“Good medicine always tastes bad.”
Auditor General Merwan Saher issued a report in late May describing the shortcomings within the Alberta health care system. The AG’s office has made many recommendations over 27 years. They find that often the recommendations are not acted on or the same problem crops up again and again. So this report was his attempt to put forward his recommendations to improve the system.
At a system level he identifies a goal of an integrated system. (like many before him) His report flags three root causes that defeat integration:
- the fragmented structure of the health system
- the lack of integration of physician services and the services of other care providers
- the lack of sharing and use of clinical information
Saher doesn’t think throwing more money at it is the answer. Alberta already pays more per capita than any other province.
- He flags the negative effects of turnover in top levels of Alberta Health Services (AHS) and Alberta Health and suggest that stability is needed. He also points other there is duplication of management in the system by AHS and Alberta Health that should be corrected.
- Alberta Health needs to back out of operational management. Politicians need to stop interfering in the system and the opposition should not expect the Minister to solve local issues. Albertans need to get more involved in their own health care and demand better service.
- There is a disconnect between the budget and health outcomes. Funding and physician compensation models should be linked results not just volume of services.
- Primary care physicians need to be integrated into the system. They impact costs within the system through the fees they charge, and the tests and prescriptions they order. But they have little connectivity with AHS.
- A significant focus should be on improved clinical information platforms for health providers, and patients. He notes that a brand new system has a major shortcoming of excluding primary care information.
The report points to best practices in other jurisdictions that Alberta could emulate.
Well, nobody likes to have an accountant tell them how to run their business. And the report calls for pretty significant change and system transformation to one more centred on the patient. The Auditor General’s recommendations “gores everyone ox” to some extent.
The industry associations for nurses and doctors are supportive. But Alberta Health Minister – not so much. In the days following the report release Health Minister Sarah Hoffman answered questions in the Legislature with a defensive and partisan tone. The Alberta Health Services site makes no mention of the report.
But it safe to assume that the report and its directions will live on. After all, the Auditor General is back to doing audits. Severely normal Albertans can expect that future reports will use the directions in the report as a lens for audit work!