At a time when central political rule over Alberta health care is complete and unquestioned, the system is suddenly expected to decentralize

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Alberta has the most centralized health-care system in Canada, and maybe the world. Now, it’s expected to somehow decentralize and give power back to local decision-makers.

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Chances of success rank along with winning the 6/49.

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Alberta Health Services has more than 100,000 employees but three people now run it with total authority — Premier Danielle Smith, official administrator Dr. John Cowell and Health Minister Adriana LaGrange.

Key decisions are made by Smith and Cowell, the hired hand who is supposed to be temporary but had his contract renewed ($360,000 for every six months.)

Mauro Chies, the CEO of AHS, takes his orders from this tiny politburo.

Alberta Health Services
Mauro Chies, president and CEO of Alberta Health Services. Azin Ghaffari/Postmedia

There’s never been a time in Alberta health care when political rule over the system has been so complete and unquestioned.

The premier fired the appointed AHS board and installed Cowell. She said they would meet regularly, collaborate and make the calls.

Conveniently, they declared before the election campaign that the health-care crisis is over due to their wise actions.

Any dissent in the top layers of AHS remained as contained as light in a black hole.

This trembling, timorous system is suddenly expected to decentralize, to give more authority to local institutions and managers.

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Muddle is already evident. Asked how she’ll implement Smith’s wishes, LaGrange essentially said she hasn’t a clue what’s to be done.

Re-create genuine regional authorities, the way most other provinces still do it?

Somehow give real local power to the five existing health “zones” within AHS?

Encourage a culture that lets local people make decisions, without fear of the central power in Edmonton?

Nobody knows, least of all LaGrange. But the challenge is daunting because no system in Canada is so conditioned to central autocracy.

Alberta Health Minister Adriana Lagrange
Alberta Health Minister Adriana LaGrange. Azin Ghaffari/Postmedia

There’s no questioning the need for change. Care often suffers because local managers can’t make decisions.

The central system was created in 2008 to save money, bring efficiencies and standardize care — all the usual buzzwords.

In some ways, it has worked. Alberta’s single-purchaser power led to early acquisition of COVID supplies.

But problems emerged very quickly after nine regional authorities were merged into one, under then-premier Ed Stelmach and health minister Ron Liepert.

Many a study has since been done, including some by the Health Quality Council of Alberta when Cowell was in charge.

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But the most striking came from the political side, after then-PC premier Jim Prentice appointed a panel to examine problems in rural areas.

In one community after another, health officials voiced frustration with sclerotic decision-making from Edmonton, to the point where they bought supplies with their own money.

“One site manager described having to obtain approvals from six different managing directors in six different communities,” said the report, released early in 2015.

“Acting out of frustration, site managers described proceeding without prescribed approval because they were tired of waiting months for an answer.

“The committee heard that basic items (screws, Band-Aids, bleach) were often purchased using personal funds because the supplies were clearly needed and it would take too long to get approval, if it came at all.

“Simple and routine maintenance tasks (changing light bulbs, fixing toilets and installing new equipment) were delayed by months and even years while awaiting approvals from ‘up the ladder’.

“Every site manager that met with the committee expressed a keen desire to actually fully manage all operations at their facility.”

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Alberta Premier Danielle Smith
Premier Danielle Smith and Health Minister Jason Copping and Dr. John Cowell the provincial health authority’s new official administrator announced steps in the Alberta Health Services reform plan at the McDougall Centre in Calgary on Thursday, November 17, 2022. Darren Makowichuk/Postmedia Darren Makowichuk/Postmedia

Health managers from decades ago, before there were health regions, still express nostalgia for the days when each hospital ran its own operations while co-operating closely with other sites.

Now we have the opposite extreme — a system utterly dependent on central authority, with results that often defy common sense.

Doctors, nurses and other health workers somehow manage to provide excellent service to many people most of the time. They aren’t responsible for absurd surgery wait times, the upheaval in southern lab testing and many other problems.

Smith likes to blame managers for the problems; the very people who don’t have the autonomy to do what’s needed, partly because of her own acute centralization.

As any doctor would say, you can’t cure one illness with another.

Don Braid’s column appears regularly in the Herald.

Twitter: @DonBraid

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