Health Authority Boards: take three!

In two recent commentaries I discussed what really are public policy issues relative to the formation and early days of the new Health Authority Boards whose membership was announced in Brunswick News just last week.  Having fired two previous boards and a CEO in what some critics in the public referred to as an unceremonious manner, the process was put in place for the appointment of successor boards.
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From the description of the appointees in the news, it looks like a very strong group of people with an interesting mix of business skill, some with some health care background, others with a healthy variety of backgrounds.  With a person with strong clinical background as chair of Horizon and a strong successful business executive at Vitalite, and with the requirement in the legislation that the two boards collaborate, the future months and years could get really interesting.

Having advocated for reform of the governance model for the health authorities for over 5 years, both publicly and privately, and having invested my life in the reforms of 1992 that eventually got forgotten, mine is more than a fleeting interest.  The only thing standing between all the issues of concern to the public and successful correction is knowledgeable, informed, strong leadership.  Money and resources are not the issue now nor have they been for many years. 

When this new board, re-constructed with new legislation, new methods of recruitment and appointment of members, Chair and CEO, gets down to business they will have to accelerate their learning curve at several levels.

First of all, for those with no background in directing health care programming, getting totally briefed on the issues of priority to the board along with the mountain of due diligence information, legal responsibilities, infrastructure, and more.  Being a member of a non-profit that requires one or two brief meetings periodically and a few hours per month is not what this is.  The issues are large, important, of real concern to the public, and constitute pretty complex public policy issues.

Changing public policy is not for the faint of heart and particularly not so in New Brunswick.  Everything in NB is political, even important matters that should not be in the political arena somehow get there.  I remember discussing an internal matter at DECH with one of our good managers who said:  I can chat with the Premier about that; I see him most days on the way to work!  Coming from Ontario where interaction with provincial politicians, particularly at a senior level, was a very rare occurrence, this was my wake-up call to life in our beautiful province!

Priority issues for the public, based on what has appeared in media and has been conveyed to politicians in the last decade include:

• Primary Health Care:  thousands of New Brunswickers still have no access to effective Primary Health Care. And many who do experience difficulty evenings, weekends and holidays when people often need help.  After-hours clinics have sprung up in many locations across the province over the last 20 years but are not even close to a substitute for organized, quality primary care.    Informed people have advocated for integrated, multi-disciplinary primary health clinics that could take on some of the characteristics of the Sault Ste. Marie model or the Taber, Alberta model.  There are some models springing up in NB and they need to become the gold standard for integrated primary care.  Urgent Care needs to be part of the solution but New Brunswick has shied away from that “hot potato” for decades while other centers have advanced.
  
  

The Department of Health cannot fix this; new thinking, new leadership, perhaps engaging some outside assistance knowledgeable in the field to negotiate new arrangements with physicians and NPs; Graham Scott, for instance, is a talented, experienced lawyer and former Deputy Minister of Health in Ontario who has been called upon by government to deal with some very difficult, challenging situations that normal processes could not handle.

• Health Human Resources:  isolated strategies at recruitment of nurses and doctors are essential when in a crisis; but they tend to be expensive, band-aid solutions.  Both health authorities have initiated culture reform processes which are in their early stages.  But both boards need to come to understand why Jim Sinegal, founder of Costco, stated emphatically that “culture is the most important thing…!”    The Magnet Hospital movement initiated by the American Nurses Association back in the 1980’s is another model that is worthy of examination.  But sustained culture reform, the kind that makes these health facilities magnet workplaces, can only take place if the governing board understands its priority, the elements of reform, and the presence of an infrastructure to execute and manage.
• Aging in Place/Long Term Care:  Filling hospital beds with frail elders, to the point that the Emergency Department gets backed up, is simply a manifestation of lack of planning, programming and sound management.  These issues have been growing for 30 years and the care of frail elders is not the same as caring for acutely ill patients.  The “fix” involves overhaul of long-term care as well as the strategy dealing with Primary Care.  Dealing with Aging in Place in isolation of fixing all that is in need of overhaul in long-term care is just wheel-spinning.
• Addictions and Mental Health:  We have heard about Mental Health issues, service deficiency, and the rapid growth of addictions and addictive behaviors for years and the problems are huge.  Serious progress has been reported in the rapid response process for which Social Development and Health Service Providers are to be commended.  The challenge for the new boards is to ensure that the strategy is firmly rooted, that it is competently led by persons with leadership skill and the support required to continue the major progress.  There has been such a long history of low priority that there is much catch-up to do.
• Access to Surgery:  Serious improvements are reported in recent months while we still hear stories from surgical specialists about the tiny amount of surgical time, they have each month in the Operating Room.  A recent case reported to me saw a serious deterioration in the condition of a middle-aged lady whose surgery, not orthopaedics, got bumped for a few months.
• Create a Connected System:  Long before the reforms of 1992, the Saint John Regional Hospital became the leader in the province with a state-of-the-art integrated computer system that required physicians to engage.  Years later, in the early 1990’s, John McGarry, them VP of Finance for Region Three, led the work implementation of technology in Region three.  In the years since the 1990’s, and with the turnover of leadership in the health authorities, there has not been a consistent approach to developing a truly comprehensive system that would easily allow the paperless transmission of data, bookings, correspondence between professionals, much less a link for patients to see their information.
  
  

The intent of the 1992 reform was to do exactly what government in 2021, finally, said should happen.  Wasted years. Leadership and focus needed.

The new health authority boards have little choice but to initiate steps to make sure there is traction on these issues, that the infrastructure is in place to support it, and to move heaven and earth to accelerate progress.  Government has, in the recent past, promised reforms; having promised and having put the governance structure in place to get there, I would wish them the best of success; it is a daunting task.

The first couple of years will be time-consuming and challenging for the new board as it was in the 1992 reforms.  It is a game of catch-up.  They will have to be persistent, strong, assertive.  Public expectations are running high.

Ken McGeorge,BS,DHA,CHE is a retired career health care CEO, part time consultant, and columnist with Brunswick News, and author of Health Care Reform in New Brunswick; he can be reached at [email protected]