Health Superboards: do they work?

[studentchar]

Hello!

First off, I just realized I have to change my username! No longer a student, now officially an RN! Yay me!!

I'm in NS, and we are looking forward to a provincial election this fall. Two of the three parties are proposing merging the provincial health boards into 2 or 3, depending on the party. I know from rumblings on here and from my friends in AB that the change to a superboard there hasn't been a smooth one. Is this still true? Has the Alberta nurses union officially issued a statement on that? Or has there been any published findings from nursing or physician's groups on their thoughts about the super boards? Friends and family here in NS don't know a lot about them, they hear cost savings and like the plan, but I'm looking for some evidence to back me on my gut, which tells me that this is not a good thing.

Any input, links to info would be greatly appreciated! Thanks!

[NotReady4PrimeTime, RN]

In theory, the notion of economy of scale is quite promising. But the application of it has to be done properly and that wasn't what happened in Alberta. When AHS was created, the boards from the 9 health regions were all given a golden handshake to fade off into the sunset... or in the case of a significant number, they were released from the regional board with severance and promptly hired by the provincial board. Instead of having 9 small boards we moved to one Big Old Board. The org chart took up more than 90 pages and there were several layers of new bureaucracy added. Managers managing managers managing managers. And the remuneration for all of these administrative wonders went from "provincial regional" to "world-class", with the rationale that the salary and benefits packages had to be "attractive" in order to acquire the best in the field. The end result was a huge number of new administrative positions, a system where no one really knew who was reporting to whom and a lot of wasted money. In June of this year, after a number of pay-at-risk (fancy word for "bonus") scandals, the minister of health fired the AHS board. Then a couple of weeks ago, after a report was released by the CAO the minister replaced the board with, 5 very high-ranking executives were fired and 70 more were given notice that their jobs were being eliminated but that other positions in the organization would likely be offered them. It's all a very complex and confusing situation. No one is sure what will happen next.

As for "single-entity" large-volume purchasing power, that didn't happen either. There isn't even uniformity of common-item purchasing from unit to unit, never mind facility to facility. The other day I was looking for silver-impregnated gauze for a wound vac dressing. Some units stock it but ours doesn't. We didn't even have a patient-specific supply and had to send a nursing assistant to another unit to beg for some. That's an unusual product for our unit, but there are many items that we use a lot of that we have to phone around for. Some things are centrally stocked (at another hospital), such as Dianeal, and if we should need something from the central stockpile, it's delivered by TAXI! Alberta Children's Hospital uses pharmacy-prepared, standard concentration meds. Our unit mixes our own using the Rule of Sixes. We waste huge amounts of drugs because AHS won't pay for 24 hour in-house pharmacy. There are literally dozens of different IV pumps across the province. I could go on all day...

Here are some links:

Some observations on health care - Vernon Morning Star

Editorial: Sickening health-care costs

Home care no-show leaves Edmonton senior on floor, soiled - Edmonton - CBC News

AHS shakeup an ‘assault' on rural care, say doctors

Alberta Health Services dismisses five top executives after review of governance

New Alberta Health deputy minister to get elevated salary of $580,000

[flyingchange]

Well said Jan!

[Silverdragon102, BSN]

Yep, something to think about however as I only havePR and can't vote but already had the phone call (Automated) from union advising against this and their concerns. Even though I can't thought I will be affected so will be watching with interest

[NotReady4PrimeTime, RN]

Yep, something to think about however as I only havePR and can't vote but already had the phone call (Automated) from union advising against this and their concerns. Even though I can't thought I will be affected so will be watching with interest

Can you expand on your union's concerns? Are they using the Alberta Experiment (now heading into its 6th year) as an example of what NOT to do?

[Silverdragon102, BSN]

The union concern is "the changes threaten nurses’ rights and hard earned benefits including seniority, job security and a say in where you work"

This is part of the message sent from the union to all it's members

Centralization of services (superboards) has not been successful in other provinces but has led to major cost increases and significant workplace issues.

Nova Scotia Votes 2013

[NotReady4PrimeTime, RN]

Well. That's long on rhetoric and short on details. It's true that by amalgamating the regions into one super-board there are significant workplace issues created. Having a single employer across the entire province and a single seniority list complicates a lot of things, from hiring to vacation planning and master rotations. It also impacts on those people who currently work for two different regions, perhaps full time in one and casual in another. Once the merger happens, the super-board will likely decree that employees shall only have a single relationship with the employer (hold only one position). So if a person is relying on that extra cash to pay their bills, they'll be in trouble. As for having a say in where one works, AHS has tried several times to eliminate provisions in our contracts that protect that right. For example they wanted to have the ability not only to float us between units but between facilities within 30 km of our home unit. UNA refused to go there and to my knowledge, no one has been arbitrarily sent to another facility to work. There has been some inter-unit floating but not as much as was feared.

Other issues that weren't really considered are the centralization of EMS dispatch and security services. In a province the size of Alberta, with huge, sporificely populated areas, both are recipes for disaster. The central EMS dispatcher will not be familiar with the vast majority of the addresses in the province, leading to delays when the ambulance can't find the location. It's not only possible, but probable that an ambulance based in one community be dispatched to another community 50-60 km away because the dispatcher has instructions to dispatch whichever team is available. Security services are no longer site-based in most communities, replaced instead with roving patrols. Imagine working in a rural ER on a Saturday night and being confronted with a combative 100+ kg customer under the influence of God-knows-what. You call security and they tell you that the nearest patrol is 25 km away and is already on a call. What do you do? Lock yourself in the med room and hope for the best? What happens to any other patients who might be in the department? Most people in this or a similar situation have called the RCMP.

There are literally thousands of of considerations that need to be examined when undertaking this kind of merger. But they're typically not identified until the process is so far down the road that there's no turning back. Ask your local candidates how some of the things I've mentioned will be managed by the super-board and pay close attention to their reactions.