Last year when the Health Minister was struggling to explain how the government was going to approach activity-based healthcare funding he said something truly brilliant. He said the government was making improvements and “As for whose idea it was, it matters not to me whose idea it was… if it’s a good idea, we’ll do it”.* This was insightful because creative idea generation is exactly what we need to crack the complex problem of providing high quality healthcare without bankrupting the province. The question is: Did Mr Zwozdesky really mean it?
Before we go there, let’s start at the very beginning: Where do good ideas come from? Are they the result of a blinding eureka moment and arrive on the shore of consciousness fully formed like Botticelli’s Venus, or do they evolve slowly, fortified by a serendipitous encounter, a fortuitous accident or the concerted efforts of others? Steven Johnson in his book Where Good Ideas Come From says it’s all of the above.
A good idea is a creative spark which collides with other ideas and is improved by the free flowing dialogue of a diverse mix of people. The improved idea may trigger a breakthrough on a hunch that has been simmering in the back of someone’s mind, it may careen down a misguided path, only to come back much improved, it may meet with a serendipitous accident which improves it one hundred fold. It took Darwin almost 2 years to connect the extraordinary diversity of the Galapagos finches with his theory of evolution and that happened only after Darwin read Malthus on Population “for amusement”. The bottom line is that a good idea needs a collaborative open environment in which to grow.
Turning now to how the Alberta government developed its solution to the healthcare crisis—the Health Minister started with the right question. He asked: “What is it that people want?”** He assembled the Minister’s Advisory Committee on Health (MACH) to dialogue with Albertans. Albertans told MACH they wanted improved access to health care, reduced wait times and a sustainable health system.
So far so good, but here’s where the process when sideways. MACH returned to base and passed this feedback on to the bureaucrats who translated what they “heard from the people” into legislation–the new Alberta Health Act. The purpose of the new Act is to provide a health charter setting out principles and responsibility (ETA: some time in the future), a health advocate to solve citizen’s concerns (reporting directly to the Health Minister and ETA: some time in the future) and what Minister Zwozdesky described as ”the single most important part of this bill”—the ability to input through an “engagement process”(ETA: some time in the future).***
To be fair, the government also made a 5 year funding commitment to health care and published a 5 Year Action Plan. Unfortunately the funding commitments is limited to the capital costs of new facilities and diagnostic equipment and does not provide an operating budget to hire the doctors, nurses or other healthcare providers who will be required to staff them.
So the end result of this bright idea is legislation aimed at increasing the ability of Albertans to talk about health care problems, not to solve them. This is not surprising for a number of reasons. One, the mandate of the MACH was to find a legislative solution. Two, the composition of the Committee included health care professionals and academics but did not include any representatives from the Union of Alberta Nurses or the Alberta Medical Association—the two organizations that best represent what is really going on in the trenches. Three, the proposed legislation was vetted in the PC Caucus. Now, Caucus may be an effective tool for political leadership and decision making, but it can hardly be described as an open diverse environment conducive to the free flow of ideas. If you have to ask for permission to voice a good idea, the idea dies—just ask Raj Sherman. Four, the PC’s hold the majority of seats in the Legislature so the efforts of the opposition parties to bring forward alternative solutions fell on deaf ears. Why? Because in the Health Minister’s view the only good idea is his idea. And here we are today, still talking about our health care problems with no solution in sight.
Darwin didn’t get from his Galapagos finches to the Origin of the Species by listening to the sound of his own voice. The Alberta government won’t get from the healthcare crisis to a sustainable solution without meaningful input from a diverse group of outsiders: experts, healthcare professionals, and dare I say it, politicians from across the aisle. To paraphrase Steven Johnson, you can develop small ideas in a locked room cut off from the insights of others, but if you want to make major change…you need company,
*Hansard, Feb 22, 2010, p.208
**Hansard, Nov 30, 2010, p 1705
***Hansard, Nov 30, 2010, p 1704