In May 2021 we will go to the polls to elect our municipal council leaders in New Brunswick. I have great admiration for all who are putting their hats in the ring; serving in municipal leadership is not as glamorous as other highly visible appointments might seem but the issues are serious, particularly in these days of social and political change and unrest.
Following a career spanning 50 years in health care leadership in three provinces and now with the added exposure of multiple post-retirement assignments, including writing columns for Brunswick News, a few have suggested that I run for a seat on the health authority board. That was from the few who actually are aware that some health authority board members are actually elected in the Municipal election process. Some say that my columns and book help them to understand issues that otherwise are dealt with in brief news articles or video clips.
I did think about it……I actually got the nomination papers and had enough people to sign to make it legal.
But then along came my better judgement. I have served on many boards both national and provincial as well as local over the years. Those boards that really were exciting were those in which results and strategic goals could actually be achieved. We set a plan with timelines and made things happen.
Other boards on which I served were less exciting but important nonetheless in that their role was more custodial, overseeing the “due diligence of the organization.”
Some of my acquaintances have accepted appointments to boards in which the organization is really buying their connections and influence and pay the board member a handsome honorarium for so doing. Such has not been my lot in life; all of my board assignments have been voluntary for the most part.
Health authority board members in New Brunswick do receive reimbursement for travel expenses and a small honorarium, nor large enough to be, in itself, a strong inducement to serve.
But the real issue is the role of the board and the governance model of health authorities. The Governance Centre of Excellence published a Guide to Good Governance, second edition, about 8 years ago. It was developed because of the large-scale mergers and amalgamations taking place in the Ontario health system with huge health care systems. This document outlines the principles of governance excellence in terms of board structure, accountability, community engagement, and more. One key element it emphasizes is that real boards in health care need to be “skills-based boards”, not politically appointed nor elected per se. That is consistent with my observations over the years.
Successful, head-turning health care organizations tend to attract persons of influence and professional skill.
There is a huge body of literature describing the characteristics of governance excellence offering counsel on vision, goals, structure, CEO selection and performance management, executive succession, corporate/workplace culture and so much more. To the question of how should a large health authority be structured so as to ensure sustained effectiveness, the answers can be found with just a bit of digging.
When the health authorities were created in 2009, government was faced with a huge dilemma, though. Managing health care excellence is not for the faint of heart and requires a disciplined approach to adhering to best practices, managing and directing continuing change, and creating a corporate culture that rewards innovation and change.
Government, however, had to adhere to the political imperatives of New Brunswick which require that democracy prevail in the board structure, that many/most key positions are politically appointed, and that the CEO serves not at the will of an effective board but the will of the Minister of Health. In practical terms that has meant serve at the will of the Premier’s office. Thus, since the creation of these large organizations, Vitalite and Horizon, we have boards of directors composed of great people who want to have influence but who, in reality, seem to have little influence.
Since 2009, only 12 years ago, there have been three CEOs in each health authority. The rule of thumb has been in such complex health care organizations that a CEO would be appointed for an initial 5 year contract renewable for a subsequent 5 year term based on achievement of performance goals. But of course, achievement of key performance goals assume, in New Brunswick, that MLAs, the Premiers office, the Ministers office, and the board are onside with what is proposed.
Which is another problem. With the greatest of respect, there is no way in the system of New Brunswick provincial government that elected officials nor cabinet can become totally familiar with the real issues of excellence in health care and how to achieve and sustain program excellence. To the credit of the health authorities, a great deal of clinical excellence has been achieved, particularly with the Heart Program in Saint John and the Cancer Program in Moncton, and more. But the plan of the early 1990’s was that by now many clinical programs would be achieving the level of program organizational excellence demonstrated by these. The Horizon leadership has been discussing that for a decade or more.
At the end of the day, the public seems pretty content with key clinical programs and they know that if they are taken with major trauma, head injury, or cardiac emergency to any of the regional hospitals they will be exceptionally well served. The major concern for the public, however, is with overcrowded emergency departments, after hours or urgent care, primary care generally, wait times for access to care, long term care and those brutal wait times in hospital for placement. They are also most upset with the mental health system as witnessed by the recent publicity and related publicity over several years.
What about workplace culture and the alleged abuse of sick time and workplace culture? The board cannot, itself, fix those problems but it can insist that they be set as a priority for change.
Can the health authorities fix these issues? Probably not. Should they be able to? Yes indeed. Getting to solutions for the mental health system or to the urgent care/after-hours service and primary care is not for the faint of heart. Some very difficult conversations and negotiations need to take place and that is tough and risky for those without a golden parachute.
But these are old problems….over 25 years, to be truthful. How could I sit for a moment on a board of directors knowing that wait times in emergency can go to 10-12-14 hours and not get that problem fixed? How could I serve knowing that we have the highest rate of Alternate Level of Care patients, 30% of acute care beds, knowing that there are vacant long term care beds in the system not being accessed efficiently?
The reason is, apparently, that the fix of those issues seems not to be within the purview of the boards. What is within their purview is to push governmental leaders to change whatever needs to be changed, be it legislation or regulations or practices, so that the influence of the board can be applied to fixing important public service problems.
So I am not filing the paperwork to run for a health authority board; I think it would drive me crazy.
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 firstname.lastname@example.org.
Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.