Like most people, Matt Anderson has good reasons for changing jobs.
He's seeking new challenges, and a chance to broaden his experience. He's looking forward to a shorter commute. A big pay increase is probably part of it as well, though he's not so crass as to mention it.
But Mr. Anderson's colleagues in the health-care sector are reading much more into his decision. His departure from Toronto's regional health authority, to take a job as a hospital CEO, is seen as another nail in the coffin of Ontario's beleaguered Local Health Integration Networks.
With little real power over the hospitals they're supposed to be overseeing, the 14 networks set up during Dalton McGuinty's first term have had trouble attracting strong leadership. That's a huge problem, because the only way they can make much progress toward a more seamless and efficient system is if their leaders show strong initiative and personally command respect.
Until last week, Mr. Anderson was held up by health insiders as a rare beacon of hope.
A highly respected young executive who had worked his way up through the ranks of the University Health Network, which controls three of Toronto's biggest downtown hospitals, he was widely seen as one of health care's rising stars by 2008. So there was considerable surprise when he took over as CEO of the Toronto Central LHIN. It hardly seemed like a plum job, particularly amid reports of board acrimony.
The reviews since then have been almost unanimously positive. "The class of the system," enthuses one health-policy veteran, echoing the general consensus.
But the hope wasn't just that Mr. Anderson would tower over everyone else. It was that his lead would be followed by other up-and-comers.
It doesn't seem to have worked out that way. And now, leaving Toronto Central after less than two years, he's sending the opposite message.
That's not his intention. He acknowledges that he'd initially been uncertain about the prospects of working for the networks, but insists he's now "bullish" about them.
He told health executives the same thing mere days before his departure. But during that speech, he briefly touched upon the new system's inherent weakness. Of the $4.2-billion budget nominally administered by Toronto Central, he said, the LHIN only has about $12-million in discretionary funding.
That point was made in the context of arguing that LHINs' power lies elsewhere, largely in bringing transparency and developing accountability agreements. But in health care as in most other fields, power rests mostly where the money is. The Health Ministry has power, because it still makes most of the big-picture funding decisions. The hospitals have power, because they still decide where most of their funding is allotted. And the LHINs are left struggling to be anything more than an extra layer of bureaucracy between the two.
It's no wonder, then, that Mr. Anderson has gone off to run the William Osler Health Centre - a place where, overseeing the Brampton Civic, Peel Memorial and Etobicoke General hospitals, he'll have direct control over an annual operating budget of about $260-million.
But the fact remains that he is leaving a job where he was theoretically overseeing health care at the centre of the biggest city in the country to run three suburban hospitals.
That being the case, how can LHINs in more remote regions possibly expect to recruit the best and brightest? And how can hospital CEOs be expected to respect the ambiguous authority of people in less coveted jobs than their own?
Mr. Anderson will probably be able to do more good for patients in his new job. But an army of policy experts argues that the key to health-care sustainability is regional co-ordination, rather than having hospitals operate as silos. It's more obvious than ever that the current model won't achieve that.