I went to the Health Care Town Hall meeting in Calgary last week. After two hours I had a headache. How come it’s never anybody’s fault?
“Fault” is defined as being responsible for an unpleasant situation. I learned all about fault when as a child I was cavorting through the house and knocked a lamp off an end table. The wire bit that held the light bulb snapped clean off the base. Oh oh. What to do? With an unerring sense of self preservation I reassembled the lamp and placed it gingerly on the table. It was fine—as long as no one touched it. That evening my mother turned it on…and it fell to bits. Who did this she asked. Silence. Well, the lamp didn’t just break by itself she said. She had a point. Given that I couldn’t pin the blame on my sister I confessed and lost my allowance for a week.
That’s how accountability works when you’re a child and that’s how accountability is supposed to work when you’re an adult—unless of course you’re the Minister of Health and Wellness. In that case you’re free to deny accountability and, if you’re feeling particularly spunky, deny there’s any problem at all.
Minister Horne demonstrated this in spades at the health care town hall meeting. In response to the question, do you think the healthcare system is in crisis, Mr Horne replied, “I do not believe our healthcare system as a whole is in crisis in Alberta, there are some relationships in our healthcare system that need attention”.*
Some relationships that need attention…? The 420 page Health Quality Council (HQC) report on healthcare mismanagement had just landed with a thud on Mr Horne’s desk. Part A described a critical lack of long term care beds which results in a misuse of acute care beds which in turn creates excessive wait times in ER and for surgeries. Part B contained heart breaking stories of bullying (known in polite society as physician intimidation) at the hands of the departments of Health & Wellness (Mr Horne’s ministry), Alberta Health Services (the administrative arm of Mr Horne’s ministry), the College of Physicians and Surgeons and certain unnamed politicians.
So who’s accountable for this sorry state of affairs? Apparently not the health minister. Mr Horne acknowledged that the HQC report findings on physician intimidation were “very disturbing” but concluded that the problem arose because the centralization of 9 health regions into Alberta Health Services (also known as the Superboard) was carried out too quickly.
Ahh, I get it, like the lamp that broke itself, it’s the process’s fault. Consequently it would be pointless to hold a public inquiry into physician intimidation to figure out what went wrong in order to prevent it from happening again. Instead we should adopt Ms Redford’s mantra and simply “move on”.
Mr Horne has supreme confidence in the ability of his ministry (Health & Wellness), the administrative arm of his ministry (Alberta Health Services), the College of Physicians and Surgeons, and the Alberta Medical Association (AMA) to develop more processes to train physicians how to advocate effectively and create a “just culture” to prevent bullying.
Others are less optimistic. Dr Swann put it best when he said Mr Horne’s plan was simply to ask the same health professionals who’d been intimidated to go back to work for the same people who’d intimidated them and rest easy because everyone’s learned their lesson and it won’t happen again.
To paraphrase my mother, the lamp didn’t break itself and the lamp won’t fix itself. The bullying problem won’t go away without a thoughtful investigation that identifies the intimidators and why they stooped to intimidation and holds them accountable so that they and others like them will never be tempted to bully a physician again.
The Alberta Medical Association (one of the parties in the relationship that “needs attention”) is not prepared to accept this milque-toast solution. While Mr Horne and his government are busy shuffling Alberta’s healthcare problems off the political stage, the AMA took pre-emptive action. It launched a new public advocacy program called “Just How Sick is Alberta’s Health Care System?” to demonstrate its commitment to a higher level of public advocacy “before, during and after” the provincial election.**
Wise move on the AMA’s part. The Health Minister can cling to the “lamp broke itself” excuse, but the AMA and the public will drag these examples of intimidation into the light. The bullying will stop when the bullies have nowhere to hide.
This is an extremely courageous move on the part of the AMA, particularly in this political environment. They need our support. Please click on the link and send your comments and concerns to firstname.lastname@example.org. Let’s work with the AMA to end bullying and get on with creating the best publicly funded, publicly delivered healthcare system possible.
*Calgary Herald Online, March 7, 2012
** AMA President’s Letter Mar 6, 2012