From outsourcing to in-house: the strategic growth of SE Health's legal department

As their group expands, lawyers offer lessons in building a department from the ground up
From outsourcing to in-house: the strategic growth of SE Health's legal department

Photo: Farah Ismail, Victoria Mitrova

Since establishing Saint Elizabeth Healthcare’s first-ever in-house legal team last year, Farah Ismail has led its strategic growth, helping the organization tackle complex legal, privacy, and compliance issues while staying true to its mission of community-based healthcare.

The department at “SE Health” has expanded significantly to include two legal associates, two paralegals, three contract specialists, and a business support specialist. Beyond these roles, the team also oversees occupational health and safety and patient engagement, areas with substantial legal complexity. “We’ve stabilized our team, with strong foundational practices in place – templates, operating procedures, and a file management system – so we can manage day-to-day legal needs in an efficient, consistent way,” says Ismail.

Associate legal counsel Victoria Mitrova joined this year after being seconded from  Fasken’s health group. She has helped Ismail develop the team’s mission and articulate the value of the legal department across the company. “Our team’s primary goal is to support SE Health’s mission of providing healthcare to thousands of Canadians,” she says. Mitrova and Ismail developed the tagline "Helping Good People Do Good Things" to underscore the legal team’s role in empowering healthcare staff while navigating the many regulatory challenges inherent to their work.

As they establish roots, balancing operational needs with strategic involvement has proven challenging. To manage this, SE Health relies on external counsel for highly specialized matters. “We’ve been leveraging our external legal counsel effectively,” Ismail says, which allows the team to participate in high-level discussions on innovation and risk mitigation – important priorities as SE Health undertakes a digital transformation. This shift to digital requires the legal team to address new risk factors proactively, ensuring robust planning on privacy obligations and other regulatory concerns. “Being involved early and helping to plan as projects evolve has been a really important piece,” Ismail says.

Reflecting on her role, Mitrova says the challenge of transitioning SE Health’s legal team from an external to an internal function met with some friction. “A lot of the resistance comes from being viewed as barriers rather than enablers,” Mitrova says, adding that her team worked to centralize processes and show how early legal involvement could simplify workflows across the organization. Working closely with HR, finance, and operations, the legal team aimed to demonstrate that they are there to support – not hinder – colleagues in achieving their objectives. “We've begun to implement policies and procedures that I think our teams are starting to have buy-in to because they've seen how they've worked over the past year,” she says.

Recruitment, too, has been strategic, with each team member selected to address a specific legal need. Early on, SE Health sought individuals with experience in corporate law and contracting, litigation, and, increasingly, human resources and procurement. To mitigate reliance on high-cost external resources, SE Health makes use of paralegals to handle more routine tasks. Ismail says, “We have seasoned paralegals who are readily available to do smaller claims and are able to manage our day-to-day function,” allowing the team’s lawyers to focus on governance and complex legal matters.

The addition of a privacy program, which previously concentrated on Ontario but now operates nationally, illustrates the growing scope of SE Health’s legal function to support the organization’s expansion across Canada. To support these developments, the legal team has laid out administrative processes designed to streamline future growth and uphold SE Health’s mission-driven approach in all legal work.

For SE Health, the journey toward building a fully operational legal department has been as much about fostering a supportive culture as about navigating legal technicalities. Ismail explained that developing a cohesive philosophy was central to this mission. Mitrova and Ismail brainstormed the company tagline together to help guide their team's focus on their day-to-day functions.

Mitrova says her experience transitioning from Fasken to SE Health provided her with a deep connection to the organization’s mission. “You don't often get the opportunity to work at the place that you might potentially want to join before you actually do,” she says, describing how her early involvement in building the department influenced her decision to move in-house.

Even after formally joining SE Health, Mitrova has maintained strong ties with Fasken, a connection she believes is invaluable. She hopes to leverage secondments and student placements to enhance Fasken’s understanding of SE Health’s unique needs.

The insights gained over SE Health’s first year have equipped the legal team to advise organizations seeking a similar path. Ismail stressed the importance of aligning legal and organizational goals, especially in a field as dynamic as healthcare. “We had the support and the buy-in from the CEO as well as the rest of the senior leadership team, so that positioned us well for success as a department,” she says. Nonetheless, the department faced challenges in defining its role and influence within the organization. The key to success, Ismail said, is “providing guidance within the confines of the law” to promote both innovation and strategic growth.

The team’s early success has not meant smooth sailing on all fronts, as Ismail acknowledges. Legal compliance in healthcare requires constant adjustment, especially with today’s regulatory volatility. “As in-house legal, we're not only navigating some of the day-to-day issues, but we're having to switch and change our approach to things depending on what's happening in the existing environment,” she says.

In-house roles like Mitrova’s present distinct challenges compared to private practice. “When you're in a firm setting, you're often focused on narrow issues,” she says, but in-house demands a practical, business-oriented perspective. Now, Mitrova grapples with a broad spectrum of concerns, including privacy, risk, and even organizational dynamics. She says her new role is much more collaborative, which presents its own challenges.

“In-house life has so many more meetings than I remember when I was at a firm. So, it's learning to balance your workload with the many interactions you have on a day-to-day basis with your team.”