The arrival of governance and integration
2 ) that had, at least in part, its origins in what might be mistaken for Frontier Era policy generation. A physician leader described generating a rough draft of what would become the governance structure.
And [the zonal committees are] looking at it from the perspective of some very specific populations
on a paper napkin for the deputy minister [of AH] in a cafeteria [and then turning it] into something concrete and then, socializing [it] and getting it ratified and voted on and accepted. (P6)
Sold as being a combination of integrative co-planning and a representative voice locally and provincially, the governance structure that was once merely a paper napkin attained more than 80% support from the 3800 family physician members of the PCNs in 2017. It created a structure in which AHS and the PCNs would co-plan their service delivery. The new governance structure includes a Provincial level PCN Committee – providing governance, leadership and strategic priorities – and five Zone level PCN Committees. The MoH, AHS, PCN physician leads, and a non-voting AMA representative are members of the Provincial PCN Committee. The sub committees are positioned at the AHS zone level, and so representatives from PCNs within each of the 5 AHS zones are now regularly drawn together with AHS personnel and community members to plan.
For their part, the cross-cultural meetings of Zone PCN Service Planning committees that bring together primary care and health system personnel, are, in their infancy. As one participant noted:
They’re just in the initial phases right now of starting to look at [co-planning]. A lot of them are focusing on addictions and mental health: no surprise [there]. But another group is [focused on] the complex, elderly. Those kinds of things. (P4)
As this implies, while the policy direction for the zonal committees splits their focus across five populations – Well and At Risk; Maternal; Chronic Co-Morbid; Addiction and Mental Health; and Frail Seniors – the on-the-ground reality is one of locally chosen emphasis within these broad categories of policy and public health concern. In this way we see the search for local solutions to universal problems adapting to include consideration, and prioritization, of issues that have recently come to be seen, in Alberta, as major social and healthcare challenges.
As fledgling efforts at co-planning specifically, and trust and integration more generally, these zonal committees remain objects of concern for both sides. On the AHS side, one participant noted:
I’m not convinced that [the planning committees are] the great leveller. But I think there’s lots of opportunity for growth on both sides. Growth and learning. (P4)
AHS feels an ownership of everything. They have a big ego, and it’s misapplied. Oftentimes I think of them as the kid at the candy store with their nose pressed up against the glass … It’s a candy store in primary care, and AHS wants to be part of it. (P2)
As the governance structure started to change, [our PCN’s] physician leader said to me, “You know, it’s like AHS is standing outside the candy shop scratching on the window, trying to figure out a way to escort in St. Louis get in.” (P11)
In describing what they see as AHS’s imperial ambitions, both participants are expressing the same anxieties that were present as the PCNs were originally created. Beyond reformulating a fear that the bigger organization might consume them, the PCN personnel are highlighting the size of the task that has been given to the local committees and the provincial-level body that oversees them.