The Public Accountability Obligation of the Vancouver Island Health Authority Board of Directors

This is an example of a citizen group accountability letter to an authority that affects citizens in important ways.

Letter sent 15 Sept to each of the individual members of the Board of Directors of the Vancouver Island Health Authority (VIHA) , the public face of the Minister of health for Vancouver Island.

Dear _______________________

In the 1990s the prestigious national Canadian Comprehensive Auditing Foundation in its study on governance stated, as its 5th principle of governance, that effective governing bodies will be able to state:

“We understand what constitutes reasonable information for good governance…and we obtain it.”

In the case of VIHA, obtaining reasonable information for good governance means that the VIHA Board must: (1) have its own processes that identify and monitor the critical success factors needed to have all VIHA units significantly affecting citizens meet performance standards that citizens have the right to see met, and (2) have effective management control exercised by the Board itself, as VIHA’s directing mind, to ensure that performance and the accounting for it in all areas meets the needed standards for each unit. Management control means having effective processes that ensure that what should happen does, and what shouldn’t happen, doesn’t.

Our first question to the Board in May 2008 asked whether the Board carries out these responsibilities. The Board’s response can fairly be judged as not meeting a reasonable standard of useful public explanation.

Our second question to the Board in July 2008 therefore dealt with the Board’s obligation to publicly explain its intentions fully and fairly to those who would be affected by them. This would obviously include all those residents and families affected by the Board’s intentions for residential care.

We simply asked if the Board agreed with the statement of its commonsense public accounting obligation that we gave to the Board, which we regard as unassailable, and, if not, to state its reasons.

Again the Board replied to questions we did not ask, and did not reply to those we asked. It stated only what it reports in compliance with the Ministry and that it has guidelines for Board decision-making. Responsibility is not accountability, and compliance with a directive is not explaining publicly the Board’s own intentions and reasons and its intended performance standards for VIHA operations, and stating credible evidence of whether all those under the Board’s jurisdiction are meeting performance and public accounting standards that citizens are entitled to see met.

VIHA Board responses to citizen questions appear written for its web site PR and, by not faithfully answering the questions asked, to lead readers to think that all is well with the Board and that it is the questioners who are off base.

Adequate public accounting before the fact includes full and fair public explanation of what the Board intends for residential care homes on Vancouver Island, why it intends it, and allotting enough time for knowledgeable, fair and valid public challenge of its intentions before deciding on a course of action.

As the world’s leading management consultant Peter Drucker, once said, “Without dissent, you don’t know what the problem is.” We have no evidence that the VIHA Board and top management genuinely seek and respect dissent, either within VIHA or externally.

The public accountability issue was brought to a head in the July 30 public Board meeting in Qualicum. Ms. Joanna Neilson, spokesperson for the Concerned Citizens for Cowichan Lodge in Duncan, cited many examples of the Board’s refusal to explain publicly, fully and fairly before the fact its intentions, reasons and intended care performance standards in closing Cowichan Lodge and shifting its residents to a private sector facility. We have no evidence that the Board dealt with transfer trauma for old residents wholly dependent on the staff and environment they know, which can be expected to be lethal for some.

Ms. Neilson summed up her remarks by pointing out that the Board had lost the public’s trust. She said that citizens wished to trust the Board, but could not. The Board cannot use the Victoria Times Colonist reporter’s failure to quote Ms. Neilson (who had made the most important statement of the whole day, quoting instead what the CEO wished to say about other things) as evidence that public trust is not a vital issue. One would think that the Board members at the table at the public meeting would be personally devastated by the citizens’ indictment.

Full and fair public accounting increases trust in an authority, and failure to provide it decreases trust. It is legitimate for citizens not to place their trust in any Ministry or authority that does not publicly explain before the fact, to a standard of explanation that citizens have the right to see met.

Our July question set out what we regard as basic standards for acceptable public explanation by authorities. VIHA Board members do not have to wait to be instructed by the Minister on what the Board’s public accountability obligation is. VIHA employees on the front lines likely wouldn’t be allowed to help with that and it is not likely that the Minister and his staff could, because public accountability is not taught to civil servants and politicians.

If the members of the Board do not accept our group’s statement of what the Board’s public accountability obligation is, we think it reasonable that the Board members, as VIHA’s directing mind, publicly explain what they themselves think are the public accountability standards that citizens are entitled to see them meet.

A useful Board reply to our letter would require the reply to be an agenda item in the next Board meeting. We know of no governing body mandate in Canada that would prevent the Board from usefully and publicly giving its view of its public accounting obligation. Simply re-stating existing Board public comments on its accountability obviously will not do, and can be expected to lower public trust in the Board still further. The Board’s response to us need not wait until the next public Board meeting and web site statement.

We expect each member of the VIHA Board to receive this letter as written.

Our July 2008 question to the Board is attached as an appendix

Sincerely,

Members of the Citizens’ Accountability Group on VIHA :

Elizabeth Coey
Nora Curry
Phil Lyons
Lyne England
Joanne Manley
Wendy Leslie
Henry McCandless

CC to the Auditor General of BC, the BC Ombudsman, Minister of Health, Leader of the Opposition, and Editor, Times Colonist

Question put to the Board July 14, 2008, by the Citizens’ Accountability Group on VIHA

VIHA’s current intentions for its responsibilities for seniors’ residential care (such as transfer trauma) highlight the issue of the Board’s public accountability. Does the Board, as VIHA’s  governing body,  agree that its public explanation obligation before the fact is the following:

The Board has the obligation to explain fully, fairly and publicly, for VIHA’s achievement goals and intentions that would affect citizens in important ways, exactly what the Board intends and why the Board intends it , stating, in the Board’s view: 

(a) who would benefit from the Board’s aims and intentions and how they would benefit, in the short and longer term, and why they should;

(b) who would bear what costs and risks from what the Board intends, in the short and longer term, and why they should;

(c) the most important performance standards the Board would require professional and other staff  under VIHA’s jurisdiction to meet, in carrying out their assigned responsibilities under the intentions;   

(d) what the Board thinks is a reasonable period of time for public challenge of its intentions and performance standards by knowledgeable and affected citizens, before the Board decides to act, and

(e) who would account, publicly and regularly, for the discharge of what responsibilities flowing from the intentions, and be required to publicly report what been achieved (as opposed to reporting activity). 

If the Board disagrees with any or all of the above, please tell us why. Note that  the public accounting requirement does NOT tell Board members how to do their  jobs; it is only the obligation to explain, meeting a standard of public explanation before the fact that citizens have the right to see met.