The deficiencies and issues that plague the NB Health System, growing for 20 years, have been well discussed in these columns and those of other esteemed columnists. Now we are at the point where, in the judgement of government, serious action is warranted that has a serious impact on people within the system.
We have been hearing much about the over 65,000 New Brunswickers who have no access to effective primary healthcare; and we have heard about the major changes that have taken place in medicine that contribute to what the public believes to be a shortage of physicians. The issues in nursing have been brewing for years and seem to have come to a boil.
Thankfully, amidst the apparent chaos, great care is given every day to people in legitimate need, when they can get to care. Miracles happen every day in Emergency Rooms, OR’s and other key areas of the system.
But what of the members of the boards of the health authorities who suddenly disappeared? These may be your neighbor, curling buddy, member of your political party…all great people who, no doubt, accepted the appointment to the governing board believing they may contribute in some way to improving the health system. However, they got there, whether elected in the municipal elections or by being favored by the party in power, all had the same goal, I expect. I know only a couple of such members, and know them to be persons of integrity and honor.
So why, all of a sudden, out of the blue are they gone, only to be replaced by a Trustee who apparently has the power of the full board, and maybe more. And why, at the same time, did the CEO, a respected specialist physician with Masters Degree in Business, find himself out of that office? Then in the Department of Health, a department that has had struggles getting its feet planted and worn down by the pandemic, several persons at senior level were suddenly moved to other assignments and replaced by other people with, perhaps, different skills.
Someone somewhere must have a plan although that seems unclear to the public and to interested observers.
In 1992, the last time New Brunswick saw major reform, a plan had been developed in the Department of Health that involved dismantling local hospital boards and replacing them by regional boards. Those who were selected to implement the hospital consolidation part of the plan at each region saw the plan that related to them. This was clearly the first step in health reform. Hospitals have been forever the main focal point of the health system as the place where serious health care issues land when the primary health care system has exhausted its services. So, it was natural to consolidate hospitals for many reasons, the dream being that eventually around local hospitals, as they change and change their roles, they would evolve to serve as the focus of health services in each local community and services would be knit together in a regional network.
This had been the vision discussed in Canada for thirty years prior to this major change and it was the dream of planners and regulators of health care services.
In the structure of the regional boards in 1992, initially each board was appointed by the Minister along with the Chief Executive Officers. With organizational development and maturity some thought that the boards could, through their by-laws, develop a method of replacing themselves with skilled people to govern. That dream did not materialize.
Then came 2008 and the merger of the 8 regional hospital corporations into two. Much public debate had taken place on the structure of the boards with many promoting elected boards while others promoted ministerial appointments. The structure of the health authority boards, as drawn, was a compromise and frankly, from the perspective of excellent governance, not a good model.
Large hospital organizations that have excellence as their mandate would never construct a governance model in this way. In the effective governance of large hospital organizations there are some key principles that are seen when you examine their organizations closely. First and foremost is a clear and motivational vision. That is followed by a brief mission summary. That all speaks, then, to the organization.
If excellence in care is to be the goal, then that commitment dictates how you appoint the board, the structure and skill set of the board, how board officers are selected and trained and by whom. It also speaks to how heads of clinical departments are recruited, appointed, terms of appointment, qualifications and leadership skill along with clinical pedigree.
These same principles apply to the description and engagement of all in any level of management in the organization. Each organization, not the provincial government, needs to understand national and generally-agreed standards of organization and management for such organizations and determine the degree to which they will establish clear requirements for appointments and engagement contractual relationships. For instance, in some provinces where universities have vibrant health administration programs, there seems to be fairly widespread acceptance of serious academic achievement as a requirement for positions of leadership and influence. There are, as well, serious programs available to physicians who have interest in leadership and organization and many of the great leaders in Canada are physicians who have been captivated by organizational leadership challenges.
Knowing national trends, having an eye on the future, understanding the real and serious issues of health care financing and organization are key responsibilities of the board members and it is the duty of the organization to make sure that continuous learning opportunities are not only available to board members but mandatory participation requirements implemented.
The board, understanding the weight of its legal, ethical, fiscal, and political responsibilities, must then recruit the strongest possible candidate as CEO. In so doing, they must prescribe performance expectations, contractual provisions, and severance provisions. It is serious business and not a business well done by government. The risks of making the wrong decisions are huge.
We live in an upside-down world and in addition to all that has been discussed in public, there are also many “elephants in the room” that do not get discussed openly; nor should they but the board, if it is doing its duty, must ensure that these “elephants” are recognized and given serious attention. One such issue would be the incidence of hacking and cyber-attacks. Hospitals are right up there with banks and all other organizations that store loads of dreadfully sensitive personal information on thousands of people. How safe is safe?
The entire issue of accountability within the system is another and it is huge. Organizations that employ thousands of people must have, in addition to great policies and great staff, a very clear line that enables each person to know exactly who is the person to whom they are accountable for professional performance, fiscal performance, policy regulation and more. In organizations that illustrate high absenteeism and frequent reported errors, those lines normally are not clear and well understood with discipline.
Reform is tough and not for the faint of heart. I know….my heart was toughened in the 1992 restructuring. Unpleasant, sometimes soul-destroying. But that is the price we pay for kicking the can down the road for 20 years.
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.