Welcome to the Noodle Bed: Alberta’s Healthcare Delivery System is Reorganizing…Again!

When former premier Stelmach said he was willing to let local hospitals make decisions like buying light bulbs for their own operating theatres I thought he was kidding.  Turns out I was wrong.

This week Stephen Lockwood, chairman of the Alberta Health Services board, unveiled a pilot project at Rocky General Hospital which will move some decision making authority to the local level.  Mr Lockwood described the pilot as “fine tuning and refining”*an organization that had recently moved from one province-wide zone to five regional health zones, after shrinking from 17, to nine, to one (the AHS).  (Think: accordian).

Dr Chris Eagle, CEO of Alberta Health Services, praised the decentralized decision making model:   “Decisions should not be passed up and down the AHS organization chart.  That is bureaucracy.  Decisions will be made as close as possible to where health care is delivered, many at the level of a self-managed operating unit.*        

Mr Lockwood provided an example of why this change is necessary:  “If you need a parking pass for a long term care patient, should the site be able to make the decision immediately?  I feel they should.  Right now there’s a bit of red tape between the request and the decision.”** 

He’s kidding right?  The AHS monolithic org structure has been in place since 2009 and they’ve just now figured out that it might be a good idea to let a local hospital issue a parking pass….??? 

The problem isn’t the centralized decision making model—private sector companies have successfully used centralized (and decentralized) decision making models for decades—the problem is that Health Minister Fred Horne does not trust healthcare professionals to make the right (read: political) decisions and as a result will not relinquish control over meaningful decision making to doctors, nurses and other healthcare professionals who would, in biz-speak, add value to the decision-making process.

Mr Horne proved as much this week when he announced his “new deal” to settle the contract dispute with Alberta’s doctors who’ve been without a contract since Mar 2011.  Mr Horne described the deal as “the government’s best offer” (translation: take it or leave it because it ain’t getting any better than this”).*** 

Minister Horne made a big deal of the $181 million pay raise he’d promised the doctors just before the election.  “That money is still there…so we’ve certainly held true to our word about the money being there”.  Interestingly, the doctors had not asked for a pay raise—they’d already settled for 0% raises for 2012 and 2013 and a cost of living increase for 2014.  Many viewed Mr Horne’s unexpected “gift” as an attempt to buy the doctors’ silence in the run-up to the 2012 election.

What Mr Horne didn’t say about the “new deal” was that his agreement to allow doctors to be part of the decision-making process was off the table.  With the election safely behind Ms Redford, Minister Horne quickly reneged on his promise to allow consensus-based decision-making, replacing it with “ministerial authority” for every meaningful decision.

And this is why doctors were guarded when Mr Lockwood and Dr Chris Eagle announced the decision-making pilot at Rocky General.  The doctors wanted more details but got none because “that would defeat the purpose of allowing leaders at every level of RGH to create a model from the ground up”.* 

That’s one way to look at it.  However given Minister Horne’s flat out refusal to allow doctors to participate in meaningful decision making, doctors involved in the Rocky General pilot project are being asked to throw darts at the dart board until they find the line between routine decisions that they’ll be allowed to make and meaningful decisions that are off-limits.

I certainly hope that the line moves a few inches away from decisions like ordering light bulbs and issuing parking passes—but I’m not holding my breath.

Let’s face it, the Ministry of Health is a centralized stovepipe command-and-control organization with Fred Horne at the top, Stephen Lockwood and Dr Eagle somewhere off to the side and layers and layers of bureaucracy below them.  It’s like a lasagna with too many noodle beds.  A gooey sticky mess.

Sadly, when politicians micromanage and second guess healthcare professionals trying to carry out their duties we’re all stuck in the noodle bed—a place stuffed with re-heated ideas and unpalatable results.  This lasagna org structure is well past its “best before” date.  Time to toss it out and start over.

*Oct 16, 2012 memo from Dr Eagle to AHS

**Calgary Herald, Oct 24, 2012, p B9

***Calgary Herald, Oct 25, p A5     

NOTE:   The lasagna analogy comes from David Baldacci’s book, Zero Day—a terrific airplane read.


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9 Responses to Welcome to the Noodle Bed: Alberta’s Healthcare Delivery System is Reorganizing…Again!

  1. Elaine Fleming says:

    I like the lasagne metaphor! There has been so much frustration for health care staff with all the attempts at re-structuring the system over the years. Not to mention the frustrations (or worse) for patients and their families. Whatever re-organization Alberta Health comes up with, they need to allow the health workers to do their jobs, and give them time to make the “thing” work.
    When our Whitemud Citizens group saw Dave Hancock at a conference almost three years ago, (and I was still a health worker) I told him that the health care system was like a giant anthill, with all the workers going about doing their jobs with purpose, looking after the needs of the public/patients And then! Out of the blue a big boot comes along every few years and kicks the whole thing over, sending workers helter- skelter grabbing the eggs and the larvae, running for shelter trying to save the colony.
    Back to the lasagne analogy, however, maybe the “chef” shouldn’t overdo the layering. And perhaps he should use a tried and true recipe, try some fresh, local ingredients and maybe he should just let the dish “set” for a bit. The results might be more palatable.

  2. Great metaphor Elaine. Did Hancock have a response? Something like Hey, remember the old expression “Together we stand, divided we fall”…a re-org causes people to worry about whether they’ll have jobs at the end of the day…this takes their focus off working together to pressure the government to improve the system for everyone. A cynical perspective but I can’t come up with any other rationale to explain this drive for constant change.

  3. Elaine Fleming says:

    As I recall, Hancock’s response was one of bemusement. But, he is an intelligent guy, has been around the block a few times, and was the health minister prior to the less- than- popular Ron Liepert. He knew exactly what I was referring to. The MLA’s/ministers can seem empathetic to the plight of patients and health workers, but in the end unfortunately, they will stick up for their colleagues and policies no matter how goofy they are. Sigh!

  4. Yes, that’s what makes all this so frustrating. The MLAs sound like their in our corner but they keep kicking over that ant hill and nothing changes. Your recent facebook post on the Whitemud Citizens for Public Health page shows just how little progress we’ve made. Sad.
    Here’s the link to Elaine’s WCPH page…well worth a read: https://www.facebook.com/groups/247338238324/ (You may need to cut and paste).

  5. Carlos Beca says:

    Susan, it is no surprise to me at all that everything is just exactly the same. The mindset is the same, the slave like atittude to ideology is the same, the people running the show are mediocre and so the results could not be any different.
    The slow death of the Health Care System is what they want in order to prepare the people for privatization. Some people of course say that the two tier health care system is not a problem in many countries and so why would it be here. Well here is my answer to that. If you live in a country that cares for its citizens and enforces the rules, then it works although not as well as people think. On the other hand if the people in charge are like our premier and friends, then the results are disastrous. I say this not because I read it, but because I have experienced it. The difference between the private and the public is horrendous and the fees at the private clinics are legalized robbery.

    • I agree Carlos. I lived in the US for 7 years and experience first hand the difference between a private and public healthcare system. The private system is dandy–IF you happen to work for a company that’s prepared to pay for quality care. In the 7 years I worked in the US the employee-contribution to healthcare benefits (in the form of deductibles and co-pays) skyrocketed. And heaven help an employee who lost his job because the company moved its operations overseas. Try getting reasonable coverage if your middle-aged and have a “pre-existing condition”. The public healthcare system can definitely be improved, but not by adulterating it with the US model. Thanks Carlos.

  6. Carlos Beca says:

    For those of you who read this blog and do not agree with the trade agreement between Canada and China that the Harper government is rushing through parliament with the speed of light, please do take the time to write an email to the Prime Minister and all the leaders of the Opposition.
    This display of anti-democratic behaviour is appaling and they have to know that.
    The document is to say the least pathetic and a 31 years commitment with a country that has no respect for human rights, spies on Canada and constantly tries to hack our systems is to say the least naive and all for the sake of money.
    Thank you

  7. Carlos Beca says:

    Thank you Susan. At first I was not sure this is the appropriate place to mention it, but when fighting dictators and with very limited resources, any place is appropriate.
    The media, as it is always the case now is way more interested in the Sandy disaster. This is one of the most important documents this government has worked on and there is no vote in the House, no discussion, no NOTHING. It is a disgrace and we allow this to go on. Not even protests work anymore because the SWAT teams will be out there immediately to make sure we get peper sprayed as soon as possible.
    I have heard this before – No discussion, no voting, no protests, no strikes………etc. It used to be called dictatorship. Now it only applies to countries in the Middle East, Africa, South America and Asia. In Europe and North America is now called Democracy.
    I finally now understand why Harper is so at ease with the Chinese leaders – they speak the same political language, except here Harper has to face the obstacles of a pseudo democracy.

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