This has been a bad week for the AHS and Dr. Duckett. On Wednesday the AHS posted its actual performance against target performance for ER benchmark wait times. You’ll recall that the benchmark wait time is 4 hours for treatment/discharge and 8 hours for treatment/admission. The AHS said it would meet the 4 hour benchmark 80% of the time and the 8 hour benchmark 48% of the time—or did it? The targets keep slipping downward. Hardly surprising since the actual performance numbers (also posted on Wednesday) indicate that some hospitals met these targets only 20 to 30% of the time.
So this is where it gets interesting. When Health Minister Zwozdesky heard that the AHS had released the wait times and targets he said the release was premature and was only part of the package of performance measures the AHS were developing. According to Don Braid (Nov 13 Herald) in the space of 8 hours–between 10 a.m. and 6 p.m.—the original sentence setting the March 2015 benchmark target at 90% was in the release, disappeared and then reappeared.
It made me wonder whether Dr. Duckett was having a bad hair day. In an article in The Medical Journal of Australia (MJA 2009: 190(12) 687-688) Dr. Duckett reflects on his 35 year career in health care in Australia. He voices a concern that the health care sector has failed to tackle the fundamental challenge which results when an aging boomer population refuses to wait meekly for health care. He discusses macro changes (things like activity-based funding for hospitals) and micro changes (like internal organizational processes which are controlled by hospital managers and staff). He wraps up his comments with the following thought: “Of course, no health care system can guarantee perfect care and perfect outcomes for individual patients. It is inevitable that some health professionals will have a ‘bad hair day’—the result of activities the night before, work pressure, momentary distraction in thinking about issues at home or behaviour of their work colleagues. Even the best intentioned health professional can make a mistake. But it is these micro interactions that determine the patient experience, and tomorrow’s patients will expect more from their encounters and will be less tolerant of practices of the past”.
It would appear that on Wednesday Dr. Duckett had a “bad hair day”. AHS staff responsible for setting benchmark targets weren’t clear on what the targets were and PR staff weren’t sure whether they should be posted. Then to make matters worse, Dr. Duckett failed to communicate with his boss, Minister Zwozdesky, who was clearly steamed about the “premature” release of the ER wait times and improvement targets. Add to this the fact that Dr. Duckett’s personal performance targets for 2010/2011 set the ER wait time benchmark for 2015 at 2 hours not 4 hours for treatment/discharge and 4 hours not 8 hours for treatment/admission. Minister Zwozdesky says he’s concerned about AHS lowering the targets and says he’d like to see the targets “…a little higher than the fingers can reach…” but setting Dr. Duckett’s personal targets twice as high as the AHS public targets creates confusion not alignment.
If we could just get Health Minister Zwozdesky and Dr. Duckett to work on the “micro interactions” between themselves and settle on a consistent set of targets, maybe we’d all stop having bad hair days.
As you have pointed out, this is a system in chaos. I had the opportunity to meet with Dr Duckett, and hear his perspectives on health issues, and I came away very, very impressed. I think the problem is alignment in the system, not Dr Duckett’s intent or his capability. My worry is that we have recruited an excellent person to do this very difficult job, and that the government is hamstringing his ability to do it, and hanging him out to dry. At some point he may well have had enough of this, and if he leaves, how ever will we be able to attract a quality person in to this chaotic system? It looks like political expediency is trumping medical excellence here……..
Sheila: You make an excellent point. The problem started in the Klein era when 1500 beds were taken out of the system, add to that rapid population growth, and not one but two Health Ministers who appear to have focused on nothing but reducing the budget deficit and you have–chaos. Albertans have expressed their dissatisfaction before, but this time they are going to hang in there until they see measurable improvement.