I am a former health care CEO and Board member whose experience includes taking over a hospital under government trusteeship following the dismissal of the whole Board, the termination of the CEO and a six month suspension of the medical staff, and a community completely torn apart. One of the early outcomes was a dramatic loss of donations which, along with cost overruns on construction drove the hospital into virtual bankruptcy, as revenues were reduced below the amount of interest on the capital debt.
The situation at the Simkin Centre is tragic because it is has affected the safe and adequate resident care resulting in a divided community. This is not a simple fix.
The governance issue is but a small part of the problem. Nonetheless, it is a significant part since the Board has set the corporate culture (A set of values to which everyone in the organizations subscribes and consequently practices). And regardless of all good intentions, the Board has the legal responsibility and liability for resident care.
Notwithstanding the collective role of the Board, I believe that individually, the Board members are sincere, dedicated people who, as volunteers, have little if anything to gain for their efforts, other than serving the community. However, people often hold to the safety of past practice (i.e. the long standing structure of the Board of Directors) rather than risk venturing into unknown territory which requires change.
First, let’s put the governance issue into perspective. The structure whereby a Board of Directors appoints Directors is a unique practice. I say that as I worked in four provinces and was familiar with the rest of Canada when I sat on the national Board and Executive of the Canadian College of Health Care Executives and the Nova Scotia Association of Health care Organizations. I was further exposed to board structures when I did some consulting for Coopers and Lybrand.
Prior to Regionalization the vast majority of institutions were incorporated as societies with nominal membership dues. Membership allowed one to speak at annual meetings, run for and vote at Board elections, as well as several other constitutional provisions. The world changed with regionalization.
Politicians wanted to distance themselves from public accountability by inserting regional boards between it and the public while maintaining and increasing their control. Part of this included a major change in structure whereby it appoints all the Regional Health Boards. The current mainstream of governance models has not served the public interest.
Readers should be clear that the politicians changed the direction recommended by the various Royal Commissions on health care. Amongst other objectives, regionalization was to reduce administration and bureaucratic expenses and provide greater independence and therefore sensitivity to local needs. It has done the very opposite; there is more bureaucracy and centralization today than ever before making it difficult for Boards to function properly.
The Simkin Centre is part of the Winnipeg Regional Health Authority. I do not think that it is coincidental that the Winnipeg Regional Health Authority is facing a similar situation with the possibility of criminal and civil action with respect to the Sinclair case. WRHA is now diverting scarce resources from patient care to deal with the Sinclair case amongst other problems.
It is usually the advice of legal counsel to say nothing. Without throwing caution to the wind, I believe, and personal experience supports that advice is wrong. Most lawsuits in health care are launched because of the lack of transparency, the poor treatment families receive and their subsequent frustration and anger.
It doesn’t require a career administrator to forewarn that the community reaction to the current structure and lack of transparency will exacerbate the situation. It will get worse if it is not addressed. The Board needs to address people’s concerns and change the corporate culture (or ensure all subscribe to it) if further crises are to be averted, damages mitigated and the community is to be healed.
Charlie Sitwell
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