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Wednesday, 12 June 2013

Alberta Health Board fired - what are the public health lessons and opportunities?

The interface between health boards and politics is fragile.   In a flash of merely hours, the entire Alberta Health Services Board has been dismissed, the provinces health system thrown into disarray and the foundations of years of construction razed with the swipe of a pen. 

At issue was an even more fundamental tension.   Governments have encouraged and support health taking a more entrepreneurial and business like approach to management.  Taking the direction to heart, the AHS built in pay incentives (aka bonuses) for senior executives (some 99 in Alberta).   The government directed the board to not fulfil its commitment to senior staff and the board refused.

When health boards become too strong and begin to exert power that exceeds that of their master, the master retains the right of execution.  In destabilizing the power structures in Alberta, government now has the opportunity to rebuild – and we all know during the process of rebuilding, expenditures decrease, planning comes to a screeching halt, and staff who lack of direction pursue nothing.  For a health system that was economically spinning out of control, and those costs driven predominately by unit delivery costs of which the vast component is compensation, this might be a logical step.

Might be because this is a province that has in the past made rash decisions without measuring its consequences – one of which led to the superboard.  It is also a province where eating a cookie in a mall can get you fired.   There are learnings for the whole of Canada that we can benefit from.

  • 1.       Health is inextricably related to politics in Canada
  • 2.       Health regions (school boards, municipal governments...) sit at the pleasure of government, so while government happiness is not a performance indicator, it is an important variable to consider.
  • 3.       Power destabilization is a highly effective mechanism for cost control and system control
  • 4.       During destabilized times, opportunities exist that the intrepid public health worker can monopolize on. 
  • 5.       During destablized times, risk is higher, but so is the potential gain.  Entrepreneurs truly understand the relative value of risk and gain – so if governments truly wish to bring a business attitude to health – here is the opportunity for innovators to shine.
Out of the ashes, the Phoenix will arise again.  More akin  is from Dr. Who, where in each incarnation, there is a different persona. 

Health boards were struck to act as a buffer zone between the public and front line workers, and politicians. Health systems are such an integral part of the Canadian culture, that they are the basis of loosing elections when tinkered with, and rarely the genesis of an election win. 

Good luck to our Alberta colleagues as they enter a period of chaos. 


  1. Cathy Richards12 June 2013 at 15:08

    I think the Board was right in fulfilling a contract they signed. Executive pay was to be baseline plus incentives to achieve goals, which were clearly rated/audited/scored. If the AB government didn't like the contract/reimbursement arrangement, the time to stop it was before the contracts were signed. Yes, we're in tough times economically, but what happens when we lose trust in agreements? When meeting an agreed goal is treated the same as not meeting the goal, how is that business like? Horne made a mistake I think, and the impact might not be immediately apparent, but what AHS Executive is going to sign an incentivized performance based contract now? I wouldn't.

    1. We are of course not privy to the contract details yet, but your point is bang on. The contracts were structured to incentivize particular deliverables with clear knowledge of the maximum achievable pay. To renege on such commitment would be a breach of contract and not fondly looked at by the courts, even if initiated by government dictum. The government may have options in legislation that could be undertaken, on this point we may yet learn whether this was driven by a desire to destablize the power, or a petty spat over 0.02% of the AHS budget

  2. An interesting perspective Dr. P. From SD in Alberta.