The Vice-Presidents

The HSC's vice-presidential structure was significantly altered by the corporate reorganization of June 1, 1994. Not only was the number of vice-presidents reduced, but the portfolio system that had been in place was eliminated and replaced by a system of program management.

Vice-presidents and portfolios before June 1994

Before the reorganization, the HSC had seven vice-presidents, each with a specific portfolio or area of responsibility. The portfolios were:

• Corporate planning
• Medical
• Nursing
• Operations
• Finance
• Human resources
• Communications and information systems (This Vice-President reported to the Senior Vice-President for Corporate Planning.)

Some of these portfolios, such as Medicine and Nursing, were known as clinical portfolios, while others, such as Finance or Operations, were known as non-clinical portfolios. There was also a vice-presidential hierarchy: four vice-presidents were titled senior vice-presidents. Under this system a person would hold a position with a specific title, such as Senior Vice-President, Medicine; or simply Vice-President, Communications and Information Systems. All but one of the vice-presidents reported directly to the President and all were appointed by the board.

The significant portfolios before June 1994 in terms of the issues under consideration by this Inquest were the Senior Vice-President Medical (a position held by Dr. J. B. (Ian) Sutherland) and the Senior Vice-President Nursing (a position held by Susan VanDeVelde-Coke). Under this structure, Sutherland also chaired the Medical Advisory Committee (an important hospital committee that will be discussed later).

Before discussing the 1994 reorganization, it is useful to outline the structure of these two portfolios (Medical and Nursing) before their elimination in June 1994.

The medical portfolio

The Senior Vice-President (SVP) Medicine was responsible for the Medical Portfolio. This portfolio supervised services delivered by the hospital's medical staff. (In this context, medical staff included doctors, dentists and scientists). The Medical Portfolio was subdivided into departments, each with its own head or chief, who was appointed by the board. Before June 1, 1994, all department heads reported to the SVP Medicine. All doctors with HSC medical appointments would have an appointment to one of the medical departments.

The medical departments at the HSC were:

• Anaesthesia
• Clinical Chemistry
• Clinical Microbiology
• Community Health Sciences
• Emergency
• Medicine
• Obstetrics and Gynaecology
• Ophthalmology
• Otolaryngology
• Pathology
• Pediatrics and Child Health
• Psychiatry
• Radiology
• Surgery

The three key departments for the purposes of this Inquest were Anaesthesia, Pediatrics and Child Health, and Surgery. The structure of these departments will be discussed later in this chapter.

The nursing portfolio

Before June 1, 1994, the Senior Vice-President Nursing was responsible for the Nursing Portfolio. This portfolio was responsible for the provision and management of all nursing services in the hospital. The portfolio was divided into six smaller divisions, each with its own director. All directors reported to the SVP Nursing.

The Nursing Divisions at the HSC, before June 1994, were:

• Surgical Nursing
• Medical Nursing
• Psychiatric Nursing
• Pediatrics and Child Health
• Adult Ambulatory Care
• Obstetrics and Gynaecology

The SVP Nursing was also responsible for Nursing Education and Research. The key divisions for the purposes of this Inquest were Pediatrics and Child Health Nursing and Surgical Nursing.

The rationale for the reorganization

The portfolio system had long been criticized because people working side by side in a ward or medical unit often fell within vastly different administrative lines of authority and accountability. Doctors, nurses, medical technicians, residents, therapists and administrative personnel, working on the same ward and dealing with the same patients, reported to different managers and responded to different managerial priorities. Unit personnel could easily fail to develop a team approach to the management of the issues that occurred in the unit. This sometimes resulted in conflicts over the medical management of patient care that required the involvement of senior managers for resolution.

The reorganization sought to break down these barriers by creating lines of authority that grouped the individuals who worked together on the same ward or in the same program into management units that reported to the same vice-president.

Vice-presidents and portfolios after June 1994

In June 1994 the system changed to one where there were only four vice-presidents, each of whom had both clinical and non-clinical responsibilities and reported to the President. The seven portfolios, including the Medical and Nursing portfolios, were eliminated. Of the four vice-presidents, the three of interest to this Inquest from June 1994 onward were Sutherland, Helen Wright and VanDeVelde-Coke.

The new structure sought to bring units together under one line of authority. No longer did all medical departments report to a single vice-president. The same was true of nursing divisions, which were renamed patient service divisions. Under the new structure, program teams were created, led by three managers with equal and joint responsibility for overseeing the program of which they were a part.

Medical departments and patient services divisions were clustered into program teams. The head of Pediatrics and Child Health and the director of Patient Services for Pediatric and Child Health were part of the Child Health Program Team and reported to Vice-President Helen Wright. (The third member of the Child Health program team was the director of Support Services, an administrative officer.)

Medical departments that were interdependent reported to the same vice-president. For example, the two other medical departments key to this Inquest, Anaesthesia and Surgery, reported to VanDeVelde-Coke.

Program teams were responsible for patient care teams. In the case of the Child Health program team, the significant patient care teams for this Inquest were those for Surgery, Pediatric Intensive Care and Neonatal Intensive Care. Patient care teams were meant to bring together front-line and administrative staff. These teams were to be made up of a section head (a senior doctor responsible for a medical service), a unit manager (usually a senior nurse) and an administrative official.

The hospital's bylaws were not updated at the time of the reorganization. As a result, the bylaws continued to refer to the responsibilities of non-existent positions, such as Senior Vice-Presidents.

Issues raised by the reorganization

The positions of Vice-President Medicine and Vice-President Nursing had always been held by persons with medical and nursing backgrounds respectively. The elimination of these positions caused some concern among staff that medicine and nursing-and nursing in particular-would lose status. Therefore, Thorfinnson gave a written commitment that there would always be one vice-president with a nursing background and one vice-president who was a doctor. (Other issues relating to nursing and reorganization will be discussed later in this chapter.)