Health bureaucracy fractious, fractured
It’s a shame.
Nova Scotia’s health bureaucracies are as fractious as they are fractured. They don’t work well with each other unless someone, like the auditor general, comes along and knocks some heads together, as if the multibilliondollar enterprise were run by The Three Stooges.
And the region’s most cherished hospital, the IWK, somehow survives despite a near-perfect void in the space where financial safeguards ought to be, protecting the $300-million-plus it costs per year to operate the place.
It was a lousy week for the mandarins in the provincial health sector and, by extension, for the provincial government that’s ultimately responsible for them and their handiwork.
Doctors and other health professionals have been telling Nova Scotians for years that the so-called health system is being run into the ground, and this week they got a little backup from Nova Scotia’s Auditor General, Michael Pickup.
The health bureaucracies — the IWK, the Nova Scotia Health Authority (NSHA) and, the mothership, the Department of Health and Wellness (DHW) — made all the right noises about accepting the auditor’s recommendations, but it’s the job of Premier Stephen McNeil, Health Minister Randy Delorey and the provincial cabinet to whip these outfits into shape.
Pickup shone a light into the murky world of health IT and went on a fruitless search for basic financial controls at the IWK.
By comparison, the object of the third chapter in his report — the Workers’ Compensation Board — emerged as a shining example of public sector efficiency and rectitude. That’s quite a turnaround at the WCB; an organization that suffered through decades as the bureaucracy Nova Scotians loved to hate is now a bastion of good governance that the health bureaucrats could learn from.
And if Pickup has it right, the health bureaucracies and the boards that oversee them have a lot to learn.
His chapter about health IT confirms what frustrated middle managers at the DHW and the NSHA have hinted at almost since the authority was created. These two organizations just don’t like one another, and don’t work well together.
More than a year ago — the third year of the NSHA’s troubled existence — the four organizations that operate the technology that underpins the entire health system embarked on a “roles and accountabilities exercise.” A year later, they’re not done trying to figure out who does what.
The three health organizations and the Department of Internal Services, which provides IT services to the entire government, set up a committee structure in an effort to get their collective act together, but the most senior committee, the executives, never bothered to meet.
Pickup notes the purpose of the Executive Committee is to keep an eye on the big picture — to provide the “strategic oversight” that ensures IT services meet the needs of the health sector, to monitor service delivery and to resolve disputes between the organizations.
Disputes between the organizations — notably the DHW and NSHA — were identified by the auditor as an impediment to the establishment and operation of effective and secure IT services across the sector.
The extended no-show by the executive committee tells us the problem resides in the nicest offices, which is where the premier, the minister, et al. might want to start if they’re thinking changes are needed to get health administration on track.
Meanwhile, over at the IWK, Pickup uncovered what appears to be a total breakdown of fundamental financial controls. The hospital’s administration couldn’t produce basic documents to support purchases and service contracts. It had no way of knowing or showing if it was getting what taxpayers paid for.
The auditor general looked at seven business processes — procurement, payables, revenue, cash and treasury, financial reporting, human resources and payroll — and found problems in every one.
While the issues at the IWK run deep — Pickup said the lax financial controls are a cultural problem at the hospital — they may be easier to resolve than the rift between the DHW and the NSHA.
The government and the most senior officials in both of those organizations have always denied the problems in their working relationship. But now the auditor general has identified a missioncritical function — information technology — where turf battles pose risk to the quality of care, and cost Nova Scotians big bucks.
It’s up to the McNeil government to get the highest paid players in the administrative structure that it created to cut the crap and start working effectively together.
Either that or get new players.