Hospital Based Leadership: Eliminating the bureaucratic vortex in hospitals

Since Alberta’s government announced plans to refocus the health care system in November 2023, a consistent message has emerged from patients, front-line health care workers and concerned Albertans alike about the flaws of the prior system. Alberta Health Services’ current zone-based leadership structure is overly complex and bureaucratic. It lacks the flexibility and responsiveness needed to effectively support facilities and staff – particularly when it comes to hiring, securing supplies and adopting necessary technologies.

That’s why Alberta’s government is changing to a hospital-based leadership structure. On-site leadership teams will be responsible for hiring staff, managing resources and solving problems to effectively serve their patients and communities. Hospitals will now have the flexibility to respond, freedom to adapt and authority to act, so they can meet the needs of their facilities, patients and workforce in real time.

“What works in Calgary or Edmonton isn’t always what works in Camrose or Peace River. That’s why we’re cutting through bureaucracy and putting real decision-making power back in the hands of local hospital leaders, so they can act fast, hire who they need and deliver better care for their communities.”

“Hospital-based leadership ensures decisions on hiring, supplies and services are made efficiently by those closest to care – strengthening acute care, supporting staff and helping patients get the timely, high-quality care they need and deserve.”

“By rethinking how decisions are made, we’re working to improve health care through a more balanced and practical approach. By removing delays and empowering our on-site leaders, we’re giving facilities the tools to respond to real-time needs and ultimately provide better care to Albertans.”

AHS’ health zones will be eliminated, and acute care sites will be integrated into the seven regional corridors. These sites will operate under a new leadership model that emphasizes site-level performance management. Clear expectations will be set by Acute Care Alberta, and site operations will be managed by AHS through a hospital-based management framework. All acute care sites will be required to report to Acute Care Alberta based on these defined performance standards.

“Standing up Acute Care Alberta has allowed AHS to shift its focus to hospital-based services. This change will enable the local leadership teams at those hospitals to make site-based decisions in real and tangible ways that are best for their patients, families and staff. Acute Care Alberta will provide oversight and monitor site-level performance, and I’m confident overall hospital performance will improve when hospital leadership and staff have more authority to do what they know is best.”

“AHS is focused on reducing wait times and improving care for patients. By shifting to hospital-based leadership, we’re empowering hospital leaders to make real-time decisions based on what’s happening on the ground and respond to patient needs as they arise. It also means leaders can address issues we know have been frustrating, like hiring staff where they’re needed most and advancing hospital operations. This change enables front-line teams to act on ideas they see every day to improve care.”

The Ministry of Hospital and Surgical Health Services, Acute Care Alberta and Alberta Health Services will work collaboratively to design and establish the new leadership and management model with an interim model to be established by November 2025, followed by full implementation by summer 2026.

Quick facts

• Countries like the Netherlands and Norway, and parts of Australia have already made the shift to hospital-based leadership.
• The interim hospital-based leadership model will be implemented at one site before being implemented provincewide.
• Hospital-based leadership, once implemented, will apply only to AHS acute care facilities. Other acute care organizations will not be affected at the time of implementation.

Related information

• Hospital-based Leadership
• Refocusing health care in Alberta