Is Houston already repeating Mcneil’s health-care mistakes?
The seeds of the Liberal defeat in the Nova Scotia election were planted eight years ago.
Shortly after taking power in 2013, Premier Stephen Mcneil amalgamated the nine district health authorities into a single unit, the Nova Scotia Health Authority (NSHA), which has more than 23,000 employees. This provided two opportunities for positive change.
A single authority should need fewer senior management positions. Support functions could be centralized.
It is easier to manage one central accounting system than nine regional ones. A central information technology function can support a robust website; most of the nine regional ones had modest offerings. Despite the government's clumsy handling, the collective bargaining processes were unified.
Second, resources and responsibilities could be managed on a provincewide basis. Specialists can be shared between regional hospitals. Agreements with related services that are not part of NSHA, such as ambulances and long-term care providers, can be negotiated provincewide.
Opportunity does not guarantee achievement. It is a big job to integrate nine organizations into one, realizing the efficiencies and creating a common culture which empowers and supports the front-line caregiver. It requires a CEO who is knowledgeable in this field and skilled in organization design and recruitment of the right talent.
That is not what happened. Janet Knox had been the CEO of the Health Authority in the Annapolis Valley, home to Stephen Mcneil, so they had come to know each other.
He appointed her CEO before appointing a board to oversee operations. No doctors were included in the board membership.
The province was divided into four zones. Her senior management team, which was also chosen before the board was appointed, included executives who held dual responsibilities, both as leaders of a zone and managers of a program of care. As a practical matter, the zone leadership responsibility received little attention. Opportunities for cost savings were not fully realized.
Some of the leadership group were very weak, but Knox was reluctant to change them or the structure. Unsurprisingly, this led to dissatisfaction among doctors and other front-line caregivers. Mcneil was far too slow to allow a change at the top.
It would be wrong to say that there was no progress. Collaborative care centres have become an important resource for delivering primary care. The authority has performed well dealing with COVID.
That said, the performance of the NSHA was not good enough. Too much decisionmaking was controlled by head office, far from the points of contact with patients. Doctors were vocal critics and believed by their communities. This paved the way for Houston's successful campaign strategy.
Brendan Carr was recruited by the board to be CEO of the NSHA at the end of 2019. On Sept. 1, Houston and Health and Wellness Minister Michelle Thompson dismissed the board and Carr and replaced him on an interim basis with former Port Authority CEO Karen Oldfield. She will head a four-person team with three current and former health deputy ministers.
Her foursome, plus Thompson and Houston, will tour the province to hear from frontline healthcare professionals later this month. This is good political theatre to emphasize the sincerity of Houston's core campaign promise.
It does not set the stage for effective governance going forward. It is good for them to get a first-hand feel for the issues faced by caregivers, and to label goals for the authority.
But to govern the authority from some combination of the Department of Health and Wellness and the premier's office would be to repeat Mcneil's mistakes, which contributed to Rankin's defeat.
It is not obvious why Houston had to dismiss the existing board and CEO while doing his listening tour. The board provided regional insights and necessary diversity of perspective.
Oldfield has no experience leading health care or large distributed organizations. Though the port's customers have thousands of employees, the Port Authority itself has only about 100.
Houston should promptly recruit a new board of experienced leaders from different parts of the province, including representatives from the African Nova Scotian and Mi'kmaw communities.
The board should, as a first duty, develop criteria, to be approved by Houston, for choosing a new CEO. It should then commence a Canada-wide search for the best possible candidate. Getting the right person will be crucial to Houston's success. Getting it wrong will haunt him at the next election.