A cautionary tale for new Ontario Health board
On March 5, Dr. Malcolm Moore, the CEO of British Columbia’s Cancer Agency (BCCA) announced his resignation more than a year before his contract expired. Moore was the third CEO at the agency in six years. His two predecessors also resigned long before their contracts were up. This high-level churn is a signal that something is very wrong at the agency that was once recognized internationally for its leadership in cancer clinical care and research.
Prior to 2001, the CEO of the cancer agency reported to the health ministry in B.C. and had responsibility for cancer staffing levels, recruitment and performance across the province.
In 2001, the B.C. health ministry ordained structural changes to B.C. health similar to the health system transformation recently announced in Ontario. This resulted in one provincial super agency called the Provincial Health Services Authority (PHSA), as well as five regional health authorities. The provincial agency took over responsibility for cancer care as well as for children, maternal, mental health and emergency medical care.
In Ontario, the new provincial super agency is called Ontario Health. The new board was announced last week. At the same time, boards of more than 20 agencies were terminated, meaning that the new directors have already taken over responsibility for all 14 current Ontario regional health authorities, as well as all clinical services, measurement of clinical quality and possibly a new supply chain for Ontario health purchases. The breadth of responsibility of the Ontario super agency is far broader than the B.C. authority.
In 2014, Don Carlow, the B.C. cancer CEO prior to 2001, expressed concerns about B.C. cancer care under the new provincial authority. Carlow said the board of the authority was too distant from cancer treatment to provide effective leadership of cancer services. The cancer CEO was now four bureaucratic levels below the ministry of health. This contrasted with the prior situation where the cancer CEO had direct connection to the ministry.
Continuing problems with retaining leadership as well as problems with clinician work load, recruitment of front-line staff and prolonged wait times have been evident since Carlow’s concerns were expressed five years ago.
At the time of his recruitment in 2015, Moore described B.C. cancer as follows, “B.C. was considered to be one of the pre-eminent cancer systems, and ….. in the last five years or so things have slipped while other jurisdictions, like Ontario, have moved forward.”
Reflecting on the impact of the health authority on cancer providers in B.C., Moore said, “everybody has been traumatized to some degree by what happened.”
Continued concern about clinician morale in cancer and other health authority services led to a third-party medical services review in May 2018.
The independent consultant recounted there was “insufficient opportunity for medical staff input/consultation as part of PHSA’s strategic planning, policy development, health human resources planning and resource allocation processes.” There was also a “lack of significant input by medical leadership at the PHSA Senior Executive Team meetings.”
Finally, there was “a perception by medical leaders that the board does not fully understand the populations served or the services delivered and is too far removed from medical staff to make informed decisions about patient care.”
These comments and the leadership crises that have undermined performance in B.C. cancer care are important for the Ontario Health board to consider as they take on their new responsibilities. The B.C. super agency is approaching the end of its second decade so performance issues cannot be blamed on inexperience.
Until last week, Cancer Care Ontario (CCO) led Ontario’s cancer system and was recognized as an international leader in cancer best practices. Any deterioration in cancer leadership or services will reflect badly on Ontario Health, especially since there was no perceived problem in CCO performance.
CCO distributed cancer funding on the ministry’s behalf motivated solely by enhancing excellence in cancer care. This focus on excellence is unlikely to continue under Ontario Health since the super agency will have infinitely more responsibilities than the terminated board of Cancer Care Ontario.
The importance of governance and leadership in cancer care is recognized around the world. Cancer Care Ontario’s board undertook this governance role in exemplary fashion. The new directors of Ontario Health may soon be asking what problem they were trying to solve when they took on responsibility for cancer care in Ontario.
Bob Bell worked in Ontario health care for more than 40 years as a GP, surgeon, hospital CEO and Deputy Minister of Health. Follow him on Twitter: @drbobbell