Right Thing, Wrong Reasons

In an eerie echo of the Calgary Lab Services bail-out of 2006, Health Minister Adriana LaGrange announced that AHS would be ending its contract for community laboratory services with DynaLIFE, “transfer[ring] all staff, operations, and physical labs to Alberta Precision Labs.” This latest spin of the political carousel puts laboratory services almost back on the trajectory they had been on prior to the 2019 provincial election — an alternate timeline of what could have been. But now it comes with added costs, stress, negative press, worker burnout, and erosion of patient trust.

Pundits, policy-makers, and politely disinterested political observers might have been caught off-guard by the announcement to “nationalize” (or de-privatize) lab services, given that such a course of action would seem anathema to the UCP’s foundational principles. They could not have been more surprised than lab workers, who once again found themselves the subject of a monumental transformation in which they were the last to know. It seems that at no point in this ongoing saga have lab workers been consulted on policy changes that will impact the future of their profession — their futures, full stop.

Sadly, this lack of consultation isn’t news at all for lab workers. After more than a decade at the centre of a political tug-of-war, many in the profession have come to anticipate the worst. In the wake of this latest U-turn, the fear is that this will not be the last battle over the future of laboratory services.

In an attempt to come to grips with the incomprehensible, I pose a series of critical questions:

• How did we get here? Where did it all go wrong?
• What does it mean for patients, workers, and the current government?
• What are the costs?
• What can we expect next, and how do we ensure those next steps support the future success of lab services?

Though it's tempting to think of the current DynaLIFE fiasco as an isolated episode — the story of an over-ambitious expansion of services to a private provider that sadly could not meet the demand — it’s important to understand that the crisis in Alberta’s laboratory services has been more than a decade in the making. The damage of years of short-sighted decisions is cumulative.

Turning points

While it is nearly impossible to provide a concise summary of the many changes in laboratory services delivery in Alberta over the last decade, there have been several key turning points:

• The ripple effects of massive cuts during the Klein premiership continue to be felt in the lab sector to this day. That included a 20% cut of the laboratory services budget, an irreparable attrition of the workforce, and a persistent infrastructure deficit from which Alberta’s lab services have yet to fully recover.
  
  
• Calgary Laboratory Services was originally established as a public-private partnership. In 2006, the private sector partners pulled out, leading to a buy-out of the lab by the Calgary Regional Health Authority. With the creation of AHS in 2008, Calgary Lab Services became a wholly public subsidiary and one of the most successfully emulated lab models.
  
  
• Failed Sonic RFP: Despite the success of CLS, successive conservative governments have repeatedly emphasized the necessity and advantages of privatized services in medical lab testing. In 2014, a request for proposals was initiated to expand the scope of contracted lab services in Edmonton and the North Zone, which were at that time delivered by DynaLIFE. The new contract was awarded to Australian firm Sonic, to the tune of $3 billion over a 15-year term. When the Alberta NDP took office in May 2015, the contract was already proving controversial, as DynaLIFE alleged irregularities with the procurement process. The contract was cancelled, incurring substantial financial penalties, and the NDP went back to the drawing board.
  
  
• Rather than simply re-run the request for proposals (which at that time was likely to produce the same bidders), the NDP government tasked the Health Quality Council of Alberta with researching the best approach for the future of the medical lab system. Released in 2017, the HQCA report recommended a single, wholly public lab service which would deliver testing and training across the province. This led to the creation of APL — Alberta Public Laboratories — in 2018. The NDP plan, negotiated with DynaLIFE, would have the private provider see out the remainder of its existing contract when it would then be bought out and absorbed into APL.
  
  
• What happened instead was a provincial election in which the UCP formed government. One of its first acts was to cancel the Edmonton Clinical Hub Lab which was to form the centre of the new province-wide service (and had been in the works since 2014). The cancellation cost millions in sunk costs, penalties and site remediation, the exact amount of which has never been fully disclosed.
  
  
• Renaming APL: In autumn 2019, with no consultation of lab staff (or the executive), the UCP government attempted to remove the “public” from AHS’s lab subsidiary, changing the name to Alberta Precision The new name’s similarity to a drilling company notwithstanding, the change imposed logistical challenges and existential anxiety across the organization. Each time the lab is renamed, reorganized, sold, or transferred, considerable sums of public dollars are unnecessarily spent on non-patient endeavours and innumerable hours of work are wasted.
  
  
• Medicine Hat, meanwhile, has had its own unique labs roller-coaster: its autonomous lab service was integrated into APL in 2018 and had not yet completed its transition when the Kenney government announced the reversal of the plan and the launching of a new RFP. Since then, services in the community have switched to DynaLIFE and will now, less than a year later, revert to APL.
  
  
• Not least in this list are the traumatic impacts of the COVID-19 pandemic from 2020 onward. Lab professionals in both APL and DynaLIFE worked beyond capacity to ensure that Alberta’s Covid testing response was among the most comprehensive in the world. Along with their colleagues in other provinces, this came at the cost of lab workers’ mental and physical health which contributed to lowered morale and further attrition of the workforce. Staffing shortages are now at critical levels in Alberta, nationally, and internationally.
  
  
• Into this already challenging context, the UCP government dropped the request for proposals which would in 2022 be awarded to DynaLIFE.
  
  

A damaging cycle

In Parkland Institute’s 2022 report on the implications of the DynaLIFE deal — Mis/Diagnosis —, many lab workers expressed how damaging this cycle of restructuring and policy reversal had been to the entire sector:

“I have been a lab technologist for 42 years and lab has always been messed around with by the government. Privatize, re-integrate, privatize, combine services to APL, privatize again. This has affected morale, relationships, opportunities, personal financial security and in some cases emotional and mental distress (burn out, depression, anxiety).” (Lab technologist, DynaLIFE, Edmonton Zone)

That leaves us now in the middle of a familiar and unnecessary mess: delays, disputes, and dismal performance. And the heartbreaking, gob-smacking bitterest truth of it all is that lab workers tried to warn us all along.

Lab workers, academics, and long-time observers of the medical laboratory sector saw these problems coming from a mile away and urged the government to reconsider their approach. In December 2022, ahead of the transition to DynaLIFE, cracks were already apparent in the foundations. Contrary to the premier’s remarks, flags were indeed raised, with urgency and alarm.

So why were the very clear lessons of these multiple failed attempts not heeded? The premier, on her radio show “Your Province Your Premier” (19 August 2023), pointed to the sole-source nature of the contract as the problem, rather than the inherent flaws of private health care. That this is the “lesson” she has taken from this situation suggests either willful ignorance or yet another UCP mission to place outcome over evidence.

What lessons could the UCP have learned, had they listened to lab workers’ experiences over the last three decades?

Lesson 1: Transparency and accountability

Throughout this labyrinthine process, neither UCP government has provided a shred of evidence that this contract would provide long-term value for Alberta’s health-care system. Repeated calls to publicize the full business case used to justify the decision, alongside a cost-benefit comparison to the wholly public plan, were ignored. At no time were Albertans informed of the quality and performance metrics for DynaLIFE — the ones the health minister says have not been met.

At no point did the government consult with those who know the medical laboratory system best: lab workers. Nor, it appears, did they consult anyone other than DynaLIFE lobbyists. Now that the plan has clearly and spectacularly failed, no one is taking responsibility: not the premier, who says “not on my watch”, nor the health minister (who was busy causing damage to another essential public service at the time of the deal), and certainly not DynaLIFE’s CEO, who has been silent since the announcement. When public services are handed to private corporations, the public’s ability to hold them to account is severed, and so is trust. Caveat emptor and all that.

Lesson 2: The illusion of cost savings

Original claims about savings were disputed and inflated. Any tangible savings over the public system were predicated on a compensation differential between APL and DynaLIFE staff. If we were to follow APL’s (mildly) favourable bargaining in early 2022 and HSAA’s fight for pay equity across the two categories, DynaLIFE’s profit margin would have been eroded.

Meanwhile, the costs to Albertans are rapidly adding up: the sunk costs (in person-hours) of cancelling the APL plan; the cost to buy back AHS/APL sites and equipment that were transferred to DynaLIFE; the cost to buy the new or in-progress collection sites built by DynaLIFE, along with new or upgraded equipment; the cost to transition and retrain the original 1,400 DynaLIFE workers, alongside the former APL workers who will have to be brought back; the amount of the original contract that may be deemed “delivered”; any financial penalties if AHS is deemed to have initiated the cancellation. Despite assurances from the health minister that the final details of the deal will be made public, we may never receive a full accounting. Crucially, we will never be able to tally the costs of delayed and missed diagnoses to the wider health system in years to come.

Lesson 3: Workforce and stability

Regardless of the financial costs to Alberta taxpayers, the real costs of this deal have been borne by lab workers. The uncertainty and anxiety over their futures has been unrelenting over the last decade, and political turmoil and unfair working conditions have only added to the strain. Labour disputes among lab workers at DynaLIFE’s parent company in Manitoba and British Columbia suggest that beleaguered LifeLabs may be eager to unload its Alberta properties if its workforce is no longer easily exploitable.

There is only one pool of workers, and they are universally exhausted and demoralized. The political instability sending earthquakes through the lab sector does nothing to attract and retain qualified workers to Alberta labs.

A successful, sustainable lab service requires respect for the centrality of lab services to frontline medical care and the willingness to foster a lab system where lab experts are at the heart of decision-making.

The biggest lesson for this government (and those who come after) is that the quality of our public services — accessibility, turnaround time, wait times, and accuracy — must matter more than profit or political point-scoring. And all the evidence from our past failures and promising successes shows that this is only achievable if the first three lessons are taken to heart.

The saga continues…

What, then, is the next step for Alberta’s laboratory services? The move to bring community lab testing back in-house under APL is a necessary step in the right direction, one that advocates and workers have been calling for from the beginning. But it is merely delivering first aid for a hemorrhaging patient. Stopping the blood loss is crucial, but insufficient on its own.

Going forward, lab services need the political will, resources, and support in order to overcome this traumatic decade. That means stability, continuity, building respectful relationships with lab workers, and adopting a sustainable recruitment and retention plan. It means investment in people, equipment, and infrastructure, all of which have been sorely lacking. It means a hub lab.

In her announcement, Minister LaGrange emphasized that the objective of this decision was to provide stability for lab services. The premier, however, has already dangerously undermined that premise with two simple words: “For now.” The looming promise — or threat — of yet another change for labs would be an injury from which the patient may never recover.

 

Photo by National Cancer Institute on Unsplash