Tuesday, May 09, 2017

Musings on HQCA's plan for integrated lab services in Alberta

Updated: 10 May 2017 (2 paras above Bottom Line +See Comments)
This blog was stimulated by a reply on Twitter to tweets I'd made about the Health Quality Council of Alberta's (HQCA) report, released May 2017, titled 'Provincial Plan for Integrated Laboratory Services in Alberta' (Further Reading). This will likely be a series of short blogs rather than one monster blog to cover the many issues involved. 

BACKGROUND
The reply on Twitter was made by a former 'kid' in Medical Laboratory Science (MLS) at the University of Alberta. I'd been tweeting (pontificating?) that the HQCA report on the needed improvements in clinical laboratory services in Alberta contained much management jargon and seemed similar to the many earlier failed experiments in improving the system. 

The 'kid' in question (I affectionately call all my former MLS students 'kids' and they graciously tolerate it), in effect, challenged me to see a potential good aspect of the bottom-line proposed solution:
  • Create a Public Agency with the mandate to govern, oversee, and deliver globally competitive, high quality integrated laboratory services across the province. 
The question: 
  • But do you think that there's also potential for better advocacy and coherence as separate entity? 
She's referring to a key issue identified in the HQCA report (p. 5) about Alberta lab services and one that has been well known for years. And wonders if a separate new agency has potential to remedy the accountability and decision making challenges that have long plagued Alberta's clinical laboratory system. 

While the HQCA report identifies all the issues and what needs fixing (most of which are well know and hardly need a special study to identify), I'm unconvinced that creation of a new separate agency is the solution.

IN THE BEGINNING 
The history of health care in Alberta is a long roller coaster of ups and downs that has left health care workers befuddled and frustrated. The one that began the modern turbulent era, albeit one of many historical tidbits (referenced in Further Reading):
In 1994, Ralph Klein’s Conservative government abolished over 250 local hospital, long-term care and public health boards of directors, replacing them with 17 health authorities assigned to geographic regions in the province, and provincial health authorities for cancer, mental health and addiction services.
  • These health system changes were part of efforts to “slay the debt”.
  • Many health care workers in all professions lost their jobs (Further Reading - History of 1990s laboratory restructuring in Alberta )
  • In the case of medical laboratory technologists (and others), they either had to abandon their beloved profession or find work in the USA and other countries. 
MY RESPONSE 
How to respond to 'But do you think that there's also potential for better advocacy and coherence as separate entity?' First, it's clear that the HQCA report has been presented the government of Alberta but no decisions have been made and several recommendations in the report are open to discussion.

Drawing on how I perceived events of the 1990s when cost saving were paramount, and granted it's just my view of realities at the time and I could be mistaken, some observations and comments on THEN and NOW:
  • The lab professionals who became leaders in the 1990s were those who toed the government's party line;
    • Naysayers were marginalized;
    • Frankly, this makes me queasy to this day; 
  • Then it was all about King Ralph's cost savings ('efficiency') via regional and centralized lab services;
    • Now cost effectiveness is equally stressed ('cost' has 78 hits in HQCA's report);
  • The proposed new pan-Alberta agency sounds a lot like a superboard, a superboard that failed;
    • Such an agency would be well removed from the realities of front-line health professionals;
    • How would the interests of Calgary, Edmonton, and other Alberta centres be managed?  I can hear the whining now;
  • Doesn't the proposed new agency add another layer of bureaucracy, one at a distance from front-line workers? 
  • Who would lose jobs under the new system? 
    • The 4 VPs mentioned in the HQCA report? 
    • Lab directors, managers, supervisors, technologists in Edmonton's UAH and RAH's multiple labs now that there'll be a new mega-lab to do all testing except rapid response? 
    • Will this include transfusion service labs, I wonder?
    • Will it be deja vu from the 1990s when colleagues had to compete against each other for the remaining positions and all were losers because the winners felt guilty for surviving?(See Further Reading)
Management decisions from afar easily morph to diktats resented by all because decision makers don't understand conditions in the trenches nor seem to care. They're often too interested in leveraging their translational experiment into a success that makes them look good (cost savings) and ensures future careers as consultants. Yes, folks, I'm taking the piss. But here's a real-life example of what's happened in Alberta: 
I hope the situation in Alberta changes, but in the last few years of my employment with AHS, there was an overwhelming culture of DON'T question any changes, keep your head down, don't make waves and don't rock the boat. (Further Reading: Kieran Biggins)
BOTTOM LINE
So could improved advocacy and coherence result from a new pan-Alberta laboratory agency? Who knows. As a contrarian with atypical views I'm skeptical. 

Please see Comments  below. The comment is by the Med Lab Sci grad whose reply to a tweet stimulated this blog. Her comment (Thanks, Anne!) is a sound rebuttal to my points and I hope you can see why I'm so proud of our MLS grads. 

FURTHER READING
HQCA: Provincial Plan for Integrated Laboratory Services in Alberta (released May 2017)

History of 1990s laboratory restructuring in Alberta (Written by me as it happened)

Timeline of a health superboard (2008-13)

Restructuring Alberta's health system (2013)

Centralization: A step back for Alberta health care? (2008)

Back to the past: Alberta returns to decentralized health care (2015)

CSTM 'I will remember you' blogs about some of Alberta and the world's the most dedicated, talented, successful medical laboratory technologists:
Musings by Dianne Powell: Lab restructuring and more
Musings by Kieran Biggins 

2 comments:

  1. Anne Halpin3:26 PM

    Thanks Pat! I’ll assume full responsibility as the ‘kid’ involved in this blog. And also, I am delighted to have some refer to me as a kid as I am not in my mid 40’s.
    I was part of the fall-out of the Klein health care cuts and worked in the US for several years in the mid-late 1990’s. That worked out OK for me as a new grad with no family, no mortgage, etc and I was lucky to work in a fantastic HLA laboratory in Texas.

    I think that the concerns that you list here from past experiences are legitimate and that we shouldn’t forget these lessons. BUT I think (and perhaps I’m being overly naïve here) that there are some differences between now and then that might make for possible success.

    The recent RFP process, although it didn’t result in privatization, involved dozens of laboratory personnel. That DID include front line staff and even the naysayers that you refer to. There were many lessons learned, many gaps realised and defined, and this knowledge and experience (and the people who were involved) are still present. And even now, I think that there are opportunities for front-line staff and staff at all levels to be involved in planning a new Hub Laboratory. There are also regular updates to staff in ways that I think did not happen in the past. I am cautiously optimistic that our current laboratory leadership is making logical decisions that will benefit that laboratory and our staff overall. It could be argued that I’m ignoring past lessons but I think that I’m not. The clinical lab is full of so many amazing people- smart, dedicated, hard-working, passionate about what they do… I could go on and on. But we are terrible at showing the public what we do. It seems to me that there is a lot of potential for a single entity to do that better.

    The clinical laboratory is evolving so rapidly right now. I feel that our days of operating in silos are gone or should be! We need to be prepared, ready, and willing to share equipment and knowledge between areas of the laboratory. I honestly believe the oversight of all labs though a single, lab focussed group will allow for that to happen. It will require us to all check our egos at the door and work together as a team. Some labs will lose some of their testing. Other labs will gain some. There is PLENTY of work for us all to do and with the impending retirements of baby boomers, plenty of jobs for all.

    To me, this seems that if this was done well, that it could be our opportunity to shine and to show the rest of the medical community what the laboratory can do.

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    Replies
    1. Thanks for the comment, Anne. It's a pretty darn good rebut of my points.

      I think my main concerns include
      * The new agency and its members will make decisions based on factors that are not necessarily best for patients but more based on cost savings über alles;
      * Will not pay as much attention to the concerns of front-line workers as they should, especially non-MD health professionals;
      * Will experiment with promoting their pet managerial hobby horses.

      I've seen this happen in our national blood supplier. They say all the right things but the reality is VERY different.

      Anyway, I hope you are right and thanks again for challenging my 'interesting POV'. <;-)

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