Even before controversy shook the organization to its foundation, Ornge was always an anomaly in the Ontario world of ABCs (agencies, boards and commissions).
Ontario’s air ambulance company was created in 2005 in an effort to bring a fragmented provincial system under the stewardship of a single not-for-profit organization. The reality, in fact, was much different. By late 2011, the organization had morphed into an unusual private-public, for profit/not-for-profit hybrid – one with 19 separate entities and more than 30 bank accounts – that would soon be laid bare on the front pages of Ontario’s major newspapers.
The focus of the organization had strayed from its core mission of providing air ambulance and related services to the people of Ontario, toward a fixation on generating business outside of the province. A series of media stories in late 2011 revealed a host of problems: a lack of transparency and accountability, taxpayer-funded executive salaries growing unchecked without being subjected to public scrutiny, as well as a variety of patient safety and operational issues.
When an organization such as Ornge begins to fall apart, it doesn’t happen in a systematic, predictable way. After Deb Matthews, Ontario’s Minister of Health and Long-Term Care, installed new leadership in January 2012, new revelations about the extent of the damage appeared almost daily.
How could this have happened? That question has been at the core of a number of audits, investigations and committees, but ultimately it comes down to two missing pieces. An organization like Ornge requires a board of directors who can think for themselves, and have their noses in the business to keep management in check. In addition, it’s essential to have a firm foundational document that provides focus and gives enough operating freedom, but is strong enough to impose penalties if the organization fails to deliver. Those two items were both absent at Ornge.
To correct this, a new, independent, top tier board of directors was appointed, made up of seven volunteers from across Ontario with considerable experience in health care, government, industry and aviation. A committee structure was created to address specific areas of concern, including governance, human resources and compensation, finance and audit, quality care and operations.
Next, the Performance Agreement with the Ministry of Health and Long-Term Care was renegotiated and signed. Among the many transparency and value-for-money enhancements, Ornge’s funding is now tied to key performance indicators; executive expenses are reported publicly; and the government has control over changes to Ornge’s corporate structure. The amended agreement also improved patient care through the appointment of a Patient Advocate and the creation of a Quality Improvement Plan.
There was also a significant crisis in leadership as frontline staff had lost confidence in senior executives. Within months, the former CEO and all his direct reports were replaced by a transition team comprised of senior members of the Ontario public service on secondment to Ornge, along with experts in paramedicine and aviation. The transition team was tasked with ensuring the core business – transporting patients safely to the care they need – remained functional as the organization underwent audits and reviews by as many as nine separate third-party organizations, while at the same time making necessary personnel and operational changes. Not to mention motivating a workforce exhausted from months of daily media stories.
During the initial crisis phase, communication was especially important. Townhall staff meetings were held twice monthly at the beginning and now once a month. Rather than relying on briefings from outgoing executives, management turned to the people on the frontlines for information. The organization also reached out to stakeholders such as patients, Emergency Medical Services agencies and hospitals, who had been largely neglected or ignored under previous leadership. Many were forthcoming, and their advice helped shape policy.
The delivery of air ambulance service involves two of the most heavily regulated industries in Canada: aviation and health care. Under these circumstances, change can be exceptionally time-consuming. While there is still much work to be done, the organization has moved on from the initial crisis into a phase of reputation recovery. While the task of bringing Ornge back from the brink is both challenging, as well as a little messy, the 19,000 patients transported each year makes this a worthy pursuit.
Ron McKerlie is interim president and CEO of Ornge. Prior to his appointment, he was deputy minister for Government Services and Secretary of Management Board of Cabinet.
