According to Danielle Smith, AHS isn’t “truly accountable” and it’s been a “management problem” for quite some time. So she’s going to blow it up. This week some brave soul leaked a 36-page slide deck asking cabinet to approve...

According to Danielle Smith, AHS isn’t “truly accountable” and it’s been a “management problem” for quite some time. So she’s going to blow it up.

This week some brave soul leaked a 36-page slide deck asking cabinet to approve a “package of reforms to refocus the health care system to achieve better outcomes for Albertans” and to signal this decision to the public.

Cabinet, bless their pathetic little hearts, approved it.

The slide deck

Instead of fixing AHS’s “management problem” and increasing its accountability, Smith is going to replace AHS with four new organizations: acute care, primary care, continuing care, and mental health & addictions.

These organizations will report to the Integration Council (made up of two cabinet ministers, various deputy ministers and assistant deputy ministers, other leaders and yet to be named sub-committees and councils), plus a Procurement & System Optimization Secretariat, plus 13 Advisory (not decision making) Councils and an expanded Health Quality Control Council.

The premier in action

That’s a lot of councils, secretariates, sub-committees, cabinet ministers, deputy cabinet ministers and assorted “leaders” to manage a service that was once managed by AHS and its board.

According to the slide deck additional changes to Public Health, EMS, and Lab and Diagnostic Imagining will be coming down the pike as well.

No one is disputing that AHS could do a better job, however, speaking as someone who’s been through more than her fair share of corporate reorganizations in the private sector, this reorg promises to be a disaster.

Why? Because it doesn’t track the reorg recommendations made by top tier management consultants like McKinsey who say in order to be successful a reorg must follow a few basic rules.

Rule One: Know why you’re reorganizing

Everything Smith has said to justify this reorganization—refocusing on patient-centered care, improving health outcomes, empowering health care workers—has been said before. The only new element is her complaint that AHS is a “management problem.”

No management consultant worth his big paycheque would recommend a massive reorganization to fix a “management problem.” Why throw the baby out with the bathwater? Just fix your management problem.

Rule Two: Understand the existing organization before you create a new one

Smith did not conduct any meaningful consultation with doctors, nurses, front line workers, or the public with respect to AHS’s existing delivery model. Consequently we can only assume the deficiencies listed in the slide deck are based one someone’s impressions, biases, or beliefs.

McKinsey warns against basing a new structure on one’s untested hypothesis and intuitions, noting that “In our experience, companies make better choices when they carefully weigh the redesign criteria, challenge biases, and minimize the influence of political agendas.”

Influence of political agendas, need we say more?

Rule Three: Establish short- term and long-term metrics

This one is pretty obvious. You need metrics so you’ll know where you are and whether the organizational changes you are making are taking you in the right direction. If someone thought  metrics would be a good idea, they failed to include them in the slide deck.

Rule Four: Identify and mitigate risks

The slide deck identifies the following risks: (1) fragmented health care deliver, (2) system disruption, (3) system failure, (4) delays in implementation, (5) public perception, and (6) carve-out risks.

Hold on. System failure?

If this was a presentation to the executive team in the private sector the CEO would stop right there. He’d demand an assessment of the risk. Is it 10%, 50%, 90%? He’d want to know what the Integration Council (which is identified as the body responsible for mitigating this risk) is doing to prepare for it. What mechanisms are in place to warn the Council that the system is on the verge of collapse? What plans has the Council made to response quickly when the alarm bells go off?

The slide deck says this group of bureaucrats will spend their time sitting around identifying efficiencies and eliminating barriers. That simply doesn’t cut it.

(Frankly, the CEO would have little confidence in the government’s ability to mitigate the risk of system failure given its abysmal handling of the transfer of public lab service to DynaLife.)   

Moving on.

The risk of public perception will be addressed by a “full scale stakeholder and communication program.” More lectures in telephone town halls I presume.

The carve-out risks will be managed by a “dedicated transformation office, supported by merger and acquisition experts who will lead separation efforts and ensure compliance to all legal and policy requirements.”

Pardon?

Our private sector CEO would stop right there. He’d ask for more information about the “carve-out” risk because it sounds like the government is getting ready to sell off parts of our public healthcare system. That’s a topic that deserves its own comprehensive slide deck.

Bottom line

The slide deck raises more questions than answers. The most important question is: Does anyone really know what’s going on.

This is a huge reorganization project and yet in the Legislature Smith downplayed it saying “we are making incremental change.” Doctors, nurses, and others working on the front line need not worry because the changes will proceed “slowly over time.”  

Nope, that’s not what the slide deck says.

Then there’s the kicker. When Rachel Notley questioned Smith’s decision to appoint Lyle Oberg, a proponent of privatized health care and a partner in Canada’s first private, for-profit hospital, as the chair of the AHS board, Smith replied “There will be no privatization.”

I’m sorry but the carve-out risk description in the slide deck begs to differ. I’ll just park that promise in the drawer next to the “nobody is touching anyone’s pensions” promise.

Danielle Smith says she’s going to improve health care by replacing the centralized AHS with a politically controlled centralized bureaucracy. Four Edmonton hospitals are at 150% capacity and the slide deck indicates that she’s not spending another dime on hiring and retaining more doctors, nurses, and front line staff.

In what universe does this make any sense?

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