I stepped off the escalator into the atrium of Edmonton’s Royal Alexandra Hospital last Tuesday, a place where fluorescent lights have witnessed thousands of life-changing moments. Today would add another – a press conference where Premier Danielle Smith was set to announce what many insiders had whispered about for months.
“The problem is the patient experience,” Smith declared, standing before a carefully arranged backdrop of Alberta flags. With those eight words, she launched what may be the most substantial restructuring of Alberta’s healthcare system since the creation of Alberta Health Services (AHS) in 2008.
The moment felt both predictable and jarring. As I watched healthcare workers peek out from hallways to catch glimpses of the announcement, their faces registered the complex emotions of people about to experience their fourth major system overhaul in two decades.
Smith’s plan dissolves the centralized AHS model and creates four new health authorities: Primary Care and Continuing Care, Community Care, Acute Care, and Cancer Care Alberta. The restructuring will transfer decision-making power away from what Smith characterized as a “bloated bureaucracy” toward frontline care providers.
“You can’t improve what you can’t measure,” Smith said, emphasizing performance metrics as core to the restructuring. “And right now, we simply don’t have the right measurements to know if Albertans are getting the care they deserve.”
Dr. Aisha Mirza, who I met in the hospital cafeteria after the announcement, has been an emergency physician at the Royal Alex for twelve years. She stirred her coffee thoughtfully before speaking.
“Every time we restructure, we lose institutional memory,” she said. “I’d feel more confident if these changes were coming from conversations with those of us who work in the system daily, rather than from political ideology.”
The Alberta Medical Association responded cautiously to the announcement, noting that while they support better coordination of care, “substantial system change always carries risk to ongoing operations.” Their statement emphasized that any restructuring should be “evidence-based and centered on patient outcomes rather than administrative convenience.”
Smith’s criticism of AHS isn’t entirely without merit. Wait times in Alberta emergency departments have increased significantly, with some patients waiting up to fifteen hours for care in busier urban centers. According to Alberta Health’s own dashboard, the province’s surgical waitlist grew to over 78,000 procedures as of January – an increase of nearly 18 percent since the UCP government took office.
However, independent health policy experts question whether administrative restructuring addresses the core issues facing Alberta’s healthcare system. Dr. Melanie Beaton from the O’Brien Institute for Public Health at the University of Calgary told me that evidence from other jurisdictions suggests restructuring rarely delivers promised improvements.
“Ontario has gone through similar cycles of centralization and decentralization,” Beaton explained during our phone interview. “The international evidence suggests that these administrative changes typically consume enormous resources without meaningfully improving patient outcomes. What consistently improves care is stable funding, workforce support, and evidence-based care delivery models.”
The financial implications of the restructuring remain unclear. Smith promised the changes would be “cost neutral,” but provided no detailed implementation budget. When I asked Health Minister Adriana LaGrange after the press conference how much the reorganization would cost, she acknowledged there would be “transition expenses” but declined to provide specific figures.
For communities outside urban centers, the reorganization raises particular concerns. In Fort McMurray, where I traveled two days after the announcement, nursing shortages have already forced temporary closures of the community’s only birthing unit three times this year.
“We’ve heard big promises before,” said Marion Richards, a retired public health nurse who has lived in Fort McMurray for over thirty years. We spoke in her home overlooking the Athabasca River. “What we need isn’t a new organizational chart. We need physicians who will stay longer than six months and nurses who aren’t working double shifts.”
Richards’ skepticism reflects a broader concern: will restructuring address the healthcare workforce challenges that disproportionately affect rural and remote communities? A 2023 report from the Rural Health Professions Action Plan documented vacancy rates approaching 30 percent for some healthcare positions in northern Alberta communities.
The reorganization also comes amid ongoing tensions between the provincial government and healthcare workers. The United Nurses of Alberta, representing over 30,000 registered nurses, expressed concern that the restructuring appears designed to facilitate further privatization of health services.
“Our members have weathered pandemic conditions, wage freezes, and now face a complete system overhaul,” said UNA President Heather Smith in a statement. “The government hasn’t earned the trust needed to implement changes of this magnitude.”
As I left Fort McMurray, driving south along Highway 63, the vastness of Alberta reminded me what makes healthcare delivery so challenging here – communities separated by hundreds of kilometers, diverse populations with unique needs, and the constant tension between urban and rural priorities.
Whether Smith’s restructuring will improve this complex system remains an open question. What’s certain is that for the doctors, nurses, and support staff showing up for shifts today, the work of caring for Albertans continues regardless of what the organizational chart looks like.
Perhaps the most telling moment came not from officials but from a patient I encountered in the Royal Alex lobby. Eighty-two-year-old Walter Chernyk, there for his cardiology follow-up, shrugged when I asked about the changes.
“I’ve seen governments come and go,” he said, adjusting his hearing aid. “All I care about is whether someone answers when I press the call button.”
