The Decline of Health Services in Alberta

The Triumph of Professional over Real Management

The past 20 years have seen a steady decline in the provision of health services to Albertans. Waiting times for surgeries, diagnostic services and emergency room visits is increasing, costs are escalating and quality of care has remained constant at best. A day doesn’t go by without the health system being labelled in ‘crisis’. All this, despite extensive efforts by health care management experts and government to ‘fix’ the problem. Predictably, these efforts at improvement have made the problem worse.

The Alberta health care system is an instructive example of the negative effects of the command and control thinking of professional management. Four false assumptions of this thinking are explored:

(i) centralization provides for greater levels of control and coordination,

(ii) economies of scale always yield lower unit costs,

(iii) increasing utilization improves efficiency and

(iv) numerical goals and targets provide direction and motivation to people.

How these assumptions  have guided efforts to ‘fix’ the system, the devastating consequences, and how these asssumptions contrast with the systems thinking of real or practicing management are examined.

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