Yesterday, March 17th, Minister Shandro announced that the government was not going to change the payments to doctors on March 31st as previously announced. His announcement coincided with Premier Kenney declaring a Public Health Emergency in Alberta due to the impact of Covid-19. I believe Minister Shandro’s has taken a temporary half step back from the government’s previous position and it is a good half step now, but it is not progress.
While there have been many things said and positions put forward, it is not clear to me what the health care system destination is, even from the various camps speaking out.
One destination could be described as driven by cost. In order to achieve an acceptable cost of the system, the government intends to impose its will to achieve a certain financial outcome.
Another destination could be described as protection of the current situation, including on-going increases in costs without achieving better health care outcomes. This does not allow changes anywhere and focuses on maintaining current incomes, workloads and management positions. This position is devoid of the recognition that needed improvements mean change and adjustment. We can’t have one without the other.
In the first case, the predictable reaction is a loss of trust and hope for the future. This includes people who have diligently “swam upstream” to work with their peers and with patients to achieve the best care goals they could. It also includes those that have a strong sense of entitlement, who are part of the problem of rising costs and intransigence when it comes to system improvements. Either way, this approach will drive people out of the system and further compromise Alberta’s capacity to provide care. While the government may achieve their spending target, there will be widespread degradation of capacity and quality of care.
In the second case, it must be recognized that the world is a dynamic place with developments in technology, procedures, and processes that have applicability within the health system. On-going resistance to change serves no one. While it may have a short-term effect of blocking change, over the longer term the system slides further and further behind creating even less safe conditions for patients and providers alike.
It is obvious that unless everyone can come to a common understanding of the destination, or the vision for health care in Alberta, we are not going to get very far. Instead, the different parts of the system and the different places of power will struggle to maintain their own course, heading in different directions while damaging everyone’s ability to achieve the delivery of safe care.
A quote from Gordon R. Sullivan & Michael V. Harper is worth reflecting on:
“Effective leadership is not about controlling from the top: it is about unleashing the power of the people”
The result, over time, of the consolidation of Alberta’s health system, has been to create a command and control culture, emanating from the politicians’ self positioned at the top.
While there was and remains great promise for more cohesive efforts and an integrated approach to population health and care, it has been stuck in the world where many separate pieces, and organizational silos, each compete for their needs and wants, in a political environment. This top-down culture has smothered the ability to contribute and innovate by the people working at or with those on the front lines of care. Politicians consistently have used their positions of power to lever their opportunities to take public credit for funding new hospitals, facilities, and shiny technology while avoiding the political risk associated with being accountable for underperformance of health care itself.
This culture has become pervasive up and down the system, over-riding many fundamental priorities that are necessary to provide safe and good quality care.
A little while after we lost Greg to the unsafe system, we thought we wanted to develop what we felt would be the right description for it. We believe that the system should provide Safe, Continuous, Collaborative Patient Partnered Care. Initially, we did not have Safe at the start of the description, assuming that this was a given. We were quickly told by people working in the system that it is needed. Since that time, we have seen many different situations where safety really has been down the list of considerations when decisions in and for the system are made. The result has meant many people continue to be harmed or die prematurely.
When I speak of Safety, I refer to patient and provider safety. Are decisions at all levels being made to maintain or improve patient and provider safety, or will they degrade it? We all can stop and make our own judgments of that. The other “safety” consideration currently in the mix is that of political safety. There is no question that political safety is a continuous consideration at the top and that flows down from there.
Many examples show what this means. It starts with a lack of transparency, both in terms of ensuring information is freely available, whether it is to provide the patient’s own health records to them in a timely and complete way, or in terms of system performance measures in a consistent and open form. The critically important investigation into failures, harm or near misses has unacceptably been left to those directly involved or in a limited way to the Health Quality Council of Alberta. The Health Quality Council of Alberta does good work but is handcuffed by a limited mandate, and a shrinking budget in spite of UCP campaign promises otherwise. No system can improve unless it is able and willing to look at its challenges and learn from them. The politics of defensiveness and avoidance of accountability must be recognized for what it is, what it is doing, and it must be stopped.
There is no question by their actions that Premier Kenney and Minister Shandro have placed themselves at the top of the leadership positions for the health system in Alberta. Their past tactics flaunting their power have increased divisiveness and resulted in the predictable aggressive, defensive positions by other leaders. All of this serves no one. Instead of committed and focused positive health professionals, we have many that are angry, confused or worst of all, disheartened. Just as credit should be given where it is due, leaders who fail us, right from the top, must also be held publicly accountable.
True care can only be delivered through genuine teamwork.
A truly safe and successful health care system will only come to be as a result of the complete pursuit of a common vision. A vision arrived at through honest consultation including diverse perspectives and the “give and take” necessary to develop it. This can only happen when there is genuine respect for and recognition of what each team member can contribute through their knowledge and experience. It will not come from a command and control attitude, nor one which is based on an individual belief in their superiority of intellect or knowledge.
The public’s measure of leadership going forward will not be by how much power is wielded by different people in various individual leadership positions. It will be by how much is accomplished in achieving effective and efficient care. Care that is safe, continuous, collaborative and patient-partnered.
Alberta still has the potential to lead the country in a better way to achieve safe care. We have great and passionate people inside and outside the system that can and should contribute both to the development of one vision and to its pursuit. While the Covid-19 pandemic adds a tremendous challenge for everyone now, our question through this and beyond, is whether people in leadership positions will step back from individual goals and step up to contribute to and be part of a better overall future. When we agree on one common destination, then we all can contribute to the many different pathways available to get there. It’s not all about power or money. It’s about working together to do the very best we can with what we have available, wherever we are.
I will close with a quote from Roy T. Bennett:
Good leaders have vision and inspire others to help them turn vision into reality. Great leaders create more leaders not followers. Great leaders have vision, share vision and inspire others to create their own.
– Dave Price
For Greg’s Family