Wednesday, 11 September 2013
Health regions, politics, power and chaos. Alberta as a case study
Anyone who has watched the antics of Alberta’s health authority structures over the years must be left with a sense of amazement, and some comic relief. From CEOs running through malls eating cookies, to public inquiries into queue jumping, the symptoms of abnormality were rampant. And that is just for those looking in from the outside, the stories from within the hallowed halls are truly astounding and DrPHealth would welcome some anonymous comments to share with across the country.
Regional health authorities were designed for three purposes.
1. To save money
2. To depoliticize health care decisions
3. Possibly, to improve health outcomes.
On the third of the outcomes they appear to have delivered reasonably well even though the evidence they would was meagre in the beginning. Albeit that despite the billions of dollars that rolls through their finance offices, formal evaluations on health outcome improvements have been incredibly scarce, almost making one believe that even the architects were questioning whether they believed they could deliver on improved care.
As for saving money, it was short term gain and very long term pain. Professional unions have wielded their expanded power and leveraged salary increases that well outpace inflation. And for the naive observer that looks at the increase only in terms of hourly wage and typical benefits, they represent only a portion of the gain. Increased numbers of steps provide for much higher pay for persons with years of experience, few if any workers start at the first step of the wage scale any more, restrictions on who is offered overtime and extra shifts means those in the system have stuffed their wallets and purses. Administrative wages have soared even higher though compared to individual hospital CEO’s in Ontario it would appear that executive wages have only been allowed to trot instead of gallop upwards.
Ah, but in the purpose of depoliticization there have been mostly clear benefits. Health regions are the perfect dumping ground. Provincial MLAs can point their fingers at the health regions, redirect complaints to the region, and for the most part advise the region that they have a job to keep health off the front pages. The public have come to believe that health regions make all the decisions and they are to blame, hence the target of their fury.
Governments do not win elections on health, but they sure can lose them. Recent elections have left voters begging the question why was health hardly debated by any of the parties?
So, what does a government do with a health region that is behaving badly? Replacing boards has occurred uncommonly. CEOs turn over with greater rapidity. And, on occasion, government rides the white horse into the forum and destabilizes the power structures catapulting the region into a state of chaos from which their is blind hope that a better world will arise.
Thus was the case in Alberta on September 10. A purge of five senior and highly experienced executives as a prelude to trimming a few of the 80 VPs, (yes that is eighty vice-presidents). Calgary Herald
Weep not for the senior executives, somewhere in their contracts are golden eggs that will finance a luxurious retirement, and they are likely welcoming the relief from years of executive decision processes. Most will be gobbled up quickly because of their knowledge and experience. More sympathy to the VPs who are much less protected and less marketable in the future.
For the front line worker, or even middle manager (several notches below a VP in Alberta), the disarray results in decision gridlock. Nothing will be approved and status quo will remain. Chaos looms for another 2 years for an organization that has never really been given the opportunity to stand on its own two feet. Budgets will be frozen and overall cost of the system will be stagnant. Good people in health care, will continue to do good work with what they have.
It has become clear that at least in Alberta, health regions are not meeting any of the goals of regionalization. Perhaps this is the precursor to finding a new way to preclude power silos developing in health.