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Long Term Care (LTC) in Canada

Mar 1, 2021

Long term care in Canada

by: Dr Hartley Stern, Senior Advisor Healthcare

Quote by Warren Buffet

At the core of long term care: Leadership and Culture

Every Canadian citizen has been affected by the COVID-19 pandemic in profound, life-altering and, in the case of seniors and vulnerable populations, life-ending ways.

The fact that 11% of COVID-19 cases and 73% of total deaths in Canada occurred in Long-Term Care (LTC), nursing and seniors’ homes (HillNotes, 2020) is the true unspeakable tragedy of the pandemic. An alarming finding contained in a June 2020 report by the Canadian Institute for Health information was that the proportion of COVID-19 deaths in Canadian LTC facilities exceeded that of other OECD countries:

“Canadian LTCs from COVID-19 were at 81% of the total, while OECD countries reported LTC COVID-19 deaths of 10-66% (average of 38%) of their totals.” (CIHI Snapshot June 2020)

Most healthcare leaders and provincial and federal political leaders knew that our ability to comfortably house and safely care for our seniors and vulnerable populations was in a shambolic state prior to the pandemic. The pandemic simply and ruthlessly exposed the weaknesses, and we as a society appeared impotent to do anything about it. The image of bringing in the military to shore up a failing LTC system is a shameful reminder that there was no foreign enemy to fight, no natural disaster to overcome, but rather our failed attempt to prevent unnecessary casualties and profound suffering due to a virus. The root causes of this disaster were well known before the pandemic, and indeed, at least two provincial governments campaigned in their most recent elections on repairing the LTC system. Yet, the evidence is clear that we all fell horribly short on the stated repair objective.

In this position paper, we review the known root causes of this disaster, including: governance, structural relationships within the broad health care system, funding (public and private), and human resources, all necessary but not sufficient to repair the deficiencies. We will emphasize what we believe are the most challenging but fundamental requirements for change: leadership and culture.

Scope of the problem

In March 2020, Public Health Canada declared Canada was officially in a pandemic caused by COVID-19. At that early point in the pandemic, it was not recognized that the bulk of deaths were going to happen in congregant settings for the elderly, namely LTC facilities, Nursing Homes and Seniors Homes. One of the challenges we would discover is the inconsistent nomenclature referring to these settings across the country (Picard 2020).

Armstrong et al. (2020) put the situation into context by providing global benchmarking statistics:

            “Numbers are changing rapidly, but to date, Canada has the highest reported proportion of COVID-19 deaths nationally for nursing home residents. Canada reports that 81% of total COVID-19 deaths are of nursing home residents. Other comparable countries report 27% (England and Wales), 28% (Australia), 31% (US), 34% (Denmark), 34% (Germany), 47% (Scotland), 49% (Sweden), and 66% (Spain). The Royal Society of Canada Working Group on Long-Term Care fatality rate for people who have COVID-19 is estimated at 3.4%,40 but that rate varies strikingly from country to country—from as low as 0.1% (Qatar) to as high as 26.3% (Yemen). In Canada, the fatality rate is estimated at 8.2%, but the Canadian fatality rate of nursing home residents is estimated at 25% (range 11%-35%). The global fatality rate for all persons over age 85, regardless of location, is 10%-27%.”

Armstrong et al. (2020) further implores relevant stakeholders to acknowledge their share of responsibility and face the dire reality of current care gaps amongst vulnerable older adults. The document highlights harnessing learning opportunities as an antidote for “short-sighted and siloed solutions” that fail to address root causes.

The analyses of why this tragedy has occurred in seniors’ congregant housing are not yet complete, but the themes emerging include the following.

A. Governance

Public

  • Multiple models of relationships to regional health authorities, acute care sector and government. No coherent theme across the provinces.
  • Multiple models in the private sector with little to no accountability to governments.

Although there has been a political attack on the private sector management, it is not clear jurisdiction by jurisdiction that public sector facilities were/are faring any better. The argument is rendered moot when both private and public sector homes are accountable to provincial authority for standards of care. The financing and management systems differ, but accountability is the same.

Howlett (2021) provides insight into some of the realities facing some LTC facilities in Ontario:

            “Ontario hospitals are currently managing 18 long-term care homes with outbreaks of COVID-19. But in many instances, the province is not sending in-hospital teams to take over management until COVID-19 has spread throughout the home and staffing has become critically low, leaving residents unable to get basic care.”

A scathing rebuke from Armstrong et al. (2020) highlights that a lack of integration across the community, continuing care, and acute care sectors in Canada may be partly to blame for many LTC facilities’ current state.

Goldfinger (2020) draws attention to the gap between policy intentions and their practical outworking, stating:
“The province’s “iron ring” around long-term care facilities has been criticized by advocates who’ve argued the policy didn’t work in controlling COVID-19 outbreaks and also contributed to adverse mental health effects among seniors who were in isolation.”

HillNotes (2020) points out the importance of co-ordinated leadership in the LTC sector, stating:
 “A June 2020 report on LTC home staffing by the Royal Society of Canada stated that “the pandemic just exposed long-standing, wide-spread and pervasive deficiencies in the sector” and made nine recommendations to address “the workforce crisis in nursing homes,” urging “coordinated leadership” between the federal and provincial/territorial governments.”

Nuttall (2021) highlights potential focus areas stating that “Former Ontario Minister George Smitherman said a “cultural shift” in attitudes toward the elderly and those who care for them is needed to bring about changes to the troubled sector, which has plagued successive provincial governments.”

Armstrong et al. (2020) further assert that“The LTC sector requires strong, decisive leadership that is willing to move past incrementalism and tinkering at the margins to true transformative change. Leadership must also be willing to devote the resources needed to achieve this. We will need the ability and courage to not only implement promising practices, but also to cease practices that are not useful or effective.”

B. Physical Structures

For many years, the acute care sector has known that shared bathrooms and multiple bedded rooms were the single biggest physical plant barrier to reducing nosocomial infection spread. The standard for new hospital construction or renovation is a mixture of single bedded with some allowance for semiprivate rooms, with complete elimination of multi-bedded rooms.

The national standard in LTC facilities is not so clear; however, the Nova Scotian code, as presented in LONG TERM CARE FACILITY REQUIREMENTS – Requirements for Nursing Home Design in Nova Scotia, (2020), provides a helpful benchmark.  The physical plant changes, including the more expensive, one patient per room option, must and will be addressed.

C. Human Resources

Howlett (2021) observes that a lack of transparency regarding staffing in LTC facilities is equally as concerning as the prevalence of cases and deaths.

A further noteworthy observation, raised by HillNotes (2020), is that the number of healthcare workers for 100 in Canadian LTC facilities is significantly lower than the OECD average.

The CIHI Snapshot June 2020 report notes that care aides often:

  • receive low wages;
  • receive minimal and variable education across the country;
  • work part-time without benefits;
  • are contracted through agencies and are unfamiliar with the LTC facility where they work; and
  • are not included in decision-making and family conferences, despite spending the most time with residents.

There were few differences between publicly and privately managed institutions. In each setting, we were unable to determine because of a lack of data how many privately engaged personal care workers were paid for by patients’ families. Still, it is widely believed to be significant and related specifically to the unacceptable level of service budgeted for by the institutions. Sinha et al. (2019) provide some insight into spending on LTC:

Table 1: Visualization of Canadian Long-Term Care Spending Estimates for 2018

Table 1: Visualization of Canadian Long-Term Care Spending Estimates for 2018,
based on Grignon & Spencer (2018) methods. (Cited in Sinha et al., 2019 pg 35)

Figure 1: Long-Term Care Expenditure (health and social components) by Government and Compulsory Insurance Schemes, as a Share of GPD, 2015 (or nearest year) Across OECD Nations (Cited in Sinha et al., 2019 pg 39)

Figure 1: Long-Term Care Expenditure (health and social components) by Government and Compulsory Insurance Schemes, as a Share of GPD, 2015 (or nearest year) Across OECD Nations (Cited in Sinha et al., 2019 pg 39)

D. Leadership and Culture

While addressing the physical structure and staffing volume needs of LTC facilities can be achieved with relative ease, bringing about the required leadership and cultural transformation to sustain an excellent care level is a more complex matter.

Leadership mindset has an undeniable impact on an organization’s culture, whether positively or negatively. Any improvements generated in the system as a healthcare leader, or a leader in any industry, always involve behavioural change.

Marrocco, Coke and Kitts (2020) emphasize the importance of leadership in LTC, stating;
“We learned from wave 1 that on-site leadership matters. We heard that homes where leaders were visible and provided clarity around staff roles and responsibilities fared better than those where leadership was less engaged. Homes with effective leaders were better prepared, had less outbreaks, and better-contained outbreaks when they occurred.”

PulvermacherKennedy and Associates (2021) observe that “time and again that when executives or leaders are very focused on self and what they want to do, rather than considering the greater good, the organization suffers as a result. Conversely, when leaders exhibit more inclusive mindsets, traits and behaviours, they feel a sense of purpose and personal satisfaction, which positively influences organizational culture.”

Effective leadership in times of intense stress and crises requires making tough choices (Picard, 2020). There is a natural inclination to think in an either-or fashion. For example, “do I set the bar high and risk losing more staff or do I avoid doing so and retain my complement of necessary employees.” The more effective leadership question uses an “and” rather than an “or.” The leader’s dilemma is, “how do I set the bar high and retain my scarce staff?”.

In affecting behavioural change, the process of coaching senior leaders can illuminate blind spots and boost performance by providing an outside perspective (Kennedy, 2017). However, the notion of the “heroic leader” riding in on his or her steed to save the day is an archaic one. Effective leadership implies building a strong and cohesive leadership team that pulls together in a crisis, challenges one another to design innovative solutions to challenging problems, and works to ensure the successful implementation of the solutions (Pulvermacher, 2020).

Finally, effective leadership requires asking staff how they can help identify or solve problems before they get out-of-hand. Effective leaders aren’t afraid to challenge people through penetrating questions and, above all, allow staff to ask them questions. Only in this manner can the leader nip issues in the bud instead of allowing issues to simmer and subsequently get out of hand.

Solutions

  • Physical plant solutions are well known and have been described extensively.
    LONG TERM CARE FACILITY REQUIREMENTS – Requirements for Nursing Home Design in Nova Scotia (2020) provides a helpful example of best practice, stating that “Semi-private rooms or adjoining rooms must be provided at a maximum 1:48 resident ratio. Written justification must be provided for the inclusion of semi-private rooms (e.g. accommodating spouses, decreasing social isolation, etc.) as part of the functional program.” This essentially establishes single bedded rooms as the standard with a few
    double-bedded rooms on special application
  • HR solutions are also well documented and include better training, higher salaries, and better staffing ratios for

Sinha et al.(2019) provides a wealth of insight into the topic, contextualizes current challenges, and concludes by highlighting enabling factors and support opportunities for Long Term Care’s future provision. GPA consider this document essential reading for leaders in the field.

Conclusion

As noted by Picard: “The only way to rein in the on-the-verge-of-getting-out-of-control pandemic is with a united front – with leaders willing to make hard decisions.” Picard (2020)

This national shame is effectively a statement of Canadian values. We have failed to protect our senior and vulnerable citizens from an existential threat. The pandemic has been framed as a failure of planning, preparation, local vaccine production capacity, political will and competence.

The most distressing debate to observe is pitting the easing of public health restrictions and taking a risk with Canadian lives vs the financial survival of Canadian businesses. These are all crucial issues that Canada must address. However, in the final analysis, it is abundantly clear that establishing the appropriate care, compassion, valuing, and housing of seniors and vulnerable populations will significantly impact business and the economy. This approach is joyfully and entirely consistent with what we believe to be real Canadian values.

We should be singing our national anthem not at every sports event celebrating our young athletes but rather at the reopening of every senior’s facility in the country: “Oh Canada, we stand on guard for thee.”

 

Bibliography

Armstrong, P., Boscart, V., Donner, G., Ducharme, F., Estabrooks, C., Flood, C., Keefe, J., Silvius, J., Straus, S. and Wolfson, M., 2020. Restoring Trust: COVID19 And The Future Of Long Term Care. [online] Rsc-src.ca. Available at: <https://rsc-src.ca/sites/default/files/LTC%20PB%20%2B%20ES_EN.pdf> [Accessed 11 January 2021].

Cihi.ca. 2020. CIHI Snapshot June 2020 – Pandemic Experience In The Long-Term Care Sector. [online] Available at: <https://www.cihi.ca/sites/default/files/document/covid-19-rapid-response-long-term-care-snapshot-en.pdf> [Accessed 11 January 2021].

Goldfinger, D., 2020. How COVID-19 Has Changed The Way Families Think About Long-Term Care In Ontario. [online] Global News. Available at: <https://globalnews.ca/news/7495190/coronavirus-covid-19-ontario-long-term-care-family-experiences/> [Accessed 26 January 2021].

HillNotes. 2020. Long-Term Care Homes In Canada – The Impact Of COVID-19 – Hillnotes. [online] Available at: <https://hillnotes.ca/2020/10/30/long-term-care-homes-in-canada-the-impact-of-covid-19/> [Accessed 11 January 2021].

Howlett, K., 2021. Paramedics Alarmed By Conditions Inside Home With Ontario’S Worst LTC Outbreak. [online] The Globe and Mail. Available at: <https://www.theglobeandmail.com/canada/article-paramedics-alarmed-by-conditions-inside-home-with-ontarios-worst-ltc/> [Accessed 11 January 2021].

https://novascotia.ca/. 2020. LONG TERM CARE FACILITY REQUIREMENTS – Requirements for Nursing Home Design in Nova Scotia. [online] Available at: <https://novascotia.ca/dhw/ccs/policies/Long-Term-Care-Facility-Requirements- Space-and-Design.pdf> [Accessed 23 February 2021].

Kennedy, L., 2017. Coaching CEOs (and other members of the C-Suite) | GPA. [online] GPA. Available at: <https://gpulvermacherassociates.com/coaching-ceos-and-other-members-of-the-c-suite/[Accessed 23 February 2021].

Marrocco, F., Coke, A. and Kitts, D., 2020. [online] Ltccommission-commissionsld.ca. Available at: <http://www.ltccommission-commissionsld.ca/ir/pdf/20201203_2nd_Interim_Letter-E.pdf> [Accessed 11 January 2021].

Nuttall, J., 2021. ‘I’m Not Sure We Care Enough:’ Cultural Shift Needed To Stop Tragedy In Care Homes, Experts Say. [online] thestar.com. Available at: <https://www.thestar.com/news/canada/2021/01/04/im-not-sure-we-care-enough-cultural-shift-needed-to-stop-tragedy-in-care-homes-say-experts.html> [Accessed 26 January 2021].

Pulvermacher, G., 2020. Is COVID-19 an opportunity to study effective teamwork? | GPA. [online] Available at: <https://gpulvermacherassociates.com/is-covid-19-an-opportunity-to-study-effective-teamwork/> [Accessed 23 February 2021].

Picard, A., 2020. With The Pandemic Surging, We Need More Leadership And Less Urging. [online] The Globe and Mail. Available at: <https://www.theglobeandmail.com/canada/article-with-the-pandemic-surging-we-need-more-leadership-and-less-urging/> [Accessed 26 January 2021].

Sinha, D., Dunning, J., Wong, I., Nicin, M. and Nauth, D., 2019. Enabling the Future Provision of Long-Term Care in Canada. [online] Static1.squarespace.com. Available at: <https://static1.squarespace.com/static/5c2fa7b03917eed9b5a436d8/t/5d9de15a38dca21e46009548/1570627931078/Enabling+the+Future+Provision+of+Long-Term+Care+in+Canada.pdf> [Accessed 28 February 2021].

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Lara Patriquin

Lara is a physician, speaker, and teacher of mindfulness meditation and of Transformative Inquiry in Albuquerque, New Mexico.

Her personal quest for well being is informed by her medical studies on the brain and on the nature of thought.

She lectures extensively in the medical and business communities about the value of clear and reliable practices that optimize key functions of the mind. Inspired by her scientific knowledge and extensive contemplative practice, Lara’s clients are able to access a more creative, successful and inspired version of themselves. 

Debrah Wirtzfeld
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Debrah Wirtzfeld

Debrah works with senior executive to facilitate organizational change management, including successful individual and team transitions. Working both one-on-one and in group settings, she assists teams in developing their strategic vision, enhancing effective team communication, incorporating best practices in board and management governance practices, including succession planning.

Debrah holds an MD degree from the University of Calgary, an MSc from Memorial University, and an MBA in Executive Management from Royal Roads University. She is a Certified Corporate Director (Rotman School of Management) and experienced facilitator in Crucial Conversations. She also holds a Certificate in Inclusive Leadership from Centennial College. Her most recent position was as the Associate Chief Medical Officer, Physician Diversity, Wellness & Leadership Development, Alberta Health Services.

Debrah is an Adjunct Professor of Surgery with the University of Alberta and has led significant change initiatives across Canada, having practiced in Newfoundland & Labrador, Manitoba, and more recently Alberta. She remains focused on the importance of building diverse and inclusive teams to support major transitions.

As a single parent to two busy sons, Debrah enjoys driving to basketball and football practices. She is a published fiction author and hopes to publish her first work of non-fiction around leadership transitions in the near future.

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Elizabeth Bagger

Elizabeth has deep expertise as an adviser specialised in supporting family businesses on their journey towards more harmonious family dynamics, stronger family governance and next generation integration and education.

As the member of a family business and the former Director General of the Institute for Family Business in the UK, she has been involved in the family business field for over 20 years. She also currently serves on the Board of a 6th and 7th-generation UK-based family business and her own family business.

Elizabeth holds a certificate in family business advising from the Family Firm Institute in Boston and is trained as a facilitator and family business advisor. She holds an MA in Post-Colonial Cultures and International Relations and a BA in languages.

Having recently relocated from Europe to Mexico, Elizabeth works globally in English, Spanish and Danish.

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Colleen Bastian

Colleen delivers executive coaching, leadership, team, and DEI (diversity, equity, & inclusion) consulting services to global leaders in small, privately owned companies to large Fortune 100 organizations.   She focuses on increasing leadership and team capabilities of leaders to perform at their highest level.

Colleen holds a Ph.D. in Organizational Psychology from The California School of Professional Psychology and a B.S. in Exercise Physiology from The College of Charleston. She is also a professional certified coach (PCC) with the International Coach Federation (ICF).

Prior to becoming an organizational consultant, Colleen was a senior sales professional at Pfizer Inc. Colleen lives in south Florida with her husband and two children.  She is a focused individual and athlete.  She enjoys competing in races and also volunteers to support marginalized communities.

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Beth Corcoran

Beth Corcoran works with clients in the area of business consulting and coaching with a focus on organizational development and human resources. Based in Toronto, Canada, she works with leaders helping them solve challenges in the area of leadership, strategy, management development and organizational performance. As an executive coach, Beth works with the C-suite, VP’s and Directors, facilitating growth, development and insight for leaders both one-on-one and in group coaching settings. Beth also teaches Business Ethics at Trent University and post-graduate Organizational Behaviour at the Centre for Business at George Brown College.

Beth holds a Bachelor of Arts (Psychology) from Queen’s University (Kingston), a Master of Arts (Psychology) from the Adler University (Chicago), and a CHRL designation. In addition, she has attended Harvard Business School (Cambridge) Executive Education, is an Adler International Institute trained coach and is certified in The Birkman Method Assessment Tool. She is completing her Ph.D. in Industrial and Organizational Psychology at Adler University.

Beth has served many organizations in both governance roles and as a hands-on volunteer. She enjoys travel, tennis and running. Beth’s long distance running took her to the Boston Marathon in 2005, which she ran with her husband Jon. Jon and Beth reside in Toronto with their two school aged daughters.

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Liz Bernhard

Liz has more than 25 years of experience as a business psychologist helping organizations grow and achieve results by making the right talent decisions globally. A trusted talent advisor with a global mindset, Liz makes strong and lasting connections with her clients.

After completing her M.A. and PhD in Counseling Psychology at Northwestern University, Liz started her career in private practice in São Paulo, Brazil. She moved to the consulting world after seeing the profound and dynamic impact of this work on individuals and organizations. She is invigorated by helping leaders gain insight into their skills and deepen their ability to leverage their own and others’ talents to increase effectiveness.

Liz specializes in talent selection, coaching and development. She has worked globally across a variety of industries, including private equity, banking, consulting, consumer products, manufacturing, energy, media, and mining.

Liz has Canadian and US citizenship and lives in Vancouver BC.  

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John A. Rogener

John Rogener has 30 years of global experience working in Fortune 500 firms in the talent development and coaching space. He is also a certified executive coach and has coached clients in the financial services, retail, not-for-profit and higher education sectors. This broad exposure of understanding human behavior in a variety of business settings gives him a unique perspective into the challenges executives face, and it enables him to identify sustainable solutions to address those challenges.

He has served as an adjunct professor at Rutgers University Center for Management Development, and also at New York University for 14 years where he was granted their prestigious Award for Teaching Excellence. 

John has a BA, an MA/Advanced Graduate Studies (Counseling) and received his coach certification via New York University. John is a member of the National Association for Talent Development (ATD) and is President Emeritus and member of the Association for Training and Development, NYC chapter. John is a recognized honoree for the New Jersey Governor’s Jefferson Award for Public Service.

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Jane Brydges

Jane has over twenty years of management experience working with large companies to support their global leadership in the development and execution of enterprise-wide initiatives. With a primary focus on strategic projects, Jane works with organizations in both public and private sectors to assist them through corporate and operational transformations to achieve greater success, guide them through challenging times, or accelerate initiatives to capitalize on opportunities.

As a senior executive advisor with extensive international experience, Jane has provided executive level thought leadership and strategic consulting in organization restructuring, digital transformation, human resources management, technology and process design, change management, and organization development. She has a proven ability to direct global program initiatives designed to improve operations, impact business objectives and or maximize overall organization productivity/efficiency to ensure growth and process improvements. Her qualifications and experience enable her to deliver strategic solutions and advice on the selection, development and execution of transformative business initiatives.

Jane sits on the Board of Governors of Bishop’s University and is an active member of the Board of Directors at the Rideau Club in Ottawa.

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Katrina Barclay

Katrina founded and ran a successful brick-and-mortar and e-commerce business for 10 years. Her contributions in business and the community led to her becoming a FortyUnder40 recipient in Ottawa, Canada in 2016. Before pivoting to business, Katrina had a career in journalism, working for such organizations as the CBC in Canada, and the BBC in London, UK.

A skilled communicator, Katrina holds a B.A. in communications from the University of Calgary and an M.A. in media studies from Westminster University, London, UK. She also completed an M.B.A at the Telfer School of Management, University of Ottawa.

Katrina sits on the Board of Helping with Furniture, an award-winning not-for-profit.

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Stephen Scanlan

Stephen Scanlan is a senior HR/Talent professional who has held senior HR roles with Deloitte, Macquarie Bank, Tangerine Bank and Dentons, the world’s largest law firm. Stephen also worked in Human Capital consulting for KPMG and Development Dimensions International. Stephen brings functional depth in human resources and change management to GPA with industry depth in financial services, real estate, private equity, insurance and legal.

He has done client work with a range of organizations including Aviva Canada, Manitoba Blue Cross, Manitoba Ministry of Health, Capstone Infrastructure, Biome Renewables and Shikatani Lacroix.

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Claudio Silvestri

Claudio has over 30 years of experience successfully leading large, complex and transformational initiatives for a variety of organizations within the Information Technology and Aviation industries.  He is known for his inspirational approach in creating alignment and organizational support to successfully achieve valuable and important outcomes through the use of technology.

Claudio is a recognized IT leader and was named Canadian CIO of The Year by the Information Technology Association of Canada (ITAC) in recognition of his leadership and vision in leading digital, cloud and mobile technology transformations.

Claudio also brings significant experience in Cyber Security specifically as it relates to governance, maturity, Board level oversight and risk management. He led the establishment of an international consortium on Cyber Security in the Aviation industry to help develop standards and leading practices to improve the safety and security for Air Navigation Service Providers.

Claudio is a member of the Ottawa Hospital Board of Governors and serves on the Audit and Finance Committee. He is a past member of the Board of Directors at the Canadian Cyber Threat Exchange (CCTX) which is a national organization that serves the Canadian industry by helping them collaborate to reduce cyber security risk. He is also the past President and Chair of Christie Lake Kids which is an Ottawa-based not-for-profit organization serving disadvantaged youth in the Ottawa valley region. 

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Colleen Bastian

Colleen delivers executive coaching, leadership, team, and DEI (diversity, equity, & inclusion) consulting services to global leaders in small, privately owned companies to large Fortune 100 organizations.   She focuses on increasing leadership and team capabilities of leaders to perform at their highest level. 

Colleen holds a Ph.D. in Organizational Psychology from The California School of Professional Psychology and a B.S. in Exercise Physiology from The College of Charleston. She is also a professional certified coach (PCC) with the International Coach Federation (ICF).

Prior to becoming an organizational consultant, Colleen was a senior sales professional at Pfizer Inc. Colleen lives in south Florida with her husband and two children.  She is a focused individual and athlete.  She enjoys competing in races and also volunteers to support marginalized communities. 

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Sharon Israel

Sharon holds a Ph.D. in Industrial/Organizational Psychology, a Master of Public Administration and Graduate Certificate in Personnel Management and Labor Relations. She is an experienced leader, coach, mentor, instructor, and teacher. She has successfully coached individuals in all levels of leadership.

Sharon created and delivered training and development programs in the areas of leadership, conflict resolution, management, teamwork, creative problem-solving, active listening, performance appraisal, workplace ethics, organizational health and stress management, and resiliency. She has extensive experience in talent management and selection systems as well as multi-faceted management assessment centers. She serves on the Board of Directors for three non-profit organizations in the field of reading education, dyslexia, and literacy.

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Hartley Stern

Hartley has held significant health care leadership positions over a 30 year period in Universities, Cancer Systems, and Hospital Systems, in Ontario and Quebec, and most recently in the Canadian Medical Liability System (CMPA). He has forged strong relationships with governments in most provinces but most significantly in Quebec while CEO of the Jewish General Hospital and with Provincial Ministries of Health and Regulators to improve the safety and quality of care in the majority of Canadian jurisdictions whilst CEO of the CMPA.

He has also driven major improvements in quality and safety using (but not limited to): compelling articulation of vision and strategy; major refinements in data acquisition and analysis; and innovative partnerships.

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Hilary Becker

Hilary Becker is an Associate Professor of Accounting at the Sprott School of Business, Carleton University in Ottawa. He holds a Chartered Professional Accountant (CPA) and Certified General Accountant (CGA) designation in addition to a PhD and MBA.

Hilary has worked as an analyst with DuPont Inc., and has consulted with Board of Directors, management and on projects for the World Wildlife Fund, the MacArthur Foundation, AFNI, Mosaid, Merck-Schering Plough, Canada Blood Services, Canadian Dental Association, Ottawa Festivals, Global Affairs Canada and CGA Ontario, among others, in areas of Blue Ocean Strategy, Performance Management, Balanced Scorecard, Tourism and Financial Literacy. Hilary is certified in Blue Ocean Strategy by the Blue Ocean Strategy Network (INSEAD University, France) and has served on the National Board of Directors for CGA Canada as the Ontario representative for 7 years ending as Vice Chair, CGA Canada prior to the merger of the accounting professions in Canada.

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Carey Stevens

Carey holds a Ph.D. in Clinical Psychology and has completed the Executive Program in Human Resources Management from University of Toronto, Rottman School of Business. He is also a Certified Fitness Instructor.

Carey has over 45 years of experience in behavioral psychotherapy, business and family mediation and forensic assessments and over 25 years of experience in the execution of large, complex business transformations. His guiding philosophy is to integrate psychological principles with innovative management practices that resolve both complex organizational challenges and result in sustainable personal changes. Carey’s unique history of blending psychological and business insights coupled with his hands-on style has provided his clients with deeper and more insightful executive coaching, transformational change management, talent management, and career transition within a business transformation environment.

Carey has provided coaching and leadership development services for individuals and several Fortune One Hundred corporations in Canada, United States, Europe, and Asia Pacific. Carey prides himself on being a builder of teams and a developer of people.

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Sandra Bertoli

Sandra is located in London, England. Her role with GPA is as a talent management consultant and executive coach. Her strength is to support professionals in identifying their potential and developing it in accordance with their aspirations. Sandra treats each project as unique and combines relevant assessment, coaching and development methods to achieve the specific goal of the individual and teams.

An Organisational Psychologist, Sandra started her career in the banking industry with UBS. She held various Management Development then High Potential Management roles at local and international levels.  She moved into the consulting world 17 years ago. Her activities focus on talent identification, assessment, individual and team coaching, leadership development as well as training fellow consultants in the use of assessment methodologies and psychometrics.

Sandra has international experience having lived and worked in Switzerland, Singapore, Paris, Brussels and London covering global assignments.  

In addition to banking, Sandra has extensive experience in the automotive industry, manufacturing, pharmaceuticals and professional services.

Sandra holds a BSc in Organisational Psychology and a diploma in Executive Coaching from the Academy of Executive Coaching in London. She is accredited in the Solution Focused methodology and in several psychometric tools (Hudson suite, Wave, OPQ, etc.). Sandra is also an in-house trainer for SHL’s psychometric tools.

Sandra is fluent in English, French and Italian.

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Marc Prine

Known for his dynamic professional style and analytical approach, Marc thrives on using data and analytics to take an objective perspective to improving human performance. His key areas of focus include working with organizations to integrate empirically supported methodologies into the management of human capital. His expertise is on optimizing the selection, development, engagement, retention, and leadership due diligence of employees through use of people analytics, assessment, and psychology.

Marc has over twelve years of consulting experience working with organizations from financial services, technology, life sciences, manufacturing and both federal and local government. Marc earned his Ph.D. in Business Psychology from The Chicago School of Professional Psychology, M.A. from West Chester University of Pennsylvania and undergraduate degree from Temple University. He is an adjunct professor in statistics and his work has been published in the Huffington Post, Forbes, and Fast Company.

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Melissa Warner

Melissa holds a Ph.D. in Industrial/ Organizational Psychology and a certificate in the Neuroscience of Business from Massachusetts Institute of Technology (MIT). She has assessed and coached business leaders for over 19 years and held a leadership role at Canadian Tire Corporation, developing and overseeing executive assessments and leadership development programs. Melissa has extensive experience drawing on neuroscience, psychology, and business, to help leaders in various sectors and business functions. She has contributed to the academic body of research through publication in books, peer-reviewed journals, and conference presentations.

In addition to consulting with GPA, Melissa is a Professor in the School of Global Business Management at Seneca College, where she teaches training and development, leadership, and human resources. In addition, Melissa sits on the advisory committee for Specialisterne, helping organizations obtain business results through neurodiversity. Her style of consulting is customized, results-driven, and measurement/results-focused.    

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Marina Ivanoff

Marina is a consultant and an Executive Coach specialized in helping individuals and teams reach their full potential. She brings a breadth of experience in human capital optimization, strategy and change management. Her industry experience ranges from FMCG, transport, pharmaceutical, public entities and financial institutions.

In the first part of her career, Marina held regional and global, operational and strategic HR roles with Griffith Laboratories, Coca-Cola Enterprises and DHL Express.

In the last 15 years, she has worked as a Leadership Consultant focusing on talent assessment, executive coaching, and leadership development. Her expertise spans leadership program development and design, facilitation, talent assessment, individual and team coaching.

In addition to consulting, Marina is a tutor at INSEAD for strategy and leadership programs and a co-founder of Acteva Stars, a boutique accelerator for start-ups.

Having lived and worked across Europe and the US, she is currently based in Singapore and has been working throughout the Asia Pacific Region for the last 10 years.

Marina holds a degree in mathematics and a Master’s degree in Individual and Organisational Psychology from INSEAD. She holds an advanced diploma in coaching from the Academy of Executive Coaching and is a certified coach (PCC) from the International Coach Federation. She is also a Practitioner Systemic Team Coach from GTCI.  She is an NLP Senior Practitioner and is accredited in several globally recognized tools (MBTI, Hogan, etc.).
She holds a certificate in Business Strategy and Financial Performance from INSEAD.

Marina speaks French and English fluently.

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Jon Donald

Jon received his M.B.A. in International Management from the Asia-Pacific International Institute.

Jon is a recognized leader in designing and implementing organizational change.  He is an expert in organizational re-design, change management, business communication, and the development and execution of change strategy. He has extensive international experience in training delivery, alternate service sourcing & governance, program development & review, performance assessment, and strategic policy and planning.

With over 23 years’ practice in consulting, Jon has extensive experience with multinational corporations, NGOs, government-owned corporations, and the public sector. Rated in the top 1% of change management experts on LinkedIn Canada, Jon co-designed and delivered an in-house organizational change strategy for a global consultancy. He has also designed and delivered change management education and training at the post-secondary level.

Jon has served on boards and advisory councils for organizations involved with youth mentorship, cancer research, and amateur sports.

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Gerald Pulvermacher

Gerry has been advising companies throughout North America for almost 50 years. Additionally, he has led 5 different consultancies including being Senior Partner and Global Practice Director of 4 lines of service (Change Leadership, Human Capital, Learning and Organization Performance) at Deloitte Consulting, was President of Oliver Wyman Delta (Canada), Managing Partner of PSS Consulting and Co-lead of PulvermacherFirth (acquired by the Hudson Highland Corporation, a publicly traded company listed on NASDAQ).

He has consulted to central banks, pension funds, multi-faceted real estate companies, oil & gas producers, pipeline companies, airports, professional services firms, lottery corporations, family businesses in such sectors as automobile dealerships and home healthcare, crown corporations and hospitals. He has sat on the Boards of hospitals, high tech companies and community services organizations. MacLean’s Magazine labeled Gerry as one of Canada’s “management gurus”. He has lectured in the business program of Queen’s University School of Business and the University of Ottawa’s Telfer School of Family Business. As a dual citizen, Gerry’s clients can be found both in Canada and the USA.

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Marion Weiler

Marion Weiler serves as an Executive Advisor, Growth Strategist, and Branding Expert. She advises and guides businesses and leaders on how to create new levels of brand loyalty internally and externally based on a culture of teamwork and collaboration with a view to achieving high impact and sustainable growth.

As a global citizen and former Senior Executive working and supporting industry-leading global brands such as Sotheby’s International Realty, BMW and IBM, serving on executive boards and leading multi-million dollar business divisions, teams and projects, Marion has gained valuable insight into what works and what doesn’t across industries.

She has a deep understanding of the opportunities and challenges businesses and leaders face as they navigate through the complexities of corporate environments, particularly complex when dealing with intercultural differences and sensitivities. At the core of her success is her talent for understanding people, and  bridging gaps and putting puzzle pieces together to recognize strengths in team members and leaders. She is also experienced at structuring organizations and teams on an international scale.