For Alberta Being the Best in the World is NOT Good Enough

I have read the leaked Government of Alberta Power Point presentation "Alberta's Health Legislation: Moving Forward"  It is a document that begs a lot of questions and raises some legitimate suspicions about the political intent of the Stelmach government on just how secure is the future of publicly funded health care in Alberta.

Bill 17, the new Alberta Health Act is now passed with Closure invoked by the Stelmach government.  I expect to hear very little about it now. The government wants to shift our attention to the "Becoming the Best: Alberta's 5-Year Health Action Plan" and not have us dwell on any boogie-man fears of a secret strategy of privateers out to make our health care system the private property right of some insurance companies.

I have not yet read the Five Year Action Plan.  It was just released yesterday. But I will read it with great interest.  At first is sounds like a revision of the Olympics motto with words like  "more, faster, quicker, reduced, best" as the hooks. There is only one small mention of a wellness aspect and that is a 32% increase in child immunization rates...what ever that means.  We need much more attention to prevention and wellness in our health action planning.  Don't you think?

I know Minister Zwozdesky had some resistance getting this Action Plan through Cabinet. But all the publicity and pressure over Raj Sherman and the leak of  July strategy document I am sure that forced the hands of the foot-draggers in Cabinet.  After all what is the point of a five year stable funding commitment if you don't have a five year plan to be able to prove you are using the money wisely?

I will comment more on both document in future blogs.  Let me say for now, on the leaked "Alberta Health Legislation: Moving Forward" it is difficult to understand the document because it is terse and in bullets points.  There is not much narrative to help one really understand the integrity and intent of the policy approach being proposed.  Some stuff is very good and other stuff is veiled political framing of a privatization agenda.  Minister Zwozdesky says this is "not his document" and he rejected it because some elements were contrary to the Canada Health Act.  Go figure!

From that statement by Minister Zwozdesky, it is safe to conclude this government document is must then "belong" to former Health Minister Ron Liepert.  Is sure sounds like his free-market competitive Fraser Institute approach to health care. Given the clear comments from Minister Zwozdesky that he rejected the leaked "Moving Forward" document, we can hopefully conclude that the public health care system in Alberta is safe from ideologically driven privatization agenda - at lest for now..  That sense of safety for the public health system in Alberta only goes up to the next Cabinet shuffle, when ever that might be.  If Minister Liepert performs as badly in Energy as he did in Education and Health, a shuffle could be sooner than later.  Who replaces Gene Zwozdesky in the Health and Wellness portfolio will tell us a great deal about the integrity and true intent of the Stelmach government on the privatization of the public health care system in Alberta.

As for the Five Year Action Plan, at first blush is it all about targets, measures and percentage but almost entirely aimed at the acute care end of the spectrum. The care and compassion, respect for professionalism in the system is not readily apparent.  Fair enough but we also need a culture shift to include encouraging personal action on disease prevention, wellness and well-being too.  Albertans must take personal responsibility for their health care and that is about each of us taking steps in the areas of prevention, including lifestyle changes as necessary.  Health care is not just all about the system.  Much of it is about us, our values and attitudes.

I get put off when I see policy documents aspiring to be the "best."  Like in this document title: "Becoming the Best:Alberta's 5-Year Health Action Plan." Stating Alberta's goal to be the "best-performing publicly funded health system in Canada is to merely measure ourselves relative to others.  That is a mugs game and is more sloganeering than a soundly reasoned policy objective.  With all the wealth in Alberta and our highest per capita spending on health care we should already be the best in Canada...but on what measures?  Life expectancy and wait times are important but not very sophisticated outcome aspirations.

We know economic wealth translates into good health outcomes.  Given the enormous wealth and potential in Alberta we should have the aspiration to be the best health care system for the world, as well as the best in the world.  That better aspiration for Alberta to be the best health care system for the world can happen in terms of investment in other areas like prevention, teaching, research and innovation.  Now that is something to strive for in addition to value for tax money and, quality care and better access times...all of which are essential but not sufficient for live up to our potential.

To close let me invite you to watch this interesting video.  It is just over 4 minutes and shows how the wealth of a country is correlated to life expectancy.  Watch it and ask yourself why the Alberta government sets its health care sights so low and narrow given our potential.  (H/T to Kim Bater for the link)

CLPNA Does Interesting Survey on Nursing Care in Alberta

We do some work with the College of Licensed Practical Nurses of Alberta so recognize this blog post is as much about my work as my opinion.


We recently did a random-sample conjoint study of 919 Albertans for the CLPNA on what values Albertans think are most important about providing them with professional nursing care. The results were interesting and more survey results are going to be available at http://www.clpna.com/ soon.

In the meantime I encourage you to visit the CLPNA site for more information on the roles, responsibilities and relationships of LPNs within nursing, healthcare and with patients.  I strongly suggest you read the blog post on the recent KEP study on the appropriateness of the knowledge and education levels of soon-to-be-graduating nurses in Alberta.

There are some interesting attributes the public sees as most important and what they want from professional nurses, be they RN, LPNs or Registered Psychiatric Nurses. The top three expecations by the public are that nurses are to be skilled, knowledgeable as well as caring and compasionate. There were 15 other attributes in the study and all were seen as important, but those are the top three concerns of Albertans when they think about what is imperative for high quality professional nursing care.

With all the changes, uncertainty and volatility happening Alberta's healthcare system the CLPNA has taken this high road approach to better understanding and focused on meeting its professional responsibility to the public. They decided to go directly to Albertans and ask what they thought was important about high quality professional nursing care.

The CLPNA then went a step further and asked those same randomly selected Albertans how satisfied they were with the performance of the nursing profession in providing the kind of care they expected.  There is lots of good news and some significant indications where there is room for improvement by nurses in those satisfaction results.  We say this survey applies to nursing generally here because we did not differentiate between  nurses, be they LPN, RPN or RNs when we asked the survey questions.

This dual approach of measuring expectations and satisfactions gives the CLPNA a clear picture of public expectations and performance impresssions on some 15 different attributes that relate to professional nursing care. What the conjoint study did was also survey members of the Licensed Practical Nursing profession on the same values. What emerged was nothing less than amazing. The over 1460 working LPNs who did the survey were 99.9% aligned with the public's priority for values and expectations of what constitutes high quality professional nursing care in Alberta.

That degree of alignment between what LPNs see as their role and responsibility with the public and patients has to be reassuring to citizens that LPNs get it. As for LPNs, they too can find gratification in the fact that what they perceive as their jobs and responsibilities as professionals are the same as the people they serve in Alberta.

These survey results have been presented and shared with officials in Alberta Health and Wellness, including the Minister Zwozdesky, Deputy Minister Ramotar, Parliamentary Assistant Sherman and head of AHS, Dr. Duckett along with other senior officals in their offices. The survey information was appreciated and well received in all instances. Now it has to be shared with others in government, other healthcare professionals, stakeholders, health advocacy groups and the general public.

So stay tuned. There are lots more interesting information coming out on the survey results.  We will deal with  the implications for providing high quality health care in Alberta soon, both here on this blog and at http://www.clpna.com/ over time.

Looking forward to your comments and questions.

Stelmach Responds to the Urban Pressure and Expands Cabinet

Alberta Premier Stelmach has just announced some additions to Cabinet with three changes for Calgary.

Ron Stevens is Deputy Premier in addition to his role as Minister of Justice and Attorney General. This is a very wise move at so many levels by Premier and not just to appease Calgary. Stevens is one of the most respected and capable Ministers in the fold.

Cindy Ady (Calgary Shaw) is Associate Minister of Tourism Promotion (with responsibility for Alberta's participation in activities pertaining to the 2010 Olympics in British Columbia). Another capable person but a strange mandate I must say. But the backgrounder on the News Release adds “Sport” in terms of “participation in communities, schools and workplaces” …maybe she is the anti-obesity Associate Minister too? We could use an emphasis on this problem (including me). Another Cabinet Vote for Calgary is the politics at play here.

Yvonne Fritz (Calgary Cross) is back but working as Associate Minister of Affordable Housing and Urban Development. She had her challenges in the Seniors and Community Services portfolio before, especially in getting crown land released for Fort McMurray housing…lots of false starts mostly because the corporate history of the government had been let go during the Debt and Deficit civil service purging in the mid 90’s. Ray Danyluk needs the help because of volume of work and the complexity of issues…an Associate Minister should help carry some of the work load. Politics is more voice for Calgary.

Finally we have Gene Zwozdesky, MLA for Edmonton-Mill Creek, as Associate Minister for Capital Planning. This is a very bright light move. Edmonton now has 2 Ministers to Calgary’s 5 but the real story is the need for more urban voices has been heard by the Premier. The importance of infrastructure planning in managing growth is a key focus of the Stelmach government. There has been serious political damage caused by years of neglect in this area. Gene is on top of the issues and at the top of his game. It is good to see this important function given the Cabinet status it needs.

I am pleased to see the quick response to the obvious need for more urban representation in Cabinet and a capable newcomer like Cindy Ady getting a chance.