We Will Be Watching Like a Hawk

A top Australian health administrator is the new president of Alberta Health Services.
Stephen Duckett, chief executive of the Centre for Healthcare Improvement for Queensland Health, beat out 140 prospects and a short list of six from Europe, Canada, the United States, Australia and New Zealand to take on the challenging task of heading Alberta's new health organization, already $1.2 billion in debt.

"He is described by people who have worked with him as innovative and as one of -- if not perhaps the leader -- in health care in Australia," said Ken
Hughes, chairman of Alberta Health Services, which was created last year after the province's nine health regions were dismantled and top administrators laid off in an effort to make the system more sustainable and accessible. "It's a fabulous opportunity to provide leadership, not only within Alberta but within Canada. ... He is an agent of change, he is a popular leader, a professor and author."

Duckett, whose wife graduated from the University of Alberta and has a sister in Edmonton, served for two years as deputy minister to the Australian equivalent of Health Canada and has a PhD in health administration. His health experience sets him apart from the health region's board, which was criticized for being largely made up of corporate and business leaders. In Duckett's role in Queensland, he said he improved safety and a leadership culture of cover-ups and bullying by broadening accountability and making safety the core business with all managers and clinicians. He helped hospitals create new care targets, then set up a funding incentive program for fulfilling those targets. Extra money was set aside to encourage doctors to keep operating rooms open on Saturdays and 5,000 staff developed skills in a new leadership program.

Duckett also expanded private delivery of publicly funded services to bring wait times down, similar to what's already happening in Calgary. Australia has a hybrid health system that mixes public and private, but Duckett said he's not going to move Alberta in that direction.
"Public funding of health services is a core principle of medicare and that, as far as I'm concerned, is not on the agenda," said Duckett, who wrote a 2005 article for the Canadian Medical Association Journal urging Canadians to be wary of allowing significant private-sector development. He argued people without private insurance didn't receive equal care and that government paid more for patients treated in the private sector.
"I'm not coming into this job saying I'm going to privatize everything in sight," he said. "That's not who I am."

Richard Plain, a retired health economist, said it might just be a coincidence that Alberta Health Services found someone from a country where privatization is embraced.
"They have picked an individual who would be intimately aware of all of the possible options that would be available to introduce a mix or a blend of private insurance and a different access to services into the Canadian system."

He said it's astounding the search firm couldn't find someone closer to home.
"It is most unusual that we would have to believe that there was no one in Canada who was capable or willing or both to undertake the overhaul of Alberta's health system," Plain said.
"This is not something I would say would be the type of approach that would instill confidence in the public. It leads to the view that something is seriously flawed that no senior top health administrator in Canada was willing to take this job."

David Eggen, executive director of Friends of Medicare, had similar concerns.
"We have lots of health-care expertise here, not only in Canada but in Alberta, that have the clinical experience and the managerial capacity," he said. "Health systems are very specific to geography and culture and realities of each region. Bringing a hired gun in from Australia, I question that."

Duckett said his first task when he begins his job on March 23 is to explore places such as Fort McMurray and Medicine Hat. His goal is to make Alberta Health Services "a shining light within Canada" by providing the highest quality of health services in a transparent way.

"You need to judge us on our performance," he said, noting he won't bring in changes without some buy-in. "You don't say, look, we're just going to ram through this whether you like it or lump it. It's not a good way for a democratic organization to work these days. To some extent, you've got to lead but to some extent, you've got to bring the population with you."

Duckett will be paid $575,000 with a bonus up to 25 per cent for performance, but no supplemental retirement plan. That's far less than the $915,000 made by Sheila Weatherill, the former CEO of Edmonton's health region, or the $1.3 million made by Calgary Health's Jack Davis. Both were laid off during the health restructuring last year.
Hughes said the lower salary, slightly above the $550,000 made by interim president Charlotte Robb, is on par with what other similar Canadian organizations are paying.

"It sets a new tone in Alberta about compensation," Hughes said. "I think it reflects the times. It reflects the role. ... It's really a responsible level of compensation."
He said the lower salary didn't limit the prospective field.
"People realized this is a rare opportunity to make a real difference," Hughes said. "For people who are interested in public service, compensation is the secondary discussion. The first discussion is what's the job and how exciting it is."
jsinnema@thejournal.canwest.com