Cut the chaos, share the pain

Thankfully we have avoided a strike at Capital Health. But in the two weeks leading up to the mediated settlement, Nova Scotians went through hell. A strike at Capital Health doesn’t just impact citizens in Metro, it impacts services and treatments of citizens from one end of the province to another. It was chaos.

In numerous interviews and opinion pieces the Minister of Health and Wellness has resisted any change to Nova Scotia’s health care administrative structure because she wants to avoid chaos. Well, the last two weeks in Halifax were a very public example of the type of chaos which already exists in our health care system. Patients and patient families have long known of and experienced the chaos and frustration of our system, but it takes the publicity of a strike to raise its visibility.

This is the second time Capital Health has prepared for a strike situation in less than a year.

Settling this recent contract illustrates the folly of maintaining 10 health authorities in this province. We negotiate one contract for teachers. But we negotiate 50 contracts for nurses and another 50 contracts for other health care workers. So with these two contracts settled we have 98 to go.

Anyone who thinks harmony has returned to the system is sadly mistaken. The precedent set by the two recent Capital Health arbitrated contracts means all other unionized bargaining units in the province will expect the same kind of settlement. Why should they expect anything less? We talk about wage parity: paying men and women the same amount for work of equal value. Why not geographic parity for work of equal value?

Had we a coordinated health care system in this province with one health authority negotiating with two bargaining units we might have labour peace, patients wouldn’t be subjected to the hell that those scheduled for care in Halifax endured, and we might have saved money by negotiating one lower pay raise across the province that is closer to the Dexter government’s one percent target. But now, thanks to the failure in Halifax to achieve negotiated versus arbitrated settlements, we are on track to pay more as various contracts come due.

There should be a move to work for the greater good, but when you have 10 separate health authorities fighting to protect their individual budgets we ensure constant labour turmoil. It’s not the job of Capital Health’s negotiators to think of the impact of their positions on the province’s nine other health authorities, but the reality is that what happens to one, sets the standard for the others.

As the strike deadline grew closer, so did calls to bring in legislation to remove the right of health care workers to strike. Does that make for better employee relations? I’ve never belonged to a union, my career was in management, but this seems a one-sided solution. Taking away the right of these workers to strike is akin to disenfranchising them, like taking away their right to vote. And why is the solution always placed on the back of the workers and not management? Why do we act as if health care administrators are infallible?

Why can’t the Legislature institute a system of incentives to ensure management works more effectively, efficiently and empathically in resolving public sector labour disputes? Rather than punish the lowest paid, by removing their rights to withhold their labour, incentivize management to act more quickly by imposing financial implications on them if they fail to deliver 100% of essential public services, like health care. As it stands now, a health care strike impacts the workers (who go without pay), the patients (who go without treatments), but leaves the administrators unscathed. Administrators may be inconvenienced in their daily workload, but they don’t experience any loss of income or perks. Why?

Using recent nursing contracts as an example, two-year contracts in this province have been taking 18-to-24 months to negotiate. Is that really necessary? Is that in anyone’s interest? Let’s incentivize administrators by tying their incomes to performance targets and harmonious delivery of essential public services. This could be a model for all public sector contacts and bargaining units in Canada. If executives find that unacceptable they are free, as anyone is, to find employment conditions more to their liking. But it is not in the public interest to suffer through never-ending contract negotiations and disputes. Our current system diverts too much time, attention and resources away from actual delivery of health care. If ever there was time for a change, it is now.

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6 Responses to Cut the chaos, share the pain

  1. Roy Jensen says:

    I have to disagree with a couple of your points first amalgamating health authorities will cost more simply because all salaries move to the top and what little you save eliminating duplication (there still has to be administration in those districts) will pale in comparison to the thousands of workers getting increases.

    Another point there is no labor peace as long as there are unions, their very existance depends on getting more for their membership ( especially govt unions there is no competition to curtail demands) as fairness is not their goal getting the maximum is. There is a problem with management and workers in NS as our outcomes, waiting lists and general healhcare service is average or below as you know. The majority of the pain as you put it has to go on the workers since their salaries represent the majority of the cost by the way the majority of the pain is not on the workers but on the patients and taxpayer who have no say inthis.

    • Thanks for writing. But I disagree with you on a couple of points. Unions exist to protect workers from heavy-handed employers. Sure, they’re going to be hard negotiators, but how is that bad? They don’t get everything they want. But do we believe the administrative class don’t negotiate equally hard against the unions or equally hard in arranging their personal pay packages?

      Let me give you an Ontario example – I give Ontario as an example because they are more open about compensation. One hospital executive who earned $140,000 a year, retired from his position at the first of a month. 30 days later he returned to the hospital to do the exact same job he left. But he came back as a consultant. As a consultant he charged $240,000 a year. Then, because he had retired he also collected his pension while working as a consultant. So in 30 days, with no additional training or responsibilities, his income went from $140,000 to $366,000 (figuring a pension of 90% his pay scale, plus $240,000).

      It’s interesting that while Capital Health was in negotiations with the unions they said what the unions wanted amounted to $26 million. However, this morning, the Premier put the costs at between $3-4.9 million. That’s quite a discrepancy.

      As for the need for administration in health care, yes we need some. But have you closely looked at how we’re set up and the waste and duplication? For example, I live in the Annapolis Valley. In Kentville we have the Valley Regional Hospital. 126 nurses are employed at the hospital. Across town in the industrial park are the health authority “corporate” offices. 160 people work in those offices. Now, this authority is also responsible for a hospital in Middleton, and clinics in Wolfville, Berwick and Annapolis Royal. Each facility has a site manager. Below the site manager are department heads, managers, supervisors and coordinators, plus assistants. Accordng to one corporate flow chart, 58 people worked in accounting/finance, while 65 people worked in the labs! (That number of lab workers has been reduced by 11.)

      When our family member was in hospital, two nurses were assigned to care for four of the most ill patients on the floor. However, when a telephone call had to be made, three people (a manager, coordinator and clerk) were involved!

      In Kentville, the top five executives have duplicate offices in the same town: at the corporate offices and in the hospital. These executives are rarely in the hospital so it would be reasonable to maintain one office for their use when there, but no, these offices sit empty most of the time. Meanwhile, I had to attend medical meetings in a closet! Given their other facilities, how many offices do they have and are we paying for? The duplication and waste is far, far greater than people realize.

      You are right that there are no measures for outcomes or those that we know of are below national averages. Those outcomes aren’t the fault of the front-line workers. The outcomes are the responsibility of management. We’re spending $50 million on 264 executives, what do we get for the money?

      Like you, I’m angry that patients and patient families have no say in the system. That’s partly our fault because we have let them get away with doing whatever they want. We have to speak up and let the politicians know we’re not taking it anymore. And if you disagree with giving the unionized staff pay raises, tell them that, but let’s not forget to demand better outcomes from everyone!

      • Josh says:

        True enough that most administrative staff work at the Chipman Building, yet time and again you ignore the fact that Mental Health and Addiction Services also operate from there. And, by “top five executives”, do you include VP Medicine Dr Lynne Harrigan? She’s “rarely” in the hospital?

      • Josh,

        I ignore the Mental Health and Addiction Services which you say operate from the Chipman Building because in the AVH corporate flow chart I’ve seen these services weren’t included. And AVH have not identified how many people are involved.

        As for Dr. Harrigan, I spent 6-to-14 hours a day for 252 days at the Valley Regional. I saw her there three times in that period. One weekend, thankfully for us, she was duty. I saw her twice that weekend. The next time I saw her in the hospital was three-to-four months later. She wore a black trench coat, looked at me through the patient room door and kept on walking. There may have been a fourth time – she may have been in the cluster of female executives who shuffled the Minister through.

        At one time I asked to see her because of concerns I had over treatments and was told by the medical staff I would have to go to her office at Chipman since she was rarely in the hospital.

  2. jim says:

    hmmm,there are 3 bargaining units.

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