What Price for Leadership?

Cheap shot.  Defined as an unsportsmanlike act.  Or as unnecessarily aggressive and unfair remark directed at a defenseless person.  Other words that can be used in place of the term "cheap shot" are jibe, barb, dig, slam or shot.

As a former (very) recreational hockey player, I've seen and experienced my share of cheap shots on the ice.  These types of actions are border line and might or might not result in a penalty being called.  They are below the belt and can look like a face wash, an extra push in front of the net, a little whack with the stick on some body part of the opposing player.  You come to accept some of this as part of the game.  You also make a choice as to whether to respond in kind.

As a former health care administrator I unfortunately have to profess to have been subjected to my fair share of what can be characterized as cheap shots in that forum as well.  The difference between the hockey reference and the administrative experience is that on almost all occasions there is no ability for an administrator to defend themselves.  Most times we either self-restrain or are restrained from responding in the interests of professionalism or maintaining good relations with one or more set of stakeholders.

So it was with more than passing interest that I've noted a number of media stories of late that I would characterize as taking cheap shots at senior managers, civil servants and administrative functions in general. 

First off the mark was the story about Alberta Health Services senior executives getting bonuses, or pay-at-risk payments, totalling $480,000.  Naturally, this made headlines in media outlets across Alberta and engendered some interesting comments from opposition politicians, journalists, and union leaders.  Wildrose Health Critic Heather Forsyth was quoted as saying "This is incredible...that they even have the guts to give themselves a bonus when they haven't met their targets." and "What kind of message does that send to the people in the front lines, the ones who are really doing the work?  It's cocky and flippant and arrogant and unacceptable."  (italics are my emphasis).  As harsh as those statements were it was nothing compared to the editorial put out by Don Braid of the Calgary Herald.  Some of this commentary went as follows:  "Your boss sets your performance target for next week.  There is extra pay for meeting it.  But you decide, hey, the weather's nice, I'll play some golf, work at half speed for a day or two.  You achieve only 50 per cent of your target.  And you get 50 per cent of the bonus, along with congratulations for half a job well done." 

Could AHS have handled the whole bonus/pay-at-risk situation better?  Probably. It's a system that is not well understood by almost anybody.  However, are Dr. Chris Eagle and other members of the senior leadership team of AHS overpaid?  Not in my estimation.  In fact, I consider Dr. Eagle and his executive colleagues to be grossly underpaid for what they are accountable for, for the level of scrutiny they are subject to, and the fact that they are pretty much working or on-call 24/7.  The comment about working at half speed for a day or two is extraordinarily laughable and speaks to the lack of information and insight on the part of the speaker.

Similar stories played out in the next few weeks.  There was sharp criticism over increases in administration costs at Alberta Health Services.  NDP MLA David Eggen (former Friends of Medicare executive director) was quoted as saying, "There's been a lingering perception that AHS is top-heavy and this does nothing to dispel that perception."  This was despite the fact that some of what made up the increase in administration costs related to such things as investments in infection control.  Unfortunately, accounting rules that AHS is subject to cause many of these types of expenses to be categorized as administrative.  Not the typical definition that most of the public and media would work by.  Rather they tend to think of administration costs as being those senior executive types that work at half speed and play golf when the weather is nice...

Next up for criticism was a pay increase for provincial civil servants.  Premier Redford approved an order-in-council that provided 4 per cent increases for senior civil servants.  Wages for these leadership roles had been frozen since 2009.  The reaction was not unexpected.  Wildrose Leader Danielle Smith was quoted as saying "Oh my gosh, you've got to be kidding me, in the middle of a budget crisis...I think it's not going to pass muster from the public,"  Scott Hennig of the Canadian Taxpayers Federation was similarly critical, implying that the positions were already well paid (if not overpaid) saying "The raise is not going to be the difference between whether they are eating cat food this month or not." 

On the bright side at least, Health Minister Fred Horne and AHS Board Chair Catherine Roozen came to the defense of various administrative leaders and their salaries as was appropriate.  Too often that type of leadership is absent in these situations and the easier, more political thing to do is freeze (or even cut) wages, suggest that some sort of investigation and corrective action will take place, and take whatever other action might be necessary to demonstrate "public accountability"

The reality is that there is a "price" that must be paid for leadership.  That price must be commensurate with the responsibility and accountability placed on these positions, and the education and experience we expect of individuals holding these positions.  These are not private sector roles to be sure, where customers and shareholders will ultimately weigh in on the appropriateness of executive salaries (although that equation has fallen apart on more than one occasion of late...).  And I'm not suggesting that public health care match private sector positions in salary and benefits.  However, if we want to recruit and retain good to excellent leaders we must appeal to more than just their altruistic nature.  Similarly, we create significant risk for our health system without investing in "administrative functions" like finance, human resources, infection control, materials management, information systems, and a host of others who are required for the safe and effective operation of a multi-billion dollar operation like Alberta Health Services.  Without an appropriate investment in these skilled people, doctors and nurses and other clinical professionals will not have the ability to provide you and I with high quality, safe care when we need it.  The Canadian health care system has always underfunded these requirements. 

Politicians, reporters, interest groups and the public should do more to inform themselves on what exactly are administrative costs and what we require of our leaders.  Cheap shots, while they might help somebody score some points in the short term, or sell some papers, or give us a sense of victory over some faceless bureaucrat or public figure - who can't defend themselves by the way - will only devalue a critical piece of our health system and demoralize those trying to help make our health system function at a higher level.  We should be concerned about not only creating a better working environment for doctors and nurses but for everyone associated with our health system.  We need the next generation to prepare for and take on leadership roles as very many of our current leaders retire in the next number of years.  And at this point, there is little incentive for people to aspire to positions of leadership in health care.  The pay is not exorbitant, the workload and demands are excessive, and the expectations and timelines are unrealistic.

Ultimately we need to place as much value on leadership for health care as we do on education and training for clinical professionals, as much as we do on the bricks and mortars of hospitals and continuing care facilities, and on investment in the latest medical technology.  If we don't, the success of our health care system will be constrained by this deficiency to the same extent as if we failed to build enough capacity in our system to deal with population demand.  It is about leadership.

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Greg Hadubiak, MHSA, FACHE, CEC, PCC
TEC Canada Chair/Executive Coach/Senior Consultant
hadubiak@wmc.ca

Helping leaders realize their strengths and enabling organizations to achieve their potential through the application of my leadership experience and coaching skills. I act as a point of leverage for my clients. I AM their Force Multiplier.