The buck (doesn’t) stop here

Island Health fails public accountability scorecard

By Stephen D. Shepherdson

The key to maintaining the public’s confidence in its government departments and agencies, is the concept of public accountability. Nothing touches Canadians like the delivery of healthcare services. Island Health’s board of directors met people in the Comox Valley last week and heard from five different groups making formal presentations.

The gap between the serious nature of the issues presented by community representatives and the response provided by Island Health is staggering. Island Health acknowledges its accountability but does it, in fact, hold itself accountable?

They did well in coming to the community. The public forum itself is important in terms of demonstrating accountability to taxpayers and the community being served. There are a number of positive initiatives underway such as the neighbourhood care model for homecare.

As measured against the high-level expectations embodied in the BC Taxpayer Accountability Principles (June 2014), Island
Health might give itself a passing grade. From the viewpoint of this taxpayer, there is much opportunity for improvement.

For example, how did the board and its presenters perform against the principle of ‘respect’? Did they engage in “equitable, compassionate, respectful and effective communications that ensure all parties are properly informed or consulted on actions, decisions and public communications in a timely manner”?

Did they “proactively collaborate in a spirit of partnership that respects the use of taxpayers’ monies” (BC Taxpayer Accountability Principles, June 2014)? In my view, they substantively missed this mark.

Island Health staged the forum in a manner that avoided any need to directly address the specific concerns of the community members assembled. Despite advance knowledge of the points of view for the five presentations they selected, no attempt was made to meaningfully address the concerns presented. By comparison, considerable hard work was put into the community’s presentations. 

Advance questions from the public were answered in a written handout that, in most cases, provided unclear and confusing responses. 

Communications specialists would call the room set-up ’confrontational’ in that it made the presenters accountable to the public in attendance while the board sat on the side as the public’s observers. The meeting was adjourned early omitting the Question
Period for questions from the floor as referenced in the published agenda.

It is disrespectful to ask people to do something and then ignore their efforts and point of view. The board lost an opportunity
to address the questions raised or even give the community one positive take-away.

What does good public accountability look like? First, leaders are clear in acknowledging the situation or issue being addressed. Second, leaders use facts and stories that deal with people to frame the issues. They employ facts and analyses that reflect current results, describe activities underway and identify root causes of the issue or problem. Third, leaders acknowledge limitations and constraints and are careful to address constituent expectations.

FURTHER READING: B.C. Taxpayer Accountability Principles

What did we hear or not hear on March 29? We did not hear that the board holds itself accountable, there was no “the buck stops here” moment.

There was no acknowledgment of issues like the need for more home care support services (except an oblique reference to working on it), the inequity of the current residential care bed allocation, and the immediate need for more residential care beds than planned. Even if solutions are not readily available, acknowledgment of issues is key to public accountability.

It was not clear that stories about people’s experience at the new Comox Valley Hospital and its state of cleanliness were heard by the board and management. The reaction was defensive, failing to differentiate between ‘unusual and critical’ vs. ‘normal’ issues with a new hospital start-up.

That reaction does not make me feel that the Board and management are in control. I would have expected to hear an acknowledgment that we are experiencing problems and this is what we are doing to resolve them. 

Finally, in terms of public accountability, we must be careful not to attribute responsibilities to Island Health that are the responsibility of the BC Ministry of Health. Financial resources are not infinite, they are limited. But Island Health is accountable for its allocation of entrusted resources, the quality of healthcare service delivery, operational improvements, employee engagement and morale, and community relationships.

The community wants and needs Island Health to be successful on all of these dimensions; after all, these are the services we need in our community. Words on a website and declarations that “we do all those things” are well intended. But, if the board and management do not acknowledge the need for direct action when issues are raised with them, then public accountability claims ring hollow.

Stephen D. Shepherdson, Comox, is a retired management consultant and operations management specialist. He wrote this commentary for Decafnation, and may be contacted at: sshepherdson@shaw.ca

 

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