Steven Lewis

“To succeed in politics, it is often necessary to rise above your principles.”  - anon.

Twenty months, give or take:  that’s how long Stephen Duckett lasted as CEO of Alberta Health Services.  Media around the world have chronicled how his cookie crumbled.  The conventional line is that he was ultimately done in by his flippant encounter with a horde of reporters.  If you’ve watched the video clip, you already know this was a misdemeanour, not a job-ending felony.  If it was the straw that broke the camel’s back, what weakened the camel’s back to begin with?  What wore out the welcome mat so soon?

Collegial, candid and open-minded
In the interests of disclosure, I did a small piece of work for AHS in 2009, on Duckett’s watch, which paid me $6,000.  I spent an afternoon with him and his senior leadership team to discuss the work.  In the 3 hour meeting, the leadership team was collegial, candid, and open-minded.  People were comfortable with each other and the quality of the discussion was high.  Duckett presided in an informal but business-like manner and guided the group to consensus.  Save for seeing him at a couple of conferences, that describes our entire relationship.  I have no inside information on the AHS Board or on Duckett’s leadership style or relationships.

A book without a cover
Both Duckett and his partner have written apologias for his tenure as CEO, each compelling in its own way.  Duckett’s is especially revealing of his mind set.  He is a rare bird in Canadian health care leadership:  a genuine intellectual at home in both the academic and health care worlds.  His farewell address to 100 of his former colleagues combines history, analysis, and a summation; it is part thesis defence and part soliloquy.  Since he’s reviewing his own performance, it is hardly surprising that he comes off rather well in the end.  But it is not without self-examination, acknowledgement of missteps, and the aura of regret.  Notable in the speech is the human touch.

Stephen Duckett is the anti-glad-hander incarnate; he has none of the practiced charm of the career executive climber and no instinct to ingratiate.  He does not work a room; I’m sure he does not know how.  Too many overseers of our bloated, hide-bound, and interest-dominated system are covers without books; Duckett is a book without a cover.  Moreover – he makes a point of this in his talk - he is Australian.  I have observed first hand that Australians are less inclined to shrink in horror at those who speak their minds clearly, and to your face.  These characteristics led many to label him a bureaucratic automaton:  not Oprah, therefore Spock.

An equal opportunity offender
So it is not hard to fathom why Stephen Duckett had enemies.  He is a strong supporter of publicly financed health care and has a keenly developed sense of distributive justice in a province that reliably spawns right-wing movements every generation.  He replaced the sweetheart deals with the private sector that made a mockery of conflict of interest in Calgary with a rigorous and transparent tendering system.  He has no patience for professional turf battles or protectionist regulations masquerading as quality standards.  And he was honest enough to admit that while his job was to improve health care, it would take major social investment to improve health.

 
In short, he was an equal opportunity offender.  When you take on privilege, featherbedding, specious arguments, and poor performance in Canadian health care, you are more often than not branding yourself a heretic.  And when you land in a new country to try to make a go of the largest and most thoughtless restructuring in Canadian health care history exacerbated by a budget crisis, you’re going to have a tough time restoring the shine to them boots.  Moreover, Duckett violated the most sacred precept of the Canadian CEOs’ code:  thou shalt demand more money as the price of progress.  He didn’t – he was prepared to find the $1.3 billion in savings the government demanded before it turned tail and gave all the money back plus a commitment to 5 years of steady increases.

Why Alberta did not “get” Stephen Duckett
Mixing a highly intelligent, principled, intellectually combative outsider with a toxic political and financial environment creates an incendiary compound.  It can take years to restore morale and clarity to a cavalierly destabilized health care system.  Every decision is subject to intense scrutiny and second-guessing is de rigueur.  Of course Duckett made mistakes, and forgiveness and benefit of the doubt are unlikely when you get on the wrong side of the media.  Like it or not, CEOs are ambassadors to the court of public opinion.  Canadian CEOs well-versed in the art of elite accommodation and network building can last a long time even if they accomplish nothing.  Those more interested in making progress than pals are on a short leash.

I don’t think Alberta “got” Stephen Duckett.    If the power brokers don’t get you, they’ll get you.  The one thing that is crystal clear is that his board divided over the order to fire him. Duckett is an intellectual, an economist, and a rationalist.  Canadian health care abhors an informed debate, cares too little about economic efficiency, and in many instances is proud of its irrationality.  Something had to give; small wonder that Duckett’s brand of reform proved stronger medicine than the system was prepared to swallow – for now.  Alberta didn’t give this stranger in a strange land much of a chance to create order out of the chaos the government created.  They hired him for who he is, and they fired him for who he is.

He asked the right questions
You can’t schmooze your way to transformation.  Maybe Duckett didn’t have the right answers, but he certainly asked the right questions, and he didn’t back down from an issue or a controversy.  The legacy of Stephen Duckett is that he made a province reveal what it is up for and what it is not.  This raises a simple question:  whom do you trust to protect the public interest and look out for the disadvantaged?  In this case, I’ll take the man shown the door over the executioners any day.

About the Author
Steven Lewis is a health policy and research consultant based in Saskatoon, and Adjunct Professor of Health Policy at the University of Calgary and Simon Fraser University.

Drawn from Australia to head Alberta’s “superboard”, the Alberta Health Services, Stephen Duckett was sacked from his post less than 2 years after being hired.