Alisa Harrison earned her PhD from Duke University in 2008 (history & African American studies). Since then, she has worked as a consultant and executive in the public and non-profit sectors. She draws on her expertise in power relations, democratic movement-building, and community organizing to work with health care providers and leaders, service users, and community partners to improve access and quality, encourage evidence-informed practice, and create a more equitable, safe, and sustainable health system. She is currently executive director at the Victoria Division of Family Practice. Dr. Harrison first wrote about her transition in April 2013.
What did you hope for in terms of employment as you completed your PhD?
I wanted work that would be intellectually as well as socially and politically engaging; I felt like the combination of research and teaching would give me that, and my research focus lent itself strongly to activism. At the same time, I struggled with the idea of working so hard to publish in places where the audience would be small, so I was always thinking about ways I could bridge the academia/non-academia gap, at least in terms of publishing. But I really wasn’t considering working outside of a traditional university or college setting at that point, at least not in any significant way.
What was your first post-PhD job?
I started working as a sessional instructor at the University of Victoria in 2005 while I was finishing my dissertation. I started with a 2:3:1 load, which is pretty hefty, particularly for a brand new instructor, and I maintained a regular teaching schedule there for almost five years, mostly in the history department, but also in women’s studies. I finished my PhD at the end of 2008, so there was a good period of time that I was working as a sessional post-PhD. But I also started working part-time for the BC government right after finishing my degree. Another sessional instructor in my department was the director of a cross-ministry policy research unit, and she asked me to join their team in 2008. So I split my time from 2008-10 between government and UVic. My government work eventually morphed into private consulting (a long story in itself!), which led me to give up teaching completely in 2010 to focus on research, writing, and project management, mainly in the health sector.
Somewhat tangentially to this question, I’ll add that I took the teaching position in women’s studies in January 2007 to cover a tenured professor’s maternity leave while I myself had just given birth two months prior, and by entirely unplanned emergency c-section, no less. I had taken the fall semester off (my baby was born at the end of October) and I was aware that if I didn’t start teaching again, as a sessional, I would likely have no job to which to return as it’s a largely first-come-first-served/right-place-right-time rather than merit-based system. The irony was not lost on me or my young students, as I stood at the front of my class leaking breast milk while a tenured professor got fully-funded maternity leave. I’d always been reasonably cynical about the academic job market, but this situation made it impossible for me to ignore the deep inequities in and inhumanity of the employment system, and was really the beginning of the end of my time in the academic world — and I hadn’t even completed my PhD yet!
What do you do now?
I am the executive director at the Victoria Division of Family Practice (VDFP). I am the founding ED, which means that when I started this job five and a half years ago (at that time, as a consultant), the organization consisted of some enthusiastic board members and a file folder. Since then, I’ve built it — in collaboration with a still-enthusiastic board and 420 inspiring at-large family physician members — into a thriving non-profit society, making measurable improvements in health service delivery in our community, and employing 15 people in full-time jobs plus a number of consultants, including other PhDs who have sought to use their skills outside of the academy. The VDFP’s mandate is to work with family physicians to improve access to excellent local primary care. We use community development and organizing principles (which I brought from my research on social movements, particularly the student movement in the 1960s U.S. South) to engage physicians in redesigning the health system based on both practice and research evidence, and using models of collaboration and consensus-building.
Up until a few months ago, I was also principal and founder of a consulting company, where I worked independently and with associates on a variety of research, writing, and policy development projects, mainly in the public and non-profit sectors. Most of my work in that regard was also in health, and always involved advocating for evidence-informed policy-making, reflecting both scholarly knowledge and the experiences and needs of service users and providers. Some of my most satisfying projects included developing evidence-based provincial standards for inpatient psychiatric interventions (a huge area of risk for people with MHSU concerns as well as for the hospitals that serve them); an evidence-based service model that enabled British Columbia to establish the first publicly-funded residential treatment centre in Canada for youth with eating disorders; and a continuum of care for eating disorders treatment to inform BC’s Ministry of Health, which has since been cited surprisingly frequently, including in areas of federal policy-making. These were satisfying both because I learned an enormous amount about these fields of research and how to bring research evidence alive for people who are not academics, and because I was able to use my academic skills to contribute in tangible, meaningful ways to making people’s lives better, at times when they are perhaps the most vulnerable.
In general, I love the variety and the challenge of working across different environments and with different bodies of knowledge. While I’ve stopped consulting (my work with the VDFP is all-consuming and I just can’t fit anything more in!), working in primary care is exciting because it touches every other aspect of the health system, so I still have that variety and challenge even as I get to specialize a bit more.
What kind of tasks do you do on a daily and weekly basis?
We all hear in the news about doctor shortages, wait times, and other obstacles to good patient care. My daily tasks are focused on removing obstacles by changing the way that the people who comprise the system relate to one another. The heart of my work is communication — listening to people, learning from them, contributing to their understanding, and building relationships of trust that enable us to work collaboratively and shift the trajectory of the health system away from disorganized silos toward coordinated, humane, and effective services for both patients and providers.
In a practical sense, this means I sit at a lot of decision-making and strategic tables where we use a variety of techniques to encourage creative, collaborative problem-solving and respectful communication, and I give a lot of presentations and/or attend meetings and events as a representative of our organization to ensure that family physicians have a voice in the system. (Or as one of my kids puts it, I am a “professional meeting go-er”!)
I spend a lot of time in strategic planning and analysis, and organizational development; working with partners in the regional health authority, provincial government, and community agencies to build meaningful relationships that make system-change possible; and supporting the VDFP’s employees and member physicians to do their work. I am “The Boss,” but I try to bring a kind of leadership that is less about wielding power and more about coaching and helping others to bring their best to our sector. I am lucky to have an amazing team at the VDFP, including an operations director who has taken on most of the day-to-day staff management. This is great because it frees me up to keep myself and my staff of talented project managers, coordinators, and administrators focused on the big vision and goals of our organization.
As ED, I’m responsible for the day-to-day operations of our organization, and for supporting our board of directors (at this point, all family doctors), which is mostly a governance board but also somewhat managerial because the nature of our non-profit is to build opportunities for physician leadership. In terms of tasks, this means regular meetings with the chairs, lots of reporting tied to our strategic plan, keeping the strategic plan fresh, arranging and participating in board development, promoting productive conflict, and creating board and subcommittee agendas that reflect our strategy and vision and enable practical action. I write a lot of policies and briefing notes, as well as evidence reviews and reports to inform decision-making, and do a lot of behind-the-scenes briefing to prepare board members for meetings with each other and with partners. I am also lucky that we are committed to being a learning organization, so I have many opportunities for professional development through daily engagement as well as focused courses of study.
What most surprises you about your job?
I think what surprised me most early on was the degree of intellectual challenge and engagement I could get without being in the academy. I really hadn’t realized that was possible. I’m still constantly amazed by the degree to which my PhD applies in a completely different setting. I trained as an historian of the 20th-century U.S., with a focus on African American and women’s history. I’ve learned to re-think what I studied to recognize the breadth of knowledge I gathered over time. So now, instead of thinking of myself as an historian (although I still am), I think of myself as someone with deep scholarly engagement with the notion of power relations and the theory and practice of social movements and change. This is the foundation for my work in health policy, in ways I could/would not have predicted going in, even though now, looking back, they seem so obvious.
I’ve also been surprised by how much I have learned about working with other people. When I came out of academia, I was very much in the mindset of gathering evidence, sorting and analyzing it, and presenting the conclusions and further questions that resulted. I believed very strongly that a rational argument and passionate commitment were all you needed to instigate change. Not true! I learned through trial and a lot of error that there is a technique to communicating evidence in a non-academic space, and a technique to politicized debate and discussion that goes far beyond going to the wall hashing out complex ideas.
The biggest learning moment was when, after a conference where I was a passionate advocate (a.k.a, bull in a china shop) for our community’s needs and I suffered some blowback as a result, a colleague said to me, “You have to get your ideas out there without shaming other people or leaving them with egg on their face.” It struck me because I really hadn’t realized that I could have been perceived so negatively — my heart was 100 percent in the right place, and my arguments were 100 percent correct, but I wasn’t acting in a way that allowed me to have much compassion for people who brought different arguments or needs. In earlier days, I would have thought compassion was irrelevant — I had a lot of justifiably righteous anger, and I thought of compromise as copping out. After my colleague’s words, I started to rethink that, and to consider what I was really trying to achieve — did every meeting need to have an element of catharsis? Did I want to be right, or did I want to be effective? The two are not, of course, mutually exclusive, but sometimes being effective means doing the work and having the patience required to create a bond with a person with whom you disagree or who brings different priorities to the table. I’ve learned that when you acknowledge the constraints other people are under, and the validity of their motivations in their context, when you build understanding, it’s possible to envision shared objectives and to achieve more than you ever would have thought possible, all while maintaining integrity, fidelity to evidence, and commitment to core values and principles.
I’ve never had to compromise my principles in order to build consensus, because I’ve learned to be as committed to the process as the outcomes — I’ve learned that if people are harmed or shamed in the process of getting somewhere, the end result is actually pretty hollow, and generally not sustainable. And the exciting part is that I’ve been able to really dig into my scholarly knowledge of power relations to get to a point where I can be an effective consensus-builder. I know some people will dismiss consensus as compromise — I used to hold that opinion — but I’ve learned that this is way off the mark. I think of consensus as a form of nonviolent, trauma-informed communication that promotes the kinds of relationships between people and organizations, and within systems, that can address at very deeply levels the inequities that cause so many problems in the world.
What are your favourite parts of your job?
My favourite part is working with a variety of people and helping shift systems to enable people to do their best work and get the results that are most needed. A key theme across my work is system transformation. This doesn’t happen in one fell swoop; it is incremental. It comes from lots of tiny actions in a million different places with many different people over time. I love to experiment with new ideas and try things without knowing what will happen — most of the work I do at this time uses quality improvement methodologies, so we are constantly building “safe to fail” experiments and prototypes that foster innovation and creativity in applied settings. I love the calculated risks we get to take, and the role I play in my various teams in helping people learn to use evidence to make change.
I also love the fact that the work I do has a direct, positive impact on people’s lives. Patients are having better experiences of health services because of the work we’re doing, and their health is improving. Because of our work, physicians and other health professionals experience improvements in the quality of their practice and daily life. Government and health bureaucracies are (slowly) changing their process models because of our influence. There is nothing more gratifying than knowing that people’s lives are better because of work you’ve done, particularly when it comes to the basic human right of health care, where the stakes are as high as they get.
What would you change about it if you could?
I would love to spend less time juggling e-mail. My inboxes are constantly overflowing. It sounds like a small thing, but it is a huge daily stressor. I disabled my voicemail and no longer publicize my direct phone number — you have to go through the office staff to find me by phone — because the volume of e-mail and phone correspondence was really overwhelming and I found there were negative consequences from being slow/unable to respond to people. I’m rarely sitting at my desk so I struggle to keep up with communication with people who are not literally in front of me, and to properly acknowledge the range of demands that come through correspondence. I try to schedule as many phone meetings as possible for my commutes to maximize my use of time, but it’s still never enough. That’s a constant frustration. I’d also like to get outside of the formal political structure/election cycle hamster wheel so that we could do truly evidence-based work with none of the structural political barriers, but of course that is a completely impossible pipe dream!
What’s next for you, career-wise?
I’m finding health leadership really fascinating and can see myself remaining in this field for a long time. I’m currently taking a seven-month leadership course for non-profit executives, which includes one-to-one work with an executive mentor, and I think about going back to school for graduate degrees in public health or business administration, just to get more formal “book learning” under my belt. One consequence of having a PhD is knowing how much I don’t know about other fields, and how much better I could be if only I had read 500 scholarly books about health systems or running a business!
Where I am now career-wise happened very quickly: I went from crying in front of my computer in 2009 about being underemployed in the midst of a global recession and non-existent academic job market (there was one job posting in my field in all of Canada the year I graduated), to more career than I ever bargained for only a couple of years later, in areas where I am having a direct impact at every level of the health system. So I’m trying to enjoy the current ride and see where it goes without engineering it too much. That said, I’m always on the lookout for new opportunities, and am just starting to work with my mentor on building a professional trajectory for myself, which focuses on successive growth within health system leadership.
I would also love to circle back to academia again with an eye towards bridging the academia/non-academia gap. I don’t see myself ever having a traditional faculty role, but with the VDFP we are now starting to develop partnerships with faculty researchers on community-based work and to supervise graduate practicum students and PhD fellows, and I would love to do more of this and find opportunities to teach students from a multidisciplinary perspective. I would like to come into academic settings and show people how big the world is and how many possibilities there are for people who like to think.
I feel like I live at the juncture of the academy/larger world, and I would love to increase the focus on that intersection, both within scholarship and elsewhere. I think “elsewhere” — government, non-profits, even the private sector — has started to embrace this intersection quite strongly, mining academia/academics for what we have to offer. I would love to be a part of efforts to promote this in academia, which tends to be much more conservative in terms of defining legitimate knowledge and legitimate thinkers, and still shockingly behind the times in terms of how it conditions grad students to think about intellectual work and engagement, and valuable employment.
What advice or thoughts do you have for post-PhDs in transition now?
My main advice is to think big: there are no limits to what a PhD can prepare you to do, and what matters most is that you are doing work you find fulfilling and that meets your practical needs, not whether or not your advisors approve or your school sees you as a “success.” Let go of the value of martyrdom; you don’t need to take a soul-sucking, barely-minimum-wage-paying contingent teaching job just so you can say you work in academia. Shaking off the chains of the academia-or-bust mentality is critical, and it can be a slow and painful process. It is worth it in the end, and it allows you to think about how to explain your background, skills, and interests to a variety of different audiences.
Learn to tailor your explanation appropriately: the answer you give about your dissertation to a book editor is different than what you’d tell an executive director of a non-profit you’re interested in or a director of a government agency, or what have you. Learn to be strategic — not in a manipulative way, but in a way that uses the sharp thinking skills you’ve built and shows that you can make innovative connections between disparate ideas, topics, contexts, etc.
And don’t forget how hard it is to complete a PhD, and how meaningful it is that you are in that tiny sliver of the population who has managed to do so. It’s easy to downplay it when everyone around you has one; but outside of academia, it’s pretty unusual, and really sets you apart from the crowd as someone with drive, commitment, intelligence, and broad skills. (And who is also lovably nerdy.)