How a football injury led (eventually) to health care’s top job

Bell is not a household name, but the decisions he makes as top health bureaucrat will affect every Ontarian.

During an interview, he acknowledges the daunting challenges that lie ahead. He’s going from managing an annual budget of $1.9 billion to one of $50 billion, almost half the entire provincial budget. He’s leaving a staff of 15,000 to set the pace for a health-care workforce of more than 525,000.

Bell will be in charge of a massive system that is woefully fragmented, ranks poorly in international comparisons of primary care, struggles to meet demand for home, community and long-term care, clumsily manages chronic disease and treats hospital emergency rooms as catch-alls for patients who fall through the cracks.

He starts the new job June 2 in the middle of an election campaign. He has no idea who his political masters will be or what policy directions he will be expected to implement. And he will be doing it all as the province staggers beneath its $273-billion debt.

The only certainty right now, Bell says, is that “the future has to be improved quality and constrained cost.”

Credited for helping make huge improvements to the province’s emergency, critical-care and cancer systems, Bell will be expected to do for the rest of the health system what he has done for hospitals.

It’s a tall order, but those who know him well — including ex-bosses — say he’s up for it. He’s that rare breed of executive who is both a good manager and a good leader, they say.

Back in 1986, when Dr. Alan Hudson was chair of neurosurgery at the University of Toronto and a neurosurgeon at St. Michael’s Hospital, he made a habit of sizing up the new talent that crossed his path. Hudson took quick notice of a young, 6-foot-3 orthopedic cancer surgeon who had just arrived from Boston.

What first struck Hudson was the way Bell coped when operations went awry, as some invariably do. An artery might rupture, a patient’s blood pressure nosedive, an anesthesiologist begin to panic.

Recalls Hudson: “I watched Bob. When things go badly in an operation occasionally, surgeons have a tendency to blame their assistants. He never did that. He always tidied up whatever the problem was and then went on with the operation . . . Weak people blame everybody else and get into a fuss and fluster.”

Bell has reputation for being affable and accessible, to everyone from board members to the rank and file.

“When you are looking at young people starting out, you want to look out for a syndrome where people are polite up and rude down,” explains Hudson, who has seen his share of fawning up-and-comers over the years.

“And when you watch them quietly, they turn around and they are very rude to a nurse. Now Bob was the opposite of that. He was equally respectful of people junior to him as he was of people senior to him.”

As Hudson went on to hold numerous top jobs in Ontario’s health system — including president of UHN and CEO of Cancer Care Ontario – he would come to rely on that impressive young surgeon for help.

Bell, 62, was set to retire next year when his 10-year contract was up at UHN. The plan was for him and his wife, Diann, also a physician, to wind down in tandem. Diann, a developmental pediatrician who treats autistic children in Regent Park, is retiring this July.

But Saad Rafi threw a monkey wrench into the couple’s plan late last year when he stepped down as deputy health minister, eventually going to run the Pan Am Games. A search committee for a new deputy was struck, a headhunting firm hired, and Bell’s phone started ringing.

“In January or February they called,” recounts Diann. “He said, ‘Darling, they called me for an interview, but really, if you don’t want me to do it just say so.’ ”

There was no point even trying to stop him, Diann says.

“Bob would never have sat home. He’s not that type. Even after this job, there will be more. And I respect him for that. He would probably drive me crazy at home,” she laughs.

Born in Wales, Bell and his family immigrated to Canada when he was just 5 and his father, an insurance salesman, got an overseas workplace transfer.

The family lived in Don Mills for a few years until relocating to Windsor, where Bell’s father bought an insurance brokerage. His mother, who had studied home economics back in Wales, got a job in social services, teaching families about nutrition and home management.

Bell is the oldest of four siblings; the youngest, Eric, has an intellectual disability. Now 50 and weighing 320 pounds, Eric lives in a Toronto group home and calls his big brother daily, often up to six times in one evening.

The brothers are tight, says Diann, noting they see each other frequently with Bell helping Eric cope with his life.

“We promised his parents, who were wonderful people, that that is a role we would play to the end,” Diann says.

The couple has six children between them; they were each previously married.

There were tough years early on when two of the children were stricken with cancer. Bob’s 9-year-old son developed leukemia and immediately after three years of chemotherapy, Diann’s 14-year-old daughter developed lymphoma. Both survived.

“We didn’t see each other much, we were crossing paths,” Diann says of those years when she worked weekends so she could stay home with the children during the week, and Bell worked weekdays, staying home with their offspring on weekends.

The couple has four grandchildren with a fifth on the way. The youngsters call grampa “Elvis.” That’s because he plays Fireman Sam with them and usually gets stuck playing Sam’s tall sidekick, Elvis, from the animated Welsh children’s show.

Diann says long hours and big demands are nothing new to a husband who is up every morning at 5, at the office at 7 and who often works late into the night on the fundraising circuit.

He somehow makes time for lots of reading and daily exercising, usually an hour on the elliptical machine while watching the news.

Physical activity has always been a big part of this overachiever’s life. He was captain of his high school football team, he has run five marathons and he likes cycling, kayaking and golfing.

Bell sayshis career path was never planned out in advance and jokes that he literally stumbled into medicine after blowing out a knee playing football as a linebacker at McGill. At the time he was studying physical chemistry with vague plans to become a chemist or physicist. But his injury got him interested in bones.

After graduating from medical school at McGill, Bell moved to Peterborough to work briefly as an ER physician. He practised as a family physician in Brampton for three years. Next stop was the University of Toronto, where he did his orthopedic residency training. Then it was off to Boston, where he spent two years training in the subspecialty of musculoskeletal oncology at Harvard and the Massachusetts General Hospital.

Bell went on to stints at St. Mike’s, Mount Sinai and Princess Margaret, where he became vice-president in 2000.

Tom Closson, another former UHN president, says Bell’s extraordinary ability to communicate has been key to his success. He’s good with large groups, he’s good with small groups, he’s good one-on-one, he’s humorous, he’s engaging.

“He has a warm style that you wouldn’t expect actually of a surgeon,” Closson laughs.

Closson says he’s impressed at how Bell’s career evolved from being a Canadian pioneer of surgery for sarcoma cancer of the bone, the type of cancer that felled Terry Fox in 1981, when the prognosis was typically bleak and limb amputation common.

Bell helped develop the first sarcoma program in Canada, taught other surgeons how to do limb-sparing operations and paved the way for the creation of six additional such programs across the country. Along the way, he contributed to more than 200 research papers, many on sarcoma surgery, and developed an international reputation in the field.

“He came from a narrow background of doing sarcoma surgery and research, a narrow part of cancer,” Closson observes.

Bell then went on to head Princess Margaret and then the entire University Health Network, which includes Princess Margaret, Toronto General and Toronto Western hospitals. In 2011, the Toronto Rehabilitation Institute became part of UHN.

“He started learning about the cancer system, then spread that out to try to get a good understanding of the broader health-care system. I think it gives him good background for the job as deputy minister,” Closson says.

Bell has also become the province’s go-to guy on some key files. After the SARS outbreak of 2003 exposed major weaknesses in the critical-care system — bureaucrats didn’t even known how many hospital beds there were in the province — he was called upon to chair a task force to fix it.

Back in 2000, breast cancer patients were often sent to the United States for radiation therapy. Bell was tapped to help build Cancer Care Ontario and the province’s capacity to care for patients here. He also chaired the Cancer Quality Council of Ontario.

From 1999 to 2001, horror stories about long ER waits appeared regularly in the media. Bell chaired a group of experts charged with getting wait times down and setting province-wide standards.

Bell’s critics — yes, there are a few — include some in the community sector who are now eyeing him warily, worried he might be too hospital-centric and not fully appreciative of their role.

“He’s hugely respected in the hospital sector (but) not trusted in the community. Why would he be? He built a hospital empire,” remarks one critic, who refused to be identified. “To me, the biggest question is how will he move out of the perspective of a CEO of an enormous, well-resourced hospital and learn about the rest of the system.”

Some critics also contend he is not the best listener.

Others are disapproving of how much money he makes. As the highest paid hospital CEO, he pulled in $827,553 in 2012. New Democrats have seized on such examples in calling for a cap on salaries of senior executives in the broader public sector of $418,000, twice the premier’s annual salary.

Though Bell is taking a pay cut in his new job, he will still be making an annual salary and taxable benefits of $436,488.

Ontario’s biggest health system problems lie in the sectors beyond hospitals. The Commonwealth Fund health policy survey shows Ontario ranks poorly compared to other jurisdictions in the developed world when it comes to getting quick appointments with family doctors, seeing family doctors after hours and rolling out electronic medical records.

Because the system is so fragmented, family doctors are often unaware patients have been treated in ERs. Patients discharged from hospital don’t see their family doctors within seven days as they should. Ontarians don’t get screened sufficiently for cancer. Diabetics are not tested often enough for eye and kidney problems. Abdominal girth, a predictor of cardiovascular disease, is not routinely measured. The list goes on.

Meantime, the province’s 25,000 doctors are under fire for not earning their keep and the province is under pressure to clamp down on the fee-for-service model of payment. Negotiations between the government and the doctors’ Ontario Medical Association, which typically end up in a tense showdown, started earlier this year — another difficult situation awaiting the incoming deputy minister.

This multitude of problems will be all the more challenging because Bell is coming from outside the bureaucracy to lead a ministry of 3,700 bureaucrats and politicians wading in at every opportunity.

“His big challenge of course is that he has never worked in the government,” remarks Closson. “As the CEO of a hospital, you have a lot more influence on the strategic direction of the organization, but at the health ministry, the minister is the CEO.”

Closson says he is confident that Bell can shift effectively from hospitals just as he did from that narrow field of sarcoma surgery.

In fact, Bell plans on using the same modus operandi he relied on to shape up hospitals to improve the other sectors of the health system: measuring, monitoring and transparently reporting on quality of care.

“The analogy is that when you lose your car keys on a dark road the tendency is to look under the street lamps, right? We have got lots of data available in hospitals and that has helped to dramatically improve care but there are still big areas of the patient journey that are still pretty dark,” he says.

Rafi describes the job of deputy health minister as exciting but relentless. It’s 24/7, there are always fires to put out, competing interests to balance and tough choices to make with more than 3,000 agencies always looking for more money.

There are emotional if not life-and-death issues to contend with: patients with rare diseases who can’t get drugs; understaffed nursing homes where residents have been abused or neglected; seniors who aren’t getting enough home care. It makes for an endless supply of fodder for question period.

“The fundamental transformation” that needs to happen has only just begun, Rafi says. “Not a lot of people put their hands up when the ministry of health becomes available because it’s a daunting job.”

It also requires a super-thick skin.

Hudson also maintains his protégé is up the task. Bell has the respect of his peers because he earned his stripes as a clinician, Hudson says.

“He’s dead honest and scrupulously fair,” Hudson continues.

“You get a lot of people who are very good managers who are not very good leaders,” Hudson says. They might be good functionaries on the administrative side, but useless at influencing others and inspiring enthusiasm.

“And occasionally you get people who are very good leaders but they are hopeless managers and they don’t even know where their office is. What I look for are people who are both good leaders and good managers and those people are not easy to find.

“Bob is obviously one of those.”