Proving it's easier to announce an action plan than implement one, parts of the B.C. health ministry's 2011 plan "to strengthen physician hiring and oversight and enhance public confidence" remain bogged down to this day in consultations.
Following the plan's release, the ministry engaged KPMG "to conduct a review of systems and processes for the licensing, credentialing, privileging and performance management of all physicians across the province."
KPMG retained Toronto-based law firm Osborne Margo to undertake a legislative and regulatory review.
They detailed a litany of ills ailing the system. No news release or news conference with these reports.
KPMG didn't pull any punches: "Stakeholders were clear that they wanted a strong ministry who advised organizations what to achieve, provided performance management frameworks and accountability frameworks, with the organizations themselves allowed to conceive and implement the necessary governance processes and delivery mechanisms."
Those same stakeholders felt the ministry "falls short of this strong stewardship role."
Osborne Margo's report noted that "some existing legislative provisions impede or interfere with quality assurance and performance management functions."
Next up was the ministry's governance model for health authorities.
Under the Hospital Act, the boards of directors of the five authorities were responsible for approving physician credentialing and privileging.
Appointed by the minister, each board has six to nine members.
Only one, Wynne Powell, didn't accept his stipend.
KPMG pointed out that "Although boards receive reports and approve privileges, most directors noted that they had to have a high level of trust that the processes within the authority were being followed... [but] there is little evidence, by way of audit or similar routine checks, to give boards comfort that these processes have been followed."
They recommended the ministry "review governance models in other jurisdictions to establish whether a case could or should be made for a different model of governance within health care to reflect commercial leading practice and allow greater levels of direct accountability for executive management."
They acknowledged that "This may be complicated as the governance model in B.C. has been established for some years and there appears to be little appetite for change."
"More than four years after the government set out its action plan, there's been some progress, but few slam dunks."
Board members are better known for who they know than what they know about health care.
A handful have a health background, including former health minister Dr. Margaret MacDiarmid, but they're the exception.
The rest include lawyers, accountants, foresters, a florist, a former broadcast journalist, financial advisers, civic politicians (past and present) and an urban designer.
Something else most of the directors have in common? The B.C. Liberal party.
Fifty-five individuals sat on the six boards last year, including the provincial health services authority.
Since 2005, 36 have made personal or corporate donations to the party totaling more than $230,000. Of the 19 who didn't, at least six have party ties.
If few board members have a health background, it shouldn't come as a surprise that KPMG found that "There (was) no common definition for 'credentialing' and 'privileging' within the system and they are used interchangeably, creating confusion."
In the "how not to get ahead in your career" department: performance oversight was being left to nurses, with physicians relying "on nursing staff to raise red flags or file a complaint if a physician is performing outside their approved scope of practice."
Osborne Margo's review revealed "a lack of province-wide standards and requirements in a variety of areas relating to physician oversight and performance reviews."
They included: "Lack of defined, clearly communicated requirements for reporting physician performance concerns to the College and a lack of requirements for the review and criteria for privilege appointments across all categories, specialties, and practice settings and the reappointment process to ensure continued competency and quality of care."
Issues with the oversight of non-hospital medical surgical facilities were also flagged, including "a lack of rigorous, province-wide standards for providers and premises to ensure patient safety."
More than four years after the government set out its action plan, there's been some progress, but few slam dunks.
As B.C. auditor general Russ Jones put it in 2014: "It is often easier to identify and address smaller, preventable issues than to try to correct broader, more deeply embedded issues."
Note: Political donations tabulated using Elections B.C. contribution database
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