Local hospital CEOs aren’t needed: top Horizon official

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Horizon Health Network doesn’t need more local managers to address problems across its expansive hospital network, says the head of the regional health authority.

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Margaret Melanson, president and CEO of Horizon Health Network, backed last week an earlier assessment of the management structure by the province’s health minister amid ongoing calls from opposition MLAs for local hospital CEOs.

Last month, Health Minister John Dornan – a former Horizon CEO himself – told Brunswick News that “another level of bureaucracy” won’t make things better on the ground.

Melanson made the same point before a legislative committee last week despite hearing fresh public concerns about the state of Fredericton’s Dr. Everett Chalmers Regional Hospital.

Green party Leader David Coon read into the record a poignant letter from a man who described the “borderline third-world conditions” his elderly father was currently facing at the Fredericton hospital.

At the time the letter was written, the man, who wasn’t publicly identified by name, reported that his father had been waiting for four nights in the emergency department for a move to a bed upstairs while they witnessed “disorganization” and a “lack of communication” amongst staff.

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“An example of this is being asked by seven different staff members for a listing of (my father’s) current medications,” read Coon, MLA for Fredericton Lincoln.

“The gaps in communication are large enough to drive a truck through.”

Melanson acknowledged the family’s experience was “very troubling,” although she noted that these types of stories aren’t unfamiliar to her given the current pressures on the health-care system.

In the face of “budgetary limitations,” Horizon staff are often caring for double the number of patients as before, according to Melanson.

On top of that, Horizon’s workforce has now more junior employees since the pandemic, she said, creating “the need for much more mentorship and support.”

“These are complicated issues, and yes we can do better, but frankly I would prefer to see us take any existing funding and redirect it to our frontline staff,” Melanson told the public accounts committee.

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Every Horizon hospital already has a facility leader, a nursing leader and a medical leader, she said, noting there are 150 senior leaders across the network.

Since taking the helm in 2022, Melanson said Horizon has eliminated three vice-president positions and reduced the number of middle managers, allowing it to redirect those funds to open family health teams and hire more frontline staff.

“I will say that we have evolved, and I would say evolved in a positive direction in the sense that now because of the intertwining of how we provide services and planning, we’ve been able to take best practices and leverage them across our entire system,” Melanson said.

Coon challenged Melanson’s position, suggesting that former hospital administrators he’s spoken with “would say these facility managers don’t have the same authority” once held at local hospitals.

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“(These former administrators) had the authority to manage laterally through departments,” Coon said, adding Horizon staff who worked under that system described that hospitals “felt much more like a community” at that time.

Coon has been calling for the return of local decision-making at hospitals to quickly address day-to-day problems in a backlogged health-care system.

He later told Brunswick News he doesn’t understand how Horizon can manage thousands of workers across multiple hospital departments “without a manager on site that is able to work across the departments to bring everyone together.”

“I agree with a lot of what (Melanson) had to say today, but on that one, I don’t,” Coon said in an interview.

Let HR specialists determine staffing: Liberal MLA

Progressive Conservative MLA Bill Hogan has also been calling for the return of local hospital CEOs in light of recent concerns over the stability of services at the Upper River Valley Hospital in Waterville.

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“I don’t agree with that at all,” the PC health critic said of Melanson’s position, in an interview. “We need to have local leadership restored because that goes a long way in attracting new young medical professionals to come to the area.”

Mayors with the Western Valley Regional Service Commission have warned that centralized management and surgical scheduling decisions, combined with staffing losses, have placed core services at risk at the Waterville hospital.

But the province’s health minister has assured the public that the hospital will remain a “full-service acute-care facility” with inpatient, surgical, obstetrical and emergency services.

Dornan has met with local leaders on the ground to discuss the situation.

Liberal MLA Sam Johnston believes that it’s up to functional HR specialists within the regional health authorities to determine if management and frontline staffing needs are being met.

“From my perspective, if there are gaps in staffing in either health-care system, we should address them fairly and timely in a prudent fashion,” said Johnston, MLA for Miramichi Bay-Neguac.

More than 15,000 workers are currently employed by Horizon Health Network, the committee heard, meaning that the 150-member senior leadership team accounts for one per cent of the regional health authority’s workforce.

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