Scroll down for a transcript, how to subscribe, and more

Welcome to Episode #28 of Habitual Excellence, presented by Value Capture.

Our guest is Rob MacIsaac, the president of Hamilton Health Sciences, from Hamilton, Ontario, Canada.

Today, we talk about how he got involved in healthcare leadership (after previously being the mayor of Burlington, Ontario, among other leadership roles). Rob shares reflections on meeting the late Paul O'Neill and what he learned from those interactions. Rob also shares three key takeaways about leadership:

  1. everybody has to be valued and respected
  2. everyone feels they are a member of a team, contributing to mission
  3. everybody needs to have the right tools to do their job

We also discuss what it means to be respected in the workplace, what it means to be recognized, and why leaders need to push toward “theoretical limits.”

We hope you enjoy the episode. We'll be back in two weeks after taking the Thanksgiving week off…



"The first [rule] is that no organization can be successful unless everybody feels valued and respected."

"The second [rule] is that everybody in the organization really has to feel that they understand they're a member of the team and what the team is trying to accomplish."

"Unless you give [everybody] some say in the organization and the ability to actually have some input into how you're running the organization, you cannot get to the upper echelons of quality..."

Click to visit the main Habitual Excellence podcast page.


To make sure you don't miss an episode, be sure to subscribe today! Please rate and review the podcast.

Subscribe or Follow - Habitual Excellence Podcast, Presented by Value Capture


Habitual Excellence (2s):
Welcome to Habitual Excellence presented by Value Capture. This podcast and our firm are all about helping you and your organization achieve habitual excellence via one unifying focus, one value-based structure, and one performance system. In other words, it's about helping you capture dramatically more value through achieving perfect care and perfect safety for patients and staff. To learn more about Value Capture and our services, visit

Mark Graban (35s):
Hey, everybody. Welcome to the podcast. I'm Mark Graban from Value Capture. We're joined today by Rob MacIsaac, the president of Hamilton Health Sciences. Rob, how are you?

Rob MacIsaac (46s):
I'm very well, Mark. How are you?

Mark Graban (48s):
Doing okay. Thank you for joining and sharing with us today. If you could start by introducing yourself and a little bit about your background, it would be interesting to hear how you ended up working in health care, in a leadership role.

Rob MacIsaac (1m 7s):
Sure. My name's Robin MacIsaac, as you heard, and I'm the president and CEO of Hamilton Health Sciences. We’re one of Canada's largest research hospitals. Although maybe by US standards, were probably still large, but not very large. We have about 13,000 employees. We're serving a catchment area, about two and a half million people, with a series of tertiary and quaternary care services.

Rob MacIsaac (1m 49s):
Generally, we would be ranked, about the number, in the top three in terms of research hospitals in Canada. They just measure that by dollars income in research. I've been in this job for about six and a half years. I came to it by a pretty unconventional route. I started my career off as a lawyer. I was working on Bay Street in Toronto, which is Canada’s Wall Street, and wasn't having that much fun there. I decided to start my own practice in my hometown of Burlington, Ontario.

Rob MacIsaac (2m 34s):
I did that. Not long after I did that, I was approached to get into local politics. I ran for the city council and became a member of the city council. Six years after that, I became the mayor of Burlington and I served for three terms before deciding to leave. I then took the job as the, say, executive chair of the Regional Transportation Authority for Greater Toronto and Hamilton, something that was ultimately called Metrolinx and is still going today.

Rob MacIsaac (3m 14s):
It's a very large going concern today. It’s responsible for running the regional transit, which is mostly a commuter rail system, but also a very significant fleet of buses and so on. I stayed there for three years. I got it up and running and started. We developed a regional transportation plan for the region. Subsequent to that, I took the job as the president of one of Ontario's large colleges called Mohawk College in the State of Mohawk for five years.

Rob MacIsaac (3m 56s):
It was a very fun job. I took this job as CEO of Hamilton Health Sciences. A lot of different sectors there, probably the common themes though across all those jobs are public service and leadership. Those are the things that I really like. I've had been very fortunate in my career.

Mark Graban (4m 29s):
Well, along the lines of public service and leadership and doing a lot of different things. Many of our guests have shared reflections about meeting the late Paul O’Neill, who among other things was the founder of Value Capture, but he spent many years working in the United States federal government and was CEO of Alcoa. He also ended up having influence in healthcare. I know you're going to share some reflections. How did you meet Mr. O'Neill? Just as a way of leading into the way he influenced some of your thinking as a leader.

Rob MacIsaac (5m 8s):
Not long after I started at Hamilton Health Sciences, my chief medical executive came to me and said, “I think we're ready to really move on to the next generation of quality improvement at Hamilton Health Sciences.” We'd certainly been thinking and doing lots in the area of quality, but I think we felt, broadly, that we're ready to get to the next step. He suggested that we take the executive team down to Pittsburgh and meet with Value Capture, which we ultimately did.

Rob MacIsaac (5m 52s):
I can honestly say it was a transformative experience for our executive group. That's where we met Paul O’Neill. It's fair to say he struck me, and I think, he struck our whole team as being an extraordinary individual. My view probably, after our first meeting, that Paul was a great American. He was somebody who really embodied many of the things that I think the US, as a nation, aspires to in terms of leadership, and excellence, and leading by example, and so on.

Rob MacIsaac (6m 45s):
I was very honored to meet him and he was very impactful on us. I think at the end of that first trip, we all felt very energized about the direction in which we wanted to take our quality improvement efforts. For me, I distilled Mr. O'Neill's message into three relatively simple rules, which is good for me because I can remember those things. The first is that no organization can be successful unless everybody feels valued and respected.

Rob MacIsaac (7m 34s):
The second is that everybody in the organization really has to feel that they understand they're a member of the team and what the team is trying to accomplish. Everybody needs to understand the vision and mission of the organization and how their role is really contributing towards it. The last is that everybody needs to have the right tools, the tools required to do their job. I know those things sound fairly simple, but if you unpack them, there's a lot of meaning to them. I think that again, although they sound simple, it is challenging to make them all true in a robust way.

Rob MacIsaac (8m 20s):
If you do, I think Mr. O’Niel was right, that those are profoundly necessary enablers to success as an organization.

Mark Graban (8m 31s):
Maybe we can unpack those a little bit, elaborate on the idea of what does it really means, on a daily basis, for employees to be respected, to feel respected in the field value? What can you do as a leader to help create that environment in a large complex organization?

Rob MacIsaac (8m 54s):
Yes, I think at the heart of it is recognizing that value is created at the coalface in any organization that. Those frontline workers are the people who, in many respects, are the only people who can really help you get significantly down the quality road. I remember a friend of mine who is a turnaround guy, a private sector individual, who took over a company, a manufacturing concern that was essentially on the verge of bankruptcy.

Rob MacIsaac (9m 39s):
He said, “I spent the first three months working on the mine of this company. I said, Hey, what's going on? Why can't we actually make a product that functions?” The workers said to him, it was a welder, and he said, “I want you to put this mask on and take a look at the weld that I'm doing.” He said, “I did it and I couldn't see a thing. I realized that the lights in the factory had been allowed to get so dirty, that nobody in the factory could really do a good job or the job they were being called upon to do.” That's something that's very difficult to discern from the CEO's office unless you're the person doing the job.

Rob MacIsaac (10m 29s):
It's a simple example but it's a great example of how the quality of the product at the end of the day is so much a function of the person actually doing the work and the insights that they can glean from it. I think, there's dignity in every job in an organization and that's because everybody is playing an important role at the end of the day, to getting to the company's vision and mission. Unless you give those people some say in the organization and the ability to actually have some input into how you're running the organization, you cannot get to the upper echelons of quality that we're all trying to get to.

Mark Graban (11m 22s):
One thing, Mr. O'Neill talked about a lot, when you talked about getting to upper echelons of quality, he would talk about, as we've explored in some other episodes, the ideas of habitual excellence and really working toward the idea of what you call theoretical limits, especially in the realm of quality and safety, could translate to me in zero harm, zero bad experiences for a patient. I'm curious if you can share some of your reflections on some of those themes that he talked about quite a bit.

Rob MacIsaac (11m 59s):
I think when I first went to work at the college that I had mentioned to you, they had student satisfaction scores that were amongst the lowest in the province. I think that those scores had been there for so long that people felt that that was just the way things were. People would often say to me, “It's a large college and none of the large colleges has really done very well when it comes to student satisfaction. There's just no way that you can get a lot better.” I set out a goal for the organization that we should be the best organization, the best college in Ontario for students’ satisfaction.

Rob MacIsaac (12m 53s):
I think nobody really believed that was possible, but we kept driving towards it. When people started to see us making significant improvements in terms of how our students regarded us, it really empowered the whole of the organization to accelerate, to put their foot down even more on the accelerator. I think after the five years that I was there, we were in the top three for student satisfaction in the Greater Toronto Area, which comprises most of the colleges in the province. People were right. It was very difficult for a large college to compete with a small college in terms of student satisfaction, but we made very significant gains.

Rob MacIsaac (13m 41s):
It really started with the notion that we needed to have a big vision, an aggressive, audacious vision for where we wanted to get to. You had to be persistent about wanting to achieve it. When people started to see progress and started to see real results, it had an impact across everything that we did. I think it changed everything. I think for Mr. O’Neil, he certainly focused on employee safety and the notion that you could not stop until you got to zero, that zero was possible.

Rob MacIsaac (14m 35s):
Well, I think that particular goal served a number of important purposes, including again, acknowledging the importance and the dignity of everybody who worked at Alcoa. It also had an effect broadly across the rest of the organization that they're, why would you try to do anything less than be the best you could possibly be at? That idea that everything you do, you should do with excellence, I think is a really important part of quality improvement. It's a really important part of leadership.

Mark Graban (15m 19s):
As Mr. O'Neill shared in his speeches, I think even if listeners go back to episode one where we shared one of those features, Mr. O'Neill would tell healthcare audiences about when he was new to the CEO role in Alcoa. He would talk about theoretical limits and zero harm. He got pushback. People are saying, “Well, that's not possible. This is just the way things are.” There's that sense of resignation, if you will, or just acceptance. I think it's interesting when an outsider can try to spark the idea of, “Well, wait a minute. Why do we have to take that for granted?” Mr.

Mark Graban (16m 3s):
O'Neill would talk about the role of the CEO of leaders as helping remove excuses from the organization, which might sound a bit harsh, but I think it's constructive. I'm curious to hear some of your reflections and again, thinking of your role in different organizations. How do we help people see what's possible? Whether you call it eliminating barriers or removing excuses, how can we go about that?

Rob MacIsaac (16m 32s):
Well, for sure, I think it starts with the CEO's insistence on dedication to excellence but I think the other thing about my second rule that everybody understands, the role that they have in terms of helping the organization accomplish its mission and vision. It implies a number of things about the job of the CEO. The first of which I think is to get to a really compelling vision for the organization.

Rob MacIsaac (17m 16s):
It's a role that's really peculiar to the CEO's job. It's something that I think can distinguish a good CEO from an average CEO. Having achieved that vision, which has to be much more than just about making a profit or balancing your books, it has to be something that people feel motivated by and then, communicating it out in a way that people can understand it and are motivated by it. I think they're both really important parts of that second rule.

Rob MacIsaac (17m 57s):
I know in every job that I've had, I've gone in and there are certain people who I've understood from the first day because of the way they were able to communicate to me about the nature of the business. There were other people who I might not have ever fully understood during the whole of my time during any particular stent with an organization. I guess what I'm driving at is this notion of clarity and simplicity in the way that a CEO communicates is really important. It's easy as anything to get caught up in the jargon of the business, but I think, especially for people coming in from the outside, you're not caught up in that jargon and nor should you ever allow yourself to be in.

Rob MacIsaac (18m 50s):
You have to be able to, on an ongoing basis, communicate to everybody in the organization in a way that they understand and in a way that they find compelling. It should be grounded in that notion of excellence.

Mark Graban (19m 8s):
Maybe a final question. When you talk about coming into an industry again, do you have any other lessons or reflections or aha moments coming into healthcare and seeing what translated from a leadership perspective and what's different or unique about the challenge in creating habitual excellence in healthcare?

Rob MacIsaac (19m 35s):
Others may disagree with me, I guess one of my big realizations about healthcare, and it's certainly been confirmed over the last three months, is that it is a sector that is very much driven by crisis, very much focused on the here and now. I totally understand why those are really important skillsets for healthcare. We've been dealing with this COVID crisis for the last three and a half, almost four months now. It's been extraordinary to watch my team and how well they've been able to respond to demands that were next to impossible, but I think that the other side of that coin is that healthcare is not naturally strategic.

Rob MacIsaac (20m 33s):
It's a sector that you really have to poke and prod to get to strategy and to get focused and to remain focused on strategy. I think, for me coming in as an outsider, that message from me to my organization has been really relentless about understanding where we're trying to be three years from now, five years from now, what the key enablers are to achieve that and then relentlessly driving those things on a day-to-day basis, making sure that almost every communication I make with the organization is related to our strategy and why we're doing it.

Mark Graban (21m 31s):
Well, really appreciate you sharing some of your thoughts and reflections here across not just healthcare, but other settings, Rob. Our guest today, again, has been Rob MacIsaac. He's the president of Hamilton Health Sciences. Is there any final thought or tip that you might want to leave the listeners and viewers with?

Rob MacIsaac (21m 53s):
Yes, if I just, again, reflect back on that first session that I had at Value Capture, meeting Mr. O'Neill, I think what I found most liberating, and I don't know the extent to which. I suspect this is a common experience across most healthcare systems. It's such a relentlessly grinding sector from the point of view of always constantly being asked to do more with less. It can definitely challenge your resilience, but I think what I've found most liberating from meeting with Mr.

Rob MacIsaac (22m 39s):
O'Neill and the Value Capture team was the idea that the way forward for healthcare was not continually asking people to work harder, to do more work. It was really fundamentally grounded in this notion that if we can drive waste out of healthcare, there's more than enough resources to do what needs to be done, but it's really about finding the waste and driving it out. I think for most of us, if you ever have any doubt about how much waste there is in the system, we just need to follow a nurse around for a shift and see how many things we ask those nurses to do, which really have very little to do with adding value to our patients at the bedside.

Rob MacIsaac (23m 35s):
There is lots more to get to, and it's a liberating thought from my perspective.

Mark Graban (23m 43s):
Well said and thank you for that that key point in that reminder for everybody. Rob again, thank you so much for taking the time and being our guests here today. Really appreciate it.

Rob MacIsaac (23m 55s):
My pleasure, Mark. Thank you.

Mark Graban (23m 56s):
Best wishes to yourself and everybody there in Hamilton, the important work you do. Thank you.

Habitual Excellence (24m 3s):
Thanks for listening to the Habitual Excellence presented by Value Capture. We hope you'll subscribe to the podcast. Please also rate and review it in your favorite podcast directory or app. To learn more about Value Capture and how we can help your organization on this journey to habitual excellence, visit our website at


Submit a comment