Right after Camille Orridge accepted her new job last summer, running the organization dedicated to coordinating and improving healthcare delivery in central Toronto, she decided to take a step back from the healthcare world to take the vacation of a lifetime. Visiting South Africa, Zambia and Botswana, though, made her realize something about her work life: Ontario's healthcare system is pretty good.

"I was overwhelmingly impressed with what we have here. We should never sit on our laurels, but we can't forget we have a good system," says Orridge, the new CEO of the Toronto Central Local Health Integration Network (TCLHIN). "The clinical treatments are solid. Customer service is what we need to work on."

During her 13 years at the helm of Toronto Central Community Care Access Centre (CCAC), which provides in-home and community-based services to help people come home from hospital or live independently at home, Orridge developed an ethos of continual improvement. With TCLHIN, her primary focus will be getting more bang for the buck out of the 177 healthcare agencies in Toronto's core -- everything from hospitals to walk-in clinics to HIV/AIDS service organizations to the YMCA to the Alzheimer Society of Toronto. Overseeing $4.2 billion in provincial spending (the budget for the TCLHIN office itself is $6 million), Orridge is tasked with persuading, coaching, organizing and, if necessary, strong-arming the agencies into improved efficiency and cooperation.

When Orridge, 63, arrived in Canada from Jamaica in the 1960s, she says she never imagined herself with such an influential position. Her first job was working as a ward maid at Toronto General Hospital. She studied her way up through the system.

"Remember that in the '60s, healthcare was where immigrants wanted to work because there were good jobs with pensions," says Orridge. "I ended up with a family in healthcare. My mother was at Toronto Western, my aunt worked for 30-odd years in the kitchen at Toronto General, my sister has been at Toronto General almost 40 years. My niece is now a nurse at St. Mike's. Healthcare was good to us."

Created in 2006, along with 13 other provincial LHINs, TCLHIN is midway through its current three-year plan, which spells out five key goals: reduce emergency room wait times, provide alternate levels of care, improve the prevention and treatment of diabetes, improve the prevention and treatment of mental health and addictions, and improve the system's value and affordability. In this edited interview, Orridge reveals an approach that's both ambitious and pragmatic.

On emergency room wait times

"I think we'll reduce ER wait times on this plan. Will we [meet the province's targets]? Probably not. ER really is a reflection of problems elsewhere in the system. For example, we're doing a lot of work with primary care, so physicians can provide services evenings and weekends so individuals don't have to wait two weeks to see their family doctor. That should end up with some reductions in emerg. By improving chronic disease management for seniors, we assist them to manage in the community before they get into crisis and turn up in emergency. Coming from the community side, I have a working knowledge of how most people manage their lives outside the acute system. Yet everything we seem to do in healthcare is about sick care, which is 10 percent of the time. Take children as an example. One of the things we know, looking at kids who come to Sick Kids emerg who are hurt, there's a direct correlation between certain housing projects. How do we get into those housing projects, look at the playground and prevent kids from being injured in the playground in the first place? That has to be done by the community, not just the Sick Kids Hospital."

On selling change to citizens

"Ontarians have been trained for a long time that their healthcare interaction is in two areas: the doc and the hospital. We haven't had a lot of public debate around changing that idea. We're seeing more awareness around community health centres, CCACs, palliative care. You almost need to double-fund as you make the shift. It's one thing to tell me that going to ER is not the best use of health resources. That's not going to change my behaviour. The family physician first needs to say, 'I have a clinic twice a week or I have room in my schedule for an emergency.' After you've had that experience once or twice, you'll do that instead of going to emerg."

On tackling problems head-on

"When you do an audit, there's always a risk of the press and the public saying, 'Look at how bad they are.' It's an uphill battle. There's a study by the Change Foundation (pdf) that Toronto Western and the Toronto CCAC participated in, to get feedback from clients and families about how well or how badly they were doing after discharge. They got the information and it was terrible! But they improved significantly once they got that information. We need to do the right thing, find out what's happening and if we get negative information, that's good. Now we know. We can do something about it. We can't fix what we don't know."

On building connective tissue between agencies

"In Europe they have a concept called "urban health." You have city planners, architects, healthcare providers, a whole group of people who come together to come up with solutions. With seniors, they have, along main streets, benches so seniors have a place to stop and rest when they're walking. When everybody focuses their attention on a group like seniors, you get one master plan that everybody is participating in. We need more of that in Toronto."

On getting 177 agencies with 42,000 healthcare workers onto the same page

"It's not physically possible to meet with all of them one-on-one. It's about starting with what I call 'the coalition of the willing.' We're moving into an era that's not about securing and protecting agencies, it's about getting services to the population to meet their needs. Agencies that are able to do that will survive, and do very well. Legislation exists [to force agency cooperation]. It would be the last thing to pull out when everything has failed."

On what good healthcare customer service looks like

"It's not about customers getting everything or that the customer's always right. Customer service is a process you can go through to get where you need. Sometimes it's the simplest things that make a difference to the clients; sometimes we just have to listen. When we talk about public consultations, advisory committees are one way of doing that. Usually when you have an advisory committee, you have the voice of the well-educated, highly articulate giving you advice and that's valuable. But we also have to find ways of getting through to folks who don't have that same voice. You're often better off doing that through focus groups, going out to the public through other agencies."

Paul Gallant is a Toronto-based freelance writer who lives in the emerging Brockton Triangle neighbourhood.