Dr. Michael Gardam, the new CEO of the Island’s health system, spoke to the CBC about the challenges of overcoming our 18,000-person waiting list for a family doctor.
Impenetrable bureaucracy has beaten down more than one Island health system revolutionary over the years; Dr. Gardam appears refreshingly frank in his assessments of the problems and the possible solutions, and I hope he sticks with it.
His take on one reason the solutions are taking so long:
“If we want to buy new computers, we go through a different branch of government. If we want to find space, we go through a different branch of government. If we want to spend more than $100,000 of money that’s in our budget, we have to go to the Treasury Board. These are rules. These are things that were identified a long time ago.”
The Achilles heel of all re-engineers is a desire to keep re-engineering until they fix everything, down to the roots.
Several years ago I attended a seminar by a senior Ontario government bureaucrat, a high level rumination on the work of the public service. Rather than rail against “silos,” the usual target of almost anyone making a case for what’s wrong with government, he suggested that compartmentalization was and always will be a part of public administration, and that we need to get over that, move on, and become better at navigating the complexity.
Although I’ve fallen victim to the silos many times, I tend to agree with that assessment. As much as Dr. Gardham might wish that the bureaucratic waters would part to accommodate his revolutionary plans, that is not going to happen, and the sooner he accepts that and embraces the confounding thicket on its own terms, the sooner his plans will bear fruit.
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Comments
It may turn out though that
It may turn out though that no fulltime employee has the free time, liberty and access either to plan or advance change within such a bureaucracy—and perhaps there’s no natural communication channel either with which to recruit others. Since bureaucracies know they need to be responsive and adapt to the results of their rules, they’d do well to employe someone full time to midwife the change. I think I’ve heard or read that as sometimes within the mandate of an ombudsperson
Though I generally agree that
Though I generally agree that bureaucracy is to be navigated rather than fixed, having worked in four provinces with or for governments - PEIs stands out, largely because the broad field of service design has never been able to penetrate inside and out. The internal departments he speaks of (and the public service commission who handles all hiring can be tacked on) are supposed to provide service to front line departments and support their outcomes for islanders, however in actuality the supports aren’t designed around the commitments of the services and thus a whole inefficient wheel spins on battling for resources, revising project timelines and justifying them, and generally tailoring work to the priorities of the supports because that’s all they have the resources to do. It’s a double whammy of a problem because not only do front like departments have no autonomy to change quickly, but they also get no benefit from centralized service because they haven’t scaled it appropriately.
I suspect he’s so passionate about it because, like me, he has recent enough memory of a more modern government operation to know how much more could be done for islanders with the resources we have.
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