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. 

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.

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. 
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)
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. 

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