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Why Danielle Smith’s Massive Health Reorganization Should Scare You

I’m a doctor. And I’m afraid for Alberta’s health care.

Stan Houston 29 Feb 2024The Tyee

Stan Houston is a semi-retired physician who has worked internationally, in primary care and practised for 31 years as a specialist in Edmonton. He also established and taught a graduate course in the University of Alberta School of Public Health.

Just over 15 years after the creation of Alberta Health Services, which centralized health authority at the provincial level, Premier Danielle Smith is promising to shake things up in a whole new way.

There is a near universal consensus that the health-care system is not working well. Its problems reflect developments and deficiencies from before COVID, but greatly aggravated by the pandemic.

And while these issues are by no means limited to Alberta, they do present some distinctive Alberta characteristics.

As patients wait for hours in emergency rooms or struggle to find a family doctor, they may cling to the hope that Smith’s big changes will fix things.

Unfortunately, there is no chance the proposed restructuring will resolve the health-care system’s problems. In fact, the key question is just how much worse they will get. Given the predictable negative outcomes of her proposed plan, Albertans may wonder why Smith has chosen this path.

The new model

While much of Smith’s criticism of Alberta Health Services has been around centralization, the model she proposes turns out not to be based on geographic decentralization of management and decision-making. Instead she has put forward a kind of operational division of authority with four groupings: acute care (a reduced AHS), primary care, long-term care and mental health/addictions.

Each is unquestionably an important, in some cases perhaps undervalued, component of health care, but it is entirely unclear how this particular regrouping will facilitate better care. A number of new bodies will also be created including a supervising integration council which will be chaired by the health minister, resulting in a more direct role for political leaders in health care. Thirteen groups intended to facilitate regional and Indigenous input will be established, as well as a procurement secretariat and mechanisms to facilitate communication and co-ordination between these various entities.

This structure might raise the question of how one of the premier’s oft-stated goals — reducing bureaucracy and management — will be met.

No health system anywhere has implemented a structure quite like this, so there is no experience to go on. Ironically, at almost the same moment that the UCP moved to dismantle Alberta Health Services, Quebec moved to consolidate its provincial system, as have other jurisdictions in recent years.

But the real issue is not which model is adopted. The model was not the problem and a new model is not the solution.

Most importantly, massive change is massively disruptive.

As an important aside, public health and prevention, long undervalued in Alberta, are nowhere highlighted in the new model, although they have the potential to have a greater impact on health outcomes than many health-care interventions, as well as reducing costs.

Before embarking on major restructuring there needs to be a high level of confidence that the proposed changes will be effective, because the costs will certainly be high. We in health care in Alberta are painfully familiar with the price of reorganization, since we went through major health-care restructuring, albeit in pretty much the opposite direction, not long ago. Changing all those nameplates, letterheads, logos, titles, email addresses, etc. is just the tip of the iceberg.

The biggest cost is the unavoidable period of paralysis. For a substantial time, nobody knows what decisions they can make, whom to talk to, how to get things approved or just how things work in the new order. Plans are put on hold, and frontline initiatives, however urgent, must wait until it is determined whether and how they fit into the new structure. Recruitment, so critical right now, is one of the decisions almost always postponed during restructuring. A general uncertainty and hesitancy prevails until the dust settles, typically a couple of years.

One of the issues where consensus is clearest is around the shortage of frontline health workers. We desperately need to keep the skilled people we have and also be attractive to health workers from elsewhere.

A recent Alberta Medical Association poll found that 61 per cent of Alberta primary care doctors had plans to leave public health care in the province. Since demand for health workers is high across Canada, they need a good reason to stay in Alberta or come here. And while the province has seen a big population influx recently, they are mainly potential patients, not health workers, exacerbating the discrepancy between patient and health-care worker numbers.

Recent graduates in any of the health-care disciplines considering a career in Alberta will certainly be taking a close look at the recent history and experience of health professions in the province.

Their decisions will be influenced by whatever surprises Smith may provide in coming days and months, as well as these past developments:

If you were a young doctor, nurse, respiratory tech or other health worker, with an abundance of options across Canada, how would you rank Alberta as a career destination?

In the absence of a demonstrable, rational basis for the proposed changes, what is driving Smith and the UCP? The premier is obviously concerned with keeping her “base” happy and defending against a push from the even farther right Take Back Alberta faction.

Some decisions such as the immediate firing of the AHS CEO and chief medical officer of health just look like Trumpian revenge.

Most concerning, particularly given the premier’s frequent and public advocacy in the past for privatization in health care: when things get worse, will privatization be advanced as the only solution?  [Tyee]

Read more: Health, Alberta

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