By Mario deSantis, October 25, 1998

The Saskatchewan Vision for Health, the blue print of health reform published in 1992, concludes the forthcoming changes of Health Reform by stating "...These changes will be made based on community values. A community-based and community directed health system is being developed to place health decisions in the hands of Saskatchewan people..."(1) In the October 8, 1998 issue, The StarPhoenix reports the failures of the current administration of health services by stating that the Saskatoon's health board should be "...more taxpayer friendly and democratic..." and that "... the board needs to bring its business out from behind closed doors..."(2) In our last article we explained how such "...concerns of closed door meetings, fiscal responsibilities and democratic running of healthcare services are not unique to the Saskatoon health district..." and that the Provincial Auditor has been addressing these concerns for sometime(3).

Something terribly wrong has happened since the implementation of health reform. Health reforms were supposed to empower the community owned health districts, instead, today there is the realization that such districts have become instruments of the centralized and autocratic health policies of both the Government and the Saskatchewan Association of Health Organizations (SAHO)(4). At the time when the districts were supposed to affirm their independence(5), the government has allowed SAHO to behave as a "private"(6) and powerful bureaucratic dinosaur(7) purporting across the province the obsolete values of conformity(8) and obedience(9) (10) against the enriching values of diversity and creativity(11) (12). The management philosophy of the healthcare environment is so archaic that they still define the manager as the leader who makes the big buck to i)make the hard decisions, and ii)get the job done through others. I wonder what kind of hard decisions this manager can make under an autocratic environment and what kind of human sensitivity this same manager must have in making sure to exploit the work of others for his/her credit. The current state of managerial confusion is further compounded by the behaviour of many health board members, who put themselves in flagrant conflicts of interest by meddling in their districts' internal affairs(13).

The continuation of a management philosophy of centralization and control has a historical background(14) and it is adamantly preserved through manipulative open or secretive(15) contractual arrangements between Sask-Health(16), SAHO, District Health Boards (DHBs) and other agencies. In addition, DHBs are composed of 12 (twelve) members, 4 (four) of whom are appointed by the government, and it is a practice that a district health consultant, an employee of Sask-Health, attend all the meetings of the DHBs. This means that Sask-Health can have detailed information of all the meetings of district health boards, and that in the last 4 (four) years it had or could have had prior knowledge of the dismissals of more than 22 (twenty-two) CEOs of district health boards(17). I hope that this policing approach to the management of health resources is not what Honourable Louise Simard referred to when she stated that reform will take place in a spirit of "...mutual aid, partnership and cooperation... the Saskatchewan way..."(18)

Endnotes

1. "Saskatchewan Vision for Health", by Honourable Louise Simard, Minister of Health, 1992, page 24

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

3. NEED OF TRANSFORMATIONAL CHANGES IN SASKATCHEWAN: Healthcare Reform and New Economic Policies, Part 1 By Mario deSantis, October 14, 1998. Http://ftlcomm.com/ensign October 1998

4. NEED OF TRANSFORMATIONAL CHANGES IN SASKATCHEWAN: Healthcare reform and Authoritarian Management, by Mario deSantis, September 30, 1998 htpp://www.ftlcomm.com/ensign

5. District Health Boards should have the authority to plan, govern and deliver health services; refer to the mentioned "Saskatchewan Vision for Health" pages 16- 17

6. In the Spring meeting of 1995 between Mario deSantis and Wayne Strelioff, Provincial Auditor, Mr. Strelioff stated that SAHO falls under his jurisdiction and that SAHO was fighting the authority of the Provincial Auditor.

7. Letter dated April 28, 1998 from Mario deSantis directed to all Chairpersons and CEOs of Saskatchewan District Health Boards. http://www3.sk.sympatico.ca/desam/paper-letterToChairsCEOs-Apr28-97.htm

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 StarPhoenix, 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 July 1998

11. THE THEORY OF LIVING SYSTEMS AND ORGANIZATIONAL CHANGES ARTICLE 4 -A CONCISE DESCRIPTION OF THE THEORY OF LIVING SYSTEMS (Living Systems: Principles of Organization and Building Sustainable Human Communities) By Mario deSantis, September 12, 1998 http://www.ftlcomm.com/ensign

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

13. Refer to the Conflict of Interest Guidelines developed by the Health District Advisory Committee (HDAC) Working Group, SAHO & Sask-Health, Fall 1996.

14. NEED OF TRANSFORMATIONAL CHANGES IN SASKATCHEWAN: Healthcare Reform and New Economic Policies, Part 1 By Mario deSantis, October 14, 1998 http://ftlcomm.com/ensign October 1998

15. The failure of the Stargarden payroll project is a well preserved secret of the Saskatchewan Association of Health Organizations.

16. Sask-Health is the name of the department of health, Government of Saskatchewan.

17. "CEO quits: Gabriel Spring boss resigns amid stories of poor office conduct", by Jason Warick, The StarPhoenix, June 29, 1998

18. "Saskatchewan Vision for Health", by Honourable Louise Simard, Minister of Health, 1992, page 24.