Alberta’s healthcare hinges on function, not structure, says rural anesthesiologist

by Chevi Rabbit, Local Journalism Initiative Reporter 

(ANNews) – Dr. Alika Lafontaine, a rural anesthesiologist in Grande Prairie and former president of the Canadian Medical Association, says Alberta’s healthcare challenges are not rooted in a single policy or structural fix, but in how the system functions day to day – and whether it is designed around patient outcomes.

Lafontaine says ongoing debates about restructuring Alberta’s healthcare system often miss the central issue: how care actually functions once patients enter the system.

He noted that governments have repeatedly attempted large-scale reforms, including moving from regional health authorities toward centralized, province-wide models. Alberta, he pointed out, was an early adopter of this approach.

“Governments have consistently tried to move from multiple different regions that manage healthcare… into these pan-provincial systems,” he said.

While acknowledging Alberta Health Services had early challenges, he added that it also delivered long periods of stability.

“Alberta Health Services in its early years had some stumbles, but ended up for a long period of time actually working pretty well,” Lafontaine said.

He added that concerns about efficiency and responsiveness in large systems are not unfounded. “Every system at some point doesn’t function in the way that it should,” he said, noting that concerns about slower decision-making and difficulty implementing change in large organizations were “probably reasonable.”

However, he cautioned that simply breaking systems into smaller pieces does not automatically fix underlying problems.

“Just breaking it down into smaller chunks doesn’t necessarily solve the core problem of how it actually functions differently, right?” he said.

He added that real improvement depends on internal change rather than structural reshuffling alone. “There’s a lot of work that has to go into culture change and having people focus on different outcomes,” Lafontaine said.

He also stressed that structure alone does not determine patient experience or outcomes. “Changing the structure doesn’t automatically change how care is delivered,” he added.

Lafontaine says one of the biggest barriers to improving healthcare performance is an overemphasis on reducing costs rather than improving care quality.

“I think one of the biggest challenges with utilizing the healthcare budget effectively, ironically, is actually the fixation on lower costs,” he said.

He argued that cost reduction should be a byproduct of better care – not the primary goal. “Lower costs are probably a secondary outcome of people receiving high-quality care,” Lafontaine said.

He added that when systems focus too heavily on financial targets, it can distort decision-making. “If the whole focus remains on how to lower the budget, I think that we’ll be disappointed when we look at this whole exercise five years from now,” he warned.

To illustrate inefficiencies in the system, Lafontaine pointed to patient experiences where inadequate assessment leads to repeated visits and unnecessary strain.

“If you go and receive care in an emergency room and you don’t get properly assessed… and then you have to return two, three times before finally convincing your provider that there’s an issue that should be investigated,” he said, “that’s an extra two visits across the healthcare system.”

He noted that inefficiencies extend beyond system strain and directly affect patients’ lives.

“There’s the extra days of work that you have to take off. There’s the ongoing stress and frustration that you have with the healthcare system,” Lafontaine said.

He also emphasized that repeated, avoidable visits represent both wasted resources and delayed care for others in need. “That delay doesn’t just affect one patient – it ripples through the system,” he added.

Rather than focusing narrowly on cost reduction, Lafontaine says Alberta should prioritize shortening the time between when a health issue is identified and when it is resolved.

“The way to utilize the healthcare budget most effectively is to try and figure out how to shorten the points between having the problem and having it fixed within healthcare,” he said.

He believes improving flow through the system would naturally reduce unnecessary demand and repeated visits. “If people receive high-quality care the first time, they don’t need to come back repeatedly for the same issue,” he said.

He added that meaningful reform requires focusing on outcomes rather than inputs. “We’ll lower costs by providing high-quality care in ways that have patients not have to see people repeatedly for care that doesn’t make a difference,” Lafontaine said.

He warned that overly narrow cost-cutting approaches risk undermining long-term improvements. “If the whole focus remains on how to lower the budget, I think that we’ll be disappointed,” he said.

Across his analysis, Lafontaine returns to a central theme: healthcare reform must move beyond organizational design and focus on culture, outcomes, and patient experience.

For him, the core question is not how Alberta organizes its healthcare system – but how effectively it delivers care once patients are inside it.