Internal survey reveals disconnect between Alberta's doctors and AHS management

Alberta doctors question how the province's health-care system is managed, the level of care provided to patients, and don't think their input is valued by senior managers, according to a leaked internal Alberta Health Services survey obtained by CBC News.

The survey's most troubling revelation is that hundreds of doctors - nearly one-third of those surveyed - say they would not necessarily feel safe receiving medical treatment from the very hospitals and clinics in which they work.

AHS chief medical officer Dr. Francois Belanger refuted that finding.

"We have a system that is safe," Belanger said. "Is it perfect? No. But we work every day to ensure that we provide the best care possible to the patients. And in fact, we have data to support that, indeed, the system is safe and provides high-quality care."

More than 2,600 physicians, about 30 per cent of the total, completed the AHS staff engagement survey in the fall of 2016.

The survey asked doctors to respond to a series of statements through a five-point scale that ranged from "strongly disagree" to "strongly agree." AHS management released the results to the doctors late last month.

Doctors questions safety decisions

Among the findings:

• Seven per cent of doctors who responded disagreed with, and 24 per cent felt neutral towards, the statement, "If I required health care, I would feel safe receiving it from Alberta Health Services."
• Nearly half of those surveyed do not believe AHS values their opinions.
• More than one-third think patient safety decisions are not made at the proper level by the most qualified people.
• 43 per cent believe AHS senior management doesn't understand the risk associated with patient care.
• Only 13 per cent believe AHS has made changes in the past year that had a significant positive impact on their practice.

University of Ottawa health-law professor Colleen Flood said it is difficult to gauge the significance of doctors' concerns around quality of care without a comparison of results from previous years

"It is not telling you about trends from one year to another," said Flood, who is also director of the university's centre for health law, policy, and ethics. "It doesn't really match (the results) to actual real evidence about declining quality or safety."

Belanger said the last survey of doctors was in 2014 but its focus was different and so the two cannot be easily compared.

But he said AHS senior management "got a bit clearer message this time" that doctors want their opinions heard and want outstanding issues addressed. Follow-up conversations between doctors and their local managers is the first step, Belanger said.

Lack of confidence in leadership

In May, Alberta's auditor general released a report that found the province's health-care system is fragmented, a problem he partly attributed to a disconnect between medical professionals and their managers. Auditor General Merwan Saher also said Alberta Health doesn't set clear expectations for doctors.

Flood said the survey results show an obvious lack of confidence in senior leadership, which may have impacted doctors' answers to other survey questions.

"It may be that some of the responses that they have are more to do with a feeling of discontent about their employer, so to speak, as opposed to the reality of whether there is actually a problem, or significant or increasing problems, around quality and safety," she said.

The Alberta Medical Association recently received the survey results and plans to discuss them at an upcoming forum. Association president Dr. Padraic Carr said it is encouraging that AHS management is interested in feedback from doctors and noted some survey results were generally positive.

But he called the doctors' answers around the safety of Alberta's health-care system "disconcerting."

"It is always concerning when physicians are voicing safety concerns," Carr said. "It is just difficult from the survey to determine what those concerns are."

@jennierussell_

@charlesrusnell