whether it's the front line or its leadership group.

QHN: Do you have any tips on networking?

Marla: There are some organizations who come and bring a group of people together. I guess when I reflect on it, when organizations send a small group of people to the Forums or Symposiums it kind of allows them to relax a little bit because they are with people that they know. And it allows them to open up a little bit so they can welcome others in a different way. As an organization I think it’s important to send more than one person so that they are not sitting there all by themselves. When an organization can contribute in terms of presentations or doing small group work there is a sense of confidence that is built up in the organization. Again, the ability to network is advanced.

QHN: What would you say you are most proud of?

Marla: I’m very proud to be an executive in healthcare. I’m proud to be able to work in a field that I feel very passionate about. I believe I’ve made some difference to how patients are received in the hospital. There is lots more work to be done and I’m glad to be involved both in terms of the quality journey as well as the service delivery journey.

Toronto East General Hospital was the first hospital in Canada to be recognized by the National Quality Institute with a Gold Award for Organizational Wellness and Quality. That is also something myself and my colleagues are very proud of .

Centre Stage Index

To view past profiles of impassioned improvers within the Network, click the one that you want to read.

December, 2007, Gordon Milak from Southwest Community Care Access Centre, London, Ontario

January, 2008, Glenna Raymond from Whitby Mental Health Centre, Whitby, Ontario

February, 2008, Michael Heenan from St. Joseph’s Healthcare, Hamilton, Ontario

Spring, 2008, Carol Annett from VHA Home HealthCare, Ontario

Summer, 2008, Ben Chan from Ontario Health Quality Council

Fall, 2008, Lindsay McGee from Huron Perth Healthcare Alliance, Stratford, Ontario

Winter, 2008, Dr. Michael Baker from University Health Network, Toronto, Ontario

February, 2009, Larry McBride from 3M Canada Company

April, 2009, Marla Fryers from Toronto East General Hospital