Overview

Alberta Health Services (AHS) is Canada's largest health care delivery organization and Alberta's largest employer with 102,000 employees. 90% are unionized staff from 5 different unions.

More than 8,600 physicians across a range of specialities work in AHS facilities. While most physicians are paid by the Alberta government, AHS does have a considerable operating budget for physician services.

Costs of care

AHS spends 70% of its annual budget on employee compensation. This includes contracted health service providers and other contracted services such as Covenant Health.

Hospital care costs more in Alberta than other provinces, but it’s not because we pay executives more or have more managers than other health systems. The AHS performance report found Alberta’s clinicians and health professionals are paid more and have premium pay incentives, which increases the costs of care.

AHS review recommendations

The AHS performance review report made 13 recommendations (numbers 1-13 of 57) related to workforce, management review and physician optimization, including:

  • identifying management positions with less than 12 staff that could be consolidated
  • reviewing the way positions are classified
  • sharing administrative support among leaders

Workforce

  1. Work with unions and government to remove or revise collective agreement provisions that impede sustainability without providing any patient benefit.
  1. Review workplace policies and processes to strengthen controls where required to achieve incremental benefits.
  1. Expand the use of the Provincial Staffing Services, as well as consider a technology strategy to enable automation and positive time keeping.
  1. Optimize staffing levels and skill mix across the organization in both nursing and clinical support services through the use of evidence-based approaches such as acuity-based staffing.

Management

  1. There may be opportunities to reduce the number of managers in some areas. AHS should review positions identified as having fewer direct reports than their peers in other organizations with the objective of identifying opportunities to consolidate portfolios and reduce management levels.
  1. Review the way AHS classifies positions and ensure it applies a rigorous and standardized approach moving forward.
  1. Look to optimize the use of administrative support by leaders.

Physician optimization

  1. Stop paying clinical stipends for services covered by the Alberta Health Schedule of Medical Benefits.
  1. In alignment with Alberta Health physician compensation negotiations and budget management initiatives, AHS should address radiology compensation and contracts.
  1. Develop a consistent framework for paying physician interpretation fees by aligning payments to 50% of the Schedule of Medical Benefits (SOMB) rate as proposed by AHS.
  1. Develop and implement a consistent framework for recovering physician overhead costs.
  1. Review ‘deputy’-level medical leadership positions, other positions not required by the medical staff bylaws and positions with less than 0.1 FTE of effort.
  1. AHS and Alberta Health should work with government and academic institutions with the aim of reducing or eliminating increases in academic salaries, in alignment with AHS and broader government salary freezes.

More recommendations

See the other AHS performance review recommendations: