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MICHAEL GARDAM: What now, Health P.E.I.?

This week saw another CEO depart Health P.E.I. A look back at the relatively short history of the health authority shows that CEOs (and boards) don’t last all that long. The government of the day gets frustrated with the state of affairs and makes changes with the promise that things will be different going forward. In the most recent circumstance, there was clearly considerable physician pushback to the government’s handling of the physician services agreement.

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This revolving door history is unusual and harmful. While the job of a health authority CEO is always within the orbit of the politicians in every Canadian province, P.E.I. seems to have a particularly hard time keeping things on an even keel. Remember that the previous entire leadership team comprised of experienced Islanders was pushed out in one way or another over the past two years, so the organization now has little corporate memory at the senior level.

There are many reasons why Health P.E.I. CEOs keep failing in the eyes of the politicians, but perhaps the most obvious one is that no CEO can fulfil the myriad political promises that are frankly removed from reality. Ending hallway medicine, getting everybody access to primary care, quick access to mental health services, access to specialists, better health-care worker recruitment are all things that have been promised but have not been delivered. This is not unique to this Conservative government as it also occurred under the Liberals from the time that Health P.E.I. was created.

Underlying every one of these promises are many challenges, some of which are within the government’s power to address such as collective agreements, and others which are beyond its power to easily address such a global shortage of health-care workers after the pandemic. As physician recruitment efforts stalled and as older physicians retired, the government felt the need to squeeze family physicians to take on an unusually large patient load, to not pay them for teaching medical students, and basically force them to make good on political promises. Things did not need to go this way, but for reasons unknown to me, this government could not recognize what a rare, precious, and mobile resource physicians are in this climate.

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Serious course correction

Where does PEI go from here? I have never worked in an organization with such an unhealthy relationship with its workers, and this recent history has only made things worse. It is going to take some serious course corrections and time to make Health P.E.I. an organization where people want to work. Having a healthy, happy workforce is key to creating a health-care system that Islanders can be proud of and would solve many of the problems facing the organization.

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Workers need to be treated with respect and must be incentivized to do what you want them to do. If you want to support your medical school, you need to pay doctors and other professionals to teach and accept that they will see fewer patients as a result. If you want more nurses to take full-time positions and wean off travel nurses, make it attractive for nurses to commit to the organization. And please stop forgetting all the other professionals without whom health care would collapse: the respiratory therapists, physiotherapists, social workers, mental health professionals, environmental services workers, and many others.

It should be obvious that new MUN medical school grads, residents and out-of-province doctors may not want to work in a health-care system where people are so openly unhappy.

Refrain from interfering

The next leader of Health P.E.I. needs to be experienced in health-care operations, professional, a listener and know that their only job is to provide care to Islanders, not to appease the politicians or get them re-elected. Health P.E.I. has a $1-billion budget and requires highly competent leadership, not political apppointees.

Politicians should know that if the CEO is successful, they will benefit. In this vein, politicians need to let the health-care system do its job and not interfere with operations, while at the same time hold the system accountable for realistic goals. Ditto for the board of directors. As it runs currently, the board is of little value and should either be reconstituted as an independent, competency-based board, or dissolved.

The bureaucracy must change. This is an area where government has the power to make change but has not gone nearly far enough to allow the health-care system to compete with other provinces. While other provinces seem to have taken advantage of the political climate in the United States, P.E.I. remains slow to respond.

Large investments needed

Health P.E.I. cannot solve all the health-care problems facing Islanders alone. Formal partnerships with Nova Scotia and New Brunswick need to be signed to guarantee access to specialty care. Large investments need to be made in patient transport and emergency services so Islanders can quickly get the care they need.

Many of P.E.I.’s health-care facilities are in desperate need of repair or replacement. This work has begun but has often been sidelined by political considerations.

I continue to believe that P.E.I.’s health-care system could be highly efficient and responsive, if the political system could help push the boulders out of the way and allow it to thrive. As things stand now, the ownership for the sorry state of P.E.I. health care rests entirely on the shoulders of the politicians who have overseen it over the past two decades. It is my hope that Islanders will see how differently Health P.E.I. needs to be run and governed going forward.

Dr. Michael Gardam is program director, healthcare leadership, executive education, Schulich School of Business and former CEO of Health P.E.I.

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