There may not be a more important medical institution in the province than the BC Cancer Agency. That is why it was so vital that the provincial government bring stability to an organization that has been beset by internal dysfunction, hurting its once stellar standing in the global cancer community.
Now Dr. Malcolm Moore takes the reins of the agency after the last two presidents lasted less than four years combined. That period was mostly marked by turmoil, which, in turn, led to a morale crisis. It will be Dr. Moore's job to fix that and restore the agency's once glittering international reputation. The government may have found the right person for the assignment.
"B.C. was considered to be one of the pre-eminent cancer systems, and I think the sense is that in the last five years or so things have slipped while other jurisdictions, like Ontario, have moved forward during that period," Dr. Moore said in an interview.
"And they've done so particularly around developing metrics on how the cancer system is performing, ensuring quality goes through all aspects of the patient's journey. I think those are the sorts of things we can introduce in B.C."
Dr. Moore comes from the Princess Margaret Cancer Centre in Toronto, arguably the top agency of its kind in the country. One initiative that Dr. Moore is considering importing to B.C. is an "external quality council" that would seek public input into the performance and operation of the cancer system – an avenue for feedback that has been sorely lacking in the province.
"It's been a nice vehicle for more broad consultation on what the cancer system should be doing and holding it to account to some degree for performance, wait-time metrics and other things," Dr. Moore said.
Dr. Moore said he was well aware of the tumult that has engulfed the cancer agency he is taking over. He said nobody likes to read stories that cast their organization in a negative light, and the BCCA is no exception.
"I'd heard about what was happening and I think some of it was personality and politics and that sort of thing," the president said. "As part of my due diligence I wanted to assure myself that the climate that caused all of these challenges had changed, and I believe it has.
"But everybody has been traumatized to some degree by what happened. In some ways it presents a new leader with a great opportunity to make things right."
One of the most pressing issues the agency faces is around personnel. Staff shortages are directly linked to many of the complaints emanating from the agency, including rising rates of stress-related problems. It is an issue he discussed in meetings with Premier Christy Clark and Health Minister Terry Lake. He said he received a promise there will be money for new hires.
"I didn't get a number," he said. "They didn't give me a bag of money. What they basically said was, 'We really want this to work and we're going to do everything we can to help you.'"
Officials with the Provincial Health Services Authority conceded late last year it could take as many as 20 additional oncologists to address the growing waiting-times problem that the agency is confronting. No one could say how long it would take to hire that many clinicians.
"We need to tie our human resources needs to workload," Dr. Moore said. "Somebody sort of lost the plot in B.C. about five years ago and it just stopped happening. What we need is some sort of agreed-upon policy with the government about how we measure workload, something that's tied to a formula that releases new positions. You can't get movement on wait times and other stuff if you don't have enough people."
He said there are clinicians at the agency who don't have proper support staff; consequently they are spending time doing what essentially amounts to secretarial work. "That's a very inefficient use of time," he said. Dr. Moore also wants to address another problem: Half of the agency's executive team holds an "interim" or "acting" title. He said one of the first areas he wants to take action on is the leadership structure of the organization, and is considering appointing a head for each of the six regional cancer centres in the province.
"It's hard to move on developing a larger cancer plan for B.C. until we have a stable, long-term-focused executive team," Dr. Moore said. "So that's going to be one of the first things I get to when I come out in September."
Dr. Moore will be paid a base salary of $350,000 a year. He will take on some teaching and research duties at the University of B.C. and Simon Fraser University that will pay him an additional $100,000 annually. His job at the agency was originally posted with the title of vice-president, a downgrade from what it had been.
However, he negotiated to have the old title restored, because it was one with which more people could identify. "It's closer to what I'm supposed to be doing as opposed to vice-president of cancer care for the Provincial Health Services Authority. If I went to a big cancer conference in New York, say, people just wouldn't understand that role as easily. President of the BC Cancer Agency is simpler."
Dr. Moore said he will spend the first three or four months on the job, touring centres around the province. It will be some time after that, he said, before he gets down to the nitty-gritty of enacting much needed change. "My goal is to see the agency get back to its pre-eminent status," he said. Which will be a big job indeed.