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Alberta Health Minister Fred Horne on Nov. 24, 2011.Sandor Fizli/The Globe and Mail

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Why is it that when you examine how Canada's health-care system is managed the classic Abbott and Costello routine "Who's On First?" springs immediately to mind?

Fans of classic comedy will recall the confusion that ensues in a discussion of a baseball team with oddly nicknamed players, where Who's on first, What's on second and I Don't Know is on third.

In Canadian health care, the confusion stems from that fact that it's in no way clear who is in charge, what they are trying to achieve and what they know (or don't know) needs to be done to reform the system. Further, the clarity with which our health care leaders communicate often rivals that of Bud and Lou.

We had a perfect illustration of this recently in Alberta. To recap briefly:

  • Alberta is trying to hold the line on health spending. As part of the belt-tightening, provincial Health Minister Fred Horne ordered the Alberta Health Services board to cancel the performance bonuses of AHS executives;
  • There was some semantic debate about whether these promised $3.2-million in payouts were bonuses, performance bonuses, or at-risk pay; the payouts range from $16,000 to $88,000 for individual executives;
  • The AHS board refused to renege on the payments, saying it had a legal duty to honour employment contracts;
  • The Minister fired all 10 members of the board and replaced them with an official administrator, a sort of caretaker;
  • The administrator, Janet Davidson, reviewed the contracts and said the AHS board was right, that withholding the bonuses would be a breach of contract;
  • The Minister shrugged and said okay but asked the executives to forgo the monies they are owed on a voluntary basis.

"Who's on first," indeed.

Aside from the comedic relief this staggering bit of bureaucratic incompetence may have provided to flood-ravaged Albertans, it actually underscores some chronic problems.

First and foremost, it reminds us that the health system – in Alberta and elsewhere – is painfully micromanaged by politicians.

There are massive organizations, including provincial ministries of health, regional health authorities and agencies like the AHS that are supposed to run day-to-day operations but they are constantly second-guessed by health ministers and the political operatives in the Premier's office.

The role of a government and minister should be to establish a vision, a philosophy, for how care should be delivered. Big picture stuff.

The AHS has a $13.4-billion budget and 100,000 employees. Why is the Minister of Health trying to fiddle with the individual paycheques of a few managers?

There is a lot of rhetoric about making the health system more business-like: Meaning, presumably, more accountable and money-conscious. That is precisely why the "independent" Alberta Health Services board was created. A corporate-like board of directors is supposed to be sheltered from the petty partisan politics that too often guide health policy decisions.

One can debate whether that is the right approach but, regardless, in this case, the board acted in a perfectly business-like manner. They were fired for doing so. That is rank hypocrisy from the so-called political leadership.

Another frequent complaint about the health system is that it lacks accountability. Alberta decided to address this issue by giving managers performance goals and then tying part of their pay to achieving those goals. Again, one can debate whether paying people "extra" to do their jobs is a good approach, but it is what many corporations do.

In this instance, the managers who achieved their performance targets were awarded bonuses, as set-out in their contracts. Then the government turned around and tried to cancel the payments to show it was tough on budget balancing.

Sorry, you can't have it both ways. And asking employees to voluntarily forgo their pay so politicians can save face is just pathetic.

What's next, public shaming of those who actually accept the money they are legally due?

We complain that talented managers and administrators shy away from health care, a field where they are desperately needed. But who would want to take a job in this circus atmosphere?

A strong health system requires a vision, organization and planning. It does not need micromanagement guided by political whimsy.

This debacle provides a timely reminder that, if we want better health care, we need to let directors direct and let managers manage.

If we want accountability, if you want results, you must surrender power.

The all-important lesson for politicians here: Sometimes the best way to show leadership is to get out of the way and let people do their jobs.

André Picard is the health columnist at The Globe and Mail.

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