President's Message

Dr. Chris Eagle is the COO Urban. At a recent meeting, I heard him lament the fact that communication between Alberta Health Services and physicians has been inadequate. I invited him to remedy that by coming out and speaking to the physicians of the Capital Region and he readily agreed to do so. A few days before our meeting, Dr. David Megran was appointed Senior Medical Executive and accompanied Dr. Eagle to the meeting. Both of these physician administrators addressed the audience, outlined their backgrounds and spoke of the challenges that lie ahead.

We were also joined by Dr. Raj Sherman, MLA and Assistant to the Minister of Health and Wellness. He was able to provide government perspective on the evolving change in our healthcare system.

Between the 3 individuals who spoke, several challenges were issued to physicians of this region.

If I estimate the meeting attendance at one hundred, I suspect this may be a little generous. I have seen less at other general meetings, but I had hoped for more. Where were all the members of the medical staff of this region? Did we choose a bad night to host this event? (The Oilers played Dallas that night. Maybe everybody stayed home to watch the game?) Perhaps it wasn’t advertised well enough? (I find this a little hard to believe as I know that Laurie in the CRMSA office sent out multiple reminders.) Or, is it, as I fear, due to a combination of factors that led Dr. Richard Bergstrom to describe our collective morass in last month’s newsletter as being “retired on the job”.

Dr. Chris Eagle is a former cardiac anesthetist from Calgary who held several administrative positions including Professor and Chair of the Department of Anesthesia, Residency Program Director for Anesthesia, Chair and Chief Examiner in Anesthesia for the Royal College of Physicians and Surgeons of Canada. He undertook an MBA at the University of Western Ontario and held several key administrative positions in the Calgary Health Region, including Chief Information Officer, Chief Clinical Officer and, ultimately, President and Chief Operating Officer. At our general meeting, he spoke to the challenge of creating a new structure for the health care system after complete dismantlement of the system as we previously knew it. Though he was intimately involved in medical administration, the changes brought about were a complete surprise to him. Two months after dissolution of the previous system, he was appointed COO Urban and charged with trying to put a system back together. Major challenges include re-establishing a structure, the connections that will link us all within this new world while respecting and restoring the unique culture that exists within healthcare. This merger involves 12 large organizations and approximately 85,000 employees. Though business mergers happen all the time, I doubt that any business school or MBA program would advocate for the kind of change process that we’re undergoing currently.

Dr. David Megran is a graduate of McGill and pursued Internal Medicine and Infectious Diseases training in Toronto and Vancouver, respectively, prior to establishing a clinical practice in Calgary. He has served as a Program Director for Internal Medicine and was the Chair of the Medical Advisory Board in Calgary prior to being appointed as the Senior Vice President and Chief Medical Officer of the Calgary Health Region in January 2005. As noted, Dr. Megran has just been appointed Senior Physician Executive. My sources tell me that he is smart, fair, principled and a superb clinician; in other words, just the right combination of talents for the most senior physician position within our new healthcare system. We understand that he will report directly to the CEO and the Board of Directors of AHS. Dr. Megran has some formidable tasks ahead of him. We are currently without any medical staff structure in this Province. Moreover, there has been precious little medical input into this massive restructuring of healthcare. We desperately need an appropriate structure to allow for medical staff input into every decision affecting patient care. Dr. Megran needs to put a process in place immediately to begin appointing individuals to key physician leadership roles. He must also address the issue of the Medical Staff Bylaws, the critical document governing the structure and interaction of the medical staff with administration to facilitate delivery of quality patient care.

Thus, the challenges are many and difficult. I fear that the challenge in the Capital Region may be somewhat greater from those in other parts of the province. A senior physician from this region asked Dr. Eagle why we must go through all this upheaval when Capital Health was providing excellent care and was repeatedly recognized as the leading health authority in Canada. A reasonable question, one that likely resonates with many in this region. The reality is that we have done well but there were significant shortcomings in the way we have been delivering care. Emergency Department overcrowding, as a barometer for the entire system, has not improved, and has likely deteriorated.

This was recognized by the CRMSA last year in establishing the Acute Care Advisory Team (ACAT) under the leadership of Dr. Tim Gillese. This group met several times prior to the dissolution of the region and held our previous CEO and administration accountable for this problem and its solution. These problems continue and may well be the worst they’ve ever been in the recent past. We have a crisis in long term appropriate housing for seniors. While some programs within the region thrived, others are struggling. Though some areas were very well regionalized, I’m not sure we were as regionalized and integrated as we thought we were. Thus, we have challenges and though we repeatedly heard that “We are the Best”, I’m not sure that the reality always mirrored the message. Significant challenges lay ahead and Dr. Eagle delicately pointed out that many regions in the Province were headed for financial ruin if changes were not made.

The biggest challenge of all, in my view, is what I perceive to be a lack of engagement by the physicians of this region. I think there are several reasons for this. First, I think there is a general sense, as expressed above, that we have been the best and what we had has now been destroyed. I, too, have been proud to work within Capital Health and have enjoyed our strong working relationship with our administration. However, it’s time to turn the page. It’s time to move on because this ship has sailed. Second, I have heard from several individuals that this experiment in healthcare reform will crash and burn. Why would we invest our time and energy in a reorganization doomed to fail? After all, this is exactly what happened the last time. The first CEO and Board of this region were dismissed after 2-3 years and only then did the rebuilding of our dismantled healthcare system begin in earnest. At times, I confess, I have shared this defeatist approach. However, I am now somewhat buoyed by the appointments of individuals such as Dr’s. Eagle and Megran. I have asked around and I do believe that these individuals are the right people at the right time. I am also encouraged by the recent appointment of our new CEO, Dr. Duckett (more on that in a future newsletter). Third, concern has been expressed that there appears to be a power shift and that the individuals highest within the current food chain (organizational chart) are from Calgary. As a native Calgarian living in Edmonton for most of the last 25 years, I don’t share that paranoia. We need the right people to step forward for the right positions, regardless of their postal code. What concerns me the very most, however, is that I fear that Richard Bergstrom is right and that many of us have truly “retired on the job”. There is a tremendous amount of apathy out there. There is clearly a sense of déjà vu, and that we have been through this before. Admittedly, it’s a little hard to muster much enthusiasm when we seem to be going through the mid-90’s all over again. I also fear that many of our colleagues are just so busy trying to care for patients in a very taxed system that we just don’t have time to surface for air or attend a medical staff meeting or get involved with reorganizing a system that most of us thought was pretty good to start with.

What I heard repeatedly at the Medical Staff meeting on February 19, 2009 is that there is a critical need for physician engagement and leadership NOW. I know that medical staff from other regions have stepped forward in some areas but the Capital Region staff is holding back. I guess we can either get involved and try to help steer this ship, or we can wait for it to sink. I’m just not sure I like the second choice much because the alternatives aren’t necessarily appealing, either. I do believe that there are some wonderful opportunities to re-shape the way we do things, improve access, and improve quality by streamlining and enhancing efficiency. This will take a major restructuring of how we do things, and who does them. The projections for the healthcare workforce are frightening; we will be desperately short of all healthcare workers into the future. It would behoove us to recognize this now and begin strategizing for how we may better work within multi-disciplinary teams to provide the healthcare of the future.

In the next few months, the CRMSA will be holding more Town Hall General Meetings. These will be your opportunity to come and hear directly from those most connected to our healthcare restructuring. I challenge you all to get involved and get engaged in this process.

Dr. Raj Sherman, MLA Edmonton-Meadowlark- CRMSA Guest speaker
What is Government doing to our healthcare system? Bring your tough questions!"
We know what they are NOT doing, come challenge Raj. What are you going to promise and when is it going to come?
When will ER's have the capacity to care for patients? When will Albertans have a Family Doc, referrals in a timely fashion? This is all about money, show me you care about patients.