Health-care upheaval: A history of changes to Alberta's system

From 200 health boards to 17, to nine, to five, to “I am eating my cookie” – a look back at decades of churn at the top of AHS

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Alberta Premier Danielle Smith announced sweeping new changes to the province’s health-care system Wednesday, breaking up Alberta Health Services into new delivery agencies.

The announced changes come a day after the NDP accused the government of trying to concentrate control over the health system in the premier’s office.

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The plan will see AHS streamlined to focus on acute and continuing care, as well as the creation of a new primary care system, and moving mental health and addiction care under the umbrella of the Ministry of Mental Health and Addiction.

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The move is the latest in major changes to the health system in Alberta, some dating back to sweeping moves made by former premier Ralph Klein:

1994

In the midst of a massive deficit-slaying effort and focus on repairing the province’s finances, Progressive Conservative premier Ralph Klein kiboshes more than 200 local hospital and public health boards, replacing them with 17 health authorities assigned by geography.

Ralph Klein
Alberta Premier Ralph Klein speaks on an open line radio talk show in 1994. Photo by File photo /Postmedia

Some argue the “local empires” were too costly, and individual requests for resources had become channelled through politicians who had little idea how to prioritize them.

At the same time, critics said the new boundaries appeared to be rooted in the politics of the rural Conservative caucus more so than practicality or logic.

2004

A decade later, those 17 boards are amalgamated into nine in an effort to make the system more streamlined and accountable.

2008

The PC government under Ed Stelmach moves to dissolve the nine health regions, prompting the creation of a single governing authority at Alberta Health Services (AHS). It comes after the fierce competition for resources among regions led to varying salary and benefit offers, and varying levels of service, depending on where you lived.

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Then-Health minister Ron Liepert spearheads the effort, with the government promising that putting the system under one governing umbrella would save administrative costs that could be channelled into front-line care — although some later claimed the move was about muzzling criticism of the government from staff and regional boards.

Alberta Health
Alberta Health Minister Ron Liepert announced plans that sets directions and outlines the next steps for future health care in the province of Alberta on December 21, 2008. Photo by File Photo /Postmedia

Health policy experts at the time warn the instability might scare medical professionals away from working in the province, while others worry the centralization would create more bureaucracy and less local decision-making, leaving rural areas with little say on how services would be run.

2009

The province announces it has tapped Australian health policy expert Stephen Duckett as AHS’s first chief executive. Ken Hughes is named board chair.

2010

At the height of an emergency department crisis, Duckett famously walks past reporters and refuses to answer questions saying he was too busy. “I am eating my cookie,” he said repeatedly. The superboard boss — who later said he was muzzled by government from speaking to media about the ER concerns — is pushed out. Duckett’s departure sparks a massive board shakeup as four AHS board members step down, charging political interference.

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Alberta Health
Malcolm Mayes editorial cartoon from Dec. 1, 2010. Photo by MALCOLM MAYES /EDM

2011

Anesthesiologist and longtime Calgary health administrator Dr. Chris Eagle is named CEO in Duckett’s place. He promises a new, more decentralized structure. Five new zones are set up.

As AHS moves to give top doctors and managers in its five zones around the province the new authority to hire staff and buy equipment, then-Wildrose leader Danielle Smith argues it needs to put even more power in the hands of doctors and nurses.

“Trying to centrally plan a $10-billion health system just isn’t possible,” Smith says.

By 2012, Smith was still critical of what she called the “unresponsive superboard bureaucracy in Edmonton,” saying it ignored local needs following the closure of a rural long-term care home.

2012

Then-Health Quality Council of Alberta CEO Dr. John Cowell releases a damning 428-page report in February that raises concerns about dangerously long emergency room waits, a culture of “fear and alienation” and political interference.

In September, the province appoints businessman and AHS board member Stephen Lockwood as the new AHS board chairman, taking the place of Ken Hughes, who’d stepped aside to run in the provincial election. Lockwood later runs afoul of government.

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Alberta Health
Alberta Health Services Board Chair Stephen Lockwood, right, and President and CEO Dr. Chris Eagle spoke about Minister Fred Horne’s announcement regarding Pay at Risk for AHS employees. They spoke on June 11, 2013 in Calgary. Photo by File Photo /Postmedia

2013

Health minister Fred Horne fires Lockwood and the entire 10-member board in June in a dispute over executive pay. He immediately names veteran health administrator Janet Davidson to the new role of AHS official administrator. From the nine regional boards five years earlier, authority for the operations of the entire health system is consolidated into the hands of one individual.

In September, Horne undertakes another health authority executive shakeup, ordering the agency to drastically cut its vice-presidents ranks, dismiss five top executives and refine its entire health management structure. Horne appoints Davidson deputy minister of Health. Cowell takes the job as AHS official administrator.

2014

Vickie Kaminski, a health-care executive from Newfoundland and Labrador, is appointed president and chief executive of AHS in March, while Davidson takes over again as interim official administrator after Cowell’s one-year term ends. Carl Amrhein, provost and academic vice-president at the University of Alberta, becomes official administrator of AHS in November. His term is due to end in June 2015.

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2015

In one high-profile attempt to reintroduce local governance, PC premier Jim Prentice pitches the idea of setting up eight to 10 new operational health districts. Then-Health minister Stephen Mandel said they wouldn’t be like the previous nine health regions, which he said were too competitive and fought each other for resources.

In May, a general election sees Rachel Notley’s NDP sweep to power, and her government soon announces AHS will again be overseen by a board structure that over the previous two years had been replaced by consecutive administrators.

Yiu Kenney
Former Alberta Health Services CEO Verna Yiu and Premier Jason Kenney. Postmedia file photos

2022

Coming off the heels of the COVID-19 pandemic, the UCP leadership race to replace premier Jason Kenney in 2022 sparks a fiery debate about the role, structure and management of AHS.

Running a leadership campaign that emphasizes grievances over the handling of COVID-19, Danielle Smith argues that AHS was too slow to expand its bed capacity to address front-line needs during the pandemic. When she assumes office, she fires the board of AHS and replaces it with a sole administrator, Dr. John Cowell, in an effort to fast-track reforms.

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Verna Yiu, hired in 2016, is fired as CEO. Mauro Chies, vice-president of Cancer Care Alberta and Clinical Support Services, becomes the interim CEO.

2023

As the province prepares for the continued restructuring of health care, Premier Smith tells reporters she will maintain province-wide integration for some things, like major surgery and heart transplants, but adding more management in local hospitals will increase services, especially in rural areas and small cities.

“It’s not about going back to the way it was before,” Smith said, adding AHS should be focused primarily on acute hospital care.

On Nov. 8, Smith announced AHS would see a streamlined mandate to focus on acute and primary care, while also announcing the creation of new delivery agencies.

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