Restructuring AHS - The Wrong Way

I was never particularly impressed with the AHS “Superboard” concept that was instituted in 2009 - it got some thing right (like centralizing procurement), but it also had the effect of gutting the ability for the system to respond to local needs.  It effectively turned major decisions into political fodder - suddenly matters like building new facilities became political footballs, with little or no regional input into matters like requirements.

After an initial period of utter chaos, which arguably lasted through 2012 or 2013, AHS started to find its feet and initiated programs like Primary Care Networks which went a long ways towards smoothing out access in the system, and in particular communication between family physicians and specialists.
Today, AHS is far from perfect, but it has done a lot to rebalance the system and introduce more local responsiveness to issues.  

What was rolled out by the Danielle Smith-led UCP government yesterday is a recipe for disaster.  We don’t have a lot of details yet, but the basic structure effectively creates a series of “silos” that will inevitably make communications between groups much, much worse. Vertical silos like what has been proposed are almost inevitably going to create walls between organizations that prevent meaningful knowledge sharing and collaboration.

Second, when I see this kind of structure trotted out in the corporate world, it almost always means that things are being lined up to be sold.  Once the walls go up, and mutual collaboration is severed, it’s relatively easy to sell off pieces and make huge profits on the sale.  Corporate “mergers” tend to go one of two ways:  The acquired entity is assimilated into the larger organization and its core functions become part of the larger whole; or, the acquired entity remains an all but separate business of its own that feeds a few % of its profits into the parent corporation - until such times as the parent company decides to skim a profit by selling it off. 

The UCP structure for health care in Alberta seems to be designed with an orientation towards the latter.  Create a bunch of isolated vertical silos that can then be dismantled.

Given the lack of detail, lack of risk management planning, and the complexity of trying to dismantle AHS into this new structure, the government’s self-assigned budget of some $120M is almost laughably small.  Having been a project manager myself, I look at that and go “you’re going to restructure a $45B organization that cheaply? - yeah keep kidding yourselves.”.  

When - or if - a more detailed plan is made available, I will look at it.  But, at the moment, I take one look at this, and my first thought is “this is a completely unrealistic plan that will be detrimental to the well-being of Albertans”.  I have little doubt that the real goal of this is to sell off as much as they can to US interests before the next election. After that, Albertans will find themselves stuck with the same affordability dilemma that so many in the US face:  Do I pay my rent or my healthcare premiums? 

Some Animals Are More Equal Than Others (The Alberta Edition)

 In KenneyLand (aka Alaberta or Bertabama), it seems that there are two sets of rules at play.  

First, let me introduce you to the saga of GraceLife Church in Parkland County.  This organization has been holding services and ignoring public health orders since Fall of 2020.  The province has seemingly been unwilling to do anything about it until recently - in fact, it took until just after Easter (we'll come back to this point in a moment) for concrete steps to be taken.  Steps that the government had to take if they were going to enforce anything with a rising third wave of the pandemic. 

In The Wake Of AHS Board Firings ...

Yesterday, Minister of Health Fred Horne fired the entire board in charge of running Alberta Health Services.

This is perhaps the second time since Redford came to power that she's done something I agree with.  (The first was reinstating funding for Gender Reassignment Surgery which was axed in 2009 in a fit of pique on the part of the Stelmach government).

Let me be clear about one thing.  Alberta Health Services is a mess.  As experiments in consolidation go, it is a disaster of unprecedented proportions.  There are serious issues when we are talking about handing out bonuses (retention, performance or otherwise) to executives at a time when front line services are being axed left and right is ridiculous.  I don't give a damn how "vital" it is to retain these executives.  If you are cutting front line services and the fat cats at the top are still getting bonuses, then something is seriously wrong with the priorities.

The issues in AHS are systemic - they start at the top and go all the way through the system.  AHS was created in large part as a way for the Stelmach government to continue the process of dismantling public health care in Alberta - a hobby horse issue that the Klein conservatives only took feinting strikes at, largely because Klein himself took a lot of the heat from Albertans.  Under Stelmach, the moves were more definite, and the results are predictable:  those at the top line their pockets and the staff on the front lines and patient care suffer.

I have personal experiences where a relative became ill with cancer recently which underscore the fundamental problems that exist when it comes to getting treatment initiated for a critical illness.  The cancer was first detected six months before treatment.  For six months, we went from doctor to doctor, specialist to specialist trying to get a clear diagnosis and more importantly, treatment.

I won't go into the number of dropped balls that I saw happen during that time.  Suffice it to say that it was appalling.  Treatment didn't start until the cancer had become a threat to the patient's life.

The problems we witnessed?  You name it.  I'm going to focus on the systemic and communications problems because those are the ones that AHS was supposed to address when it was created.

The first point is that emergency rooms and the doctors in them don't communicate with each other.  If you go to an emergency with a changing set of symptoms, and that hospital doesn't have the facilities to treat it directly, they send you home.  They don't refer to you another hospital which has the facilities unless they think your life is in danger.

This is complete nonsense.  When you are talking about diseases like cancer, early treatment is absolutely critical.  Cancer is life-threatening.  Period.  For the patient, sending them home is doing them a disservice.

Even more frustrating is the fact that there is no avenue to raise concerns over rapidly changing conditions.  When things are changing as rapidly (near daily) as they were, the system needs some kind of mechanism where a patient can demand a reassessment of their situation.  Instead, all that you get is a run-around that basically tells you to "talk to the hand".

We lack sufficient specialists to adequately diagnose and treat people.  In Calgary, there are 4 ENT specialists - for a city of over 1,000,000.  The wait times to get into see these specialists are months long, and yet that is an essential part of the diagnostic process.  With a fast moving cancer, it can go from localized and tiny to enormous and pervasive in that time.

To the credit of the treatment professionals, once you are connected to the treatment system, they do awesome work in absolutely terrifying conditions in terms of workload.

The issues I am raising speak to the fact that the parameters that exist for the front lines do not enable taking the correct steps to get issues dealt with.  If you don't have the connections already, you're stuck on the outside and it is just about impossible to get in.

Horne and Redford have an opportunity to start correcting the systemic problems that exist within AHS.  Let's hope that they take it.