AHS Review: Initial reaction

February 3, 2020

Dear Members:

Today government released the long-awaited Ernst & Young summary report of Alberta Health Services Performance Review. We have had a little time to review it, but much more time will be required given the scope and the potential implications. 

The report highlights the need for an approach to health care that is based on continuous quality improvement. The report has 57 recommendations and a potential savings of $1.9 billion. 

Many dedicated health care workers, including physicians, form the foundation of quality care and leadership in AHS and I want to thank them for their continued commitment.

In terms of my initial reaction, I want to highlight a few themes or lenses with which to evaluate the report, as well as the changes that are suggested for implementation.

Health care systems that have made the biggest advances in integration, efficiency and quality, typically have one thing in common: they involve patients as partners in care. I believe this will be essential in our province. Patient engagement speaks to more than just informing patients of changes being made in the system that they use and pay for as taxpayers. Patient input needs to meaningfully impact system design. Patients need to have a say when decisions that affect them are being made. Their involvement in implementing and moving forward on this report is essential.

Leadership of health care providers is also a critical success factor in advanced systems. By “leadership” I am not talking about a handful of individuals in a corporate structure. I mean the nurses, pharmacists, technicians, physicians and others who are on the frontlines every day with patients. Spend any time with these colleagues and you’ll hear many ideas for improving the system in practical ways. Ideas are not the problem. I don’t believe that we are doing enough to empower grassroots leadership in community or acute care (AHS). We need to get information, tools and resources and align objectives with what patients need from the system. Transformation will come when frontline teams are able to turn great ideas into reality – and that means investing appropriately in positive change. In the AHS survey, a large majority of physicians selected Neutral or Disagree in response to the statement “I have the ability to implement change and make decisions that will enhance efficiency of the work I do.” 

Relationships are essential to a healthy system. In many ways, system excellence comes from knowing who makes the decisions, the evidence and support provided to make those decisions and what is done around implications. 

Our relationship with our patients is fundamental. Our relationships with each other as physicians and health care team members are also vitally important. 

Relationships between the profession at large, AHS and government have far-reaching impact. These are defined for physicians by the Alberta Medical Association agreements, which are powerful policy tools that align resources with system objectives. Additionally, while AHS tends to view improvement flowing out from AHS to the community and primary care, the reverse is actually true. The best paths forward are those that leaders and patients across the system map out together with a common goal in mind. For Albertans, most health care and related relationships occur in the community.

Finally, I would emphasize the importance of provider wellness to system transformation. For a number of years, we have talked about the Triple Aim developed by the Institute for Health Care Improvement. The three dimensions are: patient care experience; population health; and reducing health care costs. More recently, care team well-being has been added as a fourth dimension, resulting in the Quadruple Aim model. We need to pay attention to this; it is fundamental to continued progress toward the sustainable integrated, patient centered system we all wish to see. The AMA advocates for healthy working environments built on strong physician leadership, diversity and inclusion and psychosocial wellness and safety.

We need to consider the impact on wellness resulting from the stress and uncertainty caused in recent months by Bill 21, PRAC ID restrictions, consultation proposals and other commentary. Let’s work together to support the wellness of physicians and our health care workers.

We will continue to review the AHS report. Like most reports of this nature, it will contain many ideas of varying quality and operational feasibility. We will be seeking feedback from you to provide a response to the 57 proposed recommendations. 

We have a collective goal of improving the quality of care for Albertans and we are deeply concerned about system sustainability. AHS will now look to prioritize changes. I believe this needs to be done collaboratively, not from a silo perspective, and needs to include the AMA as the representative of physicians and to support the patients we serve. 

I will say more about this in the weeks ahead. As always, please let me know what you think in the following ways:

• Communicate with me privately and directly by email if you would like a reply: president@albertadoctors.org
• Comment publicly below on this President’s Letter (please be aware that comments are public, i.e., not members-only, even if you are logged in as a member).

In your service, 

Christine P. Molnar, MD, FRCPC 
President, Alberta Medical Association