Opening remarks Civitas Vancouver

Civitas Vancouver, April 26, 2024

Over the last year, I served as President of Civitas Canada. Civitas started in 1996 and revolves around an annual conference.

Conference magic cannot be planned. It comes as a surprise. Audience and speakers connect, questions delight, and responses enlighten. Each party comes away encouraged and grateful, not just informed.

The speakers, sponsors, audience, and organizers created something extraordinary at the Vancouver Civitas conference. Better than we could have imagined. I’m so grateful to everyone involved.

Here are my opening remarks (with a few edits). I review ground rules and then try to  encourage conversation outside the ordinary.

If want to learn more about Civitas, feel free to write to see if it might be a fit for you.


Welcome to the 28th Annual Civitas Conference. My name is Shawn Whatley, and I’m your president this year.

It is really great to see you all. None of this would be possible without our sponsors. Please join me in a round of applause for our sponsors.

You know, I was very skeptical about a conference in Vancouver…

When I became president, as per tradition, I announced, at a board meeting, that the 2024 conference would be in Vancouver.

The board just stared in silence.

Finally, one person said, “That … is a REALLY bad idea. We will never fill a room … let alone pay for the conference.”

He made the whole planning committee panic.

Thankfully, panic sparked furious activity. And here we are at a SOLD OUT conference!

Thank you so much for coming and being part of this event.

Terms of Engagement

I need to say three things about Civitas — lay the ground rules, as it were.

Our purpose statement says that Civitas exists:

“to promote and deepen understanding through the exchange of a wide range of political, economic, social, religious, cultural, and philosophical ideas concerning the principles and traditions of a free and ordered society.”

Very briefly … let’s unpack three points.

ONE: We are here to learn.

Our purpose statement says, promote and deepen understanding. This means we need to be open, curious, and receptive.

TWO: We are here to be challenged through the exchange of a wide range of ideas.

The broader conservative movement includes a wide mix of ideas. You may be sitting between an anarcho-capitalist, on one side, and a monarchist on the other! This is a fantastic opportunity – don’t let it go to waste.

THREE: We follow the Chatham House Rule.

The identities of the participants are private and all discussions are not to be recorded, reported, attributed, or disseminated in any fashion.

All members and guests are asked to respect this rule.

Without this rule, we could only have conversations that were safe … and superficial. We want to go deep … so we need privacy.

 

Alright, that sets out our terms of engagement. What do we want to accomplish over the next 1 ½ days?

Goals

I’m hoping we can do two things [this weekend], and avoid one pitfall.

I am a physician and much of my time, over the last 25 years, has been spent in leadership and medical politics.

My work has focussed on improving service for patients, while improving the work experience for doctors and nurses.

Improvement means change. For example, you cannot improve wait times, without changing how people work.

But how can you change behaviour? Many of us can’t make our own children behave. How can we make 200 of our colleagues act differently?

Ideas and policy and strategy will not work to change behaviour.

They are not enough.

As Peter Drucker said,

“Culture eats strategy for breakfast.”

We need something more.

In my experience, we need to do two things.

First, we must find a wedge.

Consider emergency medicine. A robust clinical culture shapes care in the emergency department.

Culture is just a set of norms and behaviours. Culture rests on a conceptual apparatus – a whole clinical worldview.

We need to address that worldview and find cracks in it.

The best way to do that is by pointing out bits of reality that do not fit. Think Sesame Street: “One of these things is not like the others…”

For example, we would often say to the doctors and nurses in our emergency department, “Isn’t  it interesting how we break all sorts of rules to get timely care for our friends and family? They never wait in the waiting room.”

Then let that comment float; let them ponder it. It takes many similar comments to crack the status quo.

Second, we need to tap people’s internal motivation.

Not just emotion. We need to connect with their internal drive.

For example, we would ask nurses about their experience at triage. They are the wardens of the waiting room. We would ask them to talk about their experience managing a packed waiting room.

It usually took several questions, but they would soon start to tell about people vomiting in buckets for hours or women miscarrying in the waiting room bathroom.

We would just listen.

Eventually, we would ask, “Is this why you went into nursing?”

They would say, “No!”

That is the moment everything changes. Now they want change and are willing to try something new – something better.

In all of this – identifying a wedge, tapping internal motivation – we are attempting to bridge the philosophical gap between theory and practice.

Ideas need to infect people. They need to come alive to shape how people think and see the world.

Our job this weekend is to reflect on each panel and ask: Where is the wedge? And, how can we inspire?

Can we crack open the conceptual apparatus that exists around each issue? What bit of reality does not fit? Think: Sesame Street or cognitive dissonance.

And second, where is the ‘nursing’ question? [“Is this why you went into nursing?”] We must touch the fundamental aspects of human experience.

Example 1 — Finding the wedge

Here’s a quick example of finding a wedge. It’s meant to be fun. Don’t be stressed, if you don’t agree with it.

We opened the conference with applause for our sponsors.

What is applause?

Applause is a public endorsement.

Notice: applause is not transactional.

With applause, we declare that this [sponsorship] is good; not just that it makes us feel good.

It is agathos.

It is part of the True, the Good, and the Beautiful.

But hang on. How can we declare something to be intrinsically Good, in a secular, liberal democracy?

Philosophers across the political spectrum agree that modern liberalism avoids public endorsement of any preconceived Good.

In case you don’t believe me, consider three philosophers.

Starting on the radical left, Slovoj Žižek wrote that,

“[Liberalism] considers any attempt directly to impose a positive Good as the ultimate source of all evil.”

Irving Kristol, godfather of neoconservatism, wrote that

“a keystone of modern liberal secular society” is the impossibility of knowing “what constitutes happiness [the Good] for other people.”

Francis Fukuyama, great defender of liberalism, wrote that now,

“Personal autonomy [includes] the ability to choose the [moral] framework itself,” not just the particulars.

In other words, liberalism seems to say we must not declare anything Good – or at least we must not expect to be taken seriously, if we do.

And yet here we are applauding something we see to be Good.

Perhaps, we misunderstood the nature of applause?

Or we misunderstand the nature of modern liberalism?

Or maybe we misjudged modern society?

Or maybe, society isn’t so liberalised after-all?

Now, this is just an example – something fun. I’m sure you can come up with better ones.

Example 2 — Finding inspiration

Our second task this weekend is much harder. How can we inspire and tap into Canadians’ internal motivation?

Wordsworth tackled this with poetry, during the industrial revolution. He wrote,

“The world is too much with us; late and soon

Getting and spending, we lay waste our powers:

Little we see in Nature that is ours;

We have given our hearts away, a sordid boon!”

And later in the poem, he writes, “We are out of tune.”

Wordsworth is saying there is more to life than work and money and spending. We waste our talents and become out of touch – out of tune – with those around us: friends, colleagues, family, even with our own bodies.

We need to draw attention to fundamental aspects of the human experience, if we hope to inspire true change.

Aristotle did this by calling us to human excellence: wisdom, courage, self-control, justice. Christian thinkers added faith, hope, charity. We could add generosity, magnanimity, or the Roman liberalitas.

People hunger for these things. They need to hear it in our language.

One pitfall to avoid

Finally, we need to avoid a common pitfall for the right. Roger Scruton called it Hegel’s “labour of the negative”.

The labour of the negative refers to Hegel’s dialectical thought. It is the act of negation repeated relentlessly. Or as Karl Marx put it, “the ruthless critique of everything existing.”

Augusto del Noce, Italian philosopher and specialist on Marx, explains that Marx taught we cannot be free, if we accept anything created by anyone other than ourselves. If we accept anything as a given – even our own biology – we can never be truly free.

We on the right must be careful of adopting a ruthless critique of everything existing. When the left appears to be in control of everything – media, academia, culture – we risk becoming circumspect. As one speaker said at a conference in the US, “They are coming for everything.”

Now this may be true. In fact, it is what we might expect from the Hegelian left. And there is a time to diagnose and identify the negative. But then we need to turn our minds to treatment.

Scruton said it is hard to shift from a labour of the negative to positive, constructive work.

Conclusion

So in summary …

Our job is to find the cracks in the conceptual apparatus that sustains current opinion in each topic area …

… and find ways to inspire change by tapping into people’s internal motivation: “Is this why you went into nursing?”

We need to do these two things while avoiding Hegel’s labour of the negative.

 

Ontario’s healthcare agreement with Ottawa will not fix broken system

Prime Minister Justin Trudeau, left, and Ontario Premier Doug Ford attend an announcement at Seneca College, in King City, Ont., on Feb. 9. PHOTO BY CHRIS YOUNG/THE CANADIAN PRESS

Ontario’s health-care agreement with Ottawa will not fix broken system

The federal-provincial agreement represents more central planning designed to fix problems created by central planning

Published Feb 13, 2024 in the National Post

Prime Minister Justin Trudeau and Ontario Premier Doug Ford congratulated each other last week on signing a $3.1-billion, three-year health-care agreement, ending two years of haggling.

In December 2022, Trudeau had said there’s “no point putting more money into a broken system.” But by February 2023, Trudeau had forgotten his point and signed a $196.1-billion deal with the provinces. It included side deals with individual provinces to be worked out later, which we saw in Ontario last week.

Trudeau is not the only one who changed his mind. Throughout 2022, the provinces fought for a $28-billion increase in transfer payments, with no strings attached. But they settled for $17 billion, with strings to be sorted out later.

Premier Ford seems pleased that his side deal trimmed Trudeau’s strings down to a three-point plan, centred on primary care and data sharing. Health Minister Jean-Yves Duclos had initially demanded five broad and more substantive deliverables.

In a statement, Trudeau’s office said that, “Universal public health-care is a core part of what it means to be Canadian. It is the idea that no matter where you live or what you earn, you will always be able to get the care you need.”

Notice the language here: an “idea” is not a promise or a guarantee. Actual delivery of care is not part of the deal. Continue reading “Ontario’s healthcare agreement with Ottawa will not fix broken system”

Governance Eats Policy For Breakfast — Why Healthcare Can’t Change

Governance
A multidisciplinary team of doctors, residents and nurses meet at the Halifax Infirmary in Halifax on Friday, Feb. 25, 2022. Andrew Vaughan/The Canadian Press.

The Hub published my op ed. You can read it at TheHub.ca or below. Enjoy!

When it comes to fixing health care, governance matters more than policy

Without good governance, new policy will struggle with implementation like all the old policy.

Few voters had first-hand experience with hallway medicine or Canada’s world-famous wait times before the pandemic. Lockdowns changed everything. Health policy failure moved from fear-filled headlines into a tangible crisis everyone could feel.

Failure begs for better policy, or new policy to fill gaps. Planners and policy writers jump to offer solutions: surgicenters, funding reallocation, redesigned models of care, and so on.

New policy, however, cannot fix old policy, unless we know why the old failed in the first place. Most policy fails on implementation, not from bad design. Furthermore, we cannot fill policy gaps unless we understand why gaps exist. Gaps form around constraints and incentives, not from a lack of creativity. The policy environment dictates viable policy options.

How a system functions has more to do with how its governed than with the policy ideas in play. Implementation failure, constraints, and incentives all fall under the larger umbrella of governance. Governance and policy overlap, but they are different.

To fix health care, we need to start with governance: how do we make decisions? Who gets to make them? If we do not, a new policy will deliver the same old results.

Policy to the rescue

Take surgicenters as an example. Surgeons and specialists join together to build a non-hospital, outpatient surgical facility. Each centre offers a specific basket of specialty care, for example eye, orthopedic, or endoscopy services. Surgicenters can offer comfort, convenience, quality, and efficiency that hospitals struggle to match.

Surgicenters exist around the world. They are not new. In Canada, we have been trying to move care out of hospitals for decades. We want to save money and shorten waitlists. Why aren’t Canadian cities littered with surgicenters?

Current incentives and constraints make surgicenters impractical and onerous. Currently, hospitals supply nursing care, equipment, and use of the facility. Physicians use everything but do not pay for it, making non-hospital facilities a tough sell. On top of this, billing rules, regulation of independent health facilities, licensing for necessary lab and imaging services, as well a basket of other restrictions all weave together into a policy environment intolerant of (publicly funded) independent facilities.

We do not need a policy about surgicenters. We need research on why surgicenters do not exist in the first place and what to do about it.

Thomas Sowell, American economist and author, said once, “The most important decision about every decision is who gets to make the decision.”

Sowell expanded this in his book, Knowledge and Decisions: “The most fundamental question is not what decision to make but who is to make it—through what processes and under what incentives and constraints, and with what feedback mechanisms to correct the decision if it proves to be wrong.”1

Before making a change, every hospital administrator must ask, “Who needs to be in the room?” Spectacular new policy will fail in even more spectacular fashion if you ignore governance. Informal governance can matter even more. Decision makers are often not the ones listed on the organizational chart: colleagues influence through personality without title or position.

Governance eats policy for breakfast

Peter Drucker, the legendary management consultant, once said, “Culture eats strategy for breakfast.”2 We can say the same about health policy: governance eats policy for breakfast.

Dr. Dave Williams, a former astronaut and leader at NASA, served as CEO at Southlake Regional in Newmarket. He said, “It’s not clear who runs the hospital.” He was making an observation, not a complaint. “Compared to what I’m used to, it’s challenging to get things done.”

Without clarity and fidelity to best practices, governance will drift. Sowell, again, sums this up:

Even within democratic nations, the locus of decision making has drifted away from the individual, the family, and voluntary associations of various sorts, and toward government. And within government, it has moved away from elected officials subject to voter feedback, and toward more insulated governmental institutions, such as bureaucracies and the appointed judiciary.

Is this a problem in Canada? Brian Lee Crowley, managing director of the Macdonald-Laurier Institute, thinks so. Governance drift leads to central design—a temptation for all political parties.

In his book, Gardeners and Designers: Understanding the Great Fault Line in Canadian Politics, Crowley dilates on how gardeners approach governance.3 A gardener prepares the soil, removes waste, provides support, and tends to progress. Gardeners celebrate the surprise inherent in what grows and blooms. They do not manage growth for a specific policy outcome they designed in advance.

Designers dream about how to make health care better. Gardeners ask the more important question: how can we get good ideas to grow? A gardening approach to governance leaves plenty of essential (gardening) work for government. It empowers those closest to the problem and leaves design, experimentation, and implementation to them.

We cannot try to “fix” health care with new policy. Without good governance, new policy will struggle with implementation like all the old policy. We need to do first things first. Governance eats policy for breakfast.