For well over a decade in New Brunswick, many informed professionals, some former senior civil servants, others former politicians, others informed nursing persons, have been sounding the alarm about the state of Health and Long-Term Care Services in New Brunswick. Disgruntled nurses and an impending nursing crisis was foreseen two decades ago, for instance. The overcrowded emergency departments have been a serious issue since the early 1990’s. Primary Health Care Services and the issue of “getting a family doctor” has been an issue for nearly two decades.
Some of these bright people offered their help to the Gallant government but that was not acknowledged. Then some of these folks, all feeling a sense of desperation, offered to support the current government, taking heart in the Premier’s commitment, nearly 3 years ago, to health care reform.
The early attempt by the government to initiate reform in February 2020 was ill-conceived and ill-informed and it did backfire in a big way. Then after a cabinet shuffle, a new commitment to reform was made with virtual public consultations as a major element. What was reported from the consultations seemed strangely similar to many of the messages that have been discussed by informed people for nearly two decades; that is, there was nothing new.
The public had every right to expect some bold action to implement reforms and the Task Force on Health Reform, consisting of two persons with history in health care and civil service, were set loose. Nearly a year later, the same public is hearing the same messages, the family doctor wait list is growing, not contracting, emergency departments are still overflowing, ambulance services in rural areas is still reported to be slow and unreliable. While much of the service in the system works very well, access to primary care, long term care, emergency service, specialty surgery has the public very concerned. That is in addition to the concern expressed by physicians, nurses and other health professionals in the system.
Some of the issues are not unique to New Brunswick; but there are pockets of excellence across the country and this is the time to figure out what is working and why it is working and where the success stories are.
Making the abrupt changes that the Premier announced is tough; tough on him, tough on the people that are having their lives and, perhaps, reputations questioned. But that is part of the system in New Brunswick where everything is political. I learned the hard way in implementing health care reform in 1992 and the lesson that some of us learned at that time is that in health care leadership in New Brunswick, you need to be able to take lots of heat and get accustomed to job insecurity.
That aside, what the media and the public need to know is that unless government wants to continue to tinker with symptoms in the system, getting to real change requires that government either take or authorize some key decisions. Great organizations have never been built on anything less than a total commitment to a shared vision. To create greatness in the health authorities, the vision needs to be clear with the roles of the key players specified and clarified, expectations and accountabilities and great performance indicators driving the bus. One of the painful elements of getting to excellence is dealing with people whether they are nurses, doctors, accountants or others who will not accept the vision and what it means for their performance. Some may be inadequately trained for the jobs required to be performed; others may just disagree with the direction on principle. Whatever it is that stands in the way of enthusiastic support for a clear and motivational vision needs to be dealt with. That means that a few may need to be excused and “allowed” to relocate to some other job opportunity.
Unions, who have an incredible amount of influence in the management of health authorities, need to come to the table along with management and, as challenging as it may be, a new set of collaborative relationships need to be created..now! Similarly, with the medical community, physicians need to emerge into leadership roles, taking whatever leadership training is required for them to serve as true leaders in their areas of influence.
Fixing the issues to which the Premier alluded in his press conference will not happen overnight, will require strong, decisive action, will make some uncomfortable, but after a few years, all will look back and say “we did it!”
How will it be different at that point? How will staff and the public know that major change has happened?
First, the vision will be clear to everyone and will be understood and enthusiastically accepted as the main driving force of the organization. Everything, from Emergency Department operation to booking to diagnostic testing is measured against the vision.
Secondly, all employees will know to whom they are accountable and for what level of performance. Performance management now becomes a positive tool in organizational change and those managers who currently are conflicted in being both management and union member will have some role clarification to do. This is not easy stuff!
Thirdly, absenteeism and worksafe claims will be reduced.
Fourth, the quality of the workplace atmosphere will be palpable starting with pride in performance, pride in appearance, genuine concern for every patient with their interests being placed far ahead of worker convenience.
Fifth, the commitment to performance review at every level will be real and consistent. Listening to patients and the public will be re-structured and genuine.
Sixth, the approach to Urgent Care will have excellence and structure, not simply “diversion clinics” but providing service to persons who have legitimate and urgent health issues that just don’t happen to be life-threatening.
Seven, training leaders will be part of the DNA of the organization. The CEO is the public face of leadership but an organization as complex as health organizations that employ up to 10,000 people in addition to thousands of volunteers a physicians working in a variety of roles, there are literally hundreds of people with major managerial and leadership responsibility at various levels. Some of these managers will have 20 people in their group, others will have hundreds of people in their sphere of influence. Just like Disney World and Holland America, every manager needs specific training far and above their professional and technical training in order to be equipped to do the job of managing people.
Eight, a governing structure that is based on populating a board of directors who have courage, understand the vast complexity of the system, agree to take serious governance training, and have a mix of training, experience and talent to guide these complex organizations. Getting elected in municipal election or being “on the right side of politics” does not qualify anyone for these complex governance roles.
Unlike the previous attempts at reform, government would be well advised this time to assemble the right team around key issues and give the public some assurance that the focus of reform will be on issues of priority to them. The job to be done cannot be done entirely behind closed doors. Public confidence is at stake.
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@example.com or www.kenmcgeorge.com
Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.