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.