Alberta Auditor-General Doug Wylie says the credibility of non-financial performance measures has slowly degraded over time.JASON FRANSON/The Canadian Press
Alberta’s Auditor-General says the province’s reporting on how the health care system is performing is not credible and has worsened over time – an issue that needs to be corrected if Premier Danielle Smith’s plan to dramatically reform the system is to be fairly evaluated.
Auditor-General Doug Wylie made his assessment in a report, published Thursday, that found data used to validate the early success of Ms. Smith’s plan to improve the province’s health care system were inconsistent and were selected to make “performance look better than it actually was.”
The report was focused on the first months of the Premier’s health care changes in late 2022 and early 2023, and was among a batch of audits released Thursday that also looked into Alberta’s financial statements and ministerial expenses, among other things.
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Mr. Wylie, in an interview, said that the credibility of non-financial performance measures has slowly degraded over time – a problem he said is ever pressing as Ms. Smith’s government pushes ahead with her overhaul.
“There was a time where we actually added credibility to non-financial performance measures, and we’ve just completely moved away from that,” Mr. Wylie said.
Ms. Smith became premier in October, 2022, after her successful United Conservative Party leadership campaign that largely hinged on fiercely criticizing Alberta Health Services, the provincial health agency, and its handling of the COVID-19 pandemic.
Over the course of her campaign, she said AHS was either “completely incompetent” or had “actively sabotaged” the provincial government.
That November, she dismissed the 12-person AHS board and replaced it with a single administrator. Standing with her then-health minister, Jason Copping, and newly appointed official AHS administrator, John Cowell, Ms. Smith announced an action plan for the health care system and promised to report publicly on progress in 90 days.
The auditor’s Thursday report pointed out several issues with performance targets Ms. Smith’s government set for the health care system.
At the time, progress reports were supposed to use 10 performance measures such as ambulance arrival times, emergency room waiting times and surgery waiting times. Most of those performance measures changed in the two subsequent reports, Mr. Wylie wrote, and on occasion the numbers were selected to make outcomes look better than they were.
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For example, the report published in April, 2023, showed rural EMS response times had been reduced to less than 40 minutes from 60 minutes.
Mr. Wylie traced those numbers to a single week in mid-April when waiting times briefly dipped below 40 minutes from a consistent weekly average of 63 minutes.
Other measurements were never reported, sometimes because AHS never had the necessary data, Mr. Wylie wrote.
The Auditor-General also found that it wasn’t clear who was responsible for the performance reports. While they were presented under the AHS banner, they were edited by both Alberta’s health department and the Health Minister.
Mr. Wylie noted AHS “increasingly distanced itself from these reports — at times referring to them as ‘the Department [of Health]’s reports.’"
Maddison McKee, spokesperson for Primary and Preventative Care Minister Adriana LaGrange, in a statement blamed AHS for falling short in its public reporting and said it’s partly why the province turned it into a service provider under Acute Care Alberta.
The Alberta government is in the process of dismantling how health care is delivered in the province. AHS has been stripped of much of its power and the health care system has been split into four separate agencies overseeing acute, primary, continuing, and mental health and addictions care.
Acute Care Alberta, in a statement, said it will be developing policy in response to Mr. Wylie’s report.
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Mr. Wylie said on Thursday Alberta is tracking very few long-term performance metrics for the health care system. Between 2022 and 2024, only two measures were consistently reported, he said: “It’s not best practice.”
Mr. Wylie said performance measures were once reported quarterly and have since been reduced to annual events, diminishing the importance and the impact of the reporting.
“Effective and transparent public performance reporting is the only way that Albertans are going to know if these changes to the health care system are going to achieve the desired results that will benefit Albertans,” he said.
Alberta NDP Leader Naheed Nenshi said the province will try to deflect blame to AHS, “but this chaos lies squarely at the feet of this government.”
Mr. Wylie is also investigating the government’s procurement practices in the health care system. That inquiry began after The Globe and Mail first reported in February on allegations made by a former AHS executive in a lawsuit who said she was fired for investigating procurement contracts at her agency. The government says Athana Mentzelopoulos, the former AHS chief executive, was dismissed for incompetence. None of the allegations have been tested in court.
Mr. Wylie is rushing to complete that investigation before his contract expires next April.