With more information forthcoming on the new Yukon health authority, its impact on care remains to be seen
The Yukon government and the First Nations Chiefs Committee on Health have named the board of Shäw Kwä’ą, the new Yukon health authority.
Shäw Kwä’ą will be a new administrative and coordinating layer in between the Yukon health minister and the frontline health delivery organizations. The press release said Shäw Kwä’ą would work to “establish a culturally safe, community-focused, patient-centred, workforce-supportive, innovative and efficient health care system for all Yukoners.”
I have questions about how soon, say, a patient of the Pelly Crossing Health Centre or a family in Whistle Bend without a family doctor will see any difference in their health care. It is unclear what a new board can do to reduce the community nurse vacancy rate or recruit more family doctors that the Department of Health could not do already.
Veteran health care administrators will have noticed the press release did not include any new money.
Last fall, the Canadian Institute for Health Information said that 22.5 per cent of Yukoners aged 18 and over did not have a regular health-care provider. If that percentage applies to people of all ages, that’s over 10,000 Yukoners.
If the new board can solve that problem with the same budget, staff and equipment as the Department of Health had, it will be a Masters of Public Administration case study for the ages.
I am reminded of the warning former premier Sandy Silver’s Financial Advisory Panel made about this kind of thing. They wrote that “institutional reorganization can take many forms from moving around senior civil servants and reorganizing departmental mandates to consolidating [and then decentralizing] stakeholder boards in areas such as healthcare and education. This is the easiest change to undertake and the least likely to increase efficiency or effectiveness in the operations of government … this is otherwise referred to as ‘rearranging the deck chairs.’”
In the Yukon, they don’t let regular folks vote on major changes like this. So whether you feel good about it or not, you are strapped into the dog sled for the ride.
The new board has some critical items on its to-do list. Yukoners will judge it based on whether it can find a family doctor for 10,000 Yukoners, fully staff the community nursing stations (the Aug. 15 edition of the News had the latest update on nursing station closures), and shorten the lengthy waiting lists for important procedures.
Let’s look at what you need to believe in order for that Pelly Crossing patient or Whistle Bend family above to feel real change soon.
First, the new board will need to shake things up rather than continue the status quo under new letterhead. The composition of the new board suggests the government and the chiefs want to do this. The list pointedly does not include Yukon Hospital Corporation board members or senior Yukon health officials.
Looking at LinkedIn, online bios and information shared by the Yukon government, the new board has some impressive experience.
The chair is Stephen Mills, who has extensive Yukon experience as a (non-health) deputy minister, YESAB board chair and co-chair of a health advisory committee. He is a member of the Vuntut Gwitchin First Nation.
Alisa Alexander is a Fairbanks doctor and director of the University of Alaska’s Center for One Health Research in the College of Indigenous Studies. Alexander did her family medicine residency program through University of British Columbia and is a member of the Vuntut Gwitchin First Nation.
Jill Charlie is the director of health and wellness for the Kwanlin Dün First Nation. Previously, she spent 12 years with the Yukon government as a frontline Yukon nurse, nursing manager and clinical leader in the electronic health records project. She has a Masters of Public Administration from the University of Alaska Southeast.
Georgina Macdonald has over 35 years of health-care experience Outside, including executive roles in Saskatchewan and British Columbia. She has worked at both a health authority and the Canadian Institute for Health Information.
Inga Petri is a Whitehorse consultant who has lived in the Yukon since 2015 with over 30 years of professional experience.
Maisie Smith has a Masters in Counselling Psychology and is a registered clinical counsellor with the Canadian Counselling and Psychotherapy Association. Her lengthy Yukon experience includes work on Indian residential school survivors, missing and murdered Indigenous women and federal Indian day schools. She is a citizen of the Champagne and Aishihik First Nations.
Edmund Tan is the former director of health strategy for Loblaws/Shoppers Drug Mart, which has been making big investments in private-sector and digital health services. In 2024, he bought the local Shoppers franchises. He is a practising pharmacist and the chair of the Yukon Pharmacy Advisory Committee.
A few interesting themes come out of this group. In addition to not including former deputy and assistant deputy ministers in health, it does not include doctors with local family practices or nursing union representatives. The group brings outside perspectives. There will be a strong First Nations point of view with a majority of the board either being First Nations citizens and/or working for First Nations governments. Alexander brings an academic and a United States health-care system perspective on what works, and doesn’t, across the border. Tan will be deeply familiar with the efforts by private-sector pharmacies and digital platforms to expand their roles in Canadian health.
If you asked a board recruiter for gaps, they might point out the absence of a former chief financial officer or hospital operations executive. Since doctors are so important to the health-care system, the group will need to figure out quickly how to make decisions that do not have unintended consequences on Yukon doctor business models.
Second, the board will need to move quickly to hire the CEO it wants. And that CEO will need to build the team underneath them. Then they will quickly need to review all the studies and proposals developed over the last few years, since a new board and executive team will not want to blindly implement ideas created before they were hired.
Third, the board will need to move quickly on fundamental reforms and not get bogged down in the thousands of administrative decisions involved in new legal entities, pension plan transfers, overlapping union deals and so on. The board will also have to fund the reorganization. The Yukon government budgeted $9.4 million in 2024-25 for reorganization expenses, and the new board will need commitments that they will get even more cash for implementation rather than having to take money from frontline budgets.
Fourth, for real impact you need to believe the new board will be more successful than officials, doctors and unions have been previously in getting more money out of the Yukon government for health. You simply can’t serve an extra 10,000 people with family doctor services without significant new money.
Finally, you need to believe that the cabinet and chiefs committee will let the new board drive what could be a sometimes controversial agenda of change. If upset interest groups can go around the new board to the minister and the chiefs, then things could get messy. The repeated upheavals in Alberta’s health authority are an example of this.
I hope this process goes well and soon has Yukoners seeing shorter waiting lists, fully-staffed nursing stations, faster emergency visits, and more family doctor relationships. If not, given the millions spent on the reorganization, it will indeed be a Masters of Public Administration case study. Just not the kind that anyone responsible for it will want to present at a fancy conference Outside.
Keith Halliday is a Yukon economist and a winner of the Canadian Community Newspaper Award for Outstanding Columnist. The audiobook version of his most recent book Moonshadows, a Yukon-noir thriller, has just been released.