Survey says NSHA leaders are out of touch

There are a couple of ways to view the restructuring going on at the Nova Scotia Health Authority. Now in its fifth year, it's time for an organizational tuneup. Or, the place is a top-down dysfunctional mess that requires a radical resection.

A survey conducted last spring among those best positioned to know — the NSHA's nearly 25,000 employees, most of whom are what we'd call frontline care providers — suggests the latter is nearer their reality than the former.

As the authority's interim CEO, Janet Davidson, pointed out in the covering letter she sent employees with the survey results last week, the strengths and weaknesses of the NSHA are similar to those identified in the last employee survey, but overall the results were worse in 2019 than in 2016.

You don't need to spend a lot of time analyzing those results to understand where employees believe the problem lies. They tell us loud and clear.

The senior management — the leadership — of the place has been distant, out of touch, and unresponsive to the people who actually do the work of delivering health care to Nova Scotians.

And, although she walks the fine diplomatic line required of the head of the organization, Davidson's words and actions during her three months in the job say she's inclined to agree with the NSHA employees.

“As an organization, we must do better,” Davidson wrote in that letter. Sources who are well-placed to know say she was singularly unimpressed with the senior management of the organization she stepped in to lead between the retirement of Janet Knox as CEO in August and the arrival of the new boss, Brendan Carr, whose first day on the job is today.

“The current (NSHA) structure has been described as overly complex and bureaucratic, confusing and does not allow us to easily address challenges that may be unique to individual zones, teams or hospitals,” she wrote in an earlier memo to employees. The action she initiated shows that she agreed with that assessment.

Davidson stripped down the executive offices and moved both dollars and executive level operational and medical leadership out of the Halifax head office and into the four regional zones.

Carr takes over an organization in the midst of the transition Davidson began. It is also an organization that many doctors have little faith in because, they say, it broke faith with them. And, as the 2019 survey shows, fewer than half of its employees consider it a good place to work.

In addition to dealing with that disaffected workforce, the survey suggests Carr has his work cut out for him if he intends to build a healthy relationship between the NSHA's senior management and its employees across the province.

Questions related to the performance of senior management got the worst ratings on the survey, and every one of them fell well below the line that determined “areas for improvement.”

For example, a little more than one-third of employees believe senior managers act on staff feedback, and barely half of the employees feel senior managers effectively communicate the organization's goals to employees.

Employees also gave the NSHA failing grades — less than 50 per cent approval — on consulting with them about changes that affect their jobs, and on offering them opportunities to develop their careers.

On the positive side, some of the highest marks on the survey came in response to questions about the quality of care patients can expect to receive in the system and the hospitals operated by the NSHA.

Carr is returning to his home province to take on the authority's CEO job. He's a Dalhousie

medical school grad who worked in Nova Scotia as both a family and emergency doc. He was vice-president of medicine with the former Capital District Health Authority before moving on to senior health administration jobs in British Columbia and later Ontario.

By all accounts, he's been kept well informed about the organizational changes that are currently underway.

While those changes have been mostly welcomed by doctors across the province, many have adopted a wait-and-see attitude. Those docs believe that the changes required at the NSHA go much deeper than any that could be reflected on an organizational chart.