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Rethinking Ornge

By Oliver Johnson

Story by Oliver Johnson | Photos by Mike Reyno | September 22, 2014

Published on: September 22, 2014
Estimated reading time 26 minutes, 46 seconds.

The new executives at the once scandal-hit organization tell Vertical how they’re rebuilding its corporate culture and reimagining air medical transport for Canada’s most populous province.
Having spent 18 months at the head of one of the most publicly scrutinized air medical companies in the world, Dr. Andrew McCallum appears remarkably relaxed. Granted, an interview with Vertical 911 may not be the most intimidating thing McCallum has faced in his role as president and CEO of Ornge — Ontario’s air medical transportation provider — but it’s still difficult to imagine him getting flustered. The former Chief Coroner for Ontario, he has an understated manner, and provides his answers in a thoughtful and quietly considered way.
This may well, of course, be exactly why he’s the person sitting across the table from me in a meeting room at Ornge’s headquarters in Mississauga, Ont., giving a frank assessment of the current state of affairs at the organization — that and his background in emergency medicine, and strong interest in aviation (he has a fixed-wing private pilot licence).
“When that nexus between clinical care and aviation presented itself as a possibility, and that was coupled with an opportunity to take an organization that was listing pretty badly in the water, and hopefully right it, that was really an appealing thing for me,” said McCallum.
At McCallum’s side in the new Ornge is chief operating officer Rob Giguere, who has been involved in aviation management for over 20 years. Giguere joined Ornge as an advisor in April 2012 before assuming his current role six months later.
But the scope of the task the pair faced with the rest of the Ornge executive would have been intimidating to many. An extensive report from a provincial legislative committee into the company’s problems during the stewardship of founder and former CEO Dr. Chris Mazza gave a damning verdict on the organization. “Ornge under the direction of Dr. Mazza drove the air ambulance program into the ground, leaving very little to build on for the future while staff attempted to deliver core services,” the report bluntly stated.
Mazza went on medical leave late in 2011, and was terminated from his position several weeks later. He was replaced as CEO on an interim basis by Ron McKerlie (a deputy minister of government services), who then handed the reins over to McCallum in January 2013.
“[It was a] big task, there were lots of issues and challenges,” said McCallum. “But at the same time, it had a number of really skilled and able people. So if we could leverage that, I thought we had a fighting chance of dealing with the issues.”
The old Ornge
McCallum joined the company after it had endured a traumatic 12 months in the public eye. Allegations of financial and organizational mismanagement first made newspaper headlines in January 2012, starting what would become something of a feeding frenzy in the mainstream media, during which the inner workings of the publicly-funded company were gradually laid bare.
The Ornge executive was revealed to have created a complex network of for-profit companies, including Ornge U.S. Inc., Ornge Global Solutions Inc., and Ornge Global Holdings LP — indicating what eventually became clear about the organization’s plans: global expansion of the Ornge brand. And, by 2011, many of Ornge’s senior management had become employees of these new companies — a technicality that kept them off the annually-published “Sunshine List” of public employees earning over C$100,000.
As a forensic audit took place, it was revealed that Mazza had received a salary and bonuses totalling almost $1.9 million in 2011 alone, making him the highest paid public servant in the province. The audit also revealed that Ornge had spent $15 million on its luxurious 72,000-square-foot headquarters — but had then sold it to one of its subsidiaries, which leased it back to Ornge — through another subsidiary — at a rate that was, according to Ontario’s Auditor General, well above market value.
It was also discovered that when the company began a much needed fleet renewal in 2008, it ordered 12 AgustaWestland AW139s (and 10 Pilatus PC-12NGs) despite its own analysis indicating that nine helicopters and six airplanes were enough for the province’s needs. Ornge asked the manufacturer to install seating for 12 people in two of the helicopters, suggesting corporate travel rather than medical transport was the intended use for the new air ambulances (after this news broke, these two helicopters were sold).
Following the order for the new helicopters, AgustaWestland pledged $2.9 million over three years to Ornge’s charitable foundation, and $4.8 million to one of Ornge’s for-profit subsidiaries for future marketing and other services. Of the manufacturer’s charitable donation, $500,000 arrived in the form of two custom motorcycles created by Orange County Choppers (OCC), created during an episode of the TV show American Chopper. The first was unveiled to the public at a Toronto Blue Jays baseball game. The burly OCC founder Paul Teutul Sr., with trademark handlebar moustache and sleeveless shirt, drove the bike around the field; a smiling Mazza, in spotless white shirt, pressed pants, sockless loafers and batting helmet, lay supine next to him on the “themed” stretcher sidecar. The bikes were intended to promote Ontario’s air ambulance — and did appear with Teutul during appearances on late night talk shows in Canada and the U.S. — but ultimately became a symbol of excess, and an executive that had lost its direction.
Along with the rest of those living in Canada’s most populous province, the staff at Ornge read the headlines and saw Ontario’s air ambulance provider dragged through the mud. The organization was the subject of investigations by the Ontario Coroner’s Office, the Auditor General, the Ontario Provincial Police, and a Standing Committee in the provincial legislature.
Through it all, the frontline staff continued to deliver the lifesaving treatment they’d always provided, despite the fact that their ability to do the work had become increasingly complicated by the actions of the previous leadership. Staffing levels at the bases, difficulties with the AW139’s medical interior, and, in some cases, an inability to respond promptly to call requests due to a launch policy that has since been rescinded, led to plummeting morale. And the organization’s relationship with local hospitals, EMS services, and other healthcare agencies was suffering as a result. According the Auditor General’s report, in 2010, Ornge logged about 60 public complaints and 500 staff concerns, which included operational issues of varying degrees of importance.
For those brought in to right a ship that appeared to have so many holes, where do you begin?
Making a new start
The organizational changes began in early 2012, following amendments to the performance agreement between Ornge and the Ontario Ministry of Health and Long-Term Care. This immediately strengthened government oversight of the organization, and increased transparency and accountability — crucial areas in regaining public and staff trust in the corporate structure. The various for-profit entities were wound up, a whistleblower policy implemented that is overseen by an independent ethics officer, and a new conflict of interest policy created.
Today, Ornge has an entirely new volunteer board and a new executive team. Its headquarters may be in the same building, but it’s not the same place. Jokingly referred to as the “Crystal Palace” after its purchase in 2009 (reflecting its scale and appearance), the in-house moniker of “Explorer” (the road upon which it’s located) seems more appropriate today. It was clearly created with the international expansion of the Ornge brand in mind, but the juxtaposition with the highly focused ambitions of the new Ornge executive — solely to serve the province of Ontario — means that on a tour of the building today, one sees a lot of empty desks. The atmosphere is one of quiet after the storm, as islands of staff work away with a hushed focus.
“The organization was built for something different than it is now,” said McCallum, explaining the most recent round of job cuts that removed 25 management positions at the organization. “We had a lot of functions that really didn’t suit a provincial air ambulance system with a land component. As a matter of stewardship and as a matter of efficiency, we had to look at making that difficult decision.”
The cuts in management have, however, removed organizational layers, bringing upper management and the frontline closer together. This was part of a wider effort to integrate what had become a very disparate operation.
“We’ve got two complex fields — aviation and medical — that blend into our business of HEMS [helicopter emergency medical services],” said Giguere. “The two teams were operating very well independently, but there was not enough crossover between them. . . . There’s a lot to be said for economies of scale and policies.”
In effecting change, though, McCallum freely admits there was a challenge in overcoming organizational inertia. “We had to deal with a whole host of issues,” he said. “We had five collective bargaining agreements, we had to re-establish a working relationship with our folks on the labor side . . . so that they could once again trust in the organization and believe that management was trying to do the right thing for the mission. And we’ve made a lot of progress in that area.”
At the bases, the most visible demonstration of organizational change is in the form of the newly-created base managers, who work to integrate the different operational divisions in each team. “We’ve ended up with a really good team with a diversity that allows them to build off each other’s strengths and provide advice and guidance,” said Giguere. “They have integrated team meetings at the bases, so everybody understands the challenge or solution for the day. And what we’ve seen as a consequence is a more cohesive team at the base that is focused on one mission: taking care of the patient and moving the patient.”
Charting a course
A key element in the restructuring of the company has been the creation of a strategic plan — a roadmap for how the organization will deliver its core business over the next three years.
“The corporate culture here [during the Mazza era], as far as I can tell, was there wasn’t a lot of communication, discussion, and consultation internally. Certainly externally, Ornge saw itself as a thing or entity apart, it seems,” said McCallum. In his view, Ornge’s relationship with local EMS services and hospitals is, in fact, symbiotic. As such, the development of the strategic plan required the input of partners and stakeholders both inside and outside the organization — employee union representatives, ambulance services, local health integration networks, and Ministry of Health officials — to establish how Ornge should fit in the broader EMS system. “That in my view is how we can gain people’s trust,” said McCallum. “Not only do we involve them, but we actually listen to what they say and act on reasonable suggestions that are made.”
The plan, published earlier this year, contains four broad strategic goals: to improve patient outcomes, to improve service and system integration, to establish a sound fiscal footing, and to be a learning organization.
The organization believes that creating a unique mission profile for each base is key to improving patient outcomes. This process, to establish when it makes sense to use a helicopter (or fixed-wing aircraft) — or when it’s actually more appropriate to use another resource — is being completed in consultation with local staff and stakeholders.
“The current guidelines are pretty liberal in how a helicopter is being used,” said Giguere. “And sometimes if you use the helicopter on the wrong mission, it’s not available for the right mission. It’s really just a case of making sure that we blend properly with the broader emergency services across the province to get the most effective use of all the resources.”
The plan also called for the staged removal of the Sikorsky S-76A helicopters that were still being flown from some of Ornge’s northern bases. As Vertical 911 went to press, the aircraft remained in operation at just one base — Moosonee.
The Moosonee base, Ornge’s northernmost location, suffered a tragic loss on May 31, 2013, when a Sikorsky S-76A crashed shortly after a midnight departure to attend a call in the remote community of Attawapiskat, killing both pilots and two paramedics on board. A year later, the federal Ministry of Labour charged the company with 17 offences under the Canadian Labour Code related to the Moosonee operation on the day of the crash, including the pairing of two pilots that appeared to contravene Ornge’s “green-on-green” policy — avoiding the combination of two pilots who are relatively new to their positions.
As the issue is now before the courts, Ornge can’t comment on the case; but when the issue was raised in the media as a possible reason for the crash, the company said that the pilots, who joined Ornge in August 2012 and March 2013, respectively, each had thousands of flight hours —and the latter had previously spent a six-year period with the organization flying the air ambulance at that base. However, Ornge said it had taken a number of steps to improve its aviation operations since the accident, which include implementing revised standard operating procedures for night operations, additional controlled flight into terrain training for all rotor pilots, and an audit of all training records to identify and address any training deficiencies.
“We’ve hired a standards and training pilot whose responsibility will be to assist in the management of the fleet on the rotor side, but he will also be a check pilot who will fly at each base, to ensure that what we do in the simulator — what we train to do — is applied on the line and [is] enhancing operations,” said Giguere.
The Moosonee crash also raised the issue of crews in the remote north flying into “black holes” — night flights where the lack of light on the ground leaves pilots with few visual references.
“We shut down our [retroreflective] cone [landing] sites last year,” said Giguere. “We had been doing a trial of some solar lights at the pads in the fall of 2012, and by February we had our first set of lights up. The safety pilot there said it kind of turned night into day. From four miles out he could see the pad, whereas before they were flying at a point in space and then started to look with a searchlight.”
Giguere said the company now has solar lights at about 75 percent of its 91 of its helipads across the province.
As for the aircraft themselves, a long-term target in the organization’s strategic plan is to conduct a review of its fleet to ensure it has the right number and type.
“We are going to consider whether the AW139 is the right platform for this specific role,” said Peter Cunnington, Ornge’s director of flight operations, rotor wing. “At the end of the day, we may discover that it is. But we are going to go through the process to determine that, and if not, we can consider other options. But I’ve been a 139 pilot myself and there’s no doubt about it, it is a phenomenal aircraft.”
Cunnington assumed his current position in April 2012, after previously working as the captain of Ornge’s Toronto base. “I’ve been doing this long enough now that the Ontario air ambulance has become my life’s work, and I’m really passionate about it,” he said. “That’s why I came in here to help in any way I could to improve it and fix it.”
Additional to the challenges presented from moving on from the prior regime, Cunnington needed to manage the switch of flight operations from Canadian Helicopters to Ornge. “The first two years of me being here was just an absolute incredible amount of work to appease and satisfy Transport Canada that we’re on the right track,” he said. The regulator was happy for a like-for-like operational transition, but with important provisos. “We had to complete sweeping changes to improve the operation — everything from rewriting the company ops manual, to rewriting the SOPs [standard operating procedures], to rewriting the training program,” said Cunnington. “It’s now a more modern and more robust operation.”
As part of that, Cunnington has overseen a growth in staffing levels from 66 to 85 pilots, which he said has resulted in an improvement in overall working conditions for those on the frontline. However, he admitted that rebuilding relationships with some of the pilots remained a work in progress. “There’s been a lot of broken trust, there’s no doubt about it, and it’s going to take a lot of time for us to rebuild that trust, and I think that’s going to be the ultimate goal to heal this operation,” he said. “If we can kind of get that buyback from the frontline to really care about their employer, I think we’ll see some awesome change.”
A Critical level of Care
The most pressing issue for Ornge to deal with over the last couple of years on the medical side has been the layout of the medical interior, which had prevented paramedics from performing certain procedures effectively. An interim solution was created in January 2013, and a request for proposals for a permanent replacement issued later that year.
Further development on the medical side will see an increase in the number of Ornge paramedics qualified to the critical care level, the most advanced level in Ontario.
“Not every call is critical, but if you don’t have the capability to manage critical care patients in every case, you’re hamstrung, because you’ve got to try figure out how to get a critical care resource to the patient,” said McCallum. “We’ve got training, we’ve got recruitment, and we’ve got to look at how we actually accomplish the training, which in our environment is extraordinarily difficult — because in the north where the critical care paramedics are needed, there aren’t enough instances of critical care patients to rapidly acquire the experience. It’s exactly parallel to aviation: you could do ground school, but you’ve got to fly the aircraft. So it is with clinical care: you can do the book learning, but you actually have to be out there taking care of the patient in real time, under supervision.”
Improved system integration is another area of focus for the organization. As things stand, when a doctor needs to transfer a patient, they have to call a separate entity — CritiCall — to find a doctor who agrees to take the patient. And then they call Ornge and give the same information again. “The Holy Grail is one call to make, one number to call,” said McCallum. “We’re not there yet, and it’ll take time to get there, but we can certainly decrease the duplication. We’re working with the other entity to get a call center to try and as much as we can share that information. You talk about trust with our public — although we serve patients directly — our real direct customers are hospitals, because that’s who we talk to. They call us; they rely on us. In terms of trust with them, that would be, and will be, a huge point.”
The dispatch center at Ornge will also have a large role to play in the organization’s future development, and it, too, has seen recent change. A new operations control manager (OCM) position has been created to oversee the dispatch team. Working alongside a transport medicine physician for consultation, the OCM has access to the broader provincial picture with the belief that this will result in a more refined allocation of resources. When the mission profiles for the bases are complete, they will help define the parameters for a planned computer-aided dispatch system that will further refine the process. McCallum said this software, once in place, will also help Ornge improve its data acquisition — a crucial aspect of helping it become a learning organization.
A Different Tone
There was a period when it seemed the only time Ornge made news, it wasn’t in a positive fashion. But in the two-and-a-half years since the Mazza-era corporate culture made headlines, it seems as if there has been a tangible improvement in the organization’s public profile.
“There was a first responders’ emergency services day at the airport the other day, and they invited us. That didn’t really happen a year-and-a-half ago,” said Giguere. “A lot of the credit has to go to our front-end people who were resilient through the challenge, and [are] now fully supported with a management team that knows that it’s about the frontline.”
Aside from anecdotal evidence, McCallum points to Ornge’s improved performance in the surveys it regularly conducts to gauge hospital satisfaction of its service. “We’re not where we want to be yet,” he said. “I want us to be the benchmark — that’s the goal — so that people say, ‘Well, how do they do it there? Because we want to emulate that.’ Naturally with the history here, it’s taking time, but there’s a lot of positivity as well.”
Despite the media scrutiny inherited as a result of the previous executive’s actions, he said Ornge’s relationship with the press was, in fact, very good. “You’ve got to tell the story as you see it — and I accept that entirely,” said McCallum. “I think our job is to tell the truth and admit to our errors, because they’re going to be there. Any human enterprise that strives to do something is going to fail at times — it has to. Never will you always step correctly and get it right the first time.”
It’s an honest response, but that’s hardly surprising — when asked what his experience as Ornge CEO had taught him, McCallum’s reply is immediate. “It’s the need to be authentic,” he said. “To me that means just saying what you’re going to do, and doing it — and being straightforward about why you’re doing it. We don’t want to overpromise and under deliver. It’s really important that we say what we’re going to do, do it, and then let people judge for themselves.”

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