Alberta Health Services (AHS) is the single health authority for the Canadian province of Alberta and the "largest integrated provincial health care system" in Canada. Headquartered in Edmonton, AHS delivers medical care on behalf of the Government of Alberta'sMinistry of Health.[3] It operates 850 facilities throughout the province, including hospitals, clinics, continuing care facilities, mental health facilities and community health sites, that provide a variety of programs and services. AHS is the largest employer in the province of Alberta. In 2019, AHS served 4.3 million Albertans with a staff of 125,000 staff and 10,000 physicians,[4] and an annual budget of $15.365 billion.[1] Sean Chilton is the Acting President and CEO of AHS and reports to Dr. John Cowell, the AHS Official Administrator. The Official Administrator is accountable to the Minister of Health and the Premier.
Overview
Alberta Health Services reports to Minister of HealthAdriana LaGrange with Athana Mentzelopoulos serving as AHS President and CEO as of December 2023. On September 19, 2024, Angela Fong was appointed AHS Board Chair.
According to the AHS 2022 annual report, AHS' workforce includes over 113,000 employees, 9,500 physicians, 170 midwives and 9,700 volunteers. AHS serves 4.6 million people who reside in Alberta.
History
From 1992 to 2000, Alberta's Conservative Premier Ralph Klein oversaw deep cuts to provincial health as part of his focus on eliminating Alberta's deficit.[5] Klein replaced hundreds of local boards of directors of hospitals, long-term care and public health services, with 17 health authorities based on geographic regions. He also created provincial health authorities for cancer, mental health and addiction services. Per capita spending on health was cut from CA $1,393 in 1992 to $1,156 in 1995.[5] At the same time, Klein eliminated or reduced hours for 14,753 positions in health care. Three downtown hospitals were closed by the Calgary Regional Health Authority—one of the hospitals was leased to an American for-profit health group" and the old "Calgary General Hospital was blown up in October 1998". This left many Calgarians "without access to emergency care in the downtown core."[5] The "controlled implosion of Calgary General Hospital"—the Big Bang—was described as the "dawn of a regionalized, integrated healthcare system in Alberta."[6][7]
Alberta Health Services, which was established on May 15, 2008, is a quasi-independent agency of the Alberta government with a mandate of public health services throughout the province under the Ministry of Health.
Ed Stelmach, who served as Alberta's premier from December 2006 to October 2011, as leader of the Progressive Conservative Association of Alberta, introduced major reforms to Alberta's health-care system. On May 15, 2008, Health Minister Ron Liepert announced that as of April 1, 2009, one provincial governance board—the Alberta Health Services Board—would consolidate the "$13-billion-a-year system into one public corporation", replacing Alberta's nine regional health authority boards— Aspen Health Region, Calgary Health Region, Capital Health Region, Chinook Health Region, David Thompson Health Region, East Central Health Region, Northern Lights Health Region, Palliser Health Region, and Peace Country Health Region.[8]
On April 1, 2009, the Health Governance Transition Amendment Act dissolved the Alberta Mental Health Board, the Alberta Cancer Board and the Alberta Alcohol and Drug Abuse Commission,[9]: 12–3 [10]: 44–49 and completed the transition to Alberta Health Services (AHS).[11] Alberta Health Services funding of gender-affirming care for transgender people was also delisted in 2009.[12] It was restored in 2010 after resistance from psychiatrist Lorne Warneke[12] and other advocates.
Prior to these changes, health services in Alberta had undergone several governance reorganizations, which resulted in fewer separate public organizational entities, in 1996,[13][14] 2003,[15] and 2006.[16]
The Ernst & Young December 2019 review said that AHS could save "up to $1.9 billion annually". The NDP opposition called the UCP's proposed changes to AHS, the "Americanization of AHS."[4][17]
Organization
AHS provides health services to some patients in British Columbia, Saskatchewan, and the Northwest Territories, as well as to over 4.3 million Albertans.[4]: 3
Alberta Health Services has been organized so as to separate acute hospital facilities (with separate reporting lines for major tertiary, metropolitan and regional hospitals) from smaller hospitals and community services, the latter of which are organized into five zones (North, Edmonton, Central, Calgary and South). The Calgary Zone, for example, includes some sites and services formerly administered by the Calgary Health Region while other services have been reorganized on a provincial scale.[18]
Governance
Stephen Duckett was the inaugural president and chief executive officer of the newly created health "superboard", Alberta Health Services, and served from the spring of 2009 until November 2010, when then-provincial Health Minister Gene Zwozdesky asked him to resign.[19] Significant budget cuts—of about CA $1 billion—were imposed on AHS by Premier Stelmach, soon after Duckett's appointment.[20]
Chris Eagle served as AHS CEO from November 23, 2010, until October 17, 2013.[21]
On June 12, 2013, Minister of Health Fred Horne fired the entire AHS Board over its refusal to cancel executive bonuses.[22] Three days later, Janet Davidson[23] was appointed the AHS official administrator by Minister Horne to act in place of its board of directors. On September 12, 2013, John W. F. Cowell replaced Davidson as the official administrator.[24] AHS has subsequently had Carl Amrhein and David Carpenter as official administrators.
The Alberta Health Services Board was re-introduced, effective November 27, 2015 with Linda Hughes appointed as the board chair.[25]
On April 4, 2022, the AHS Board asked Mauro Chies, Vice President, Cancer Care Alberta and Clinical Support Services, to serve in the role of interim CEO on a temporary basis.
Dr. Verna Yiu served as AHS CEO and president from June 3, 2016, to April 4, 2022.[26]
In 2021, Gregory Turnbull, QC served as board chair, Dr. Sayeh Zielke as vice-chair, and Brian Vaasjo, Deborah Apps, Heidi Overguard, Dr. Jack Mintz, Natalia Reiman, Sherri Fountain, Hartley Harris, Tony Dagnone, OC and Vicki Yellow Old Woman serve as board members.[27]
On Nov. 17, 2022, Dr. John Cowell was appointed Official Administrator for Alberta Health Services (AHS) by the Minister of Health and replaced the existing board of directors. The Official Administrator has responsibility for the governance of AHS, working in partnership with Alberta Health to ensure all Albertans have access to high quality health services across the province. The Official Administrator is accountable to the Minister of Health and the Premier.
On November 16, 2023, Sean Chilton was named Acting AHS President and CEO. [28]
By 2010, AHS was maintaining and running a number of different types of facilities and services.[33] These included Cancer care for the prevention, detection, treatment, education and care of cancer patients, as well as to facilitate research of cancer; continuing and long-term care
for the treatment of patients with complex health needs requiring 24-hour on-site services from registered nurses; emergency for immediate care of patients with all types of conditions; hospitals for medical, surgical, or psychiatric care of the sick and injured. There were also laboratories for the processing of medical samples and tests; mental health and addictions services for treatment and care of patients diagnosed with mental health or addiction issues and emergency medical services.
AHS is directly responsible for both ground and air ambulance operations in the province, provided through a mix of both direct delivery and contracted providers.
A wider array of miscellaneous health facilities include physiotherapy, occupational therapy, home care, hemodialysis and others, and also include Public Health Centres which provide services such as prenatal, postpartum, health promotion/disease and injury prevention, bereavement services, communicable disease and school health. They also fund affordable housing for seniors at facilities, such as Silvera for Seniors.
Urgent care services include treating patients with unexpected but not life-threatening issues requiring same day treatment.
AHS also operates X-ray and imaging clinics for procedures such as MRIs, X-rays and other types of scans.
Laboratories
In the early 1990s, most of Edmonton's hospital labs were privatized.[34] The Edmonton regional health authority had a 15-year contract with the private company Dynalife, which was ending in the early 2010s.
The provincial government ordered regional health authorities to cut lab spending, which resulted in more public laboratories being established by 2005.
By 2006, all of the lab services in Calgary were under public control.[34]
In December 2013, Alberta Health Services proceeded with "its plan to privatize all of its diagnostic lab services in Edmonton".[35] AHS sent out request for proposals (RFP) for a "private provider to establish a single $3 billion lab for the Edmonton Zone."[36]: 2 [35] By October 16, 2014, Australia's Sonic Healthcare, a private company, had been selected.[37] They would have replaced "hospital labs operated by AHS and Covenant Health, as well as the services now provided by the private company Dynalife." When the NDP won the 2015 Alberta general election, the contract with Sonic was cancelled.
By 2016, the largest medical testing facility in northern Alberta was the central laboratory facility owned and operated by a private company in Edmonton, Dynalife.[38] As of January 23, 2016, DynaLIFE Dx was owned by Toronto-headquartered LifeLabs and the Burlington, North Carolina-headquartered LabCorp, or Laboratory Corporation of America Holdings, which operates one of the largest clinical laboratory networks in the world. LabCorp had acquired all outstanding shares of Canadian medical laboratory services company Dynacare Inc. for $480 million in May 2002.[39]
In August 2016, Elisabeth Ballermann, then-President of the Health Sciences Association of Alberta (HSAA), which represented 1,600 lab workers in both the private and public sector, said that HSAA members had "long wanted lab services delivered by the public system". Ballerman said she was convinced they could work in the public sector. She expressed concern that under the contract, the new facility to house the Edmonton lab would be owned by a private company, not by Albertans.[40]
The newly elected United Conservative Party (UCP) government's Health Minister Tyler Shandro, cancelled the construction of a new super-lab—a "$595-million centralized public lab facility next to the University of Alberta's south campus".[41] Shandro also exited the "planned $50-million buyout of private lab services company Dynalife by 2022", saying that he disagreed with the NDP's decision to "nationalize Dynalife – to nationalize laboratory services in Alberta."[41]
On October 24, 2019, under Health Minister Shandro, Alberta's consolidated laboratory services previously provided by multiple organizations in Alberta under the newly named Alberta Precision Laboratories Ltd (APL), a wholly owned subsidiary of AHS, with Tammy Hofer as Chief Operating Officer (CFO) and Dr. Carolyn O'Hara as Chief Medical Laboratory Officer (CMLO).[42] Prior to consolidation and during the transition period, laboratory services were provided to AHS through Calgary Lab Services (CLS), Covenant Health—the largest Catholic health-care provider in Canada, DynaLIFE, Laboratory Services (AHS), Medicine Hat & Brooks Collection Sites, and Lamont Health Care Centre.[43]
As of October 2019, APL continued to "work collaboratively with DynaLIFE, under contract to provide lab services in Alberta."[43] By November 30, 2019, the union that represents public laboratory workers expressed concern that 850 jobs in the public labs, could be lost, after Minister Shandro and APL sent out a Request for Expression of Interest (RFOI),[44] "to gauge market interest from private third parties for the provision of community lab services in Alberta" as part of their investigation into "new service delivery models."[45]
AHS testing services include AHS Lab Services (Central, Edmonton, North and South zones), Genetic Lab Services, ProvLab, Calgary Laboratory Services, and DynaLIFE Medical Labs.[46]
ProvLab, which "operates under Alberta Health Services (AHS) Laboratory Services" and has "been in existence for over 100 years", was renamed Public Health Laboratories. It is based in Calgary's Foothills Medical Centre and Edmonton's University of Alberta Hospital in Edmonton. Its focus on "public health and specialized microbiology" including "surveillance, research, specialized laboratory testing and outbreak and emerging infectious diseases response."[47]
The south zone includes major centres such as Lethbridge and Medicine Hat serving approximately 309,000 Albertans.
A large network of hospitals is maintained in the outlying communities of Alberta. South Zone includes[49]
A large network of hospitals are maintained in the outlying communities of Alberta. Calgary Zone includes[49]Canmore General Hospital (Canmore), Claresholm General Hospital (Claresholm), Didsbury District Health Services (Didsbury), High River General Hospital (High River), Strathmore District Health Services (Strathmore), and Vulcan Community Health Centre (Vulcan).
Following the death of Myra Crow Chief on April 21, 2022, a human rights complaint was filed against AHS and the Strathmore facility with the Alberta Human Rights Commission by her surviving husband Benedict Crow Chief. In response to the complaint, AHS said they will continue to meet with Siksika Nation to discuss their concerns. It also announced the creation of a "Wisdom Council" focusing Indigenous health priorities, services and resources, made up of public members from across treaty areas and Alberta's health zones.[50]
Central Zone
The central zone includes major centres such as Red Deer. Serving approximately 480,000 Albertans.
A large network of hospitals are maintained in the outlying communities of Alberta. Central Zone includes[49]
Serving approximately 1.4 million Albertans, the Edmonton Zone administrative offices are located in Seventh Street Plaza. The Edmonton Zone comprises territory formerly administered by the Capital Health Region and includes eight acute care sites (hospitals) in the metropolitan area, which include.[49]
The north zone includes major centres such as Grande Prairie and Fort McMurray. Serving approximately 480,000 Albertans.
A large network of hospitals are maintained in the outlying communities of Alberta. North Zone includes[49]
Alberta's Emergency Medical Services, which include both ground services, air ambulances have been the responsibility of AHS since April 1, 2009. This includes inter-facility hospital transfers and EMS dispatch. Prior to 2009, municipalities were responsible for providing ground services.[51] By April 10, the provincial air ambulance had also transitioned to AHS.[52]
In 2019, EMS averaged about 590,000 ambulance responses annually,[53] with approximately 30% of these being patient transfers between health care facilities, and 70% being emergency responses. 2023 saw a continued increase in responses throughout the province. AHS EMS responded to 602,300 events with the majority again being emergency responses.
AHS EMS consists of numerous ground ambulances providing Advanced Life Support (ALS), Basic Life Support (BLS) and single manned ALS Paramedic Response Unit (PRU) members providing support in an SUV.
The AHS EMS Special Operations Division is composed of paramedics who specialize in a variety of qualifications including
- Rapid Access Paramedics (RAP) capable of providing access to festivals and large gatherings utilizing bicycles, golf carts and a variety of response vehicles.
- Incident Response Paramedics (IRP) whose primary role is providing expertise on CBRNE, Hazmat, and Mass Casualty Incidents.
- Public Safety Unit (PSU) provides medical support to municipal police services during large gatherings/protests.
- Tactical Emergency Medical Support (TEMS) responsible for providing immediate medical support/expertise to municipal police tactical teams during operations.
AHS EMS Rank Structure
MANAGEMENT EMPLOYEES (NON-UNION)
RANK
Chief Paramedic
Executive Director
Associate Executive Director
Director
Manager
Supervisor
—— Quality Assurance Strategist
INSIGNIA
FRONTLINE EMPLOYEES (UNIONIZED)
RANK
Acting Qualified Supervisor
——— Public Education Officer
Clinical Educator
——— Coordinator
Advanced Care Paramedic
Primary Care Paramedic
Emergency Medical Responder
INSIGNIA
SUPPORT EMPLOYEES (UNIONIZED)
RANK
Vehicle, Equipment and Supply Services Technician
Emergency Communication Officer
INSIGNIA
Protective Services
Alberta Health Services provides physical security, asset and staff protection, and various law enforcement capabilities at corporate properties. This is accomplished with a multi-tiered system including Corporate Investigations, Peace Officers and contracted security companies across Alberta.
Comparison with other provinces
In general, Alberta, which has been the province with the highest GDP per capita for decades, spends more money per capita on public services, including on health, than any other Canadian province.[4]: 3 This disparity between Alberta's healthcare spending and other provinces is often a topical election issue and was a focus of the MacKinnon Report. According to a 2019 report, health care accounts for about 43% of the public expenditures in the province.[4]: 3
Per capita Health Care Expenditure in Alberta compared to the National Average, in 1997 constant dollars, 1975 to 2019[54]
Graphs are unavailable due to technical issues. Updates on reimplementing the Graph extension, which will be known as the Chart extension, can be found on Phabricator and on MediaWiki.org.
^Martin, H.; Rushford, P. (1998). "The Big Bang approach to health reform: an update from the Calgary Regional Health Authority". Hospital Quarterly (2): 43–50.
^Philippon, D. J. and S. A. Wasylyshyn (1996). Health-care reform in Alberta. Canadian Public Administration 39(1): 70-84.
^Reay, T. and C. R. Hinings (2005). The Recomposition of an Organizational Field: Health Care in Alberta. Organization Studies 26(3): 351-384.
^Hinings, C. R., A. Casebeer, et al. (2003). Regionalizing Healthcare in Alberta: Legislated Change, Uncertainty and Loose Coupling British Journal of Management 14:S1(December): S15-S30.
^Casebeer, A., T. Reay, et al. (2006). Experiences of Regionalization: Assessing Multiple Stakeholder Perspectives across Time. Healthcare Quarterly 9(2): 32-43.
