It’s a very instructive read, the 101-page Alberta Health Services Performance Review that Premier Kenney is using to cut health care budgets. Nobody is questioning the need for restraint and cuts, the debate is the how and where cuts should be made.
Two comments, in different sections of the report, gives a good clue. On page 6, the authors reiterated the financial and operational efficiencies gained in 2008 with the move from a governance model of nine regions to one consolidated entity—Alberta Health Services (AHS).
Major items resolved were inequalities and competition between regions, accountability and significant reductions in health care spending. By 1995 per capita spending on health care had dropped by 17 per cent.
In this most recent report, governance wasn’t addressed until page 90 even though the conclusions in that section were eerily similar to those of 2008. The report states, “compared to other jurisdictions, Alberta has significant functional duplication”, and that zone-based silos are beginning to re-emerge.
Governance inefficiencies should not come as a surprise to anyone who has worked in a large organization.
Organizations, as they evolve, add new functions eventually leading to power struggles, duplication and inefficiencies.
Forty-one Primary Care Networks (PCNs) and 16 Strategic Clinical Networks (SCNs) were introduced since 2008 clearly impacting the governance model. Public health has gained in importance and technological advances are revolutionizing our health services.
The report authors list six areas where significant functional duplication between AHS and Alberta Health is occurring—analytics, public health, PCNs, SCNs, infrastructure and information technology.
As well, the special agreement and relationship with Covenant Health did not allow AHS to exercise effective oversight over Covenant Health as a part of an integrated health system.
Re-engineering governance to weed out duplication is the first step on the road to renewal.
Reducing the fat in bureaucracies, curtailing empire builders and making sense of responsibilities leads to substantive cost savings up the chain—not down at the front-lines where services are directly impacted. Simply slashing budgets has the opposite effect—duplication and empires are maintained and the least powerful, front-line workers, bear the brunt of the cuts, as do services.
Even as an outsider, it seems reasonable that our current two-headed structure—AHS and Alberta Health—needs to be re-worked.
On paper, Alberta Health is the policy arm of government and provides some level of oversight, whereas AHS is the deliverer of services. It seems obvious that PCNs and SCNs should be solely under AHS’s authority and Covenant Health be accountable to the integrated health system and not run as a ‘free spirit’.
The report recommends Alberta Health should be focused on system-wide strategy and priority setting.
With health care making up 43 per cent of the provincial government’s total operating costs, I would also argue its oversight and auditing responsibilities should be enhanced.
A robust Alberta Health would keep the Health Minister current on trends and problems making it unnecessary to continually waste tax dollars on outside consultants, another expensive duplication.
Given that Premier Kenney made no mention of governance when the report was released, it is unlikely he intends to do the hard work of governance renewal—the cornerstone of structural efficiency and right-sizing.
Rather, his pursuit of private surgeries will add even more governance inefficiencies and competition for finite resources.
In 2008, former Premier Ralph Klein took the heat and re-vamped governance.
The results were positive and their efficiencies lasted almost 10 years.
Unfortunately, Premier Kenney seems unable to think beyond boom/bust budgeting, blaming others, and villainizing doctors and nurses.
Schimke has been through three organizational re-structures; Syncrude, kept job; Amoco, lost job; College of the Rockies, responsible for cutting 20+ positions.