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Confusion, overlap, redundancies in Alberta’s continuing care system:report

EDMONTON — There is confusion, duplication, and questions over who’s accountable for what in Alberta’s continuing care system, the province’s health watchdog reported Thursday.

Charlene McBrien-Morrison, executive director of the Health Quality Council of Alberta, told a news conference in Calgary that there is confusion not only among the providers, but within them as well.

“Quality and safety management in continuing care lacks clarity in roles, responsibilities, and accountabilities among the Ministry of Health, Alberta Health Services, and contracted providers,” said McBrien-Morrison.

“Within Alberta Health Services alone there is a similar lack of clarity regarding roles and responsibilities in continuing care.”

She spelled out problems in a number of areas, starting with no standardized system for handing out contracts to service providers.

She said the province needs to put all contracts under one master template and that “Alberta Health Services make explicit where the responsibility and accountability for continuing care contract compliance monitoring and oversight resides.”

She said the current audit system needs work.

“There are duplication of auditing processes, audits and standards often overlap or address the same issues, and there are many, many types of audits,” she said.

She said the system is also hampered by a crazy quilt of multiple surveys and questionnaires to gauge feedback from those who use the system.

“It makes it difficult to consistently assess the client and family experience,” she said.

There is no system to record and track safety issues, she said.

“No single repository exists of continuing care safety information from across the province.

“This significantly impacts the ability of the continuing care system to identify and analyze safety issues.”

Continuing care encompasses a range of supports, from having caregivers come to one’s home to full-time care in a stand-alone facility.

In a separate report, the council also said that those who need the care should have some degree of choice in determining the option that’s best for them.

Health Minister Fred Horne and Vickie Kaminski, president of AHS, were to respond to the reports later Thursday.

Horne’s department is responsible for health policy while AHS handles day-to-day health care delivery.

AHS was created in 2008 to replace all regional health boards on the philosophy that centralized management would reduce waste and duplication, save money, and improve service.

However, AHS has struggled with wait times, faced accusations of doctors being abused by administrators, and frequent staff turnover at the executive level.

Just over a year ago, Horne fired the entire AHS board for refusing to comply with a request from him to not hand out legally binding executive bonus payments.

The NDP and Wildrose parties said everyday Albertans are reaping the confusion sown by Horne and the creation of AHS.

“They created a system where they put layers and layers and layers upon layers of bureaucracy, and nobody is talking to each other,” said Wildrose critic Kerry Towle.

“There’s no local decision-making. There’s no autonomy or innovation.

“What we really have in this system is a bunch of people covering their butts all the time, and it doesn’t put the clients’ needs first.”

NDP critic David Eggen said centralizing health regions without carving out lines of authority has actually worsened health care.

“Alberta Health Services has been a failed experiment and very expensive,” said Eggen.

“It seems like everyone’s responsible, and no one’s responsible. That’s not a way to run a multibillion-dollar operation.”

Both said the solution lies in decentralizing AHS to allow for more decisions at the regional level to deal with the unique circumstances of each zone.

 
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