May 29, 2023
By Annamarie A. Fuchs. Creator, Partners in Health | Conversations.
Albertans are at the polls today, deciding which party will run this province over the next four years. The key issue second only to the economy is healthcare.
One of my biggest frustrations in all my years in healthcare has been the politicization of healthcare where decision making is driven largely by whether an initiative will strengthen the likelihood that a party will be elected or re-elected. Ultimately, efforts to create a high quality and sustainable health system often have very little to do with decisions that are made during an election cycle.
Case in point – in the 1970’s during Premier Lougheed’s tenure, dozens of small, single story and unsustainable hospitals were built across rural Alberta to gain the support for the rural vote. It worked. However, those decisions continue to haunt us to this day and as recently as 2014, the Edmonton Journal explained that the
“use of infrastructure for political benefit has been a long-standing practice of governments everywhere” where sadly, many hospitals have declined in use and where many ERs are sparsely used, and operating rooms are closed…”
We are now stuck with widespread and “crumbling infrastructure…secretive funding decisions, and political manipulations… as rural hospitals remain underused because of a system manipulated by politics.”[1]
Today conversations continue about how to find ways, despite the condition of these hospitals to ensure the right care is available to rural residents.
Another case in point – $1.8 Billion was earmarked in February last year to expand the Red Deer Regional Hospital[2] where any expansion, if it occurs, will not take place until at least 2030. That’s years down the road while clinicians and activists in the central Alberta area have been reporting for years, extraordinary patient safety issues associated with unprecedented delays in access to care.
What is the role of a Board of Directors in healthcare?
The concept of governance in decision making in healthcare is generally not well understood by the voting public and its role in a universal health system is often seen as ambiguous at best. Until recently, governance in Canada’s largest integrated health authority, Alberta Health Services, was delivered by a highly qualified and diverse group of independent professionals whose role it was to hold AHS executives and management to account. However, for the second time in a decade, that role came under the scrutiny of Alberta’s elected officials who had an election looming.
Not unexpectedly, the Board of Directors was fired in November and the same ‘official administrator’ appointed in 2013 when that board was fired by a previous premier, was appointed again in their place. Make no mistake. While an ‘official administrator’ may have a role to play in an organization by coordinating decision making and choosing what priorities to focus on (and which to set aside), that role is by no means a ‘governance’ role and it is ultimately loaded with bias. Instead, I would suggest that as taxpayers we are currently paying salaries to two operational leaders – an official administrator and a CEO and no formal governance over healthcare in this province currently exists. This should raise alarms for every Albertan.
This sadly predictable decision prompted me to think that it may be time we talked in greater depth about the value that a diverse and independent board of directors offers a health system and the public. Board governance is well understood in the corporate world where board members owe a duty of disclosure, honesty, loyalty, and candor, … and to disclose facts that could impact the business of the company.”[3] Peter Drucker however, called hospitals “the most complex form of human organization we have ever attempted to manage”[4] so it begs the question, why would we think for a second that we can do without a board of directors overseeing healthcare in this province? In healthcare, our customers are the patients we serve and mistakes can cost lives.
Healthcare customers (patients) are not widgets. There is an ebb and flow to healthcare that can be predicted to some extent but for the most part, there is massive uncertainty and unpredictability in healthcare. Having an expert, diverse, and committed independent board of directors is the only way the public can be assured that the right decisions that are patient driven and apolitical are being contemplated.
Independent and qualified governance leaders offer expertise in business, law, healthcare, academia, and more. The efforts of a good board of directors ensure, to a great extent, some balance in decision making between meeting the interests of the organization and the customers they serve alongside the expectations of government, and the community. It’s no easy task and it is simply not one that can be accomplished by one individual.
During their tenure, the former Canadian Patient Safety Institute (CPSI) wrote extensively about governance in healthcare. One health authority they worked with emphasized that “the ultimate responsibility for ensuring quality rests with the board members of health organizations.”[5] Ross Baker et al (2010)[6] also went on to explain that boards influence performance in healthcare when they are actively working in partnership with executive leaders and management and where they hold them accountable for high quality performance and demand that they focus on continuous improvement in delivering and sustaining quality care. Again, that can’t happen without a diverse group of highly qualified independent professionals who know how to investigate and ask critical questions of the executive team WITHOUT driving operational decision making. It’s a subtle but critical point – a good board of directors knows to keep their noses in the operations of a business (in this case a healthcare system) while keeping their fingers decisively out.
As we wait to learn the outcome of today’s election, ask yourself if you want an official administrator whose primary responsibility it is to support initiatives that are high priority items for a government seeking re-election or an independent board who together will hold decision makers to account and enable the tough decisions to be made that will support initiatives designed to improve quality, safety, and appropriate access to the right care over the long term for all Albertans.
[1] https://edmontonjournal.com/news/local-news/alberta-hospitals-crumbling-rural-facilities-underused-and-system-manipulated-by-politics-with-video
[2] https://rdnewsnow.com/2022/02/23/1-8-billion-announced-for-red-deer-hospital-expansion/
[3] https://www.kellysantini.com/articles/fiduciary-duties-corporate-directors-your-obligations-responsibilities-and-business#:~:text=As%20a%20fiduciary%20of%20a,the%20business%20of%20the%20company.
[4] https://www-2.rotman.utoronto.ca/insightshub/healthcare-life-sciences/managing-the-most-complex-orga
[5] https://www.patientsafetyinstitute.ca/en/toolsResources/GovernancePatientSafety/ExecutingGovernancePatientSafety/Pages/default.aspx
[6] file:///C:/Users/Owner/Downloads/HQ_vol13_no1_Baker.pdf
