Opinion: On health care, local decisions lead to better outcomes

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By Krystle Wittevrongel 

When decisions are made closer to home, they tend to more accurately reflect the reality on the ground.

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This is something that Premier Danielle Smith and Health Minister Adriana LaGrange seem to understand based on the plan they presented to reform Alberta Health Services. They’ve even gone so far as to make local autonomy one of the seven guiding principles for the reform. 

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The plan presented to Albertans talks of splitting Alberta Health Services into four different organizations, each focusing on a specific aspect of health care: primary care, acute care, continuing care, and mental health and addiction. While there has been endless tinkering with the system for decades, this reform is the largest since 2008, when then-premier Ed Stelmach centralized the system and merged the regional health authorities. 

The only problem with this talk of local autonomy is that based on what was unveiled, it’s hard to see how local decision-making will be operationalized among the 12 local advisory councils and Indigenous advisory council to be established. 

Although having different specialist organizations is an interesting idea, it doesn’t solve the issue of excessive centralization in the province’s health system. We’re not getting much more regional input from Fort McMurray, Lethbridge or Grande Prairie by replacing one Edmonton headquarters with four Edmonton headquarters 

In contrast, empowering different regions to make their own decisions would give us a health system that responds faster and better to local needs. While we all need faster access to health care, not every region faces the same issues.

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Some of those differences might be obvious — you’re more likely to see skiing injuries ending up at hospitals in Banff or Canmore than in Drumheller — but others are less so. 

For instance, patients at the Grande Prairie Regional Hospital had to wait the longest in the province for knee replacement surgery, with 90 per cent receiving treatment within 191 weeks, compared with 97 weeks provincewide. And yet, the same facility is among the fastest in the province when it comes to completing CT scans.

By bringing decision-making closer to front-line workers, both geographically and hierarchically, negative trends can be noticed faster and corrected sooner.

The other advantage of decentralization is an improved ability to experiment with different solutions to our health-care woes.

After all, it’s much easier to implement organizational change in a smaller organization than in one as large as Alberta Health Services, with its more than 100,000 staff members.

It’s also no secret that some issues, such as long wait times, are plaguing emergency rooms in every part of the province — despite the fact that Alberta spends more per person on health care than many other provinces, including Quebec and Ontario. 

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By creating a number of smaller regional units, as opposed to a large conglomerated administrative structure, ideas for small changes are more easily applied and can potentially generate interest and awareness higher up the ladder.

A good way to visualize it is that there are far fewer administrative rungs to climb between front-line workers and their local hospital executives than between those workers and AHS executives in Edmonton.

This tends to favour initiative-taking and experimentation on a regional level. And if experimentation is on the rise in every region, then the entire province becomes a laboratory for ideas, where the best methods can be identified and then replicated in other places.

Hopefully, when Smith and LaGrange provide us with more details, we’ll see more of that kind of decentralization in Alberta’s health reform. Because just splitting one Edmonton headquarters into four risks doing very little.

Krystle Wittevrongel is senior policy analyst and Alberta project lead at Montreal Economic Institute.

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Originally posted 2023-11-18 13:00:16.