​The Case for Civil Service Overhaul

New Brunswick is a wonderful province in which to live and retire!  Its assets and attractions are many ranging from beaches, beautiful and breathtaking coastline, great hunting, fishing and other outdoor sports, cities with wonderful walking trails, churches, academic institutions and ever so much more.  It was identified in 1992 as a province in which the health care system could become a model for the country.

Despite its qualities and attractions, highways and streets and related infrastructure seem always in need of major overhaul.  And the health and long-term care system, despite the years of talk of reforms, still seems stuck with many issues that impact quality health and long-term care.  Indeed, the TJ article on June 6.25, written by Andrew Waugh, reported that national comparisons show NB as the worst performer in Canada in terms of Emergency Department wait-times. 

It is clear that emergency department wait times, organization of and access to primary care, and long-term care are all very much interconnected services.  For anyone desiring to make a difference in our health care system, that is the first thing they need to understand.  These inter-connected relationships have been documented in the literature for half a century!

At election time, attention always goes to those seeking office with strong pressure from the public to promise to fix these things that have been so bothersome to the public for decades.  Once elected, it often seems to take light years to get even the most obvious small change made be it dangerous road conditions or more than obvious “fixes” for the most basic of health and long-term care issues.

In my own career, I invested the first half of my career in two other provinces where I had the honor of serving in what would now be defined as “prestige teaching hospitals”.  It was a great experience in both provinces to serve leadership roles as we advanced the direction of these institutions and getting that done with the cooperation and support of local and provincial governments.

Then I moved to DECRH in 1990 and got my wake-up call.  I soon learned that in NB, there is an entirely different culture that pervades everything health and long-term care.  Unlike my previous experiences, the presence of government in every aspect of hospital operation was profound.  Never before did I have to seek permission from the regulators to execute some very basic executive functions.  What I discovered was a level of government micro-management that I had not experienced in Nova Scotia or Ontario.

Long-term care has been a challenge forever and compromised when it was taken from the Health Department and established as part of the Social Services structure.  Long-term care is about providing not only accommodation but total health and social support for frail elders and persons with other challenges that prevent them living safely at home. 

The most basic organizational issues that could lead to major system improvement never seem to see the light of day, or so it seems.  Why else do the same themes appear in “senior and long-term care plans” created by each government in the last 20 years?  The same themes but without action-plans and deadlines.  Meanwhile, senior care suffers undeniably.

Whether Long-Term Care returns to Health or whether it resides in an independent department is not at all the issue.  The issue is:  these services are so critical to the population (they are absolutely essential services) that not only should they be provided, managed, directed, and led by persons with specialized training and experience, but the time has come for that same requirement to be applied in the regulatory structure. 

In organizational development, those in leadership are trained to look for persons with “requisite knowledge, training and skills” as the organization is being developed.  They commence with a clear statement of vision and purpose and all else follows from that.

When the Edmonton Oilers decided to create a Stanley Cup contending team, they did not take anyone who expressed and interest in hockey even though they may have done well in recreational hockey.  On the contrary, they painstakingly have sought out leadership that really knows the game and surround leadership with the array of talent required to compete and win (strong, experienced, and people with the strong drive and determination to win).

In organizational books that line the shelves of great leaders, authors describe how focus on “requisite skills and talents” applies to service and production organizations as well as public services.

The regulatory structure in NB did recognize, in 1992, that health and long-term care was on a collision course with survival.  And they successfully convinced the political structure that the issues were such that action was needed not in the future but now!

In the those days, health and long-term care departments were directed by persons who had experience and training in health and long-term care.  Not so much in the last 20 years.

The people who fill the valued positions in the civil service do so with the greatest of intentions and are, for the most part, excellent people who want to do good work.  I have gotten to know many over the years.
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But it is the system that, at least in Health and Long-Term Care, is the obstacle and politicians take the heat and the blame for those system failures.  To issues of long wait times, overcrowded emergency departments, access to primary care the public is tired of hearing the lame excuses such as “well, every other province is experiencing that…...!”

That, for the most part, is true but they don’t tell the rest of the story which is:  they generally are doing something about it!

How can government finance a Primary Care division (not cheap) for 25 years and still have so little to show by way of progress?  How is it that provinces surrounding NB are attacking the home care file with specific strategies that had an immediate impact within months!

Minister Dornan is wise to commit to Collaborative Care as a model for Primary Care.  New Brunswick has such a long-road of catch-up to do that it will be many years before there is measurable impact on over-crowded emergency departments.

Or how about the issues defined in the Lamrock Report that actually are sobering if not disgusting!   Why has it taken 8 full years to get a Dementia Strategy that is only half a strategy.  Some outside the system have consistently said that the civil service itself cannot create a meaningful strategy but a team of knowledgeable and experienced persons could do it in a very short time…. but not 8 years.

From feedback that I have received from respected persons who have played strong roles in other departments, it would seem that there may be some common threads here that government would do well to investigate and act on, but only if there is a rock-solid commitment to reform and improvement in public service.

They would do well to start by identifying factually the factors involved in high turnover of key positions, issues of relevant leadership development, the extent to which the concept of requisite skills and preparation form the centre core of position descriptions and mandatory requirements.  I acknowledge that this is a bit harsh but our system must take whatever steps required, controversial and annoying as they may be to some, to ensure that baby boomers and all who follow have a hope of experiencing a health and long term care system that has consistently better performance scores.

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 [email protected] or www.kenmcgeorge.com