Andrew Neuner, CEO of the Health Quality Council of Alberta leaves his position this week after tendering his resignation a number of months ago. At some point in time, we will learn from him what was behind this for we don’t believe that he has lost his passion for trying to bring improvements to Alberta’s health system. He has led a dedicated team to investigate and report where good things have been getting done, and where potential improvements could be made. They also have elevated their understanding and then reporting how patients feel about the treatment they have had from the system.
Our family was very fortunate that the courageous leadership of the HQCA was willing to step outside the box and investigate all they could around the circumstances and gaps, that Greg encountered leading up to his premature and tragic death. The Continuity of Patient Care Study released in December of 2013 was unique in many ways and has been foundational to our work as Greg’s family, in trying to support much-needed improvements in the system.
The report included 13 recommendations made to close the gaps Greg encountered, and it also included “lessons learned” from our family’s perspective. The report was not well received at the time by some in the health system, and while many clinicians have told us that they have learned from it in how to take things into account in their practice, at the larger system organizations level, much less has been adopted. The greater the requirement for collaboration between system players, the less that has been accomplished.
We know that in the early days of our work, there was a great deal of defensiveness in the system and at the system leadership levels. Indeed, at the time Minister Horne was not happy about this report being done but later, after he was no longer in government, he told me that he felt it was the best work done during his time.
The HQCA was established to be a third party body that could investigate how the system, and the different parts of it were/are performing. Under the legislation its first object is: …to promote and improve patient safety and health service quality on a province-wide basis.
It is very important that there is a strong public reporting role to ensure that those organizations who have the health and safety of members of the public under their control, perform well and to continuously improve. In the health system’s case, this role is very critical because there is no other independent body that is designated to do this work. In fact, there is no “patient safety act” while this kind of legislation exists in other industries where there is risk to the public.
In the case of the health treatment system, it is ultimately managed by the politicians of the provincial government. In today’s world, the vast majority of politicians see recommendations for improvement as a criticism reflecting negatively on them personally. The result is they see no value in being transparent when things do not go well or where the best opportunities for improving are. This is the opposite of what is needed and what exists in other industries. There a true safety and continuous improvement culture is seen as fundamental to those sectors’ responsibility to their customers and to the public at large.
The tension between those in charge of the health system, and the HQCA has manifested itself in reduced funding. The Notley government took this action during their time and while Premier Kenney and the UCP campaigned on a platform of increasing HQCA funding, they have effectively cut support for it as well.
It must be very frustrating for the wonderful people at the HQCA to be working very hard to try to make things better for Albertans. They face not only the historic defensiveness but at a time when health care spending and demands are increasing, they have to deal with reduced budgets for their work within their role.
Clear public transparency to Albertans by those leading the health system is critical to our safety and our health going forward. Without a properly empowered and funded third party investigating and reporting to the public, the system priorities become political ones. We have seen this before, and certainly through the Covid-19 pandemic, there have been instances of this as well. We also have heard the political spin put on some of the events and the decisions made, that does not stand up to closer inspection. Patient and provider safety has not been the first priority in these decisions.
It is difficult for Albertans to see and to understand what the challenges are and which opportunities for improvement should be strongly supported when much of the information needed to make this judgement is not easily accessible. Vested interest parties and political leadership rarely provide it.
Health care must be a team effort. Our family believes that the health system should function as a team that provides Safe, Continuous, Collaborative, Patient Partnered Care. There is no room for political priorities or personal agendas in that.
We need a stronger HQCA to help ensure we are always aware of what is taking place and that we are moving in the right direction. There are no signals at this point that current political leadership values what the HQCA was set up to do, or what the great people there have been trying to do in their effort to support improvement. In the end, it may take strong and broad public reaction to force the change from short term political priorities to ones that reflect public transparency, public safety and public care.
Thank you, Andrew, for all the work you have done while leading the team at the HQCA. We know that you will do more good work wherever the future takes you.