Janet Davidson, the person appointed by Health Minister Fred Horne to review the structure of Alberta’s health system, has concluded what many critics have been saying for years: there are too many managers.
As a result, the number of vice-presidents at Alberta Health Services will drop to 10 from 80 immediately. Horne has directed AHS president and CEO Chris Eagle to spend the coming weeks scrutinizing every AHS management position to determine whether it is worth keeping.
While the initial steps appear to have dropped 70 people from the senior executive team, only five positions have actually been eliminated. The other 65 will receive new job titles and be “repositioned to where they can better support front-line activities,” according to Eagle. The termination of five senior staff members will result in $2.1 million in severance pay.
Davidson was appointed in June to examine the organization of AHS senior management in response to a report by the Health Governance Review Task Force in February. The task force was itself created in order to explore ways to improve governance of health care following an investigation by the Alberta Health Quality Council of Alberta published in February 2012 into what was wrong with the system. That investigation was motivated by repeated criticism from front-line health staff and political opposition parties of the management at AHS since its creation in 2008.
All three reviews determined there are far too many AHS managers with vague job responsibilities and little connection to patients or front-line care. Davidson’s report contains the clearest suggestions for solving the problem, beginning with the elimination of the majority of senior executive positions.
During a September 10 press conference, she explained, “the prior organizational structure did not, I believe, emphasize patients or front-line staff. The structure was confusing to navigate and left people outside and inside the organization unsure of who held responsibility and accountability for key decisions.
“Engagement, and particularly engagement with patients, was not always meaningful and as a result there have been examples where communities feel left out.”
Moving forward, Davidson said, “the primary focus of Alberta Health Services must be to provide high-quality health-care services to Albertans.... Alberta Health Services must work collaboratively with stakeholders, including patients, to support a continuously improving and high-performance health system.... Any additional layer or layers of management between front-line staff and the president and CEO must add value to Alberta Health Services’ objectives of providing high-quality patient care and research....
“We do have a good system, but I believe that it can be significantly better.”
With the release of Davidson’s review, Horne admits concerns with the system’s administration cannot be dismissed.
“The consultation on rural ambulance services, the home-care process and food services for seniors in continuing care are three examples of issues that have demonstrated the need to revisit the question of the organizational structure of this large organization,” he said during the conference.
Eagle, the president and CEO, promises “you will see far fewer senior leadership positions” once AHS has finished its own survey.
“We will review every management position from the front-line to the top of the organization to ensure that each supervisory position actually adds value and not just more bureaucracy,” Eagle said at the same press conference.
Opposition parties quickly issued statements in support of the government’s acknowledgement of structural problems at the senior level, yet many criticized it for taking so long to act.
“I’ve always said there are too many managers managing managers,” says Alberta Liberal Leader Raj Sherman. However, the party contends the changes cannot stop at the senior level, and that there must be “a dramatic reduction in the numbers of middle managers at AHS and a serious investment in front-line staff” in order to combat the issues with AHS.
NDP health critic David Eggen pointed out that front-line positions continue to be lost at a greater rate than management.
“Just today we learned that AHS quietly axed its triage doctor positions in ER rooms across Edmonton,” says Eggen. “Nurses and other health care professionals are being laid off daily.”
“I don’t think shuffling around a few senior health executives at the top of our giant bureaucracy is going to mean very much in the way of treating more patients,” Wildrose Party Leader Danielle Smith said in a party press release.
“Our health-care professionals are the glue that holds our system together and they have been very clear for years; we need more local decision-making…. Getting rid of five vice-presidents just doesn’t help,” added Wildrose health critic Heather Forsyth in the same release.
Davidson’s report does call for AHS administration to be split into north and south zones in the province. Government officials stressed that her review was strictly concerned with management issues, not overhauling the structure of AHS or decisions that would directly affect front-line staff.
Davidson has also been appointed Deputy Minister of Health as of September 10.