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Albertans are rightfully proud of Canada’s universally accessible, publicly funded health-care system.
Specific to Alberta, in its founding conference, the United Conservative Party committed itself to “…a healthcare system that is universal and a healthcare system that is universal and comprehensive, preventative rather than reactive, ethical and accountable, sustainable and cost-effective, accessible and portable, blends public, non-profit, and private sector provisions, and implements effective strategies that will lead to a world-class system with improved quality of life.”1
If elected, a UCP government is committed to maintain or increase health spending, and will maintain a universally accessible, publicly funded health-care system.
Alberta Health Services (AHS) was established on April 1, 2009. It is the largest public-sector employer in the province, with more than 110,000 employees. (This includes more than 8,300 staff working in AHS wholly-owned subsidiaries such as Carewest, CapitalCare Group and Calgary Laboratory Services.)
Despite the high level of funding provided by the Government of Alberta to Alberta Health Services, health-care outcomes have been declining over the past few years.2 More money is being spent, yet wait-times are getting longer and other metrics are disappointing. After ten years of operation, it is now unclear whether Albertans are receiving value for the $15.2 billion they will provide to Alberta Health Services this year.3
It is therefore time for a comprehensive performance review of the organization, in order to drive greater efficiencies and improve service levels on the front-lines.
Total management staff at Alberta Health Services is estimated to be 3.5 percent of total staff, or about 4,000 positions. Alberta Health Services is also supported by nearly 10,300 physicians. Of them, more than 8,400 are members of the Alberta Health Services medical staff.
- Open-heart surgery wait-times have increased by nearly 50 percent, from 14.9 weeks to 22.2 weeks, between 2014/15 and 2017/18.
- Cataract surgery wait-times have increased by nearly 30 percent, from 29.9 weeks to 38.4 weeks, between 2014/15 and 2017/18.
- Hip replacement wait-times have increased by nearly 30 percent, from 28.7 weeks to 36.7 weeks, between 2014/15 and 2017/18.
- Knee replacement wait-times have increased by 23 percent, from 33 weeks to 40.7 weeks, between 2014/15 and 2017/18.
- The percentage of patients from the Emergency Department (ED) treated and admitted to hospital within eight hours, has declined from 46 percent to 43.9 percent between 2014/15 and 2017/18.
- The percentage of patients treated and discharged in ED within four hours has fallen from 78.5 percent to 76 percent, between 2014/15 and 2017/18.
- The percentage of children receiving required scheduled mental health treatments has declined from 82 percent in 2014/15, to just 67 percent in 2017/18.
- The average wait-time in acute/subacute care hospital beds for continuing-care placement, has increased from 42 days to 51 days between 2014/15 and 2017/18.
- The total number of people waiting for continuing-care placement increased from 1,544 to 1,937, between 2014/15 and 2017/18.
- The percentage of clients placed in continuing-care within 30 days of assessment, has gone down from 60 percent to 52 percent, between 2014/15 and 2017/18.
- Only 52 percent of clients are placed in a continuing-care facility within 30 days of assessment. This falls short of the NDP’s target of 65 percent. The number has dropped from 60 percent in 2014/15, and 69 percent in 2013/14.
- Too many people are taking up beds, whose care needs could be met by an alternative level of care. (ALC.) Four years ago, (2014/15) the percentage of bed-days used by people whose care needs could be met by ALC – 17.4 percent – was only 12.2 percent.
In view of the foregoing, a UCP government would, if elected, commission a comprehensive performance review of Alberta Health Services. The purpose would be to identify possible savings and efficiencies, to reallocate significant resources away from administration, to front-line service delivery and improving customer service.
- Compare performance against other provinces and best practices, to examine and deal with the causes of increased wait times and performance issues.
- Establish a front-line driven process that closely engages AHS employees in a review of the performance of their own organization, and seeks ways to improve front-line services. Using various means of employee engagement – town halls, web-based surveys, focus groups, special web sites, social media, and specialised AHS employee teams, the Review would invite employees to look at old patterns of management and service delivery, and to suggest innovative ways for the AHS to do business in the future.
- To ensure objective assessment of AHS costs and processes, and to realign the way it addresses the most pressing needs, subject matter experts from an outside consultancy firm will be assigned to employee teams. Employee teams will solicit cost-savings, best practices, innovative delivery mechanisms, etc. from front-line employees and recommend ways to cut costs and improve service.
- The Report of the AHS Performance Review will be presented to the Government no later than December 31, 2019.
- The Report will be released publicly and the recommendations will be incorporated into Budget 2020 and subsequent budgets, as needed.
- The key objectives of the AHS Performance Review will be:
• To examine the AHS management structure and recommend suitable consolidation and reorganization;
• To evaluate all AHS programs, services and policies, to identify overlapping functions and outmoded methods.
• To identify opportunities to make AHS operations more responsive to the front-lines, and to Albertans who need medical attention.
Over the past twenty years, more than 25 U.S. states have conducted performance reviews that on average, have led to ongoing savings of between two and three percent of state budgets.4
Savings of that magnitude within Alberta Health Services would result in annual savings of nearly $300 to $450 million, to be reinvested in frontline services.
That said, the AHS Performance Review is not intended to be merely an exercise in cost reduction.
It is meant also to leverage the collective wisdom and expertise of front-line employees, gathered over many years of service, in the cause of improving AHS performance. Rather than having policies dictated by Alberta Health and the AHS executive team, without adequate front-line input, AHS employees will take ownership over the review of their own organization and make recommendations geared to improving front-line performance, and their own morale.
The cost of such a review is expected to be between $2 million and $3 million.5
A comprehensive performance review of the AHS, after a decade of operation, is recognition that longer-term solutions are required for sustainable control over AHS budgets, while maintaining front-line programs and services at an appropriate level.
- Source: Alberta Health Annual Report, 2017/18, https://open.alberta.ca/dataset/4bb6bc99-ab59-47fd-a633-dfc27d7a049e/resource/94b95989-e03a-4acc-8bf9-f080f911abf0/download/health-annual-report-2017-2018.pdf
- Source: State of Delaware, Governor Jack Markell’s Plan for Fiscal Responsibility, 2009.
- Manitoba had KPMG conduct a review of health care sustainability at cost of $750,000.