| Managers clogging health care’s arteries

The proliferation of administrative staff in social services is causing unnecessary waste

News about Quebec politics lately has focused on widespread corruption at almost every level of government, the kind of corruption we’re used to seeing in movies. I was tempted to add to the outcry, but when I tried to write, all I really had to say was, “Duh.” Truth is, something rather more disturbing has preoccupied me since coming across an article that has been sitting on the desk at my mother’s place for quite some time.

My mother is a hospital social worker. Like most front-line workers, she’ll stupefy you with stories about our health care system’s management. I’ve listened to these stories the better part of my life, but in the past ten years they’ve become increasingly difficult to stomach. The substance of the transformations she describes is nauseating. I’ve managed to subdue discomfort with the idea that years of thankless service have compounded her cynicism. The article on her desk says otherwise.

In September, an article in La Presse reported statistics from the Fédération des médecins spécialistes du Québec explaining that since 2000, the number of administrators of Quebec’s health care system grew 52 per cent and the number of managers grew thirty per cent to a total of 100,000 employees. In the same period, the number of caregivers (doctors, nurses, orderlies, physiotherapists, et cetera) grew by only six per cent to 108,000. Administrators and managers (A&M) accounted for 85 per cent of that 40,323 increase in employees. For argument’s sake, assume that additional A&M earn a modest average $50,000 per year (undoubtably an underestimate). That’s two billion dollars, which, according to Statistics Canada’s 2009 figures, is over ten per cent of the total cost of health care and social services in Quebec.

In the face of exploding waiting times for everything from emergency services to long-term care, the A&M of our health care system have proposed what exactly? More A&M. I called my mother to enquire, and what a timely call. She directed me to an article in the Gazette describing a patient unable to return home, which is both his wish and the best option for his care. There is no more funding for the approximately fifty dollars a day of home-care he needs, so instead he’s stuck in an acute care hospital bed costing our government almost $1,000 daily. It turns out, my mother is the patient’s social worker. The whole story is painful.

My mother described a one-hour meeting that included herself, another clinician, and five managers, convened to “solve” this non-problem. The whole scenario is like a Marx Brothers film. The meeting’s conclusion was to order an assessment of the patient’s home environment, a procedure inherent to the care request submitted by the patient’s clinicians weeks prior. That assessment finally took place nearly two weeks after that meeting and reported that the patient’s home requires a standard piece of equipment. That piece of equipment, which I found used on Ebay for $100, deliverable in a few business days, would take our health care system at least another two weeks to acquire.

Perhaps if all that new A&M had instead been health care workers and equipment, the assessment wouldn’t have been needlessly delayed, the equipment would have been available, an unnecessary meeting wouldn’t have occurred, and there’d be plenty more coin in our government’s coffers. The best part is that when my mother expressed how unacceptable her patient’s situation is, she was “questioned” by yet another manager for expressing frustration. How many managers would you guess my mother reports to? In 1991, when she would come home excited about the amount of work she’d completed, she had one boss. Today, when all my mother seems to do is express exasperation, she’s reports to four bosses. If you think this particular case is some kind of exception, you are mistaken.

The state of affairs reminds me of a FedEx commercial where an employee in training is asked to perform a basic task and says, “You don’t understand… I have an MBA,” to which his trainer replies, “Oh, you have an MBA? In that case, I’ll have to show you how.” To the workers that actually provide care, these types of “problems” are an absolute no-brainer. Additional A&M, in a variant of Parkinson’s law, doesn’t solve care provision problems, it often creates them – at an opportunity cost of at least two billion dollars – so that they can then be solved by people who actually do the work: that’s a triple whammy and everybody is suffering. o