​Health Care Reform: It All Comes Down to Leadership

In 1995 when the government of the day was going to the polls and Hospital Regionalization was politically hot and risky, I was encouraged to move on from being CEO of the Region 3 Hospital Corporation.  For three difficult years, beds had been cut in rural areas, staff were laid off, and the atmosphere in rural New Brunswick was not ideal for an election.  Having been professionally trained and certified, and being still in the midst of a career that had been very successful in other provinces, I was happy when one of the strongest leaders in the province, Dr. L.D. Buckingham, invited me to work with him in Moncton.

I had admired him since we both were students in the early 1960’s so this was a great relief from the politics of health care reform.  But the job was not in health care, which had been my first love; it was in a Church in Moncton that had the reputation of being the fastest growing protestant church in Eastern Canada.  Indeed, under the leadership of Dr. Buckingham, the Moncton Wesleyan Church now had a reputation beyond Moncton and extending well into Canada and the U.S.

It was a welcome relief from the daily distress of press, layoffs and bed cuts to a work environment where I actually was able to help people, work with an energetic and visionary team, and feel some wonderful affirmation from people.  From CEO in health reform to Pastor of Outreach and Discipleship was quite a shift!

His first instruction to me in my adjustment was:  “just remember:  everything either rises or falls on leadership.”  The now legendary John Maxwell, author of many books and favorite speaker in North America on Leadership, a personal friend of Buckingham, had instilled that truism in him and he made sure staff all understood it! 

And so it is with Health and Long Term Care in New Brunswick.  That there is a huge issue with the public and for government goes without saying.  The question has often been posed by the public:  how did it all fall apart so quickly?  Why suddenly is there a huge list of “unattached patients?”  Why do people die in Emergency in such seemingly shocking ways?  Why is the scarcity of nurses and doctors such that Emergency Rooms close with frequency and those who are left use terms like “below an acceptable standard of care” to describe what they do?  Why does the list of persons waiting for long term care seem to be so constant and why do nursing homes, armed with good employee benefit plans and relatively competitive salaries, have beds closed due to lack of staff?

None of this “just happened” and, indeed, as Buckingham and Maxwell have said for years,  everything does rise or fall on leadership.  I am not speaking of specific people nor specific positions.  In the case of Health and Long Term Care, we have systems that are far too complex for the periodic tinkering of elected officials who feel the pressure to be seen to be making decisions in the wake of political challenges.  No, it is larger than that.

This is public policy at its core and public policy that governs such complex systems needs to be treated with enormous respect.  Consider two major decisions taken by governments in the last two decades.  First was the split of Health and Community Services from one gigantic department into two separate departments.  This was done during the term of Bernard Lord while I was comfortably back in Ontario!  As I recall from news clippings, there was a thought that the department was too large to be manageable, and it did consume well over half the provincial budget.  There were annual budgetary stresses as there have been since 1959 with health budgets and, I expect, someone thought that it would be easier to control costs if the department was split and had separate administrations and political leadership.

What was not considered, in retrospect, was that a major element of “Community Services” was Long Term Care which, as literature explains, is a continuum of the health system.  Indeed, one priority for the last few years has been the “seniors in hospital awaiting long term care”, otherwise referred to as Alternate Level of Care patients.

In retrospect, those public policy issues do not seem to have been clearly analyzed and thought through and NB is the only province in the country in which health and long-term care reside in different departments.

Another major policy decision took place in 2008 during the Graham government.  This government got a lot accomplished, but the funding of the 8 regional health authorities was an annual source of challenge at budget time.  The decision was taken to amalgamate the 8 regional corporations into 2 health authorities.  Serious public policy issues, in retrospect, do not seem to have been thoroughly assessed.  There has been serious discussion over the years over the structure, role and function of the boards as well as the appointment processes for board Chairs and CEOs.  Indeed, there has been instability in leadership and, according to news reports over several years, less than positive public satisfaction over things for which the boards should have some authority such as  the ALC issue, the overcrowded Emergency Departments, the Human Resources issues, most notably nursing and doctor recruitment and retention.

These both were huge public policy issues that seem to have been made through political processes in the absence of external counsel involving people with exemplary expertise in the structures and processes of successful large health systems.  In my past I have worked with some complex major teaching hospital centres and never would our organizations take decisions of this magnitude without a long and thoughtful process involving independent, sometimes international, expertise.

Prior to the 1992 hospital reforms, for instance, the prominent internationally-recognized firm of Llewellyn Davies Weeks worked for months in preparing the way and key recommendations for the NB government to follow.  And even so, it took years to find the right timing and array of talent to pull it off.
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Public policy drives public service; flawed policy drives flawed service.
Ken McGeorge,BS,DHA,CHE is a retired career health care CEO, part time consultant, and columnist with Brunswick News; he is the author of Health Care Reform in New Brunswick and may be reached at kenmcgeorge44@outlook.com or www.kenmcgeorge.com