Funder Focus: Gale Murray and Linda Cash of the Change Foundation
February 3, 2003
by Nicole Zummach
This month in our continuing series of interviews with some of Canada's leading
funders, we feature the Change Foundation, which was founded by the
Ontario Hospital Association in 1995 to promote, support, and improve health
and the delivery of health care in Ontario and beyond. CharityVillage spoke
with president and CEO Gale Murray, and program manager Linda Cash,
about the foundation's efforts to foster positive change in the healthcare
sector by encouraging research, collaboration, evaluation, and the dissemination
of information.
CharityVillage: Why was the foundation created and what need is
it filling in the healthcare community?
Gale Murray: In 1995, the Ontario Hospital Association (OHA) was thinking
about whether or not it should still be in the insurance business, and coincidentally,
a US company by the name of Liberty Health was interested in coming into the
Ontario and Canadian market for supplementary insurance. So the OHA sold Blue
Cross and realized sizable capital gains. That, in effect, is why they started
the foundation - to endow the foundation so that there would be some ongoing
resource to address the questions of change that were going on in healthcare
and in the broader community, and to be able to do research, to understand
more about change, and how healthcare organizations can most effectively respond
to it.
The mandate of the foundation then evolved to include, beyond research, also
grants for innovation; the idea being to provide seed money to let organizations
test out new, and hopefully better ways of delivering services. Complementing
those two fundamental core services, is also our development and education
program, where we try and take the findings from the research and the grants
and communicate them to a broader audience so that the learning can be transferred.
I think we are fulfilling the need of researching change issues and innovations,
both in the context of Canada but also internationally, and then providing
healthcare organizations with information, tools, and templates that they
can use to adapt more effectively to the change. So at our heart we are a
knowledge type of organization, and interested in its transfer.
CV: You are involved in some broadly defined areas: research, development,
education, and grants. What is your main area of focus and where do you feel
your strengths lie?
GM: Well, I would like to think we excel in all of these areas, but
I think our fundamental strength is that we try to complete the circle. So,
if we do find out something new in the research and the grants program we
don't simply leave it there. We attempt to take that learning and transmit
it through dissemination strategies, but also at times, to translate it into
tools and templates that others can use more easily. One of the fundamental
problems for the uptake of new knowledge is that managers in healthcare have
very little time to be doing research. They are very much involved in having
to deal with operational issues on a day-to-day basis, not research that might
take six months or a year. We try and bridge that gap, and I think that is
part of our strength.
The other related strength is the fact that we are closely connected to providers,
both through the hospitals but also through engaging other healthcare organizations
in our work, whether it's as members of our expert panels that provide input
into the research, or whether it is being involved in our workshops or seminars.
We are not researching in the ivory tower; we are attempting to do research
with the decision-makers very much at the table.
CV: Perhaps you could expand a bit on how you are involving others
in the work of the foundation.
GM: We have an e-network of organizations that we try and communicate
with on a regular basis. I think we probably have a couple of thousand organizations
in the network. This is where we periodically send out newsletters and let
people know what we are doing, and where they can find more information.
Linda Cash: For every particular focus or area that we are researching
or working in, we build a network around that area so that we can call upon
the expertise of other people working in that area for their advice and input,
and also to assist with the dissemination and the uptake of the information.
While we are collecting material, we'll perhaps have a research roundtable
where the experts will look at the information and give us input. We might
also hold workshops or seminars where we share that information, and ask people
to share what they are doing.
CV: Where are most of the organizations in your network located?
GM: Our network is predominantly from Ontario, but some in Canada,
and some are international as well. One of the programs we use both for the
dissemination of knowledge, but also as part of our researching, are our international
study tours. For the last five or six years we have been doing an annual tour
of the UK, taking along people from healthcare in Canada. Most of them probably
come from Ontario, but we are now drawing people from the other provinces
to study the UK system, and particularly to look at innovation in that area.
Then in turn, we have people from the UK visit us each year to look at the
Canadian healthcare system. We now offer this program in Australia and Sweden
as well, and are building international networks through that process.
CV: The Change Exchange, your online forum, seems like another unique
way of bringing change leaders together. How did it get started and who is
participating?
GM: I mentioned that when we do research we know that managers and
decision-makers often, because of time pressures, don't have a lot of time
to see what is new in an area and think about how they might apply it. So
we came up with the concept of the Change Exchange where, based on evidence
or new research, we look at creating tools and templates, particularly for
managers and hospitals to undertake new processes.
LC: It takes the theoretical work that has been done and the information
around best practices, why and how it works, and then it gives the manager
the basic tools to apply it and use it. It gives them that bridge.
GM: When we set up the exchange, we had about thirty individuals from
different organizations; some of them managers, some of them planners, some
of them consultants, and some researchers involved with putting it together.
Now, through our grants program, we are trying to encourage people to consider
doing pilot projects in the area. That, again, illustrates how we try and
make our four focus areas work together to reinforce one another.
CV: You did a report on financial management in Ontario hospitals
a few years ago. You also do an annual financial review of 139 Ontario hospitals.
What have you found in doing this research and what is your relationship like
with the hospitals?
GM: Hospitals participate voluntarily in any of our activities and
are not under any compulsion to participate. Although we would like to have
100%, we usually have about 90% of the hospitals actually submitting their
audited financial statements for review. What we have found is that there
has been a chronic financial problem with hospitals in the last number of
years. They are all having very significant financial problems and that comes
up in deficits that we are seeing year after year. The reports that we have
done, because we are a third party, substantiate to government that there
is a significant funding issue.
CV: As a result of these reviews, are there any changes being made
in the hospitals?
GM: I think the change that needs to be made is there needs to be a
cash infusion, and the government has committed another $350 million to be
invested in hospitals. The other fundamental issue is to look at the funding
system. The government has agreed to institute multi-year funding as opposed
to annual budgets. Then the third thing that has to happen is that we have
to look at the whole - how to fund hospitals appropriately.
CV: What was the foundation's reaction to the Romanow Report?
GM: We haven't responded yet but we do expect to do a paper on our
response to the Romanow Report over the next two or three months. Our response
will be looking at the report in terms of our particular mandate - change
and the drivers of change - what the future scenarios are looking like, and
how well Romanow is responding to some of those changes. In particular, we
are interested in science and technology and how that is going to impact health
and healthcare, as well as information technology and the web, as we become
able to create and transmit much more information, not only to professionals,
but to consumers. I would say that the fact that there has been a national
mission on healthcare is a good and important thing and that hopefully it
will help move the system forward to address challenges.
CV: Some of the projects you fund are related to very specific medical
issues affecting certain segments of the population. Other programs that are
funded have very practical implications for large segments of the population.
What are you looking for when assessing grant applications?
LC: First of all, when we were looking at the grant application we
are looking for innovation, and new and different projects. What we are also
looking for is that there may be an innovation the grant applicant is using
in a particular disease like diabetes or asthma, but we also ask them how
it could be more broadly applied and to comment on that. Often you can take
a particular focus or context that can also have a broader application and
can be applied in other areas. So we are looking at those things that will
improve health outcomes and improve the health of our communities as well
as influence and bring forward change in healthcare services to improve the
way those services are delivered. Each of our grants has to have an evaluation
component, because we want to ensure that we are looking for innovation and
change based on evidence.
We also ask that they design specifically a dissemination and knowledge transfer
plan, because again, it's the idea of taking those innovations, testing them,
evaluating them, and sharing the lessons you've learned. When things don't
work you learn lessons as well as when they do work, and it is important to
share those lessons so that we do improve people's efficiency and enable them
to make those changes, but also not to repeat mistakes. The first step in
the process is very focused on innovation, and that is really the first thing
we look at - the innovative practice. We want to encourage and enable a broad
range of applicants and not just focus on hospitals and certainly not just
health science. We would like to see those proposals coming in from the community
and smaller organizations.
We will be putting out a new grant proposal, a new call for Letters of Intent,
in early March. We substantially expanded our grant program in the last two
years by partnering with the Ontario Ministry of Health and Long Term Care.
This is a very good example of how we can build on funding. The Change Foundation
puts in $500,000 a year, the Ontario Ministry of Health is putting in $500,000
a year, and each of the grant recipients matches that grant. So in fact, by
putting different sources of funding together, we can really leverage that
funding.
CV: What role do you see the foundation playing as the healthcare
system evolves? Where would you like to see the organization in ten years?
GM: Given our name and our mission, we would like to be a catalyst
for positive change to improve healthcare delivery. We would hope that when
people think of the foundation that they will think of us as being on the
leading edge of change, but also that we are providing them with some useful
and reliable information to help them manage more effectively.
Gale Murray has been president of the Change Foundation since 1997. Linda
Cash joined as program manager in 2001. For more information about the foundation,
visit: www.changefoundation.ca.
