To fix the NSHA start with corporate governance

Nova Scotia’s new Premier, Tim Houston, and Health Minister Michelle Thompson are to be congratulated for their swift action on health care. Less than 20 hours after taking their oaths of office they fired the Nova Scotia Health Authority CEO and dismissed the board of directors. 

One can only image how many years our new health minister, a former nurse, has been thinking about what she would do if it were up to her. Let’s hope this era of change is more front-line driven.

I was skeptical about the election campaign platform to re-organize health care. In the last 20 years we have had two major reorganizations of health care. We have also studied, tweaked, changed and modified all aspects of it. And the same problems and issues persist. The one constant has been the health care executives, who have survived changes in government regardless of their on-going performance failures. Until now. So starting with a clean slate is a positive step.

What is worrisome is devolving management to local areas because our history shows an uneven level of and access to care. As I have previously said, localized health authorities were fiefdoms, where the health executives controlled, some suggest stacked, the health boards. Members of three of the previous nine boards told me they were bullied, disregarded and silenced. Plus, with a decentralized system bad decisions are more easily hidden when they are localized.

With this accelerated pace of change, I and those in the medical community I consult, have two ideas for the Minister’s consideration.

The first comes from one of the province’s senior surgeons, who suggests we make health care a Crown Corporation. Ideally, it would be a national organization, but given how impossible it is for the federal government, 10 provincial governments and three territories to accomplish anything (the 2003 National Health Accord they all supported went nowhere) we could scale his idea down to a provincial crown corporate structure. 

This doctor is frustrated by the lack of universal governance in health care and how political decisions factor in to how and where health care is delivered. 

A Crown Corporation for health care is a radical idea, but the doctors and health consultant I mentioned this to are supportive. A retired family physician said, “The current ethical problem and source of difficulty is that government assesses, regulates and insures the services government is said to deliver.” A rural practitioner felt “it certainly bears thinking about.” And a health care consultant said, “It really does reframe the concept.” All were excited by the idea.

While the idea may cause traditionalists in the NSHA corporate headquarters to spit out their coffee, it seems an interesting idea for front-line care givers.

The second idea on reorganization of the NSHA is also about governance. We need an activist board of directors. I wonder how often, if ever, the previous directors said “no” to the health executives? Or have they just been cheerleaders lending legal credence to the wishes and actions of the executives?

The new NSHA board should look less like members of a country club and more like the province. Political parties work to ensure women, Acadians, the First Nation and African-Nova Scotians are represented in the Legislature, so should the NSHA board. We should have dedicated board seats for a registered nurse, a doctor (either in practice or recently retired) and someone from the patient perspective, whether a former patient or involved family member. We need these frontline voices to counter the glowing spreadsheet solutions presented to the directors.

And we should pay directors for their time. It is absurd to put billions of taxpayer dollars in the hands of volunteers. We don’t even trust film classification to volunteers. 

The NS Film Classification Board pays movie reviewers $50 per half day, plus expenses. That rate, like the rates for all of the Province’s agencies, boards and commissions, was established in the 1970s. It’s ironic that the province’s largest single expenditure is overseen by people working for free. We don’t trust film classification to volunteers, so why would be put our health care system, the province’s largest expenditure, in the hands of people who couldn’t review a movie?

By compensating NSHA directors we open up the board to a wider cross section of the province and not just the well-connected. We could bring in the self-employed, for example. Effective boards are more than nice lunch on a quarterly basis, interrupting the rush through an agenda. Corporate directors have four or five days of prep work for each board meeting. That time and commitment should be recognized. And for something as important as health care we need more than the usual generic background of usual government appointments.

As we look for a new NSHA board let’s look outside the small, semi-incestuous pool of Halifax-based directors and recruit people with ideas, questions and experience delivering and receiving health care in this province. We have seen that you get what you pay for.

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