Capital Region Medical Staff Association 

Dr. Mark Joffe, President’s MAY 2009 Newsletter

Welcome to Alberta Dr. Duckett!

On March 23, 2009, Alberta welcomed its new President and Chief Executive Officer of Alberta Health Services, Dr. Stephen Duckett who will lead the healthcare system of Alberta as we morph from 9 health regions into one. 

Dr. Duckett’s training is as a health economist.  He has a significant background in both health administration as well as in academics and health education.   He held a variety of positions within the Australian health system prior to assuming the position of Professor of Health Policy and Dean of the Faculty of Health Sciences at LaTrobe University, one of the largest providers of health professional education in Australia.  In 2005, he assumed the position of Chief Executive of the Centre for Healthcare Improvement in Queensland Health. 

Dr. Duckett assumed his position in Queensland at a time of some turmoil within the public health system.   The Bundaberg Scandal emerged from a combination of factors but reflected profound malaise within the healthcare sector and raised serious issues related to quality of healthcare delivery.  The healthcare bureaucracy lacked accountability and needed revamping. Clinical Practice Improvement Payments were introduced as a means of linking funding to quality outcomes in healthcare and we should anticipate introduction of process and outcome benchmarks with payment to reward excellence.

As an academic, Dr. Duckett has written extensively; he has 125 peer-reviewed publications to his credit.  This opportunity to read what he has written and what he thinks is a refreshing change, just as is the recognition of his formal education and PhD, unusual for a Government that seldom seems to value a formal education.  (Why else would we have the lowest graduation rate from high school of any province in the country?  But that’s a topic for another day.)

Dr. Duckett has written extensively about the Australian Health Care System and health reform.  In particular, he has written volumes about defining performance measures and rewarding quality and safety.  He succeeded at ensuring that a very large number of healthcare workers participated in a quality and safety training program in Queensland.  He has also written about equity in health care access and  about living in the “parallel universe”, the public/private mix of healthcare delivery in Australia (CMAJ 2005;173:745-747).

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As Dr. Duckett launches his career in Alberta, I would like to offer a few friendly observations and suggestions to ease his transition and ensure success:

1.      Revamp the Mission Statement -The current AHS Mission Statement reads something like, “Get Your Healthcare Fast and Cheap”.  Admittedly, nobody reads mission statements anyway and they can’t be all things to all people.  However, I’d like to see something that inspires, perhaps something about quality, innovation or the importance of teaching and preparing the next generation of healthcare providers.

2.      Seek Clarity on the Roles of AHW vs AHS - I am confused about the role of Alberta Health and Wellness in the new world.  AHW used to coordinate and mediate between health regions.  This role no longer exists.  I understand that AHW should define policy while AHS operationalizes it.  However, from experience (including Swine Flu), I have concern about uncertainty between roles and that policies, standards and directives may come from AHW, with duplicate or contradictory ones from AHS.  In many areas, the expertise now resides in AHS (as it should) and not within AHW.  Surely this is an opportunity to streamline.  I appreciate that an all out battle with the funding source isn’t likely what a new CEO would look for but I think savings and efficiencies are to be found and the role of AHW needs serious re-thinking.

3.      Review the Organizational Chart - The current AHS organizational structure is extraordinarily complex and doesn’t always reflect natural referral patterns or hospital realities.  Geography is important and can’t be ignored.  The current org chart reminds me of the wiring of my home theatre system – it’s extraordinarily complex and a little mysterious and 5 years later it still doesn’t work – just what I fear for AHS.

4.      Involve and Invest in Physician Leaders -Good leaders surround themselves with good leaders. Involve physicians in this change process – not token, volunteer involvement but significant, compensated involvement with responsibility and authority.  Invest in creative, dynamic physician leaders.  They’re out there, though they may be hiding, immersed in the increasingly difficult task of providing quality patient care.  Identify physician leaders, encourage and fund administrative training where appropriate and fully involve the physicians of Alberta in creation of a workable healthcare system.  When patients are sick and injured, they do not seek out a health administrator, they seek their physician or, increasingly, multi-disciplinary teams that are led by physicians. Creative and innovative healthcare strategies and solutions almost always involve physicians.  Or, to state this another way, physicians make the fundamental and expensive decisions in healthcare – what investigations to order, who to admit to hospital and for how long, whether to operate and what kind of operation, and when a patient can no longer work to support themselves and their family or return home to care for themselves.  As we reform the system, those making these critical decisions must be directly involved.  As you have written, “To influence their own destiny, doctors need to participate in the design and management of healthcare reforms that are targeting value for money.” (MJA 1997; 167: 184-185 )

5.      Invest in People and Infrastructure During this Time of Transition -Dr. Duckett and his administrative team face a daunting task – how to reform the healthcare system at the same time as we face a global economic slowdown and a massive deficit within the healthcare budget?   This will take immense creativity and some goodwill on behalf of AHW and Treasury.  This is a time for investment in our healthcare system – a need to build, integrate and enhance.  We need to take the best from all areas of this Province and expand.  This will take time and considerable investment in both dollars and people.  Rather than doing this, AHS has been freezing and cutting, and many good people within the system have left.  This is not the time to be letting creative, dedicated, competent and talented individuals go. We need change management and transition; this will take some investment, investment that will surely pay off in the future. There will be rewards to reap and efficiencies to be had.  However, this difficult transition period will take investment and creative people working hard in order to make this happen.  We cannot do this on the backs of those already overtaxed within the system.  We’ve seen and lived through the slash and burn strategies of the ‘90’s.  It didn’t work then and it won’t work now.  Let’s do it right this time.

Dr. Duckett, this is our system and we want to work with you. Never forget that this is about patients and patient care.  Change in the system should facilitate access, quality, efficiency and effectiveness.  Ultimately, what is good for patients is almost certainly good for the system.  Alberta has a spirit of creativity, ingenuity and getting things done.  Let’s do this together and make it work.  There are opportunities to enhance programs and efficiency.  Let’s get on with the business of streamlining healthcare in this Province.  The Physicians of Alberta want this to work.  The Patients of Alberta need this to work.