Is it a “bed” or a “space”?

Posted on January 22, 2011 by susanonthesoapbox

The 5 Year Action Plan – Part 2

OK, pop quiz.  What’s the difference between “long term care” and “supportive living” (also known as “assisted living”)?  You don’t know do you.  Neither did I until I read a letter (Jan 15/11) to the Calgary Herald written by Mr Harrigan, Director of Labour Relations for the United Nurses of Alberta.  Mr Harrigan points out that contrary to what the Government would have you believe these two terms are not interchangeable.  “Long term care” refers to care in a nursing home or auxiliary hospital.  It requires on-site nursing care by RNs and LPNs (licensed practical nurses).  “Supportive living” also requires on-site care, however it is generally provided by trained aides, not regulated RNs or LPNs.  The critical distinction here is that patients living in long term care facilities require significant daily nursing care because they are not as healthy as patients in supportive living facilities.  Pretty straight forward, wouldn’t you say.

Remember this distinction when you read the PC’s 5 Year Action Plan.  For some reason the Health Minister insists on lumping the two terms “long term care” and “supportive living” under the rubric “continuing care”.  Take a look at the glowing press release describing the 5 Year Action Plan which promises to deliver “more spaces for continuing care (68% increase in the number of people moved out of a hospital bed and into a community care setting)”. This is a reference to an additional 2300 continuing care “spaces” (not beds), which it turns out, are the backbone of two of the 5 strategies in the Action Plan:  the strategy to reduce ER wait times and the strategy to provide seniors with more choice in continuing care.   I’ll admit that the addition of 2300 continuing care “spaces” likely will provide seniors with more choice in continuing care, however it will do absolutely nothing to reduce ER wait times.  Why?  Because patients who require long term care are simply not healthy enough to leave the hospital and move into “community care spaces” which in this context appears to be “assisted living” or “supportive living”.  Pushing frail patients out of acute care beds in order to make room for ER patients waiting in the aisles on the first floor will simply result in these very same patients returning to those very same acute care beds, after putting in the required wait time in ER.  This is not a wait time reduction strategy, it’s a revolving door strategy.

This leads me to a comment (quite a few actually) made by the Privacy Commissioner, Frank Work.  Commissioner Work took the Stelmach government to task for its lack of transparency.  He called it “…the difference between a culture of secrecy and a culture of openness”.  An eloquent and perhaps a career limiting statement.  The Commissioner’s comments were directed primarily at the access to information, however he shared his thoughts on the process of government in general and said:  “People who want our votes…espouse accountability and transparency.  The first of Premier Stelmach’s five priorities when he ran for election in 2006 was to govern with integrity and transparency”.

 

Simply put, those who promise transparency should deliver on it.  Touting the addition of 2300 “continuing care”  spaces (whatever that means) as a mechanism to reduce ER wait times is dishonest and misleading.  Surely the people of Alberta deserve better.

Posted in Alberta Health Care | Tagged , | 4 Comments

Where are the Doctors?

Posted on January 15, 2011 by susanonthesoapbox

The 5 Year Action Plan – Part 1

On Nov 30 the Alberta government released its 5 Year Heath Action Plan.  The Health Minister said it’s “… what Albertans told us they expect…” This appears to be a reference the Health Minister’s Advisory Committee;  the same Committee that Dr Noel Grisdale, the outgoing Alberta Medical Association president, said excluded the AMA from the public participation process and re-designed the healthcare system in 75 days.  A task that Dr Grisdale characterized as “mission impossible”.  Notwithstanding the AMA vote of no confidence, the PCs pressed on and eventually came up with 3 radical changes to the healthcare system.  They rolled the 9 regional health boards into the AHS, they made a 5 year funding commitment and they pushed through the new Health Act.

The next chip to fall was the 5 Year Health Action Plan.  The press release states it will reduce wait times for hip surgery and in ERs, provide more continuing care spaces, provide quicker access to radiation oncologists and emphasize wellness.  What the press release fails to make clear is that these promises won’t become reality until March 2015—4 years from now.  More on the issue of clarity in Part 2.

First a quick overview of the 5 Year Plan itself.  It contains 5 strategies.  These are (1) improving access and reducing wait times, (2) providing more continuing care for seniors, (3) improving primary health care—everything from screening to access to health practitioners, (4) staying healthy and (5) building one health system (a catch-all for everything from revamping the Health Act to improving patient safety).  The strategies are supported by short-term and mid to long-term (mostly long-term) action plans.  But as we all know, the devil is in the details.

Let’s focus on one example, reducing wait times and improving access to GPs and specialists.  The Plan promises that in 2015 a patient will have access to cancer treatment within 60 days.  This is premised on having access to a GP within 2 days, access to a radiation oncologist within 1 month and access to radiation therapy within 1 month after that.  The Plan’s goal is to deliver access to radiation therapy by Mar 2012, however it is unable to deliver timely access to a radiation oncologist, presumably the person who would schedule a patient for radiation therapy, until Mar 2013—14.  Furthermore, timely access to a GP, which is the first hurdle a patient needs to overcome in order to get the referral to the specialist in the first place, is not addressed at all.

The Plan is curiously silent about doctors, period.  It fails to acknowledge the probability that the number of GPs and specialists will have to increase in order to meet the wait time/access targets.  The only reference to accessing medical personnel appears in the discussion of Strategy #3—improving primary health care.  This is the grab bag of health promotion, screening, rehab, etc.  The Plan notes that a variety of professionals are required and that primary care teams are effective.  Can’t argue with that, but in describing how Albertans will better connect to family doctors and other providers the Plan simply states it will “Expand Albertans’ access to primary health-care teams, giving 100,000 more Albertans access to primary health care”. This is a tautology—I am going to expand access to primary healthcare by giving 100,000 more Albertans access to healthcare—and leaves open the critical question of how?

All of which raises a fundamental concern with the 5 Year Health Action Plan.  Where are the doctors?  And how is Mr Stelmach going to deliver “the best-performing, publicly funded health system in Canada” by building more facilities but not adding more GPs and specialists?  Is this an oversight or is Mr Stelmach simply creating a demand for the private doctors who will be called in to deal with the backlog when patients are denied access to treatment because they can’t get past the first portal—seeing a GP within 2 days—let alone the second portal—getting an appointment with the specialist within 30 days?  Could it be that the people who worried about the privitization of Alberta’s healthcare system, first proposed by Ralph Klein and recently confirmed by Dr Raj Sherman, were right?  I guess that’s what happens when the AMA ticks off the Health Minister (then Mr Liepert) by telling him that he’s embarking on mission impossible.

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Shakespeare Got It Right

Posted on January 8, 2011 by susanonthesoapbox

Dr Duckett may be gone but he won’t soon be forgotten.  In his farewell speech to senior AHS staffers he set the record straight with a number of provocative comments.  The most significant of which was this:  “Alberta spends more per capita (adjusted for age and sex) than other Canadian provinces and gets less”. Is this really true?  If so, does that mean that there is no direct relationship between healthcare spending and the quality of healthcare service?

Bingo:  It’s not how much you spend, but how you spend it.

CHCI data shows that in 2010 Alberta spent $4295 per capita on healthcare but ranked #7 in healthcare performance.  Ontario and BC, which ranked #1 and #2, spent $3547 and $3543.  Let’s just call it $3545 even.  That’s $750 less per person than Alberta.  But Ontario and BC succeeded in being the top ranked provinces in healthcare performance—for three straight years.

One reason for this perverse outcome is that greater spending doesn’t guarantee greater value.  In fact if an organization refuses to measure its outcomes, the value equation is completely meaningless.  Dr John Cowell, CEO of the Health Quality Council of Alberta, believes that Alberta’s healthcare system does not adequately measure the output (good health) or the cost of that output (cost per clinical outcome).  Consequently it cannot systematically assess value or sustainability.  In other words Alberta taxpayers are throwing a lot of money at this problem–$15 billion to be exact—but the government and AHS have yet to figure out how to get the best value for those tax dollars and the people of Alberta continue to suffer.

The non-relationship between healthcare spending and healthcare performance also plays out on the global stage.  The Euro-Canada Health Consumer Index (ECHCI) 2010 ranks Canada’s healthcare performance at 25th out of the 34 countries surveyed.  And yet with a per capita spending rate of $3662, Canada is one of the highest per capita spenders in the group.  Only 3 countries outspent Canada.  They are Switzerland (ranked 5th) Luxembourg (ranked 8th) and Norway (ranked 11th), all performed significantly better than Canada at #25.  Twenty-one countries spent less than Canada but still outperformed it in healthcare delivery.

Given that Canada’s and Alberta’s healthcare problems do not stem from a lack of money, it is unlikely that throwing more money into the healthcare budget will improve the situation.  So what will help?  Before we busy ourselves with sharing best practices and learning from others, let’s be frank about what is getting in the way of delivering good performance.

Cue Dr Duckett.  The ex-CEO’s speech is laced with comments alluding to the problems created by continual political meddling and missteps.  He notes that “The media along with politicians only see the short term and often fail to connect the dots” and that “ The AHS operates in a politically charged environment.” He describes the government’s failure to provide adequate funding for long term and non-acute care facilities which exacerbated the ER crisis and notes, rather pointedly, that the government failed to keep its commitment to fund universities and colleges to graduate 2000 nurses a year and that further funds are needed to train 1000 health care aides a year in order to truly transform the workplace.

 

This brings me to the ECHCI discussion about the Netherlands which ranked #1 in performance in 2010 and has ranked in the top three since 2005.  In addition to the organization of its healthcare insurance system (a topic for a future discussion) the authors note that the Netherlands healthcare system has removed politicians and bureaucrats from key decision making processes, leaving the operative healthcare decisions to the medical professionals.  They state that politicians and bureaucrats seem to be further removed from these decisions in theNetherlands than any other country in the indexand argue that this is “an important reason for the Netherland’s outstanding performance.”

So taking a cue from Shakespeare (but without the fatal consequences) might I suggest that the first thing we do is get rid of the politicians and let the medical professionals make the operative healthcare decisions.  Surely they wouldn’t do any worse.

Posted in Alberta Health Care, Politics and Government | Tagged | 4 Comments

A Second Chance

Posted on January 2, 2011 by susanonthesoapbox

Soon after Dr Duckett was hired he received a phone call from Mr Hughes, the AHS Board chair, and Mr Sieben, the AHS Audit Committee chair.  They told him that they’d “…just become aware of the need to do a significant financial correction, dimensions still unclear but certainly north of $1B.” No doubt this was unsettling news for Dr Duckett, however, it turned out to be devastating news for Albertans.  Why?  Because the AHS and the government missed an ideal opportunity to rethink their approach to healthcare.   Instead of leaping to the simplistic solution—cut costs—they could have asked themselves:  What does a high performing healthcare system look like?  What should the government and the AHS do to make Alberta’s healthcare system, in the words of Premier Stelmach, one of the best in Canada?

These are not easy questions, however, we’re not starting from scratch.  There are plenty of examples of high performing healthcare systems available, both internationally and here in Canada.  A good place for the government and the AHS to start would have been the Canada Health Consumer Index (CHCI) 2008 report.  The report assessed the quality of healthcare performance of each of the 10 provinces using straightforward benchmarking and evaluation methodologies.  The result is a comparison of performance across five categories:  (1) patient rights/information, (2) primary care (access to a family doctor, homecare and elderly care), (3) wait times for specialists, cancer radiation therapy and diagnostics, (4) patient outcomes (infant mortality rates, cancer 5 year survival rates, heart attack mortality rates) and (5) range of services (access to new drugs, vaccinations, cataract operations).

The Dec 2008 report placed Ontario, BC and Nova Scotia in the top three spots and landed Alberta squarely in the middle of the pack.  Although Alberta ranked slightly above average in most of the categories its final score suffered as a result of wait times.  The CHCI pointed out that Alberta spent more per capita on healthcare than any other province but its middling score was “…indicative of an inefficient system that wastes money.”.

So the government had a choice.  It could default to its usual practice and slash the healthcare budget or it could pause to consider whether there was a better solution.  Unfortunately the government went with Plan A—slash the budget, without an adequate analysis of the outcome.  The results of this ill conceived decision have been documented in the 2009 and 2010 CHCI reports.

The Dec 2009 report ranked Alberta in 4th position, behind Ontario, BC and New Brunswick.  Once again Alberta showed strong performance in patient outcomes, but this was offset by wait times which were the longest in the country.  Of particular concern was access to cancer radiation therapy.

By Dec 2010, Alberta had fallen to 7th position, tied with Nova Scotia, and just ahead of PEI and Newfoundland.  The top performers were Ontario, BC and New Brunswick.  The only factor preventing Alberta from falling to the bottom of the list was, once again, its strong performance on patient outcomes.  Thereby confirming the anecdotal evidence that once you make it to the front of the line (assuming you don’t die first) you will get excellent care.

So where does that leave us today?  Well, Dr Duckett is gone and the search for his successor is underway.  The government and the AHS have been bruised by the public backlash over their pathetic performance over the last 18 months and are being given a second chance to fix the problem.  The 2008, 2009 and 2010 CHCI reports state that Ontario and BC have had the best performing healthcare systems in all of Canada for three straight years.  If the Alberta government is sincere about finding a solution to the healthcare crisis it would be well advised to examine the best practices that have been developed next door and across the street.  Let’s hope they do so. 

Posted in Alberta Health Care | 2 Comments

Real Evidence Bites Back

Posted on December 29, 2010 by susanonthesoapbox

Lawyers are taught never to ask a question on cross-examination if they don’t already know the answer.  They are also taught never to rely on a case to support an argument if it also includes statements that can turn around and bite you.  It is clear that Ken Hughes, Chairman of the Board of Alberta Health Services, is not a lawyer.  Mr Hughes wrote a letter to the editor (Dec 26,2010 Calgary Herald) taking issue with a comment made by David Taras, a political scientist.  Mr Taras said that the health care system under Stelmach was collapsing.  Mr Hughes flew into high dudgeon, asking “Where is the evidence to substantiate such an offhand, sweeping statement? Having dismissed Mr Taras one would expect Mr Hughes to dazzle the reader with persuasive evidence that there is no health care crisis.  So what did Mr Hughes say?

First he starts with the obvious:  Alberta was hurt by the global recession, the population is aging, the population is growing, new treatments and technologies cost money.  This is not evidence in support of a good (or even a mediocre) health care system, but a list of excuses for a poor one.  Mr Hughes also tries to twist the argument away from a lack of confidence in the health care system to a lack of confidence in the health care providers.  He says “We are proud of the work of all of our health-care providers and confident in their skills and commitment. Albertans can and should be confident as well.” Mr Hughes may be surprised to learn that Albertans haven’t lost confidence in their health care providers;  they’ve lost confidence in the health care administrators, namely the AHS, and their political masters.

The heart of Mr Hughes’ argument rests on the Health Quality Council of Alberta (HQCA) report: 2010 Measuring and Monitoring for Success, which he says “…demonstrated that while patients have concerns, they have not lost confidence in the system nor think there is any reason to think, again based on the evidence, that they believe the system is collapsing.” I just finished reading the report and wonder:  Did Mr Hughes actually read it?

The report is well written and well researched.  Its theme is the power of measurement and its use in improving the quality and sustainability of health care.  The report addresses the role of innovative information management.  The only comments that have the slightest bearing on Mr Hughes’ argument arise in the context of accessibility:  48% of Albertans rated access to health care services as easy and 54% who visited the emergency department rated access as easy.  The response rate was 38%.

The report did not ask Albertans to comment on their confidence in the system or whether they think it’s collapsing—hardly surprising given that thesurvey was conducted from Feb 24 to May 11, 2010.This was 5 months before Dr Parkes wrote to the Premier and the Health Minister expressing his deep concern about the fragility of the health care system and warning of a “potential catastrophic collapse”.  The Parkes letter ignited a public debate that has raged ever since.  For Mr Hughes to assert in Dec 2010 that Albertans have confidence in their health care system based on the results of a survey conducted in Feb/May 2010 is, at best, disingenuous.

Mr Hughes suggests that the “crisis” is political rhetoric and not a honest assessment of the system today.  This is the “turn around and bite you” part.  The HQCA report concludes that:  “Alberta’s $15-billion per year health care system does not measure its primary output (restoration or maintenance of functional health) or the cost of that output (cost per clinical outcome) in order to systematically assess value and potential sustainability.  As such, it is difficult to understand system-level cost drivers in each health care sector—drivers that can help explain what increases costs after general inflation, population growth, and aging have been taken into account. In other words, no one knows what’s going on.

One might conclude that it’s not just the people of Alberta who lack confidence in the state of health care in the province, it’s also the HQCA.  One might also conclude that the real reason why Mr Hughes did not provide any compelling evidence in support of his argument is that there isn’t any.

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8 Magical Minutes

Posted on December 24, 2010 by susanonthesoapbox

Do you remember Carlos Castaneda, the American anthropologist who started his career writing factual accounts on Mesoamerican shamanism and ended it writing fictional stories infused with magical realism?  Stelmach’s year-ender interviews with the media indicate that he’s going down the same mystical path as poor dear Carlos.  Stelmach is holding fast to his belief that there is no health care crisis and is confident that he and the PC’s will weather this storm.  In his view no other party can compete with the PC’s proven results when it comes to overseeing health care (or the  economy for that matter).  Stelmach says the PC’s “…have a very good track record.  This is a party that has had the trust and confidence of Albertans for 40 years…”;  furthermore only the PC’s can be trusted to manage Alberta’s health care system.  Brave words, but not a view that is shared by others.    

David Taras, a political analyst, university professor and author, describes the health care system as “collapsing”.  This is more than an opinion, it’s a fact.  Consider a very simple metric:  the number of beds per population.  Canada has 3 beds per 1000 Canadians.  This ranks Canada 26th out of 30 countries in the OECD, the Organization for Economic Cooperation & Development – a group of countries which includes Australia, the US, the UK, most of Europe and South America.  In 1995 Alberta had 1 bed for 400 people and today, as a result of the Tories aggressive cost reduction campaign, Alberta has 1 bed per 515 people—about 50% fewer beds than the rest of Canada.  Does that sound like a “very good track record” to you?

But not to worry—Stelmach and Zwozdesky have a plan to restore public confidence.  They’ve created an 8 minute video reassuring Albertans that there is no crisis and explaining why Dr Sherman was booted out of caucus.  The video was supposed to be posted on the PC Party website last week.  No need to go looking for it, it’s been delayed due to “technical difficulties”.  No doubt the same “technical difficulties” that sidelined the emergency surge protocol for 18 months and the 5 year health care plan for 5 months.

I don’t know about you, but 8 magical minutes created by the PC spindoctors won’t do a thing to restore my confidence.  Only a clear statement of accountability backed up by metrics—where we are today and where we expect to be in the future—together with a concrete action plan will do that.  It’s either that or a handful of Castaneda’s magic mushrooms.

Posted in Alberta Health Care | Tagged | 2 Comments

Lethbridge–Check It Out

Posted on December 18, 2010 by susanonthesoapbox

The Health Minister has been saying for months that he is open to suggestions on how to improve Alberta’s health care system.  However the credibility of his statement has been seriously undermined by the Premier’s steadfast refusal to admit there is a health care crisis and by the Health Minister’s disdainful dismissal of every recommendation offered by the opposition parties and  medical experts.     

It also appears that the Minister is not yet ready to unveil the recommendations made by his own team of external consultants.  McKinsey and Company, a global management consulting firm, landed a $1 million contract to produce a plan to improve the Alberta health care system, however this plan has yet to see the light of day. 

Perhaps the suggestions made by the opposition parties are too costly and perhaps the improvements suggested by McKinsey are too radical.  Maybe it would be helpful to look for answers a little closer to home.  How about Lethbridge?  Greg Weadick is the Conservative MLA for Lethbridge-West and the parliamentary assistant for Advanced Education and Technology.  On Nov 24, 2010 he spoke in support of the new health bill and made a remarkable comment about the state of health care in Lethbridge/Medicine Hat.  This region serves two urban centres (Lethbridge and Medicine Hat), a widely dispersed rural population of ranchers and farmers and, in Mr Weadick’s words “a great swath” of southeastern British Columbia.   Sounds like a scaled down version of the Province of Alberta, doesn’t it? 

Lethbridge and Medicine Hat continue to be among the top few hospitals across the country that regularly meet the Canadian Associate of Emergency Professionals (CAEP) wait time targets.  These are the same targets that Dr Sherman tried to enshrine in the new Alberta Health Act.  In the Lethbridge/Medicine Hat area the average wait time is about 2.5 hours.  The other Alberta hospitals are struggling to meet the target wait times of 4 hours for treatment/discharge or 8 hours for treatment/admission. 

How did Lethbridge/Medicine Hat accomplish this?  Mr Weadick says that “…men and women on the front line …worked together and created protocols where wait times …were significantly reduced.”  One way this was achieved was by increasing the number of continuing care beds by 50%, up from 1000 to 1,500.  If we’ve learned anything from this crisis it is this:  adding continuing care beds frees up acute care beds which in turn frees up ER beds which reduces wait times.  Another creative solution was to work with the municipalities and the health care providers to create a joint fire-ambulance service.  This resulted in more efficient, less expensive service. 

This achievement is all the more astounding when one considers that it was achieved during that period of increased confusion, decreased morale and reduced autonomy that resulted from the merger of the nine decentralized health regions into the monolithic AHS.

So Minister Zwozdesky, I understand your reasons for dismissing the suggestions from the opposition parties—it’s just not politically expedient—but won’t you at least follow up on the comments made by your own parliamentary assistant (for education and technology no less) and  check out Lethbridge?

Posted in Alberta Health Care, Politics and Government | 2 Comments

A Pretty Good Job???

Posted on December 13, 2010 by susanonthesoapbox

I don’t know about you but I’m getting a little tired of being told that health care costs are out of control and that somehow it’s my fault because I run to ER at the first sign of the sniffles.  The provincial budget for health care is $15 billion.  That equates to 42% of the provincial budget—15 years ago the entire provincial budget was $15 billion and health care accounted for only 26% of it.  So what happened?   Here’s a punch list of poor decisions and bizarre missteps described by a number of MLAs during the debates on the new Alberta Health Act.

A good place to start is the vaporization of hospitals and health care professionals.

  • 3 Calgary hospitals (which equates to 1,500 beds and 10,000 support staff) disappeared when the General was blown up, the Holy Cross was sold—for $5 million right after the completion of $32 million in upgrades—and the Grace was converted to the HRC which was also closed down when the government terminated its contract.
  • By 2010 the number of acute care beds had dropped to 7,800, down from 13,300 in 1989.  The health minister has promised to add back 360 beds, but can’t confirm whether they will come with trained staff.
  • In 2008 the Premier promised to hire more nurses but in 2009 the AHS laid off 448 nurses at a cost of $24 million in severance, then in 2010 it announced a plan to hire 500 new nurses—net result, we’re still short staffed.
  • In 2010 Alberta medical schools cut 31 spaces due to a lack of government funding; institutions responsible for upgrading foreign accredited doctors cut the number of seats from 60 to 40.
  • The proportion of alternate level of care (ALC) beds in acute care hospitals rose from 3.6% in 2002 to 5.5% in 2008.  That number is still climbing and making even fewer acute care beds available to ER patients.
  • Alberta hospital occupancy rates now run at 100 to 110%.  The optimal occupancy rate is 85%.  Anything higher creates inefficiency and no surge capacity.
  • Preventive care has been cut by 50%.

And if this isn’t bad enough, the government tripped over itself time and time again when it rolled the 9 health regions into the Superboard.

  • Pensions for 119 health service managers were enhanced at a cost of $45 Million.  One happy recipient of this largess was Jack Davis, the ex-CEO of the Calgary Health Region.  He walked away with a lifetime pension of $270,000/year.
  • Severance for the ex-CEOs of the 9 health regions resulted in payouts in excess of $6 Million.
  • Bureaucracy  and inefficiency increased when the AHS created seven organizational layers where once there had been four.  An example:  no vacancies could be filled without Dr. Duckett’s approval notwithstanding the fact that the AHS has 87 people functioning at the VP, Senior VP, or Executive VP levels.
  • Dr. Duckett was fired after 18 months and left with a severance package of approximately $700,000.
  • Minister Zwozdesky interfered with the autonomy of the AHS Board to such a degree that four board members resigned.
  • The Auditor General announced that the AHS had misallocated nearly $1 billion and was building facilities with no funding agreements in place.

So who’s responsible for the skyrocketing health care budget?  Clearly not sniffly patients.  Unfortunately Minister Zwozdesky doesn’t appear to realize this.  On Nov 30 in the middle of the debate on the new Alberta Health Act, the Minister said: “…it’s very clear that the [AHS] is accountable to the minister for the delivery and operation of the public health system.  And that’s what they’re trying to do:  operate the public health system.  They get their money—guess from whom?—from the taxpayers.  Guess who has to sign off on that budget?  I do.   I’m accountable for it, and so are they for delivering and operating within those parameters, and they’re doing a pretty good job of it.”  Well, Minister Zwozdesky, in any other context, the man accountable for the budget would be trying to figure out what went wrong rather than patting himself on the back for doing a “pretty good job”, especially when the person providing the funding is the taxpayer.

Posted in Alberta Health Care, Politics and Government | Tagged | Leave a comment

The Lens of Politics – Part 2

Posted on December 7, 2010 by susanonthesoapbox

So in reviewing the events of the last two years one can see that the government reacted swiftly and decisively to neutralize the medical community and the regional health boards who were trying to fix the ailing health care system.  It consolidated the health boards (one board is much easier to control than nine).  It instituted a Code of Conduct which effectively gagged the whistleblowers who called for improvements in patient care.  It ousted the troublemakers:  Dr Sherman tried to hold Stelmach and Zwozdesky accountable and was tossed out of caucus.  Dr Duckett slipped up and became a convenient scapegoat to divert public attention away from the real problem.  Zwozdesky tightened his grip on the AHS Board and four directors resigned.  In the words of Dr Andreas Laupacis, “The interference of Minister Zwozdesky in the AHS Board’s decision about how to deal with AHS CEO Stephen Duckett’s recent episode…clearly violated the board’s independence.”   

In addition to cleaning house and doing away with the dissenters, the government, through the AHS issued a flurry of press releases to demonstrate that health care was back on the radar screen.  In the last month we’ve seen the announcement of the ER surge capacity protocol (a suggestion contained in the EDIT report which had lain dormant since mid 2009), countless wait time targets, performance targets for mental health, patient satisfaction surveys, increased access to continuing care, and of course the long awaited 5 year plan (which had been ready to go since June 2010 but was stalled for reasons known only to the health minister).

If you view these events through the lens of politics you’ll see two things.  One:  a colossal misstep on the part of the government in 2008 when it wrongly assumed that the top priority for Albertans was the reduction of the $8 billion deficit regardless of the deleterious impact it would have on the delivery of quality health care and two: damage control on all fronts to obscure the cause of the health care crisis which started with the ill-conceived decisions of the Klein government and was exacerbated by the Stelmach regime.  Will the damage control work?  You tell me.  In the middle of the November, Stelmach’s approval rating was 21%.  Sounds low, but consider this.  The year before he only scored 14%.   That is politics, and the only benchmark that Stelmach and Zwozdesky truly understand.

Posted in Alberta Health Care, Politics and Government | Tagged , , | 2 Comments

The Lens of Politics – Part 1

Posted on December 5, 2010 by susanonthesoapbox

How did the Alberta health care system melt down so dramatically in such a short space of time?*  In 2008 Dr Parks and other ER doctors provided the government with hard evidence that there was a serious problem by documenting 322 cases of substandard ER care in just one hospital.  Dr. Sherman, a practicing ER doctor and MLA worked diligently to get the government to acknowledge the problem and address it.  Doctors inside and outside of the Legislature have been sounding the alarm continuously for over 2 years.  In Dr Parks’ view “…they didn’t get it”.  Dr Sherman’s says “[Health Minister Liepert] just didn’t get it or he didn’t want to hear”.  So what’s going on?  Do the Tories truly not get it or have they sacrificed health care in the interests of political expediency?  The answer becomes clear when you look at the events that have unfolded since the last election.

In Feb 2008, Stelmach called an election and the ER doctors seized the opportunity to tell the Health Minister, Dave Hancock that they would go public with their concerns if the government refused to address them.  Stelmach realized that the timing of such a revelation could negatively impact the election and directed his staff to meet with Dr Parks and the AMA Emergency Medicine Section.  Stelmach ultimately promised to create 600 new long term beds to ease overcrowding and to create an expert committee—the Emergency Department Integration Team (EDIT)—to review the situation and develop a plan to ensure that the national benchmarks for timely emergency care were met.  Most importantly, Stelmach put these promises in writing.  This pacified the ER doctors who agreed to remain silent.

In March 2008, the Tories won the election with a 72 seat majority.  Dr Sherman was delighted to learn that he’d been appointed the parliamentary assistant for health, but quickly realized that his new boss, Ron Liepert, was focused on controlling escalating health care costs and not remotely interested in reducing ER wait times.  Sometime during this period Jack Davies, the CEO of the Calgary Health Region, popped up and sounded the alarm (again) by asking for $115 million to eliminate the deficit and add beds to address ER overcrowding.

In July 2008, the government responded by firing the 9 health board CEOs and rolling their organizations up into the AHS or Superboard.  The Board brought in a Code of Conduct which was described by Dr Sherman as “draconian” and was interpreted by the medical profession as sending the following message:  “Anybody who says anything, look out…We’re going to hammer you” (Hansard Nov 24, 2010, p 1552).   This reaction was not pure paranoia.  The government may have ignored Dr Parks’ letter outlining the fate of the 322 patients in ER, but the hospital administrators subjected him to an accusation of delivering poor care to a patient.  Dr Sherman and others who voiced their concerns suffered the same fate.  Even before the recent allegations about his mental health, Dr Sherman had been embroiled in a 10 month struggle with the administration to clear his name and regain his hospital privileges following unfounded claims of poor care (Hansard, Nov 24, 2010, p 1551).

In Jan 2009 AHS announced that it had hired Dr. Duckett, a health economist, to lead the effort to improve health care delivery in Alberta.  Dr Duckett’s priority was to reduce the deficit and he was successful.  However the quality of health care continued to deteriorate and by late 2009 the Health Quality Council of Alberta reported that ER wait times were now 30% longer than they had been in 2007.

In Sept 2010 at the annual meeting of the Emergency section of the AMA, the ER doctors’ frustration boiled over and once again they wanted to go public but were persuaded by Dr Sherman to Zwozdesky who had replaced Liepert, a chance to make improvements.  In October 2010, Dr Parks wrote to Zwozdesky, Stelmach and the AHS stressing the need for immediate action.  Zwozdesky and the Premier ignored the letter but it was leaked to the media and the situation exploded….

*See also the special report by Matt McClure (Dec 5, 2010 Herald) 

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