June 3, 2003

Health Authority Performance

BC's Auditor General is a master of subtlety. Without directly criticizing the Campbell government for failing to account for the largest line item in its budget, his May26th news release said "Strelioff believes that clear performance agreements can contribute to effective delivery of the $6 billion of public money spent by health authorities in delivering health services to BC people." BC's six health authorities have a budget of $6.6 billion - the 0.6 that was missed in the Auditor's news release is 0.6 of a billion or $600 million. $6.6 billion is over half of the health budget and almost a quarter of all provincial government spending. Note that the Auditor said that the performance agreements "can contribute" rather than saying that they "do contribute". Throughout his report, he suggested hope for the future while criticizing the status quo.

"Accountability" is one of the favorite terms in the New Era, and like Orwellian New Speak, it doesn't necessarily mean what ordinary people might expect. Witness, for example, how government abuses question period by having back benchers lob friendly questions, or look at the staged cabinet meetings and try to find one revealing question or hint of a debate. The Auditor wisely observed that "We also thought it was timely to review these agreements because they are emerging as an accountability tool across government."

It could be that the word "accountability" is used in the New Era, not to mean that government is held accountable, but as a catch phrase that political spinmasters think will appeal to the public. That could explain why the Auditor reported "Our first major finding is that the agreements lack a specific purpose." It is ironic that the Auditor's report came down within days of a Supreme Court judge ruling that the Minister of Health is legally and politically accountable for the health system. The Auditor reported on how ambiguity can interfere with accountability. He wrote that "In addition, to hold a health authority accountable for meeting a specified level of performance, we believe that greater clarity is needed about who makes decisions, when decisions are to be jointly made, and how unusually sensitive or controversial issues should be handled."

During debate in the Legislature on Health Service Minister Hansen's budget, Hansen took the position that he would not interfere with management decisions made by the health authorities. It is fair enough to say that the Minister shouldn't micromanage the system, but he should be accountable for meeting important objectives. According to the Auditor "We found that the agreements have not achieved their potential of becoming the key accountability documents between the ministry and each health authority. One main reason for this finding is that the agreements do not state the most important objectives for the regional health care system."

When the BC Liberals were in opposition, they continually stressed the importance of measuring outcomes rather than inputs. Times have changed. The Auditor reported that "Good performance agreements set measurable targets. We found that many of the targets in the agreements are vague, e.g., improvement in the performance of emergency health services. Apart from the financial targets, they are often not seen by the health authorities as requiring significant effort." Perhaps that is because the real objectives of the Campbell government are financial, and patients' outcomes are not on the radar scope. The Auditor found that of the 22 performance measures in the agreements, 15 are concerned with process improvement, two set expectations for internal results, and only five address patient/client outcomes. Keep in mind that the Campbell government eliminated infant mortality as a performance measure in all of its service plans. Even though it is not a surprise from the Campbell government, it is disappointing that the performance measurements for health authorities are big on budget management but silent on infant mortality. Perhaps pressure from the Auditor will help to change that.