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Alberta Premier Danielle Smith and Minister of Health Jason Copping address the children’s medication shortage in Edmonton, on Dec. 6.JASON FRANSON/The Canadian Press

Alberta’s health leadership has significantly turned over since Danielle Smith became Premier, as firings or resignations have hit the three most senior public-health doctors, the province’s chief paramedic and the board of the centralized health authority.

The changes were made after Ms. Smith’s successful campaign to lead the United Conservative Party, in which she promised to overhaul the structure of Alberta Health Services, which she blamed for mismanaging the COVID-19 pandemic and prompting the need for business restrictions and vaccination mandates, which she opposed.

Ms. Smith has since made health care one of her major priorities as Premier, setting in motion a process that the government says will address wait times for surgeries, emergency room visits and ambulances. The Opposition New Democratic Party and public-health experts argue the scale of the leadership changes could not only affect timely public-health advice but also could stifle progress at a time when the system is facing serious challenges.

One of Ms. Smith’s first major acts as premier was to fire the 12-person, part-time board of AHS and replace it with a single administrator, John Cowell, who is responsible for ushering in the health care reforms. The Premier argues that having a single person working full-time on the file will allow for more rapid change.

That same week, Deena Hinshaw was removed as chief medical officer of health and replaced by Mark Joffe, a senior official with AHS who was appointed on a temporary basis. Since then, two deputy chief medical officers of health have also resigned, in addition to the top paramedic.

There also remains an interim chief executive officer of AHS after Verna Yiu was fired under the direction of former premier Jason Kenney.

Both AHS and the Alberta government maintain that changes in leadership will not distract from work to address the health care system’s problems, which have been exacerbated by staffing shortfalls, a recent surge in respiratory illnesses and capacity issues seen across the country.

“Any suggestion that recent changes are unprecedented or a threat to the continuity of health care services is simply wrong,” Steve Buick, press secretary to Health Minister Jason Copping, said in a statement. “Anyone familiar with leadership transitions in a very large organization like AHS would say that the changes recently are clearly not beyond the normal capacity of an organization on that scale to absorb.”

Mr. Buick’s statement thanked the former health leaders for their service.

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AHS spokesperson Kerry Williamson said staff have worked to increase capacity and improve access to patient care through the pandemic and that work continues. “None of these recent changes have impacted our ability to enhance patient care,” he said in a statement.

Gaynor Watson-Creed, a public-health physician who previously served as Nova Scotia’s deputy chief medical officer of health, said sweeping and swift changes made in the absence of clear reasoning points to a system in crisis. “There is a loss of confidence, there is a loss of faith, there is a loss of capacity to get the job done – something is happening there and that is not a good signal for public health,” she said.

It would have made more sense to avoid tumult by working with existing leadership and using their expertise to push forward meaningful changes, said Dr. Watson-Creed. “Right now, they’ve created instability in a system that really can’t afford it at time where predatory disease threats have not gone away.”

The first casualty of Ms. Smith’s organizational restructuring was Dr. Hinshaw, who served as the chief medical officer of health throughout the pandemic under Mr. Kenney. Dr. Hinshaw was repeatedly a target for Ms. Smith during the UCP leadership campaign.

In November, Dr. Joffe was appointed to the role on a temporary basis. He was previously juggling the chief medical officer of health duties and that of an AHS vice-president and medical director, but is now the top doctor full-time, said Mr. Buick. “It’s still interim,” he added. “I don’t know of a timeline or target date for appointment of a new permanent CMOH.”

Dr. Hinshaw frequently provided public-health advice during her tenure through social media or public press conferences. Since his appointment, Dr. Joffe has provided one written statement on the spread of respiratory illnesses, and posted to Twitter last Tuesday after an absence because of “unexpected account issues.” In the tweet, he recommended Albertans wash their hands, stay home when sick and get vaccinated if they choose.

Dr. Watson-Creed said losing timely advice from a trusted voice can be jarring for the public and erodes confidence in the entire system. “You can understand how the public-health system, itself, would have trouble rebounding from those changes and that’s before you’re talking about what else might be at play that’s hampering connection with the public,” she said.

Last week, Mr. Copping also confirmed Alberta’s two deputy chief medical officers of health, Rosana Salvaterra and Jing Hu, submitted letters of resignation. He did not provide details of their departure. The same week, AHS confirmed that senior provincial director of emergency medical services and chief paramedic Darren Sandbeck, who oversees emergency medical services, will leave his role on Jan. 9, but declined to provide details of his exit.

Dr. Hu and Mr. Sandbeck could not be reached by The Globe and Mail. Dr. Salvaterra declined an interview request but voiced her admiration for Dr. Hinshaw and Dr. Hu when her resignation was confirmed. “I consider myself fortunate to have had the opportunity to work alongside them for these past 14 months,” she said.

At AHS, Mauro Chies will continue as interim CEO until a permanent replacement is selected. Tony Dagnone, one of the fired AHS board members, previously said the board had narrowed down the search for a new CEO to three candidates before they were disbanded. Mr. Williamson, the AHS spokesperson, said the search will resume in coming months but declined to say whether those candidates were still interested. There is also temporary leadership taking the place of Mr. Sandbeck, said Mr. Williamson.

Abi Sriharan, director of systems, leadership and innovation at the Institute of Health Policy, Management and Evaluation at the University of Toronto, said change can be beneficial to health organizations but she said the situation in Alberta is alarming. Dr. Sriharan said people stepping down from their roles after firings points to culture issues within the organization and could have a ripple effect.

“With a lot of interims and transitions, a lot of decisions will get delayed,” she said. “And this is going to cause frustration for people already in the system. People will start saying, ‘Enough is enough. I need to leave.’” Dr. Sriharan said there should be clear reasoning when changes like this take place, which she said hasn’t been shown in Alberta.

David Shepherd, NDP health critic, said the widespread changes to leadership only worsen existing problems, such as staff morale. He said Dr. Cowell has been hailed by Ms. Smith as a “lone ranger to the rescue,” but that real change will require greater consultation with front-line workers and health care experts.

With a report from The Canadian Press

Editor’s note: An earlier version of this article incorrectly suggested public health doctors are part of AHS, the centralized health authority. They are not. This version has been updated.