Scathing review of Nova Scotia Health Authority, 2 years after merger

A paper by a group of medical professionals in Nova Scotia offers a scathing review of the two-year-old Nova Scotia Health Authority, saying the organization isn't agile enough to respond to local needs and is subject to political interference.

The decision to merge the province's nine district health authorities into one occurred Apr. 1, 2015, as a way to cut administrative costs and share resources. 

Kevin McNamara, a former deputy minister of health in Nova Scotia and one of the paper's co-authors, told the CBC's Information Morning the new administrative body is trying to apply a "one size fits all" approach to health care, and it isn't working.

He gave the example of a situation on the South Shore where a program that allowed mental health workers to collaborate with the sexual assault team was altered following the merger, because the authority wanted to make things "equal across the province."

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Dr. John Ross, a medical professor at Dalhousie University in Halifax who also had a hand in writing the paper, said we don't have "the agility now to be able to respond to the variations in this province."

The system needs to be nimble enough to get the most out of local experts, wherever they might be located, he said. 

Recommendations

The group, which also includes geriatric psychiatrist Dr. Jeanne Ferguson, palliative care doctor Robert Martel and family physician Dr. Ajantha Jayabarathan, made these recommendations:

1. Stop political interference in health-care delivery, including requiring that some decisions be approved by the premier's office.
2. Overhaul the board of directors to include frontline workers, and make the contents of the meetings open to the public.
3. Create four zones to allow decision-making to reflect the unique needs of each region.
4. Create an inter-professional clinical advisory group to provide advice.
5. Design emergency plans in each zone to address blocked access to services for patients.
6. Develop a framework for evaluating what works and what doesn't.
7. Incorporate more complex-system design experts, such as industrial engineers, to ensure the system is working.

Executives respond

Executive director of operations for the Nova Scotia Health Authority's central zone, Vickie Sullivan, said she disagrees with the idea of dividing the authority further into regions. "I think that would be a step backwards," she said.

Management of the Nova Scotia Health Authority is already organized by zone, with local leaders in each of these four locations: western, eastern, northern and central.

The idea behind the merger was to make things simpler and cheaper, and this could jeopardize that. "We need to look at a health-care system that is sustainable," Sullivan said.

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She urged Nova Scotians to be patient. "Change is hard work and it's going to take a number of years to accomplish our end goal," said Sullivan.

As for the problem of perceived political interference, she said the public should not be concerned. "There is an accountability agreement" between the authority and the province that "very clearly delineates" the rules.

Sullivan also said engaging with the public is a priority. She gave the example of the seven community health boards in the central zone that she meets with monthly.

CEO of the Nova Scotia Health Authority, Janet Knox, said one of the benefits of a merger is that local knowledge can be shared across the province in such a way that everyone benefits.

She gave the example of a project in Pictou County where the goal was to make home care more accessible. We "found the local solution there and then just moved it across the province," Knox said.

She said the authority strives to base its standards of practice on the best evidence available, but acknowledged it is important to pay attention to "local nuances." 

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