Twenty-two years of Alberta Health Services (AHS) and the promise of efficiency, effectiveness and financial stability has led to nothing. The richest province in Canada has delivered patient outcomes and an all-but-collapsed health care system equivalent to the poorest provinces in the country. Successive federal cuts to health care transfers under both Liberal and Conservative governments, had an undeniable impact on the public health care systems of poorer provinces. It should never have had an effect on the natural-resource-rich provinces of B.C., Saskatchewan and Alberta. It’s just that these provinces ‘chose’ to underfund and desecrate their systems.
Even today, the UCP government and most UCP leadership contenders are bent on more privatization. Here’s the roadmap. Housekeeping, food services, laundry, MRIs and labs are already privatized or well on their way. Next will be surgeries, contract nursing, privatization of ambulance services and eventually private hospitals with lucrative government contracts.
The introduction of ‘peak efficiency’—the holy grail of business—into health care delivery shows the UCP’s arrogant ignorance. Maximizing staff and equipment usage in health care has given us today’s crisis. It has been the ruination of our ambulance services.
All communities fought hard to keep local dispatch for their ambulance services—but even the largest, Calgary, couldn’t stop the UCP. And here’s the reason, centralized call centers are integral to ‘peak efficiency’ ratios and future privatization.
Let me tell you a story that a working EMT shared with me. His team works 100 km north of Calgary. Yet they are often dispatched to emergency calls in Calgary because they are the closest ‘idle’ ambulance. They immediately hit the road, always hoping for the patient’s sake, that a closer ambulance will free up before they reach their destination. Most often it does and they return to their station.
With senior management’s focus on peak performance, this makes sense—worthless work can bolster efficiency ratios.
Statistics will show that their ambulance was dispatched within the targeted time (even though 100 km away) and productivity stats will show that the asset (ambulance) and the personnel (EMTs) weren’t idle, but working. Everyone, but the patient, and the road-weary, overworked EMTs, are happy—the stats look great!
Before AHS and the full-throttled move to privatize health care, the Alberta government allowed ambulance services to be run in conjunction with municipal fire departments.
The contrast is absolutely striking today. Urban areas with full-time fire departments still run their operations as an emergency service. As emergencies cannot be planned, but only anticipated, municipal fire departments are staffed for ‘potential peak demand’, not ‘peak performance’.
They’re not chasing their fire trucks around to record busyness. Idle time is considered a fixed cost and is budgeted accordingly. Fire departments are staffed and equipped to perform at a moment’s notice, responding to small and catastrophic situations. And, most importantly, saving lives starts with local dispatchers, not someone sitting in downtown Calgary or India responding to an Oyen call.
Quantitative measures like peak efficiency can give contradictory results in operations where profits aren’t the end goal. The ambulance example highlights this fact. Putting goals in place to reduce ‘idle’ time is self-defeating when unplanned emergencies are a core service.
A performance measurement can improve efficiency in one area, but it could lead to higher costs and unacceptable outcomes elsewhere. And that is where we are today. Emergency medical providers, with some of the highest stress jobs in the world, are short-staffed and treated like factory workers making widgets. Of course, care suffers.
They need mental recovery time. They don’t need to be running around in an ambulance to a call they are most likely never to reach. They need their scheduled time off and their vacations. Pushing paper around on a Premier’s desk, debating, talking and drinking whiskey at the Oilman’s Club is child’s play compared to those working in ‘life and death’ careers.
Applying measures to increase the number of widgets produced per hour is effective in industry, but demanding the same from health care workers (hours of care allowed per patient) doesn’t work.
Earning profits is easy when compared to running a health care system where inputs (patients) are all uniquely different, production (assessment and execution of care plans) are never standardized and the finished product (discharged or dead patients) aren’t predictable—nor can patients be ‘sold off’ if they are too expensive to treat.
COVID proved this point. Long-term care facilities across the country run by for-profit corporations served up much higher death rates per resident than did not-for-profit and government run facilities. Their cleaning standards and staffing levels had no surge capacity. The moral of the story—profits put patient care in second place.
The Town of Castor’s council are now sounding the alarm about ambulance services in their area. Seems the Castor ambulance is often pulled out of service to cover communities like Hanna and Stettler. Often, it’s not because Hanna’s ambulances are busy, but their ambulances are short of staff.
Most Albertans have worshipped at the altar of ‘public service’ efficiency for so long that the importance of extra capacity to deal with unexpected events was never appreciated.
Even the Egyptian pharaohs, recorded in the first book of the Bible, understood the importance of surge capacity. They devised seven-year plans to withstand famine, drought and plague. Yet today, in our advanced technological world, our health care system has no surge capacity, no ability to take shocks—no excess beds, no idle ambulances, no excess equipment, no extra doctors or EMTs or nurses—nothing but hot air from politicians!
We’re experiencing first hand the folly of putting our lives in the hands of free market ideologues and business executives who themselves are seldom prepared to handle a financial bust, let alone a health crisis. The oil industry, after successive busts, is still unprepared when oil prices drop. They simply fall back on an easy and simplistic solution—lay off thousands of workers and/or declare bankruptcy.
The AHS board and successive conservative government’s decades-long decisions to lay-off thousands of health care staff to balance the budget is now our Achilles heel. Unlike oil workers, health care can’t ramp up staffing overnight.
The solution isn’t more privatization.
Andrew Nikiforuk in his prophetic book, ‘Pandemonium’, authored 12 years before COVID, wrote, “Maybe it’s time to abandon what Wendell Berry calls our ‘arrogant ignorance’ about everything. Maybe it’s time to return to local virtues that question bigness and power. Maybe it’s time to learn a new canticle for creation that encourages, as Saint Francis did, humility.”