I am heading into a meeting this afternoon on Foresight this. Foresight is not about making prediction like a futurist but it is about extrapolating possibilities based on evidence, experience, insight and a bit of intuition.
That said here is my non-prediction anyway. I believe the Alberta Health Services Super Board will be gonzo sometime this summer. ..and it should be. The government has approved a five year spending envelope for healthcare in the last budget and covered off the deficits of the Superboard at the same time.
With assured healthcare funding for five years, I assume they are working a five year business plan for health care delivery in Alberta as well. With Registered Nurses in contract negotiations now and the Physicians into negotiations next year, my guess is the government will take back the duty of delivering health care in Alberta. Then who needs a Superboard?
The Klein era governance model was ostensibly built on regional advisory boards of local citizens who were presumed to be best able to know, assess and advise Ministers and government on local issues. In reality that policy proved to be more fiction than fact, especially in the execution and application. I know this firsthand from some of the work I do.
There is a full report done by the Province of Alberta on governance and conflict of interest around provincial government agencies, boards and commissions. The process was lead by Allan Tupper (formerly of the U of A and now at UBC) many years ago. The implementation of the report’s recommendations is now in the care of a senior provincial bureaucrat in Executive Council office. So far as I can see not much has been done about the recommendations. My guess this is mostly due to political inertia and a lack of political will.
The regional board system was implemented in health, childrens’ services, persons with developmental disabilities and perhaps other departments too. It has all turned out to be just another level of expensive governance without authority, expertise or an informed knowledge base to be very effective. They ended up being buffers to protect Ministers from having to deal with the rabble commonly known as citizens. Bottom line we have good people trying to do s job in a bad governance system and no political or administrative intent to change the dynamic.
These board members do not effectively connect with the local population or deal openly with local issues. My evidence and experiences suggest these regional advisory boards did not effectively connect with the government or the Ministers either. I had a conversation one such Minister who appointed well-meaning citizens these regional advisory boards. I asked if any of the appointed board members had ever given direct advice to that Minister. The answer was no. By the look on the Minister’s face in response to the question, I know a light bulb had just been turned. Perhaps that Minister had just realized why there were so many problems in the field that the Minister was chronically unaware.
It is in this context why I think the AHS Superboard will be extinct in a few months. The healthcare system started on this regionalization kick with 17 of them. That soon became 9 and one day, overnight and out of the blue, those were collapsed into one Superboard. The cynic in me says the Minister of the day wanted to fix an obvious regional leadership problem they had in the Calgary regional health board. The government did not want to look like they were picking on Calgary for political reasons, so they decided to dissolve all the regional health authorities into one. No advanced warning, no consultation, no review of the implications or consequences…and no thoughtful plan of implementation. It was just raw politics that were at work in that decision.
The former Minister of Health has since been shuffled and a new much more capable Minister is in place. A new Deputy Minister is in charge and he has the ear and confidence of the Premier. The government is back making the serious policy and implementation decisions about health care. The new leadership in the Department and Ministry of Health and Wellness has been reversing the mistakes of the former Minister and has taken almost all of the power away from the Superboard.
The Superboard and its administration were still (are still?) in the competitive slash and burn damn the torpedoes mindset of the former Minister. They failed refused or neglected to see there was a new Sheriff in town. As a result many the programs and initiatives the Superboard was implementing were stopped, stifled or reversed by the new Minister. The confusion as to roles, responsibilities and relationships between the Superboard, the Ministry and the department was enormous but it is being resolved – effectively, appropriately and dramatically from my point of view.
The political reality is the Minister and the Premier wears the good, bad and ugly politics of healthcare policy. Not the faceless members of the Superboard. The new Minister and Deputy Minister know this and, to their credit, they have taken back the control of the healthcare system into government. They are meeting people, professions and stakeholders to get a serious and in depth sense of what is going on in the field.
They are making positive changes, adding money and allowing for longer planning time frames. And they are burying the idea that private sector marketplace models based of competition will make the public healthcare system stronger and more accountable. The fact that the province has to spend $2.8 million of taxpayer dollars just to bailout a Calgary based private surgical centre from bankruptcy shows the folly of the radical right wing healthcare policy of past and possible future political regimes in the province…if the Wildrose replaces the Stelmach conservatives next election.
So while the governmet is on the job of discarding the AHS Superboard, I strongly suggest they do the same thing and dump all the regional buffer boards including in Childrens’ Services and Persons with Developmental Disabilities (PDD). They are doing more harm than good when it comes to open, transparent and accountable governance. They are not effectively governing or connecting community to government or service providers. They are political buffers for politicians – pure and simple.
Good governance is always good politics. The opposite is hardly ever true.
I agree with your point regarding the role of appointed Boards. What would replace them? Would this government even consider the option of resurrecting ELECTED health boards. This would go a long way in restoring the local democracy in the Province. Unfortunately this government has demonstrated over and over again how dismissive they are of junior levels of government be it Health Boards, School Boards or Municipalities. At least that is the case until they need something to blame for their own maladministration or wrong headed decision making.
ReplyDeleteHealth care is complex, expensive and critical to citizens. Addressing health care issues and developing longer term strategies are important roles for government and can't be left to a so-called Super Board who seemed more intent on pushing ideology and letting everyone know they were the "boss".
ReplyDeleteYes. lets hope we see the last of the Super Board and Stephen Duckett
I agree with getting rid of all boards which are predominantly stacked with polical appointees. Not sure the answer would be to go back to an elected board however. This often leaves the voter looking at a list of names on a ballot sheet with not enough information on hand about the persons abilities to make a decision on whether they would be competent enough to do a good job of representing the citizenship. Plus often these candidates are nothing more than want-to-be politicians or politicians in training. Why not move to a more direct approach? Where each health facility has to conduct regular town hall meetings in order to solicit feedback on how their operations are meeting the needs of the citizenship. These meetings could be augmented with surveys and other feedback instruments - like surveymonkey - that allows for more direct participation of Albertans. The health facilities would have to report back on what actions have been taken to address any concerns raised or advice provided through these various feedback loops. This system could also include some sort of pass/fail scoring system so the direct input from Albertans would determine the future fate of the health facility and the public administrators involved in the delivery of health services in Alberta.
ReplyDeleteKen, I agree with your assessmenmt that raw politics have driven the changes away from the at least somewhat reasonable model set up by Ralph in the early 90's. The Superboard can be disbanded and health policy centralized in Edmonton. Quite frankly, none of that really matters as it is all process versus results. One can't argue with the fact that we can't afford to continue to fund healthcare unchecked going forward in this province. And whether you likes Liepert's way or you want Gene's way or you want to vilify the Wildrose even though they have not had a chance (yet) to try and make things better, the bottom line is the Alberta healthcare model is unsustainable.
ReplyDeleteI know polictically it will take the likes of the next "ralph" or "ralphette" to have the fortitude to change the system to where we can once again afford it. The other option, and I know I will sound truly cynical or Machevallian, is that the system is continued to be given planning extensions, money continues to be thrown at it and it continues to grow into a bigger monster than we currently have until it implodes and we have to truly start over. I'm afraid Tommy Douglas's dream has to go the way of the dinosaur.
An interesting idea of using surveys and town hall meetings to gather input. The questions, however, are often very complex and require a great deal of consideration of the background and, understanding of the ramifications, for each of the alternatives. Gathering and presenting this information is the role of the professionals in any system.
ReplyDeleteAn ELECTED board brings to bear the questioning of the public at large to the proposed solutions. Just as in a large corporation, the CEO and the CFO etc provide the expertise, the Board of Directors represents, or should represent, the general shareholders.
Publically elected Boards represent the interests of the PUBLIC in matters of public policy and interest. They are not administrators or experts but have a role of questioning and opening public debate on issues affecting the public interest. Thus the discussions at the Public Board table ensure that decisions are made in the Public interest and the Board is accountable to the electorate for the decisions.
The American model, town hall meetings and referendums in the form of Propositions that bind legislators, often lead to diametrically and mutually exclusive decisions. For example California voters decided that class sizes were to be limited by law and also that education taxes to pay for schools and teacher salaries was to be reduced. Both laudable goals but mutually exclusive.
This is the risk of having the general public make decisions without full knowledge of all the circumstances. It is also very time consuming for everyone. Representative democracy allows for the Public to have input but delegate much of the hard work to the representatives.
The superboard is one of the only good ideas coming out of this government. Why keep paying dozens of administrators millions a year - a la Jack Davis - to run more than one board, when all we need is one?
ReplyDeleteMy point Anon at 8:03 is do we even need one SuperBoard to administer healthcare? Why not have one line of authority, transparency and accoutability - the Minister and the Department?
ReplyDeleteWhat do others think? Are these regional boards in health children and PDD areas bridges from community to government or just walls that keep citizens out and send filtered information to the Minister and government officials involved?
As the appointed boards, such as the AHS Board and the PDD are currently structured they simply are vehicles for the government to appoint people who will support the governments action as well as provide a convenient way for the government to have someone else take the ire of the public for unpopular decisions.
ReplyDeleteIf the board, whether elected or appointed, is totally funded by the Provincial Government then the Board has no independence in action. The Provincial Government cuts the funds (or freezes funding) which results in reduced services. The Government, at least in past years, then says that the Board made those choices. The accountability is not there.
In comment regarding having one direct organization. How would the diversity of the Province be addressed? One central body would tend to have 'one size fits all' formulas which have not proven very effective in the past. The distance from the people served to the decision makers would also lead, in my view, to a decrease in public involvement in, and ownership of, the decisions.
The principle of having decisions made as close as possible to the people affected by the decisions is a fundamental basis of democracy.
9:26 AM - I agree with you. As long as we have a govt that "punishes" anyone that dares to speak out against them, we will not have democracy in AB. I have served on both appointed and elected boards, but in AB it is a no win situation. You want to represent your community, but if you speak out you are "punished" by the govt.
ReplyDeleteThere is lots of intimidation bullying, coercion and othere kinds of abuse of agencies, groups and individuals who receive and rely on government funding. This is happening in dangerous ways under Harper but the Stelmach govenmetn has taken up the cudgel and is adept at using it at the political and administrative levels in a growing number of cases.
ReplyDeleteThe pursuit and preservation of power instead of good governance is often shown to be reckless and abusive. Citizens have to take back control of the democracy and re-engage in the political culture to change that. We need a new system to replace the old one that is now at least causally corrupt because of
Ken;
ReplyDeleteI agree with you in principal. Holding the Minister and the Department responsible is what led to the creation of the superboard in the first place. The gutting of the system under Klien, allowed the too many cases of wrongful death in the hospitals, the too many cases of kids, young people, elderly and marginalized people suffering and in many cases, dying, and when the people and the press found those exact people culpable, the focus had to be directed elsewhere. You recall David Swann fell on his sword over it. And Iris Evans is still in Stelmach's government.
When we citizens hold our elected accountable, things in Alberta may change.
Dave B
I would have to agree that the regional boards do not connect the goods/services that they are supposed to provide, to that of the community.
ReplyDeleteThese boards and even the many "public members" assigned to other bodies that have some sort of legislative backdrop are generally political appointees, many have good hearts but some are just P.C. candidates in waiting.
What is sad about this from my point of view is that you get structures that don't have the capacity to provide responsive real-world direction to the organizations they indent to serve, as the real power is centralized.
When the powers that be can't handle the operations because of the neutered governance that is in place, then they get stuck with paying overly inflated salaries to those with the skill sets necessary to get the job done. These are also the same people that won't bother to work within existing structures as some will tell you they don't want to work for impotent organizations and generally would rather find something better for themselves.
The other reality not discussed is that the P.C. Government is not really interested in good governance as they would rather privatize everything and let the market solve all problems. This government has the belief that the market makes efficient use of resources, not good governance, coupled with strong strategic planning, and well developed public and private capacities.
My experience both in Municipal government and School Boards leads to the conclusion that the bully tactics started with the Klein governments which acted as if they were the sole owners of the Province. This set in place a mindset among the successors, including the Civil Service, that that is the way of governing. Intimidation, threats, withholding of resources, stonewalling decisions, casting accusations of mismanagement, etc were, and continue to be, the ways of this government.
ReplyDeleteIf these don't work, dismantle the system (AHS, amalgamation of Boards, elimination of Boards, etc).
This Government has got to go in order to bring back some civility and concept of the common good to Alberta.
Paul Hinman and the Wildrose Alliance have been very clear: dismantle the superboard and get more local decisions. Re-establish local health boards in every city and town. This is the only way to provide local input and I don't care how much it costs. Only the Wildrose Alliance sees this clearly.
ReplyDeleteWhat a crock - the WAP has no interest not capacityh to accept never mind allow local decisions. It is a totally old line party that is command and control from the top and through the centre...decentralization is a myth with them
ReplyDeleteThe superboard is a crock. We need local boards in all cities and towns for local decisions. The local government is always the most efficient. Paul Hinman is a genius.
ReplyDeleteBetter yet it's time for fully privatized health care.
ReplyDeleteHi Ken,
ReplyDeleteI'm posting the following on behalf of my boss, David Swann, Leader of the Official Opposition, only because he doesn't have a Google profile and I do :-)
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Ken, you've raised good questions about health policy direction and health delivery. I believe the two should be separated, by the way, since the latter should be more responsive and responsible to people and the unique needs of Alberta’s different regions.
The solitary, central AHS board can’t do this job effectively or efficiently. It should be replaced by five or six zonal delivery boards – including, of course, zones for Edmonton and Calgary.
Our public health care system should follow common policy, reporting, measurements and financial accountability, but right now management is too centralized for best delivery of everything from security to neurosurgery to cleaning services to cancer care. Decisions affecting 90,000 employees and materials management must be handled in more timely ways.
Patients and staff are suffering from an unwieldy and constrained system. I would return to a zonal system, reinvest in community prevention and protection programs and ensure seniors’ care is a priority to free up space in our hospitals.
Thanks for keeping this important issue alive.
Best wishes
David Swann
Leader of the Official Opposition