Headwaters Health Care Centre: Cholly Boland, CEO

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The terms “full-service” and “community-based” can be seen as contradictory. In that light, the question is: How can a medical facility offer its patients access to the medical care they need while at the same time maintain the environment of a small-town setting?

That’s the role of Headwaters Health Care Centre, a 108-bed acute (and a 33-bed chronic care) healthcare provider with facilities in Orangeville and Shelburne, Ontario. Both communities are located about one hour northwest of Toronto, Canada’s largest city.  Headwaters serves a population of approximately 110,000 people on a $50 million budget, employing 650 professionals, 70 physicians and supporting about 300 volunteers. Both facilities (WRONG – only Orangeville provides these services – Shelburne is chronic care and rehabilitation) provide basic healthcare and emergency care, as well as specialty services such as cancer care, dialysis, obstetrics and surgery. Headwaters’ mission is to provide high-quality healthcare services as close to home as possible.

“We try to provide as many services as possible as close to home as possible,” said CEO Cholly Boland, who has been with Headwaters for almost a year. “We do that while observing as much quality and excellence as possible. We don’t cut corners. We don’t settle for anything less than the highest quality as we can possibly produce even though we’re a smaller community.”


Boland credits much of Headwaters’ ability to provide widespread services to forming partnerships within the community. The organization has raised $1 to $2 million a year, which he said is phenomenal for a community this size and is a reflection of how well the local community regards its healthcare provider.

“We have all kinds of partnerships, whether they’re with hospitals or for home care or long-term care, where we work together for the benefit of our community and our patients,” he said. “Given our size, we can’t offer all the specialties here.”

Headwaters also has close partnerships with medical practitioners within the area. For example, a patient suffering a heart attack that is picked up by ambulance in Orangeville is taken to the cardiac unit of a hospital located about 45-minutes away, where they are treated immediately and then taken to Headwaters for recuperation.

“What that means is if we can’t provide that service locally on a high quality level, we partner with nearby facilities and our residents can benefit from that,” Boland said. “They just wouldn’t otherwise have access to that level of specialty.”

Likewise, Headwaters has a similar arrangement for patients with serious mental conditions that come to the centre’s emergency department. They don’t have psychiatrists on staff, so that patient would immediately be transported to a state-of-the-art mental facility, also located about 45 minutes down the road, that is better suited to treat that patient.

Relationships are also important when it comes to technology vendors. Boland said Headwaters works almost exclusively with a company called MEDITECH for its information systems, forming what he refers to as a “two-way partnership” with the technology provider.


As a more than 50-year old healthcare provider, Headwaters continues to incorporate advanced technology into its operations, upgrading what were state-of-the-art digital imaging advancements originally made in 1997. Within the last two years, the center focused on improvements in its diagnostic imaging areas, upgrading its CT scanner and introducing a digital mammography program. In addition, the hospital is updating its PACS.

“When it comes to technology, our patient records are almost completely electronic,” Boland said. “We have very little paper here. There are very few hospitals in Ontario and no facilities that are our size that are anywhere near as advanced in the terms of technology for clinical use.”

Keeping pace with technology and the costs associated with it are a challenge, particularly in Canada, where the majority of hospital funding comes from the government, Boland said. With the current economic downturn, he said fiscal issues have become an even greater pressure point.

Smaller is Better

One advantage to running a smaller medical facility is the reduced number of individuals involved in any process, whether it involves deciding on new equipment or implementing new policies. This allows for physicians to be involved in the decision-making process for new technology, for example. Overall, it makes for more open lines of communication, Boland said.

“We don’t have to convince tens of thousands of people to learn to adopt a new technology,” he said. “We have a manageable workforce that is quite agreeable to change.”

Headwaters’ size reflects on its small-community culture in the best possible way, Boland said.  A patient coming through the emergency department is greeted as a member of the community, rather than a number. There’s even a chance that one of the physicians or nurses who sees the patient might know him or her, or a member of their family.

Part of that small community feeling continues through the centre’s staff operations. Headwater conducts staff forums among employees, doctors and nurses who are working closely with a particular matter. These forums, Boland said, are designed to look at work being done and decisions that need to be made for that work to be performed more effectively.

Compassion and Quality

Headwaters’ focus on compassionate interpersonal relationships carries over to the CEO’s organizational viewpoint on quality.

“We have a very robust quality program that looks at safety and customer service, as well as makes sure the systems that we have in this organization support the provision of good quality care,” Boland said.

One of the things the hospital has done to improve quality is implement the Lean Production System, an assembly-line methodology developed originally for Toyota. Since implementing this program about 18-months ago, emergency department wait times have dropped considerably compared with the Ontario provincial average of 13 hours to an average wait time of only four hours at Headwaters.

“That’s a direct result of the work we’ve done with Lean,” Boland said.

Another quality enhancement tool utilized at Headwaters stems from a program developed in the United States called Hardwiring Excellence by Quint Studer. The principles of Hardwiring Excellence focus on reassuring the patient, making sure that they get the information they need, taking immediate action when there are quality issues and taking action on them for the betterment of the patient. Boland said every one of the hospital’s managers has attended a course on the principles, and they maintain a regular Studer steering committee in the hospital to make sure they’re keeping the principles in active use.

The keys to success for a community hospital like Headwaters remain constant – quality excellence, partnerships and technology. Regardless of size, CEO Boland keeps his staff on point and able to provide big-hospital service in a small community way.

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