When Peter Pisters graduated from medical school at the University of Western Ontario in 1985, he headed to the United States for specialized post-graduate training that was not available in Canada at the time. But Dr. Pisters, a cancer surgeon, married father of three and St. Catharines native, always yearned to come home, even after ascending to a senior position at Houston's prestigious MD Anderson Cancer Center.
Earlier this year, Dr. Pisters, 54, finally returned to his home country to become the new president and chief executive officer of the University Health Network, the powerful group of academic hospitals that includes Toronto General Hospital, Toronto Western Hospital, the Princess Margaret Cancer Centre and the Toronto Rehabilitation Institute.
Dr. Pisters spoke about his admiration for universal health care, the advantages of going undercover at employee orientation day and the lessons he learned while wearing flip-flops in the Toronto Western lobby.
Toronto Life magazine named you one of the 50 most influential people in the city before you even arrived. Any pressure?
Well, I think that's clearly not a reflection of me personally, but of the magnitude and success of the organization. I'm extraordinarily proud to be able to join an organization as prestigious as UHN at such a critical point in the evolution of health care.
MD Anderson is a pretty big-deal institution. What made you decide to leave and return to Canada?
Some of it is certainly driven by the incredible professional opportunity. There's also the love I have for the country and the respect and admiration I have for the magnificent social contract that exists here for universal health care.
Was that something that bothered you when you were practising in the United States, that there wasn't that same social contract?
Incredibly. I saw MD Anderson and cancer centres in general as fantastic places where clinical miracles occur every day and amazing discoveries happen. But I saw that occurring within a framework where walls were built around the organization and barriers were put into place for patients who couldn't afford to receive care or didn't have the right insurance. We never saw those patients.
Are you feeling pressure to deliver great care with a limited budget, especially at a time when hospital budgets are likely to stay frozen for the foreseeable future?
I think that's a challenge that exists throughout Ontario. It's not unique to Ontario. We want to be able to build [on] the fantastic programs that have existed here for specialty care – organ transplant, cancer, cardiac care. But at the same time, we want to think about the needs of the community we serve. How do we need to position UHN to become the community hospital of the future?
It's funny you say that. I think the last thing people think when they think of UHN is 'community hospital.' It's so well known as an academic and research centre.
The reality of UHN's identity as a community hospital was very obvious to me when I first began to research the organization. Before even the first interview, I went to Toronto Western and I sat in the lobby in shorts and flip-flops. I really looked at how care was being delivered, how the employees interacted with the patients, who was picking trash up off the floor, who was helping patients to find their way. That helped me to understand the culture of the organization.
To get a feel of the place, you went undercover in the lobby?
Yes. That's the best way to learn about any organization. If you go as a secret shopper, you can get a lot of insight.
What did you do on your first day?
I chose to enter through the Toronto General emergency room, arriving at 6:45 a.m. and bringing breakfast for the night shift. Sitting down with them created an opportunity for me to talk to the people who had worked through the night caring for [patients during] the influenza epidemic that we were dealing with at that point.
What else have you done in your first weeks?
In my first week, I made certain that I got out to every site. I got into some of the labs that are key to UHN's research mission. I also went to a new employee orientation. I went incognito, initially. I then could seat myself amidst a group of new employees, introduce myself to them as 'Peter from corporate,' and ask them a little bit about [themselves]. After the executive speech, [the leader] said, 'There's another new employee here you might want to meet.' That gave me an opportunity to stand up and talk to them as a group and tell them, 'I'm really one of you. We're here together.'
You're the undercover boss.
I learned a tremendous amount from the process, in terms of what we say to new employees, the messages that we deliver and how we help them to understand our culture of patient safety and quality.
How well do you know your predecessor, Bob Bell, who is now the province's deputy minister of health?
I first ran into Bob when I was a medical student and he was doing outreach clinics in London, Ontario. As our careers evolved, Bob became a site leader for sarcoma here at Princess Margaret and I was the site leader for the same disease at MD Anderson. Bob also operated on my father-in-law when he developed a problem related to cancer, so we had a personal connection to Bob as a physician. He's been an unofficial mentor to me for a long time.
What has it been like for you personally to move back to Canada and settle in Toronto?
I'm just thrilled to be back here. Our family, we're four seasons people. I don't mind the cold weather at all.
This interview has been condensed and edited.