This Friday, May 19 will be the fifth anniversary of Greg’s death. Memories and his presence are felt every day but at the same time a lot has happened in the last 5 years. Like on most anniversaries and milestones now are an appropriate time to reflect and also the time to plan our path moving forward. So our plan for the next 3 days is to share our current thoughts as we look back at our 3 priorities. First up is:
Learning from Failure
The public relies on health organizations to work with individuals and families to provide the right care at the right time. In Alberta, management and oversight of the health system rests with the Alberta government and through them the largest organization is Alberta Health Services (AHS.)
In a competitive market when an organization underperforms its users or customers seek an alternative that is doing better quality work. If a consumer perceives a product or service to be too expensive they choose a more cost effective option. This is a different world than Alberta’s health treatment system. While at the Primary Care level, in theory, if you are not satisfied with the treatment or service provided at one clinic it is possible to go to another (although this is often limited by the number of doctors available.) When it comes to the large consolidated organization of AHS, it is a different matter. When you need care beyond your family or primary care physician you enter a world that provides few options for patients and families.
While there is value in a single system, it is well recognized that monopolistic government organizations must have counter-balancing policies and entities in place to make sure the organization is successful in delivering services to the public. Policies include mandatory transparency on how the organization measures of quality and efficiency of the tasks and duties they are responsible for. Transparency builds trust and enables public accountability for continuous improvement and learning from challenges and mistakes.
It is also important to have a fully independent organization that has been given the complete authority to monitor performance and efficiency, examine areas of lower performance and investigate failures. The organization must have the authority to make recommendations but also to ensure the implementation of those recommendations. This organization is the public’s eyes, ears and voice needed to guarantee the monopoly acts in the public’s best interest.
In Alberta, the structure is compromised by the fact that past and present governments have placed politicians at the top of the organization. Politicians, by their very nature, focus on political priorities. Political priorities that often trade votes in certain areas during election campaigns against the broad and long term obligations of the health system. In AHS’s case, the revolving door through which many different CEOs have been ushered in and out, and the firing and appointing of the “public” Board of AHS reinforces the point. Further evidence comes from the fact that few Albertans know who makes up their public board, or could name their Chairperson. The board has very little public profile while the Minister certainly has been seen and heard speaking about the affairs of AHS.
We can see therefore, that the critical characteristics of transparency and accountability are very difficult to deliver to the public when the monopoly is managed by politicians.
What about the fully independent body with the powers to investigate, recommend and enforce?
The Health Quality Council of Alberta (HQCA) is an organization that has been provided some authority to investigate and provide recommendations but essentially none to ensure recommendations are implemented. It is not expected (nor encouraged) to take on investigations that the government has not asked it to do. It is also reliant on the government for its tiny annual budget of $7 million when compared to the $21+ billion government expenditure of taxpayer’s dollars in Alberta’s health treatment system. Once again, it is easy to see how difficult it is to help the system improve, if provincial political leaders and their short-term politics are allowed to drive priorities away from transparency, accountability and real system improvement.
Our experience as a family since Greg’s death nearly 5 years ago now, was of two different worlds. The HQCA did a careful, sensitive and hard job of investigating what happened to Greg in the non-AHS world. We were encouraged to challenge and engage during this progress and we were pleased to do so. They produced the first report in December of 2013 which included a series of recommendations aimed at closing the gaps they found in Greg’s care. They followed this up in July 2016, with a review of the progress (or lack thereof) of the implementation of their recommendations. While progress has been slower than hoped, at least there is some visible improvement in a transparent and accountable way.
We were told that AHS has done their own investigation and that things were going to change, but to this day we have not been provided anything in writing on the details of their investigation. Of course, with this lack of transparency and avoidance of accountability, there is no way of really knowing how much has been done.
Healthy and responsible organizations celebrate their successes and learn from their failures together. Unhealthy ones only speak to their successes and deny or hide their failures to the detriment of all.
In the world of health care, people’s well being and lives are at stake. We know individuals are not perfect and we all make mistakes but what makes humans better than lemmings is that we can use our intelligence to learn and avoid repeating the pitfalls. We can work as a team to share responsibilities, minimize the risk of mistakes, and to develop solutions. It is better for those we care for, and better for those doing the caring.
The characteristics of public transparency and accountability must be required of Alberta’s health system, including Alberta Health Services. The mandate of the Health Quality Council of Alberta and its funding must be changed and enhanced to make it completely free of the oversight and the influence of the politicians of the Government of Alberta. The funding level must be increased to a level appropriate to investigate and drive improvement in the sector that consumes the largest single expenditure of taxpayers dollars in this province and that is trusted with the care and well being of every one of us who live here.