Sunday January 7, 2007
Centralized mentality sabotages progress
I happened to be riding in a car, one day, with two people who both provide programs to make seniors more mobile, more able to take care of themselves, more able cope without outside assistance.
For reasons that will become clear, I cannot identify either these travellers or their programs.
One described the exercise program she ran. “One woman couldn\’t take more than a few steps on her own when she started,” she said. “Last week she walked by herself two blocks to the grocery store, without help.”
The second person had similar stories to tell.
I asked if I could write about their programs for this column.
“Good God, no!” said one.
“If Interior Health knew about it, they\’d shut us down in an instant,” said the other.
Both programs apparently depend on local administrators skilled at disguising some expenses.
Neither passenger hid their scorn for the Interior Health Authority. “It\’s the biggest mistake the Liberal government made,” said one.
I don\’t think their views are unusual. I sense a rising level of discontent with the quality of health care being offered throughout this region.
Declining quality
Ten years ago, we rushed my aging father to Kelowna General Hospital when we feared he was having a heart attack. At that time, we were all impressed with the care he received from a cardiologist, our family doctor, and the nurses.
My father felt he received better care than he would have in Vancouver.
I doubt if many patients would say the same today. Emergency patients spend days on stretchers. Operating rooms sit idle. Waiting lists expand.
In May, about 65 medical staff members passed a non-confidence vote against Interior Health and their hospital\’s management.
"It\’s unusual and unprecedented for a group of medical staff to say they don\’t trust the ability of the IHA," said pathologist Dr. Doug Mulholland.
Four pathologists resigned rather than renew their contracts.
The chief of emergency at Kelowna General Hospital, Dr. Jeff Eppler, criticized “politicians, bureaucrats, and health care administrators” for failing to provide adequate facilities.
According to Eppler, hospitals “warehouse patients in the emergency department… There aren\’t enough acute care beds. Instead of going to a ward, they remain in emergency.”
Dr. Stephen Krywulak agrees. A lack of beds for patients recovering from surgery makes it difficult to shorten wait lists.
Before Christmas, Health Minister George Abbott announced $25 million to help reduce surgery backlogs.
Last March, the Courier reported, Interior Health restricted orthopaedic surgeons to 17 joint replacements a week. When the surgeons defied that order and did 20 to 22 a week anyway, Interior Health cut them down to 12 a week in September.
Given these policies, not even $25 million will reduce wait times, Krywulak suggested.
Toxic system
The problem is not the medical personnel. It\’s the system they work in.
The Interior Health Authority was created to bring spiralling medical expenses under control. So its roots are administrative. Not service.
I don\’t fault IHA administrators specifically – they have done exactly what was asked of them. Of course, so did prison guards at Abu Graib and at Auschwitz.
The Liberal government\’s mistake was to create a centralized structure just when the business world was discovering decentralization.
Corporations “flattened the management pyramid.” They broke up traditional hierarchies. They shifted authority down the line to staff who actually did the job or worked directly with the public.
The federal government bought into the trend – at least in theory – by “devolving” responsibilities to the provinces. Provinces likewise “downloaded” onto municipalities.
Bucking that trend, IHA attempted to gather into a single administrative structure the oversight of health care in 55 communities from the U.S. border to Williams Lake to Alberta – 700,000 people scattered over 200,000 square kilometres. The only thing these communities have in common is not being part of the Lower Mainland or Vancouver Island.
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It\’s also worth pursuing Charlene Fairchild\’s United Online site. Another site worth visiting is David Keating\’s \”SeemslikeGod\” page.
Any centralized organization sees decentralized activity as a threat. A freelance editor discovered that when she attempted to return to her current U.S. residence after spending Christmas in Alberta.
“Homeland Security,” she wrote, “held me up so long that I missed today\’s flight.” She recommended allowing six hours to get through security.
In an e-mail, she wrote: “The security guy demanded that I tell him the REAL REASON I had for going down there because HE WAS GOING TO FIND OUT” (her capital letters).
He insisted on seeing pay stubs, to prove she was a freelancer.
He wanted telephone numbers for people who had assigned contracts to her. American numbers only, though; Canadian numbers didn\’t count. Fortunately, she had a home number for one contact person. Over the New Year\’s weekend, who\’s at the office?
She came out of the experience wondering, “Is editing subversive?”
No, editing is not. Freelancing is. Freelancing, by its nature, offends the centralized mindset. One cannot go over the freelancer\’s head to a non-existent boss.
Freelancing requires individual initiative — anathema to people who work in rigid structures. Like Homeland Security. Or any organization like Interior Health.
Their task is not to reason why, nor to bend rules. They simply apply policies created by someone higher up.
The centralized mindset assumes that intelligence resides at the top of the pyramid. Everyone else does what they\’re told.
As an extreme example, U.S. forces believed that eliminating Saddam Hussein or Osama bin Laden would cause terrorism to collapse. It didn\’t. Saddam Hussein\’s capture did not reduce Baghdad bombings. Insurgent attacks increased after Abu Musab Zarkawi\’s assassination. Osama may or may not still be alive; terrorism certainly is.
Top-down management doesn\’t work any more — if it ever did. Central command never substitutes for a unified vision, a common commitment.
When any institution – be it a health authority, a church, a Wal-Mart – starts treating its own internal efficiency as more important than serving its customers, it\’s in trouble.
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Copyright © 2006 by Jim Taylor. Non-profit use in congregations and study groups permitted; all other rights reserved.
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