Unwise Choices?

At age 26 I had the honor of being named Acting CEO of the IWK Hospital for Children in Halifax.  It was brand new with all the bells and whistles on University Avenue.  This opportunity came after the NS government had sponsored my education in Hospital Administration at the University of Toronto.   I was available when IWK needed someone for 18 months after which time they were successful in recruiting a more seasoned, experienced CEO to guide this superb organization.  It was a delight, at that age, to rub shoulders with the Goldbloom’s, Gillis’, Grants, Ernsts, Ross’s of the world, all who taught me so much about what it takes to make a hospital great and perform at world-class standards.
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Fast-forward to Halifax Infirmary at age 30, a 418-bed teaching hospital just purchased by government from the Sisters of Charity where my job was to guide the organization thru the transition to becoming part of the public hospital system.  That presented large challenges and opportunities in managing the evolution from one set of cultural norms to a Crown Corporation model.

Then at age 36 I was invited to accept the President and CEO job at one of Canada’s prestige teaching hospitals, Kingston General Hospital.  As a major component of the Queens University Health Sciences Complex, this hospital did some landmark work in transplantation, joint replacement, rehabilitation, high risk pregnancies, open heart surgery and more.  Many staff were also important elements of the medical, nursing and rehabilitation education programs including the CEO who had the privilege of presenting to medical and graduate students periodically.

In all those positions, and others that I held, training and certification of knowledge were highly respected and most of my colleagues, both within the hospital system and the governmental system with which we worked, had training and experience in similar programs.  Both practitioners and civil servants spoke a similar language which was a great help in getting the work of directing excellent health care programs manageable. Not only did we enjoy a common body of knowledge but a thesis requirement in addition to oral examinations before a team of peers who could tell if you had it or not!

In 1990, however, I responded to the lifelong dream of someday returning to my home province where my in-laws were living, where other family lived, where I had my initial training as a nursing orderly at old VPH in the early 1960’s.  The DECH had just been in the new building a short time, the CEO was retiring, the hospital had endured many months of front-page publicity with a human resources dispute that was supposed to have been dealt with.  So, I was invited to serve as the new CEO effective September 1990.

The price for living in Fredericton to be near family was a 40% reduction in compensation.  In those days, compensation for hospital CEOs in NB was dreadful and was tied to some junior civil service scales.  But it was important to be home, so home we came.

Thus started the culture shock!  New Brunswick hospitals have never been managed in a manner to which I had been accustomed in Ontario and Nova Scotia.  Hospitals in NB were classified as Part 3 of the public service, technically outside government direct involvement while “enjoying” the constraints imposed by governmental regulations.  I soon learned that the scope of authority in running a New Brunswick hospital, particularly a regional hospital in the provincial capital of a small province, was severely limited relative to the two other provinces in which I worked.

In both provinces, CEOs functioned as CEOs; as the name implies, they were paid as and expected to be leaders, making decisions within the bounds of by-laws, regulations, budgets, legal frameworks, constraints of the many professional and external factors that influence decision-making.

Directing a regional hospital in the provincial capital in which the hospital sector was defined as Part 3 of the public service was an arrangement with constraints that I had never experienced, even when directing a Crown Corporation in Nova Scotia.

I soon learned that, particularly in Fredericton, most professional staff knew many of the political leaders and seemed to have close connections to them.  Basic and reasonable administrative decisions were, I found, often outside the reach of the CEO or board.  Much of what dictated the operation of the hospital had its roots in government policy. 

Sure enough, in February 1992, after many reports and years of discussion, the Minister of Health rose in the legislature to announce the dissolution of all hospital boards and replacing them with 8 regional boards.  Commencing July 1, the regional boards commenced a unique journey never done before in Canada; I had the honor of being the CEO of the Region Three Hospital Corporation.

The COR and Conservative Parties quickly took aim; now the recommendations of consultants for decades became a bad idea because the McKenna Liberals had decided to make it happen.  In the provincial capital, the Region 3 Hospital Corporation was quickly in the cross-hairs of any seeking political exposure.  While opposition in Fredericton was not significant, the rural communities felt very threatened with the combination of doctors, nurses and would-be politicians stridently opposing even the most innocent and positive actions taken by the new corporation.

Nothing in grad school training or experience in hospitals or government in other provinces was preparation for the response to this.  But it was, despite the opposition, the right thing to do; hospitals were all struggling financially and in other ways and needed support.

Then there was the provincial election of 1995.  Election preparedness always involves shedding sources of visible distress and it fell to me to leave this visible role.

The very capable John McGarry, one of the strongest financial analytical minds in health care, who had been the VP of Finance, was soon appointed CEO.  So off to a new career in another city and province for me.

Since those days, much has changed in other provinces but the primacy of training and experience remain.  Training programs in BC, Alberta, Saskatchewan, Ontario, Quebec and Nova Scotia prosper and make great contribution to health care policy.  A focus on education and training for those in leadership and establishment of operating systems that put Excellence in service first would be a great first step.
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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