The NSHA needs more executive cuts

The Nova Scotia Health Authority announced some paring of their executive ranks, but it isn’t enough.

https://www.thechronicleherald.ca/news/local/ns-health-authority-cuts-vp-positions-pledges-to-give-local-zones-more-power-380091/

The article says three vice president positions have been cut. Whether those former vice presidents go or stay in some other capacity isn’t enough. The NSHA has not lived up to its mandate. I can say that because merging the province’s nine health authorities under one umbrella organization was my idea.

In 2009 my mother had a small stroke while having blood work done at Valley Regional Hospital in Kentville. Another health problem occurred and over nine months of daily visits to VRH I saw and heard many things that didn’t make sense. As a former newspaper publisher/business owner I saw ridiculous organizational and communications problems.

Prior to our family’s exposure to the system I used to believe everything would be great if only government gave health care enough money. I have since learned that no one in health care has any idea of how much money is enough to make the system work.

Doctors and nurses at Valley Regional told me their problems and issues, then connected me to their colleagues across the province. I learned universality of their issues. One issue was how medical talent and assets where under-utilized. While Halifax surgeons couldn’t keep up with the need, operating rooms in Windsor, Middleton, Pictou and other hospitals were dark. Surgeons were leaving the province because they couldn’t get operating room time.

In 2010 I started writing about health care on this blog and for The Chronicle Herald. I proposed merging the nine authorities into one to reduce duplication of management, streamline delivery of care, redirect CEO and VP compensation to front-line workers and utilize all provincial assets to speed up the delivery of care to produce better patient outcomes. Previous articles on this site highlight the extent of the executive duplication.

In February 2013, long before the writ was dropped for the October election, the former Leader of the Opposition, former health critic and a member of the Liberal Party office met me in a Wolfville coffee shop to discuss a vision for a merged health authority. Meanwhile former Health Minister Maureen MacDonald and Premier Darrel Dexter rejected the concept and repeatedly said they weren’t going to import chaos to NS health care.

When the Liberals took office they were astonished to learn how advanced the Department of Health’s planning was for a merged health authority. While the NDP publicly decried a merged system, behind the scenes they were working on the very idea.

In the last six months I have been at two public meetings in the Valley where people have wishfully mused about returning to more responsive local health authorities. They forget how poorly served we were under the previous nine health authorities.

Under our previous nine-authority system the goal was to treat patients within 100k of their home. This resulted in backlogs in some places and under-utilized facilities and medical expertise in others. If you were a patient in Windsor, because that was under Capital Health, you would have to go to Halifax rather than Kentville, which is closer. Nine health authorities were territorial.

The problem with the NSHA isn’t the system, it’s the management. We hired the same people who frustrated us when they managed the smaller health authorities to run a much larger organization. And perhaps stung by Opposition criticism of her spend-thrift ways at the Annapolis Valley District Health Authority (AVDHA), where administrative expenses were 8.3 percent of budget which was 60 percent above the national average, NSHA CEO Janet Knox kept a tight reign on information about provincial health. So tight was the information flow that the NSHA executive offices are constantly referred to as Fort Knox by Valley Conservatives and front-line medical workers.

Staffing is one of the great NSHA secrets. The NDP government introduced the Nova Scotia Public Sector Compensation Disclosure Act, which requires publicizing the name and compensation figures for anyone receiving $100,000 or more from the taxpayer.

The purpose of the compensation disclosure act was to give taxpayers a type of public oversight of expenditures.

Originally, most of the health authorities, universities and other organizations covered by the Act listed the names, titles and compensation of the province’s 1 percenters. Even the AVDHA provided this information. However, when the NSHA was formed job titles were dropped from the compensation report.

Retired Halifax physician and Dalhousie Medical School lecturer Dr. David Zitner often says, “you can’t manage what you don’t measure.”

Without job titles there is not real transparency in management of the NSHA. Without job titles, the compensation disclosure is merely a prurient act. Having job titles would allow us to see if organizations, like the NSHA, are top heavy in managers and executives. It could provide insights into problem areas in staffing and help the public understand how our money is spent.

This year’s public compensation numbers are a prime example of this transparency failure by the NSHA and government.

In fiscal 2017-18, the NSHA filing listed 884 names. However, fiscal 2018-19’s filing contains 2,699 names! This wasn’t a massive, across-the-board pay raise, but the distribution of public service award distributions, which for senior executives ranged from $49,441 to $132,183. For privacy reasons this isn’t detailed in the filing.

If we can read an individual’s name and compensation, how is it more invasive to know that part of the package was a one-time payment? How is it more intrusive to know their job title or area of responsibility? This level of secrecy doesn’t make sense.

The NSHA has a spreadsheet – which they provided – showing the names, job titles and amounts paid to these thousands of staff. John Gillis, director of content and media relations wrote in an email, “Regarding inclusion of titles in the reporting, the audited document posted complies with what’s directed in legislation, but acknowledging the value of understanding the roles of the people identified, we have always made available on request a version that includes that information.”

What is troubling is that of the 2,699 people paid over $100,000 this year by the NSHA, 725 were vice presidents, directors, managers, coordinators, consultants, advisors, analysts, and some other managerial title holder. Other managers and executives earning $99,999.99 aren’t listed.

The raison d’etre for merging nine health authorities into one organization was to streamline management and direct money from the executive suite to frontline care. These executive numbers show the NSHA is not keeping with the vision for merging health authorities. Not enough heads have rolled at the NSHA.

When I wrote my first book, Sweat Equity, Atlantic Canada’s New Entrepreneurs, I learned that government and civil servants love process. The disconnect is that entrepreneurs – and the public – focus on results and outcomes. This is the problem with the NSHA. They’re health bureaucrats who love “process”.

The other problem with our health executives and decision makers is their disconnect with front-line care. When Knox was head of the Annapolis Valley District Health Authority, she worked from the corporate headquarters in the industrial park in Kentville. In the nine months I made daily visits to Valley Regional I only knew of three visits she made to the hospital. I knew that because I heard nurses groan, “What is SHE doing here? She only shows up when something’s wrong.”

The NSHA headquarters is again an anonymous glass office building in an industrial park in the HRM. Once again, health decision makers are disassociated from the front lines. They don’t see patients, doctors, nurses, other health workers or the worried, concerned looks of patient families. Health executives need more than a spreadsheet relationship with what medicine in this province looks like.

A post script:

The former Chief of Staff to the NDP Premier of Nova Scotia has written The Chronicle Herald to praise part of what I wrote and disagree that the NDP were working behind the scenes to merge health authorities. He wrote, “The NDP respected local decision-making. And yes, there were detailed plans for more efficiency in the backroom, to free up funds needed to ensure everyone had access to a family doctor.”

But the CoS claims this was not about merging the nine authorities. That’s his historic perspective of his party’s actions. The Liberal government found the organization done under the NDP so advanced it saved them a year of planning. That assessment came from the top levels of the current government. It boils down to: he said, he said.

Believe which version you want. I’m sticking with the Liberal story because our family’s experience under NDP health care was so hellish. Health care under the NDP was not great. It was so poor that it inspired me to launch this website.

 

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5 Responses to The NSHA needs more executive cuts

  1. buddyboy546 says:

    Let’s hope a new broom sweeps clean at the NSHA.

  2. Mary M says:

    …and now we hear about potential plans for “local representation”, a move back to decentralization. Having regional administrative and executive infrastructure was not successful in the past, so what’s new? I truly find it astonishing that we simply keep “rearranging the deck chairs”, so to speak, instead of truly analyzing and rebuilding our broken system. Some years ago, a local doctor suggested the NS healthcare system was a fractured group of fiefdoms, cobbled by myriad collective agreements. Until and unless someone has the fortitude to challenge all such structures from a patient centric point of view, we will not successfully address our challenges.

    • I think it would be helpful if the executives worked on offices in hospitals and not some sanitized anonymous bunker miles away and if someone on the NSHA board had ever been a patient or cared for someone in a prolonged hospitalization. I’m not criticizing the doctors and nurses, but if you have been a patient or had someone in hospital you hear the frustrations of those working the front lines.

  3. jlg says:

    As the honchos at the Hlx HQ of the NSHA give themselves a “pat on the back” for ridding some chafe from the ivory tower….and I’m sure compensating the chafe with generous taxpayer severances……one has to wonder…….who and how many will those honchos in Hlx be appointing to run the new, improved local puppet shows.
    Or, should we again go to the definition of insanity……same thing over and over again.
    My money is on the latter.

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