By Mario deSantis, October 18, 1998

In our past article "Healthcare Reform and Authoritarian Management"(1) we showed how the authoritarian management approach is creating a "Big Brother" syndrome which is interfering with the democratic empowerment of District Health Boards, the affirmation of our individual rights to privacy(2) (3) (4) (5) and the proper allocation of taxpayer dollars(6) (7). The present healthcare provincial policy of centralization(8) and related management by fear(9) (10) are not compatible with the democratic health reform envisioned by the Saskatchewan Vision for Health(11) and related legislation. Therefore, I was not surprised when the authors of the article "Health board policy wrong"(12) warned all of us of the unprecedented disrespect of the democratic principles by the Saskatoon District Health Board in absolving "...itself of the need to hold monthly public meetings by revamping its communications policy..." The authors of this article go on to say the following:

"...But instead of working to make its business more taxpayer friendly and democratic, the health board has decided the answer is to make itself less accountable and more distant from those it serves. Former board member Maurice Vellacott suggested last year that the board needs to bring its business out from behind closed doors... For an institution that is already saddled with an image problem-most people consider the health boards a convenient creation by the government to buffer itself from criticism over provincial health policy-the district health board is on the wrong track with its latest communications strategy... The only communications strategy the board needs is one that makes it clear that Saskatoon District Health is accountable, open to ideas and that public input is not only welcome but that it is essential. With its recent decision to reduce the number of public meetings, the board is moving ever further from that ideal..."

The above mentioned concerns of closed door meetings, fiscal responsibilities and democratic running of healthcare services are not unique to the Saskatoon health district; it is a matter of fact that these concerns are widespread across the province and they have come to the attention of the Provincial Auditor(13) for sometime. We are not dealing with temporal concerns which are just happening now. These concerns are of a systemic nature, and they are consequences of the continuation of a centralized and authoritarian management(14) directed and enforced by the Saskatchewan Association of Health Organizations (SAHO)(15) through most of their member district health boards. These systemic concerns go back to the late 70s when Mr. Hewitt Helmsing(16) became the CEO of the Saskatchewan Health-Care Association (SHA), fired half of this agency's staff and developed an autocratic and most powerful organization centred on power, obedience(17), and closed door decision making policies. This was the time when health care leaders such as Mr. Harvey Fox, former CEO of the South Saskatchewan Hospital Centre, and Mr. Elmer Schwartz, former CEO of Saskatoon City Hospital, built personal empires at the expense of Saskatchewan taxpayers(18). This was also the time when I wrote a paper(19) on the application of queueing theory to properly staff the emergency rooms (ER) of Saskatchewan hospitals, without realizing that the cities of Saskatoon and Regina had already an over supply of acute care beds!

The Saskatchewan Association of Health Organizations plays a prominent policy role in the administration of provincial health services, yet nobody has been able to evaluate the integrity of the services provided by this organization. In the Spring of 1995, I had a meeting with Mr. Wayne Strelioff, Provincial Auditor, and at that time he stated that SAHO falls under his jurisdiction(20). We are in 1998 and there is no sign that SAHO will ever be audited by the Provincial Auditor. It appears that SAHO, through its member health districts and allied organizations, is such a powerful and intimidating organization (21) that it is above the social accountability of the taxpayer money it manages and above the law(22). Therefore, in the next articles I am going to evaluate the integrity of some services of this organization as they transpired through my own personal experiences.

REFERENCES/ENDNOTES

1. "NEED OF TRANSFORMATIONAL CHANGES IN SASKATCHEWAN: Healthcare Reform and Authoritarian Management," by Mario deSantis, September 30, 1998 htpp://www.ftlcomm.com/ensign/desantis12/desantis12.html

2. "Privacy, not price matters: Strelioff", The Leader-Post, Regina, Sept. 26, 1997 httpp://www.auditor.sk.ca

3. "Doctors wrestle with SHIN privacy concerns", The StarPhoenix, April 30, 1998

4. "Medical association won't back SHIN bill", The StarPhoenix, May 2, 1998

5. "Health files will remain private: Nystuen", The StarPhoenix p. A7, April 30, 1998

6. Paper: "A Historical Perspective of the Saskatchewan Health Information Network", by Mario deSantis and James deSantis, March 1998 http://www3.sk.sympatico.ca/desam/paper-SHIN.htm

7. "Economics of the new Health Services Support Group (HSSG) payroll system through Stargarden software" by Mario deSantis, January 24/1995. http://www3.sk.sympatico.ca/desam/paper-econ-stargarden-jan24-95.htm Also refer to the letter dated May 2, 1995, from Mario deSantis directed to the then MLAs Mr. Ron Wormsbecker and Mrs. Judy Bradley, a copy of the letter was formally sent to Honourable Lorne Calvert, Minister of Health.

8. Presentation of the healthcare system architecture to vendors and software developers. Presentation sponsored by SAHO, Sask Health, and Economic Development. Regina, January 12, 1995. A brief report by Mario deSantis. http://www3.sk.sympatico.ca/desam/paper-presentArch-Jan12-95.htm

9. This is an example of management by fear practised in the healthcare environment: article "SUN decries gag order: Memo reminder of confidentiality rule, health board", by James Parker, The Star Phoenix, THIRD PAGE, May 8, 1998

10. "EXAMPLES OF MENTAL MODELS IN SASKATCHEWAN HEALTH CARE AND RACISM", by Mario deSantis, July 1998 http://ftlcomm.com/ensign/desantis3.html July 1998

11. "Saskatchewan Vision for Health", by Honourable Louise Simard, Minister of Health, 1992

12. "Health board policy wrong", by Steven Gibb, Les MacPherson, Sarath Peiris and Lawrence Thoner; The StarPhoenix, SP Opinions, October 8, 1998

13. Refer to the Provincial Auditor Saskatchewan Reports for 1996, 1997, and 1998

14. "NEED OF TRANSFORMATIONAL CHANGES IN SASKATCHEWAN: The Learning Organization, and Knowledge Economy" by Mario deSantis, September 20, 1998 http://ftlcomm.com/ensign/desantis10/desantis10.html September 1998

15. The Saskatchewan Association of Health Organizations (SAHO) was created in 1993 and it absorbed the former Saskatchewan Health-Care Association (SHA)

16. In the 70s Mr. Hewitt Helmsing was the owner of Helmsing Funeral Home in Regina and Chairman of the Board of the Regina General Hospital. Also, refer to the article "Helmsing, SHA settle", by Mark Wyatt, The Leader Post dated Sept 29, 1993, Regina

17. This is the way SAHO unleashes human creativity in healthcare. We are supposed to be knowledge workers in learning organizations; instead, SAHO purports a management approach where people must do what they are told! Also, refer to the article "Obedience to Authority", by William Livingstone, 1995, FES LTD http://www.mv.com/users/davidc/fes/shortc/issue13/24page.html

18. "Invitation by the Regina Health Board to comment on the Atkinson Report", brief by Mario deSantis, May 8/1992 http://www3.sk.sympatico.ca/desam/paper-Atkinson-may08-92.htm

19. "Analysis of Staffing the Operating Room by Grassman's Queuing Computer Algorithm", by Mario deSantis, 1979

20. The professional work of the Provincial Auditor has been questioned by many parties including the Cabinet, Saskatchewan Power and the Workers' Compensation Board; in this respect refer to the Provincial Auditor Saskatchewan 1997 Fall Report Vol 2.

21. I have the documented evidence of one instance when an employee of SAHO physically participated in the wrongful dismissal of an employee of a district health board. This is an outrageous abuse of power and a trampling of individual rights by SAHO. Will the eventual SHIN bill protect our individual rights to privacy and confidentiality?

22. SAHO is the strongest governmental lobbying agency in the field of healthcare. SAHO has adamantly supported the implementation of the SHIN's infrastructure to consolidate the medical records of every resident of the province before even any related legislation was passed. This legislation, the eventual SHIN bill, would impinge on the actual private and confidential information of medical records.